Dear Dr. Roach: I am writing about your recent answer regarding sunbathing. I heard that the best way to get vitamin D is to spend a short amount of time (say 10 minutes) in the sun every day. What do you think about this? — CS
Answer: Most people don’t need to worry about vitamin D. Ten minutes of sunlight on your hands and face is enough to get the vitamin D you need. Recent large studies have found no benefit to vitamin D supplementation, so if your goal is to get more vitamin D, sunbathing for even 10 minutes is a good idea. I don’t want to risk sun damage.
People who should consider taking more vitamin D include people with osteoporosis. People who don’t get any sun exposure at all (whether they’re housebound, living in an institution, or wearing sun-protective clothing). People who cannot absorb vitamins (people with celiac disease or who have had bariatric surgery). People taking drugs that increase vitamin D metabolism (seizure drugs such as carbamazepine). In such cases, vitamin D levels are indicated.
Dear Dr. Roach: I am a 93-year-old healthy woman. I take Lovastatin 40 mg once a day for high cholesterol, but my cholesterol levels are consistently high when tested. My doctor isn’t worried, but I am. Why doesn’t lovastatin lower cholesterol levels to normal levels? — SA
Answer: Lovastatin (Mevacor) was the first statin drug approved, but newer statin drugs are more potent and have fewer potential side effects. That means no more patients are taking lovastatin. Still, it is true that if you stop taking lovastatin, your cholesterol levels will rise.
If necessary, you can also switch to more powerful drugs such as rosuvastatin or atorvastatin, which are very likely to lower your cholesterol levels even further.
But there’s a real lack of data on people in your age group. I don’t know if lovastatin is really helping. Some of my patients, who are in their 80s and 90s, prefer to continue taking it, and the data shows continued effectiveness in preventing heart attacks in older adults. Statins are especially helpful for people at high risk. However, some people prefer to stop taking the drug, especially if it is causing side effects or interacting with other medications.
Dear Dr. Roach: Levothyroxine and synthroid have really bad side effects. Is Cytomel an option? Are there other medications? –PL
Answer: There are two main thyroid hormones used in thyroid replacement therapy (levothyroxine and triiodothyronine). The standard is levothyroxine, also known as T4, and a very common brand name for levothyroxine is Synthroid. T4 itself does not have much thyroid activity, but it is converted in the body to the active hormone triiodothyronine, also known as T3. T3 is also available under the brand name Cytomel (a bioequivalent synthetic form of T3, also called liothyronine).
T4 is a standard treatment because it uses the body’s own mechanisms to produce the active hormone. Because T3 is quickly absorbed and rapidly metabolized, it can lead to fluctuations in thyroid hormones during the day, even when administered twice daily. Additionally, those treated with T3 had a higher risk of heart failure and stroke than T4 users, likely due to having too much thyroid hormone during the day.
I don’t know what side effects are occurring. Sometimes I see people who respond well to one brand of thyroxine, and I ask the pharmacist to write a prescription for that brand instead.
Dr. Roach regrets not being able to respond to individual letters, but will incorporate them into his columns whenever possible. Readers can email questions to [email protected] Or write to us at 628 Virginia Dr., Orlando, FL 32803.
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