Acid Reducing Drugs Cause Rebound Acid Production

Proton pump inhibitors help block acid secretion in the stomach to treat heartburn, reflux and other acid-related conditions. Members of this class of medication include esomeprazole (Nexium®), lansoprozole (Prevacid®), pantropozol (Protonix®), rabeprazole (Aciphex®), omeprazole (Prilosec®), and dexlansoprazole (Kapidex®).

In recent years the popularity of proton pump inhibitors has been on the rise and some experts even believe these medications are over prescribed.

A July 2009 article in the journal Gastroenterology now suggests these drugs actually cause the problems they are intended to treat. To get to this conclusion, researches took two groups of healthy volunteers with no history of heartburn. They treated one group with esomprazole and the other with a placebo for 8 weeks.

After the initial 8 weeks both groups were given a placebo for the next four weeks. The subjects reported their symptoms of heartburn, regurgitation and dyspepsia (indigestion) weekly during the study period.

In the initial 8 weeks both groups reported similar symptoms but in the following four week, the subjects who were treated and then switched to placebo reported more symptoms then those who remained on placebo during the entire study.

The results of this study indicate discontinuing the use of a proton pump inhibitor causes rebound acid secretion, a phenomenon where there as an overproduction of acid after the medication is stopped.  The extra acid produced then leads to heartburn symptoms.

After discontinuing these medications, symptoms begin after about 1 week and may persist for 4 to 8 weeks.

In light of this new information it may be prudent to talk to your doctor before starting to take one of these medications. Ask if there is a more mild treatment which may be beneficial for your condition or if a short course of therapy will provide the benefits you need.

Also, if you have been using one of these drugs for some time and have persistent symptoms when you stop taking your medication you may want to consider step-down therapy.  This is when you switch to less powerful acid reducing medications to treat the “withdrawal” symptoms from the proton pump inhibitors. Talk to your doctor about how to do this effectively.

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Too Much Selenium Linked to Diabetes

Selenium is a mineral found in soil and water. As a result plants absorb selenium from the soil. The amount of selenium found in plants is dependent on the soil content.

Soil in most areas of the United States has high levels of selenium, especially in the high plains of northern Nebraska and the Dakotas. Foods grown in high selenium areas of the United States are distributed nationwide and consumed by people all over the country helping to prevent low selenium intake

Soil selenium levels in parts of China and Russia are very low. Food is often grown and eaten locally in this part of the world and selenium deficiency is more common in these areas,

The Function of Selenium

Selenium is required for good health but only in very small amounts. In the body, selenium combines with proteins to form selenoproteins. Some selenoprotiens are used by the body as antioxidants to help prevent cellular damage by free radicals. Others help regulate thyroid function and play a role in immune function.

In addition to these functions, researchers have studied the use of selenium supplements for various conditions such as prevention of some cancers, prevention of coronary heart disease and treatment of rheumatoid arthritis. For more information refer to the selenium dietary supplement fact sheet from the National Institutes of Health.

Selenium and Diabetes

Because of evidence showing a relationship of high selenium levels to diabetes, a team of researchers evaluated the selenium levels in 917 adults. The study group were adult over 40 from the National Health and Nutrition Examination Survey (NHANES) conducted in 2003-2004. The researchers found that as serum selenium levels increased, so did the prevalence of diabetes, glucose levels and glycosylated hemoglobin levels. The study can be viewed here. http://www.ehponline.org/docs/2009/0900704/abstract.html

The researchers concluded the need for further research to determine the role of excess selenium levels in the development of diabetes in the US population.

Certainly, supplementation with selenium should be avoided unless directed by your doctor. Also, in the United States there are many multivitamins that have selenium included. It is too early to draw any conclusions, but these vitamins should be used with caution.

Here is another research article indicating a link between selenium levels and diabetes.

Serum Selenium and Diabetes in U.S. Adults

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Why You Need a Universal Medication Form

There is only one person who knows all the medications a patient is taking at home. That is the patient them self. Unfortunately, health care providers such as doctors, nurses and pharmacists cannot effectively provide care without complete information. This is why you should utilize a Universal Medication Form.

What is a Universal Medication Form?

