A pharmacist's look at the supermarket and beyond

Month: August 2016

Cholesterol: the Good, the Bad, and the Sexy

Billions are spent in this country to lower cholesterol blood levels. The two newest agents would cost $14,000 per year, FOR THE REST OF YOUR LIFE! Or at least until something better comes along. It’s a safe bet that the something new will NOT be cheap!

I have been thinking more about things that we have labeled as bad for us in such extreme ways that we may have overreacted and caused ourselves more harm than if we had just tried a little moderation and try to “act naturally,” meaning use our bodies as they are designed. As I discussed, some sunlight is essential for our bodies, particularly for synthesizing Vitamin D. It occurred to me that many of our issues regarding high cholesterol are a result of our modern lifestyle and nutrition. In order to see how we arrived at the point where over 70 million of us in the United States have high cholesterol (actually high LDL, AKA “bad cholesterol”), we must first have some idea what roles cholesterol has in the healthy body.

Cholesterol is an interesting molecule, on one end a -OH (hydroxyl), making it an alcohol and slightly water soluble, then four hydrocarbon rings, the hallmark of a steroid, and finally a hydrocarbon “tail” which is the oil soluble portion of the molecule. These characteristics give cholesterol its unique qualities. Cholesterol is transported around the body via the blood by lipoproteins. That is where the infamous LDLs and the happy HDLs come into the story. The cholesterol carried by these proteins is the same, only the proteins are different.

Cholesterol is a part of virtually every cell in your body, maintaining cell wall structure, integrity, and function. It is the key starting material for the sex hormones for both genders, for the corticosteroids, and bile salts, which are essential for digestion. Cholesterol is sexy beyond its conversion to testosterone, estrogen and progestins. Cholesterol and related sterols are part of sperm production, transport, and even seem to play a role in capacitation of the sperm after ejaculation. When sperm come in contact with various sterol-binding biochemicals produced by the uterus the sperm is “turned on” and now able to fertilize the egg. Changes in cholesterol levels have been linked to changes in vaginal lubrication, pH, and possibly other factors affecting female fertility. Every sexual act requires cholesterol, with climax and ejaculation consuming some cholesterol each time. To some degree, sex (yes, even by yourself) directly lowers cholesterol, not to mention the other healthful benefits for mind and body.

Cholesterol is converted to vitamin D as discussed previously in this blog. It is also critical for serotonin receptors and other neurotransmitter receptors. It protects our nerve fibers and plays many roles in the brain, many yet to be clearly defined.

Obviously, dietary sources of saturated fats plays a role in the soaring incidence of high cholesterol. However, when seeing all the important functions of cholesterol in the body, I cannot help but wonder if our modern way of life, beyond nutrition, also plays a role in our dysfunctional lipid profiles. I already discussed how we have been taught to shun the sun. Could this avoidance of a normal biological process that uses cholesterol be a factor in higher cholesterol? I recently read that millennials are having less sex than previous generations (mine included!). Could this reduction in sexual frequency also contribute to higher cholesterol? There are some studies looking for a link between SSRIs and other psych drugs and high LDL cholesterol. Are we monkeying with normal biological pathways that require cholesterol for proper function and thus raising cholesterol levels? Are we denying our bodies the fun and frolic that keep us healthy?

Human physiology is amazing and its complexity continues to hold many secrets. Our biochemistry is a wonderful dance of chemical reactions, all trying to reach equilibrium and all part of a great feedback system that strives to keep us going. All those chemical reactions will only reach final equilibrium when we are dead. We have learned that when you tinker with one part of a biological process with drugs or other exogenous material that we can get unexpected results or “side effects” such as the dry cough from the buildup of bradykinins due to ACE inhibitor drugs.

