Health

Ask Dr. Roach: Supplements are not well regulated | Lifestyle

Dear Dr. Cockroach — Doctors have prescribed statins to reduce LDL cholesterol. This was 131. HDL was 70. I stopped taking it after 3 weeks because my muscles were pulled at the top of each hamstring. I run 20 miles a week. After 35 years of running, this never happened. Well, two years later, I read an article about milk thistle reducing LDL. I started taking it daily 3 months ago and an annual physical examination 2 weeks ago showed that my blood test showed that my LDL was reduced to 105 and my HDL was reduced to 71. The doctor and I were surprised and satisfied. The only difference in my lifestyle was milk thistle. Have you ever experienced a patient who reduces LDL while taking milk thistle supplements?

— Anon.

Dear reader — Milk thistle has been shown to lower LDL cholesterol. The best evidence also comes from people with diabetes. However, it is unclear whether milk thistle is as effective as statins in reducing the risk of heart disease. Not all treatments that reduce cholesterol have been proven to reduce the risk of a heart attack.

Supplements are not as regulated as prescription drugs, so they rely on the manufacturer’s words to provide the right product. A 2019 review of available milk thistle products showed dramatic fluctuations in the amount of active ingredients and levels of pesticide residues, mycotoxins, and bacterial contamination.

Despite some benefits in the trial, milk thistle cannot be recommended as a treatment to lower LDL due to the poor quality of the products available in the United States. We recommend that you consider another statin trial. Pravastatin, fluvastatin, and pitavastatin have a lower risk of muscle effects than other statins.

Dear Dr. Cockroach — I take Prolia every 6 months for osteoporosis / osteopenia. My endocrinologist says this makes me more susceptible to UTIs and respiratory tract infections. This seems to suggest that Prolia may have some immunosuppressive effect. Does it only work on osteoclasts and bone resorption? How does being in Prolia affect the immune response to COVID-19 vaccination?

— LI

Dear reader — Denosumab (Prolia) is a monoclonal antibody that blocks the receptor activator of the nuclear factor kappa-B ligand (RANKL). One effect of this obstruction is to prevent bone formation, function, and survival-

TX BodyLeft: I think your endocrinologist was very cautious about the potential increased risk of infection. The risk of infection may not exist at all, and if it does, it seems small.

There is no data on the efficacy of the COVID-19 vaccine in people taking Prolia, so we cannot be sure of an answer. However, since the degree of immunosuppression seems to be small, it is unlikely that Prolia will significantly reduce the effectiveness of the vaccine. Certainly, it is safer to get the vaccine than if you did not get the vaccine. It is advisable to continue to pay attention after vaccination while the community is still infected.

Contact Dr. Roach [email protected]

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