A Universal Medication Form is an easy to use document where a person can record medication therapy information. This information needs to include allergies, immunizations, prescription medication, over the counter medication, herbal products and vitamins.

It also needs to record the strength and dose of the item as well as how it is taken such as frequency, time of day and special instructions. It should also state brand and generic names of the product whenever possible and the reason for taking it.

What to do with the form.

Once the Universal medication form has been completed it should be kept in a wallet so it is with you at all times. It needs to be shown to all health care providers such as doctors, nurses, pharmacists, and dentists. They need to have a complete list of medications, herbal products and vitamins to make accurate clinical decisions. Without this complete list, some important problems or interactions could occur.

What if something changes?

If it is a minor change, it may be possible to simply update the form. For example, if the doctor changes one medication simply cross off the old medication and add the new one to the form. In other instances, there may be major changes. In this case it is better to simply fill out a new form so it remains easy to read.

What are the benefits of using a Universal Medication Form?

There are many benefits to using one of these forms.

First, it can be difficult to remember to take all your medications correctly. In fact up to 50% of people are not taking medications correctly as soon as 3 days after discharge from a hospital. This form provides an easy way to keep track of medications and the way they should be taken.

Second, this form makes it easy to remember which medications are being taken during a visit to the doctor’s office. Having a complete and accurate list of medications when you visit the doctor is essential in receiving appropriate care.

Third, in the case of an emergency if you have one of these forms with you, the paramedic or ER doctor will have a complete list of your medications readily available for review when providing emergency medical care.

Fourth, having a completed medication form with you at all times could decrease the chance of medical mistakes and adverse reactions. Your doctor will immediately have a list of all your medications for review before adding something new.

Tips for use

• Fill out the form completely, listing all required information. List all medication both prescription and over the counter medications.
• List all herbal products and vitamins and supplements even if they were not prescribed by a doctor. This information is vital as herbs and vitamins can affect therapy and have potential for interactions.
• Keep the form with you at all times.
• Keep the form updated religiously.
• Keep a copy of the form at home in a safe place and tell a loved one where the copy is so they can find it if needed.
• Show the form to all medical professionals who care for you.

Conclusion

A universal medication form is a great tool to help keep track of medications. The best Universal Medication form I have come across is here. Universal Medication Form

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Who Should be Taking Asiprin?

Aspirin has been in people medicine cabinet for over 100 years. Before aspirin was discovered, the bark and leaves of the willow tree were used to relieve pain and fever. The active ingredient in the willow tree bark and leaves is salicin. Eventually aspirin was derived from salicin and Bayer began distributing aspirin powder in 1899.

From this early beginning a lot of research has been done with aspirin and a lot of information has been gathered. Despite a long history, there are still many unanswered questions. There are many people who use aspirin that should not and many who are not using aspirin that should.

Aspirin Uses (in Adults)

Aspirin can be used to treat pain, fever, inflammation, headache, arthritis and lower the risk of heart attack and stroke. There are some indications aspirin may be effective in preventing Alzheimer’s disease and some forms of cancer but it is too early to tell.

The rest of this article focuses on daily low dose aspirin to prevent cardiovascular disease.

Aspirin’s Major Risk

The problem is when aspirin is taken daily for extended periods of time such as heart health. In this case there is a serious risk for gastointestinal bleeding. Doctors have been trying to balance the risk of bleeding with the benefit of preventing heart problems.

Secondary Prevention

After someone has had a heart attack or stroke, doctors try to prevent a second event form happening. This is known as secondary prevention. It has been generally accepted that after a heart attack the benefits of daily aspirin therapy out weight the potential risks. In fact the ACC/AHA (American College of Cardiology / American Heart Association) guidelines states all patients (who have had a heart attack or stroke) should be placed on low dose aspirin indefinitely unless contraindicated.

Primary Prevention

Primary prevention is the attempt to prevent a first heat attack from occurring. The U.S. Preventive Services Task Force (USPTF) has published new guidelines to help determine who should be taking aspirin for primary prevention. USPTF aspirin guidelines.