It is clear that we function best when we eat mostly unprocessed foods low in saturated fats, and live an active lifestyle with regular exercise and sexual activity. Get outside, move around, make love, laugh, eat healthy, and you may find high cholesterol does not come knocking on your door. When I pay attention to what I eat, get outside and walk or ride my bicycle, and have some time to frolic, I not only feel better, my lab work shows numbers like this:
Cholesterol: 136
HDL: 48
LDL: 68
Those are my last lab results.
They took 3 blood pressure readings:
Blood Pressure Reading 1: 120/70
Blood Pressure Reading 2: 130/80
Blood Pressure Reading 3: 122/80

I report all this to show that even a man in his sixties can make lifestyle choices that lead to good health without pharmaceutical assistance. Somewhere around 25 million people take a statin drug to lower cholesterol. What if we didn’t just look for an easy answer like taking a pill and embraced cholesterol as a vital part of us that can be harnessed and utilized for good physical and mental health?

I believe that it is possible. Live and love!

D3D2: Into the Light

Vitamin D2, 50,000 units, is a fast mover in our pharmacy. This baffles me, because we have known for quite some time that vitamin D3 is a far superior form of vitamin D. The cool thing about D3 is that our bodies can manufacture D3 from cholesterol and exposure to sunlight, specifically, UVB light. I’m not going to go through the hard science here, but I do think it is fascinating and worth your time if you are so inclined. Vitamin D is important for your bones, your muscles, and your mental health!

I’ve been doing a lot of walking lately, getting ready for the Susan G. Komen 3-Day walk. I was about 3 miles into a morning walk when a fellow motioned to me that he wanted to talk to me. I turned off my headset and he proceeded to tell me that this was not the best time of day to get my vitamin D and started talking about “solar noon” which he described as from after 10AM till 2PM. I had taken my shirt off to get some sun and he must have assumed that I was on a mission to get some vitamin D. I do indeed like getting my vitamin D naturally and I also like not looking like a beached white whale when I visit Hawaii or the Caribbean. Hawaii But, please take note! I try very hard to limit my sun exposure, paying close attention to the length of time and the time of day that I walk around without a shirt on. I’m pretty white. To tan, I must expose myself very gradually to the sun, which works out great for vitamin D production. The usual recommendation is about half the time it takes for the skin to turn pink. For my skin, that’s about 20 to 30 minutes depending on time of day.

Living in Arizona, this whole “solar noon” thing intrigued me. Walking at high noon in Arizona, in August, is just plain crazy. It’s friggin’ hot! I told the guy that the amount of UV radiation reaching us during the day is somewhat of a bell curve so I was still getting my vitamin D even though it wasn’t even 9AM yet. That’s what my logical, scientific mind thought, anyway, and later I decided to see if I could verify that theory. I discovered the WillyWeather website that has the UV index for the Phoenix area, day by day, hour by hour. Lo and behold, it’s a bell curve!

My science served me well in this case, at least as far as the bell curve theory. But am I getting any vitamin D synthesized? Most sources that I checked suggested a balance between exposure and protection. It appears that a UV index around 3 is what will yield good vitamin D synthesis while minimizing the risk of skin damage and the formation of those dangerous radicals that could lead to skin cancer. I am pretty happy to discover all that. During these training walks we often start at 5AM. I will often take my shirt off around 7 to 7:30, if in an appropriate environment, and get covered back up by 9AM. This seemed intuitive to me and I feel more comfortable doing this now that I have done the research. The UV index in the Phoenix area hits 3 between 8AM and 9AM. Again, I trust in that bell curve and feel that even when the index is 2, I am synthesizing some vitamin D. Plus it feels good to have the morning breeze on my skin! We all live under the same sun and as long as we respect its power, we can all benefit from it.

Getting back to those bottles of 50,000 IU vitamin D2 on my shelf.. How long will it take for prescribers to catch up with the science and start ordering D3 for their patients? Both forms are very low cost and well tolerated. For some great guidance and solid information, visit the Vitamin D Council website. I encourage my pharmacist friends to spread the word so that we can get D3 onto that shelf where we have the D2 stacked now. To my physician and other prescriber friends, what are you waiting for?