Joseph M. Wildman, MD
Hematology, Oncology and Internal Medicine
Putting the Patient First

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From the NJ Independent Press this summer:
Conversations with your doctor
by Dr. Joseph M. Wildman

This past winter, a controversial study showed that Vytorin and Zetia, two of the most widely prescribed medications in the battle against cholesterol and hardening arteries, weren’t working the way we’d hoped they were.                                                                                                                                                                                   In the wake of the VYTORIN/ZETIA meltdown, we are being admonished not to forget diet and exercise as essential approaches to cholesterol control. This prescription is also ensconced in the preamble to the indications for statin use;  you might notice the sentence “this drug is indicated as an adjunct to diet” tacked on to your box of pills. How appropriate is this advice?  Unfortunately, even the diet enthusiasts admit that diet alone achieves, on average, only a 5 to 10% reduction in serum cholesterol. There are exceptions to the rule:  I know a few
 of them, but I can still count them on my fingers.  These people can drop their cholesterol by 80 or 100 points with diet. You can’t count on being one of them.   They are different from you and me.  And what about the cheery people on TV who have lowered their cholesterol 6 or 8 points by eating oats every day?  Have they accomplished anything?  For General Mills and Quaker Oats, yes; for themselves, not much.   First, did they really do it?  A study quoted on the Cheerios box reports an average 4% decrease in  “bad cholesterol” in subjects who consumed 3 cups of cereal per day.  If that cereal was accompanied by skim milk, they were devoting more than 20% of their daily calorie allowance to Cheerios alone.  And suppose they did do it?  If the subjects had average baseline cholesterols of 220, they were still well above the target of less than 200.  To my way of thinking that accomplishment doesn’t warrant forcing down a breakfast that you
 despise every day.    Bottom line: eat Cheerios if you like them; take a statin or niacin if you need to lower your cholesterol.                                    Now what about exercise?  Jane Brody of the New York Times wrote an encomium to  exercise a few weeks ago, saying, in essence, that exercise makes everything better.  This may well be true.  Exercise is certainly good for your bones, your muscles and your mood.  It may even be good for your heart (less convincing evidence here)—but not because it lowers cholesterol!  Even the most fervent heart-health zealots will admit that exercise does not lower total cholesterol and that it will raise HDL (“good”) cholesterol very modestly. So exercise if you can, but depend on appropriate medicines to change that cholesterol reading.

Dr. Wildman practices internal medicine, hematology and oncology at 100 Northfield Ave., West Orange.  He is available by appointment to discuss this and other health issues.  Phone: 973-243-7000.

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