In brief the guidelines state:

• Aspirin is not recommended for men younger than 45 or women younger than 55 years.
• Aspirin is recommended in men age 45 to 79 years to reduce heart attack risks when the benefit outweighs the risk of gastrointestinal bleeding.
• Aspirin is recommended in women age 55 to 79 years to prevent ischemic strokes when the benefit outweighs the risk of gastrointestinal bleeding.
• In men and women over 80 years there is not enough evidence to asses the benefits against the potential risks for daily aspirin use.

What dose should you take?

It is still not completely clear what is the ideal dose of aspirin to take to prevent heart attacks and strokes but according to an article in the March 17 Annals of Internal Medicine higher doses are not better than lower doses. In fact, lower doses in the 75 to 81mg range are as effective as higher doses but have a lower risk associated with them. This is especially true if Plavix (clopidogrel) is given with aspirin.

Conclusion

There is still more research to be done to evaluate who should and should not take aspirin but these new guidelines bring us a few steps closer. As always, every person is different and you should discuss the risks and benefits of aspirin therapy for your specific situation.

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Xylitol Can Prevent Middle Ear Infections

Acute otitis media (AOM) is commonly know as a middle ear infection. According to the American Academy of Pediatrics (AAP) it is the most common infection for which antibiotics are prescribed. Also, about 80% of all doctor visits in the United States for otitis media results in the doctor prescribing an antibiotic.

Despite the high frequency of antibiotic prescribing for otitis media, this may not be the best course of therapy. It is common practice in some European countries to treat just the symptoms AOM initially and use antibiotics only if symptoms do not improve.

One reason to avoid antibiotic treatment initially is the possible development of antibiotic resistant bacteria. Antibiotic resistance is when bacteria change in some way that makes them less sensitive to antibiotics thereby making the antibiotic less effective or not effective at all. Antibiotic resistance is one if the CDC’s top concerns. Also treating resistant infections can be very difficult and expensive. Learn more about antibiotic resistance from the CDC here.

Another reason to avoid antibiotics in AOM is the American Academy of Pediatrics guidelines support symptom treatment with observation for otherwise healthy children over 2 years old with non-severe uncomplicated AOM. See Dr Greene’s web page Antibiotics and Ear Infections for more info. Be sure to talk to your doctor about your options and the benefits and risks with antibiotic treatment versus observation.

Prevention of Acute Otitis Media

The best way to avoid antibiotic use for AOM is to not get AOM. There are a few things that can be done to reduce the frequency of AOM. First, reducing the number of upper respiratory tract infections by avoiding daycare can help reduce the incidence of otitis media. Also, breastfeed during the first six months of life results in fewer middle ear infections. Finally, xylitol has been shown to reduce the frequency of AOM.

Xylitol

Xylitol is a sweetener found in some chewing gums. It was originally derived from birch trees but can now be made from many sources. It known to prevent the growth of some bacteria. It was found to decrease tooth decay in people who chewed xylitol sweetened gum over those who chewed gum sweetened with sucrose.

In 1998 the journal of Pediatrics published an article in which xylitol was studied to see if it could prevent AOM. They studied xylitol gum, xylitol lozenges and xylitol syrup against a placebo. They found a 30% reduction in AOM for the xylitol syrup, a 40% reduction for the gum and a 20% reduction for the lozenge. As a result of this study the researchers noted a decrease in antibiotic usage in the xylitol groups. Dr Greene has another great article Ear Infections and Xylitol

Given this information, a new product is now available in the United States. Xylarex (xylitol) oral solution by Arbour Pharmaceuticals. It is a prescription only product but it is classified as a medicinal food. When given as 3.3 grams (5ml) three times daily it has been show to decrease the occurrence of AOM by 39%

For more information about xylitol or to purchase xylitol gum visit www.xylitol.org

For more information about Xylarex visit www.Xalarex.com

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“Save at the Pharmacy” Book Just Released

I am pleased to announce the release of my new book “Save at the Pharmacy – A practical guide to reduce medication costs”. This is my first book and I wrote it to help people find more affordable ways to get the medications they need. In this post I am going to give you some of the information that is contained in the book. Here are some ways to save money at your next visit to the pharmacy.

