#Middlebury
DEAR DR. ROACH: Do you prescribe vitamins or treatments to enhance the immune system? – C.N.
ANSWER: I do not. In my opinion, a healthy diet makes a deficiency of a vitamin or mineral severe enough to weaken the immune system unlikely. Stress reduction (through many techniques) and good sleep are more important than supplements.
People think that a daily vitamin and mineral supplement is like an insurance policy against a good diet. However, many studies have shown that taking vitamins does not, in general, lead to improvements in prevention of disease, including heart disease, cancer or infections. So I would be much more likely to recommend a better diet (especially in the fresh fruits and vegetables) than I would a supplement.
Many adults have not gotten all the vaccines that are recommended, and these are a huge benefit to your immune system for those specific bacteria and viruses.
DEAR DR. ROACH: I am an 81-year-old male in generally good health. I am maybe 10 pounds overweight. I have had no heart attacks or cardiac symptoms. I walk on the treadmill for exercise.
I have controlled hypertension, and have been taking simvastatin, 10 mg. My LDL is 71, very favorable. My HDL is also good, at 73.
Several years back, when I started the statin, my doctor added Zetia, 10 mg. At the time, I wondered why this would be OK, and he said, “Well, there is a certain synergy there.” While I have continued taking the Zetia and suppose it might be helpful, I wonder if I need it. I say this because it is rather expensive (about $500 a year with my part D coverage). It is the only thing I take that costs me this much.
My reading of the literature suggests that while Zetia might help the LDL level, there is no evidence that it improves longevity (i.e. cardiovascular). – J.P.
ANSWER: This is a confusing subject, because the theory (that lowering cholesterol protects your heart) and the evidence (that it actually works) don’t exactly align. High cholesterol certainly is associated with a higher likelihood of heart blockages, which can lead to heart attack and death. However, not all treatments that lower cholesterol reduce risk of heart attack.
On the one hand, there are treatments that lower cholesterol that do help your heart. The Mediterranean diet clearly reduces risk of heart attack. Dr. Dean Ornish’s plant-based diet of very little fat and little or no meat, in combination with stress reduction and smoking cessation, actually reverses blockages in arteries in some people. Statin drugs reduce cholesterol and help prevent heart attacks, at least in people at high risk for them.
On the other hand, ezetimibe (Zetia) reduces cholesterol, but like most nonstatin drugs to treat high cholesterol, it has not been proven to reduce heart disease risk. It tends to have few side effects and probably is not harmful. But you are correct that it is expensive, and like all medications, it can possibly cause harm. Being conservative about medication, I very rarely prescribe it. Studies are ongoing, and I will readdress this topic when there is more evidence.
Dr. Roach regrets he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. To view and order health pamphlets, visit www.rbmamall.com, or write to Good Health, 628 Virginia Drive, Orlando, FL 32803.
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