Talk to your doctor

This is the very first thing you need to do. If the doctor is not aware that cost is an issue for you, they will not usually take this into consideration. Doctors are faced with a large array of medications to treat some conditions. Often times, many of the choices work equally well. If you tell them that you want a less expensive option, they will often try to accommodate the request.

Do you really need the medication?

Many people often assume when a doctor writes a prescription that they definitely need to take it. But sometimes the doctor will write a prescription simply because they believe the patient expects one. When you visit the doctor, let them know you are not expecting to get a prescription unless they feel there is a definite need for one in order for you to get better. When they do write a prescription ask if there may be an alternative course of treatment which would work for your condition.

Is there an alternative?

Many times there are several classes of medications which will all treat the condition equally well. Sometimes an alternative class of medications will be less expensive. Check with your doctor or pharmacist to see if this applies to your medicine.

Avoid free samples

These are enticing because they are free. The problem here is they can increase costs in the long run. If your condition becomes stable on one of these treatments, you and your doctor will be reluctant to switch to another drug when the samples run out. These medications generally cost more than some other medications which may have been on the market longer and have generic equivalent options available.

Use manufacturer loyalty cards

Some manufacturers provide loyalty cards through the doctors office or online. These cards will reduce the copay you pay through your insurance. They often are reusable for 6 to 12 months. Over time these can provide substantial savings. I have posted a short list of drugs which have loyalty cards here. Here is a recent customer’s example. Nexium through insurance costs $40.00 copay but there is a $30.00 loyalty card available. This card reduces the copay by $30.00 to make it $10.00. The card is good for 6 refills for a total savings of $180.00.

Sign up for a discount card

Everyone can benefit from prescription discount cards. The uninsured are the primary group that can benefit from these cards but there are benefits for the insured also. The benefit of one of these cards when you have insurance is best seen when a drug is not covered by the plan. In this case, you can use the discount card to avoid paying full price on the medication. A lesser known benefit to the discount card is when you have generic medications that carry a standard copay such as $10.00. Depending on the medication and the discount card, it could be less expensive to purchase a 3 month’s supply using the discount card than paying $10.00 each month using the insurance card. Get a free discount card here.

These are just a few of the money saving tips covered in the book.

Here is the link Save at the Pharmacy.

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Save Money With Prescription Drug Discount Cards

Many people have never heard of a prescription drug discount card. This is unfortunate as they may be missing out on potentially substantial savings at the pharmacy. Millions of people across the country are saving money on prescription medications by using these discount cards.

What is a Prescription Drug Discount Card?

A prescription drug discount card is exactly like it sounds. It is a card that provides a discount on prescription medications at the pharmacy. These cards should not be confused with prescription insurance coverage. They provide no benefit beyond simple discounts to the consumer. That being stated, these cards can provide substantial savings given the right circumstances.

How do prescription discount cards work?

Generally anyone can sign up for a prescription discount card. There is usually no qualifying needed. You can get one regardless of age, income health conditions or coverage by insurance. Once you have the card you can use it at any participating pharmacy. Present the card to the pharmacy staff when you drop off the prescription. The discount is given by the pharmacy on your medications by reducing the profit margin made by the pharmacy.

You win by getting a discount on your medications and saving money without having to shop around. The pharmacy wins by attracting more business, filling more prescriptions and potentially selling other items. This is known as companion sales.

Many of these drug discount cards have no sign up fees and no monthly fees although a few do carry a small fee.

Who should get a discount card?

Pretty much everyone should get a discount card. You never know when you may need it. The primary group of people who should get a discount card is the uninsured. In my practice, about 10% of prescriptions are filled for people with no prescription drug coverage. If you fall into this group, then a prescription discount card is a must.

Even those who have prescription drug coverage can benefit from these pharmacy cards. Most insurance plans have a list of medications they do not cover. In this case a discount card would prevent your having to pay the full retail price if you still choose to purchase the medication. Also, sometimes your insurance company has a specific copay. For example, you may pay $10.00 for a 30 days supply of a generic medication. But if you were to use a discount card, you could end up getting a 3 month supply for $10.00 to $15.00 depending on the medication.

People covered under Medicare part D can definitely benefit from a discount card. Sleep medications and anxiety medications are often not covered under these plans. Using a pharmacy prescription discount card for these medications would reduce the out of pocket costs for these drugs.

How to you get a prescription discount card?

There are many places you can get a discount card. Many employers already provide them to their employees. Check with your job to see if there is one available where you work.

Also, many states and cities are offering prescription discount cards to their residents. Check with your local governments to see if they have a program.

Another place you can get one is from large companies you already do business with. For example, sometimes banks provide them to their account holders. AAA has a plan available to its customers and AARP also has a discount card available. There are many more companies who provide these valuable benefits to their customers.

One of the easiest ways to get a prescription discount card is to visit www.Pharmerdon.com. There you can fill out a very basic form and print yourself a discount card in less than two minutes. This card is free. There is no sign up or monthly fees. It can be used at over 40,000 pharmacies across the county. Savings can be anywhere from 10% to well over 50% depending on the medication. Here is the direct link to the signup page for the pharmacy prescription discount card.

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CDC Promotes Get Smart About Antibiotics Program

Due to an increase in antibiotic resistance, the Centers for Disease Control and Prevention (CDC) has launched a program to educate the general public and health professionals about this growing problem. Their goal is to provide information about the appropriate use of antibiotics. The name of the program is Get smart, know when antibiotics work.

Every year millions of people visit their doctors due to cold and flu symptoms, sore throats and bronchitis. Both the common cold and the flu are caused by viral infections. Often times people expect the doctor to write a prescription for an antibiotic to treat their cold symptoms. The problem with this is that antibiotics are not effective in treating a viral infection. Antibiotics are only effective in treating bacterial infections.

Despite this fact, doctors often feel pressure to give patients antibiotics when they are not indicated. In a recent issue of the British Medical Journal (BMJ) 13% of doctors admit to using antibiotics as a placebo. A placebo is a treatment or medication that the doctor does not expect will make a difference in the outcome beyond the patients positive belief that the treatment will work.

The CDC is trying to help consumers understand when it is appropriate to use antibiotics and when they provide no benefit. They say taking antibiotics when you have a viral infection may do more harm than good putting you at increased risk for antibiotic resistant infections. When bacteria are exposed to antibiotics, then can change in various ways and become resistant to the antibiotics they have been exposed to and sometimes to others in the same class. The next time they are exposed to the antibiotic, the drug is less effective or not at all effective and the bacteria continue to grow.

To avoid the development of resistant bacteria it is important to know which conditions should not be treated by antibiotics. The CDC says infections that are caused by viruses should not be treated with antibiotics. These conditions include colds, flu, most coughs and bronchitis, sore throats (except strep throat) and some ear infections.

The CDC feels strongly about preventing the development of resistant bacteria because these resistant bacteria can spread quickly from person to person threatening the community with difficult to treat infections. The CDC has gone as far as sending letters to many major retailers raising concerns about some of their antibiotic promotions. Large chains like Giant Food Stores, Meijer, Publix, ShopRite, Stop & Shop and Wegmans are promoting free antibiotics. Some of these retailers have tied their promotions to the cold and flu season. These free antibiotic promotions are putting even more pressure on doctors to prescribe medications when they are not needed. Also, sometimes doctors are being asked to write for an antibiotic from the free list when they feel a different antibiotic would be more effective given the clinical presentation of the patient.

In my practice I encounter patients who believe they need an antibiotic to treat a cold. It is this perception the CDC is attempting to change. Any promotion that competes with the CDC’s efforts needs to be re-evaluated. Some of these companies have claimed they want to help people by giving away needed medications. Although well intentioned, the risks to the community probably outweigh the benefit to the few they may have helped. I believe choosing a different class of drugs to promote would provide more help to people without the possible negative outcomes. A good example of a different class of drugs which would provide real benefits is heart medications.

Here is a video explaining the development of antibacterial resistance

Learn more at the CDC website about antibacterial resistance.

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Over the Counter Treatment Of Seasonal Allergies

According to the American Academy of Allergy Asthma and Immunology seasonal allergies (aka hay fever) affect over 35 million Americans and results in 16 million visits yearly to the doctor. Symptoms often appear at about the same time every year and can include runny nose, sneezing, congestion and itching in the ears, eyes, nose and throat. Seasonal allergies are usually triggered by airborne pollen from trees grass and weeds and from mold spores.

Allergy

An allergic reaction is the bodies over-reaction to substances in the environment. These substances are often called allergens because they cause the allergic reaction. The symptoms of an allergic reaction are very similar to that of a cold but a cold will usually resolve in 7 to 10 days while an allergic reaction can last for weeks or even months. Also the nasal discharge during a cold is often thick and yellow but in an allergic reaction it is thin and clear.

Treatments

Treatment for allergies can be as simple as using over the counter products or it can include visits to the allergist for allergy skin tests and immunotherapy (allergy shots). This article focuses on over the counter therapy. If you do not find relief from these suggestions you should seek further assistance from your doctor.

Histamine

When exposed to an allergen, the body responds in several ways, including producing extra histamine. Histamine causes inflammation, swelling, a runny nose, sneezing and itching. Histamine also narrows airways in the lungs (constricts bronchi) and increases stomach acid secretion.

Antihistamines

This class of medications is a good starting point for treatment of seasonal allergies. There are several over the counter antihistamines available, many of which were once only available by prescription. They work by blocking the action of histamine in the body.

Antihistamines are generally separated into first and second generation agents. The first generation antihistamines are considered to be sedating while the second generation agents are commonly known as non-sedating. In reality, all antihistamines have the potential to cause drowsiness.

Some of the more popular first generation antihistamines are diphenhydramine (Benadryl), chlorpheniramine (Chlor-Trimeton), clemastine (Tavist) and doxylamine (Unisom). Doxylamine and diphenhydramine are so sedating they are commonly marketed as sleep aids. Clemastine is less sedating than these and chlorpheniramine is less sedating than clemastine. A benefit to these antihistamines is their ability to decrease mucus production in the nose due to their strong anticholinergic side effects.

The second generation antihistamines include cetirizine (Zyrtec), and loratadine (Claritin). They are much less sedating than first generation antihistamines and are dosed once daily. They also have fewer side effects but as a result they are less likely to dry up a runny nose.

Check with your doctor before using antihistamines if you have glaucoma, prostate problems, emphysema, bronchitis or you are taking sedatives.

Decongestants

Since congestion is one of the symptoms of allergies, it makes sense to use this class of medication to get some relief. There are only two oral decongestants available over the counter. They are phenylephrine (Sudafed) and pseudoephedrine (Sudafed PE). They work by constricting blood vessels. This in turn results in shrinking of the nasal mucosa (the mucus membranes) allowing more air to pass, improving drainage and a less stuffy feeling.

Decongestants can also be found in nasal sprays such as oxymetazoline (Afrin). They can provide more immediate relief oral decongestants but the nasal sprays should not be used for more than 2 to 3 days due to worsening of congestion after stopping. This is known as rebound congestion.

Talk to your doctor before using decongestants if you have high blood pressure, heart disease, thyroid disease or diabetes.

Combination Antihistamine Decongestants

There are many combination products on the market. There may be a benefit to taking a combination product because the two classes of medications work together to improve symptoms. Have your pharmacist help you select a combination product that is right for you. As an alternative, you could buy a decongestant and an antihistamine separately and take both together. An advantage to doing it this way is you can selectively take one or the other or both together depending on your symptoms.

Nasal Irrigation

This is a good alternative therapy for seasonal allergies. It is an ancient technique of using a salt solution to bathe or wash the nasal passages. The theory is by washing away the allergens and mucus you improve normal function and decrease inflammation. Read more about nasal irrigation.

Cromolyn Nasal Spray

Cromolyn nasal spray (Nasalcrom) is a less commonly used medication. It can be used in combination with other treatments. Cromolyn helps stabilize mast cells. These are the cells that over react to pollen or other allergens causing the allergy problems. Buy stabilizing these cells, they release less inflammatory chemicals such as histamine. In order for cromolyn nasal spray to be effective it must be used several times a day. Symptoms may take 1 to 2 weeks before they improve. Do not use to treat sinus infections, asthma or cold symptoms.

Local Honey

An alternative therapy for allergies involves eating 1 to 2 teaspoons a day of local honey. Local honey is defined as honey made within 30 to 300 miles (depending on who you talk to) from where you live. Bees make honey from plant pollen (often the same ones causing allergies). The theory is that continuous daily exposure to the pollen in the honey decreases the chance you will react to it when exposed in the air. Some people swear by this but the studies that have been performed do not support it according to this article. http://www.aaaai.org/aadmc/ate/category.asp?cat=988

Conclusion

There are lots of treatments available for seasonal allergies. If you suffer from seasonal allergies, start your treatment a few weeks before your symptoms usually start and continue through the allergy season. If the above treatments do not provide relief you will need to seek the advice of a doctor.

Here are a couple of good resources

Check out your local pollen counts www.pollen.com or National Allergy Bureau

According to the American Academy of Allergy Asthma and Immunology

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You Need to Understand Your Cholesterol Numbers

What is Cholesterol?

Cholesterol is a waxy substance found in all cells of the body. It is essential for normal function. Cholesterol is also used by the body to make some hormones and other chemicals. About two thirds of the body’s cholesterol is made and stored in the liver. A high level of cholesterol in the blood is known as hypercholesterolemia. High blood cholesterol increases the chance of having a heart attack, stroke or chest pain. There are usually no symptoms of high cholesterol which is why everyone over the age of 20 should get their cholesterol checked every 5 years.

Once the results of the cholesterol test are available it is important to understand what these numbers mean. Cholesterol is carried through the blood stream on lipoproteins. There are three major categories of lipoproteins which are typically measured. These are HDL (high density lipoprotein), LDL (low density lipoprotein), VLDL (very low density lipoprotein).

Total Cholesterol (mg/dl)
Less Than 200	Good
200 to 239	Borderline High
240 and over	High

HDL are considered “good cholesterol” because they carry cholesterol from the body to the liver. This is good because the liver is responsible for removing cholesterol from the body. A high HDL will reduce your chances of heart disease.

HDL Cholesterol (mg/dl)
Less Than 40	Major heart disease risk
40 to 59	The higher the better
60 and above	Considered heart protective

LDL are considered “bad cholesterol” because they carry cholesterol from the liver out to the body. This is not a good thing because a high LDL is associated with an increased chance of premature heart disease and death.

LDL Cholesterol (mg/dl)
Less Than 100	Optimal
100 to 129	Near but above optimal
130 to 159	Borderline high
160 to 189	High
190 and above	Very High

VLDL are also considered to be bad because they carry triglycerides from the liver to the body. A high triglyceride level is also associated with heart disease.

Triglycerides (mg/dl)
Less than 150	Normal
150 to 199	Borderline high
200 to 499	High
Greater than 500	Very High

To get a handle on what your goal is for an ideal LDL cholesterol you need to know what your 10 year risk for heart disease. You can access the National Cholesterol Education Program’s 10 year risk calculator here. Once you know this number then find you LDL goal below.

LDL (mg/dl) Goal by Risk Level
High Risk – You have heart disease, diabetes OR a risk score of 20% or more.	Goal is less than 100
Moderate high risk – You have 2 or more risk factors and a risk score of 10 to 20%	Goal is les than 130
Moderate risk – You have 2 or more risk factors and a risk score less than 10%	Goal is less than 130
Low Risk – You have 0 or 1 risk factor	Goal is less than 160

Risk factors:

• Cigarette smoking,
• High blood pressure (140/90 or higher or on blood pressure medication)
• Low HDL (less than 140mg/dl)
• Family history of heart disease (in father or brother before age 55, in mother or sister before age 65)
• Male 45 years or older, female 55 years or older

Understanding your cholesterol numbers and how they affect your risk in development of heart disease is essential. With this information you can work with your doctor to develop a plan to improve your numbers and to reduce your risk. Medication may be needed to help you achieve your goal. In all cases, lifestyle changes will be required to achieve the maximum benefit and reduce your risks the most.

A great resource to help you make lifestyle changes to lower cholesterol can be found at the National Heart Lung and Blood institute website here. Your Guide to Lowering Cholesterol with Therapeutic Lifestyle Changes (TLC) You can print a free copy off the site or you can order a copy by calling 301-592-8573.

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