Statins (OT)

There was a lot of interest last time this was aired but I was left with a few unanswered questions...
How significant is the fat in processed Pork slices as I find it a very convenient source of sandwich filling?
How linear is the response to dose levels? A recent test found 4.2 total (2.4 LDL) for a dose of 20mg. Pre-statins, I had levels of 6.8 and 7.2 total. I would like to drop the dose to 10mg.
I asked how long it takes for the body to return to normal after stopping medication and was told 2 weeks. I was also told to resume treatment to double check any noted changes.
--
Tim Lamb

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On 03/05/2013 21:41, Tim Lamb wrote:

Surely this is something only your doctor or specialist nurse is qualified to answer. Seeking advice on an Internet NG about this seems very unwise to say the least.
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Peter Crosland snipped-for-privacy@yahoo.co.uk

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wrote:

_Especially_ uk.d-i-y !
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Frank Erskine

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Yes. However, they may already have asked more pertinent questions than I did in the allotted 10mins. Some of them may have a better scientific understanding of the answers:-)

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Tim Lamb

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On 04/05/2013 08:07, Tim Lamb wrote:

If you feel the basic ten minute appointment is too short you can ask for a longer one. Any GP practice thas does not do that is not doing their job adeqautely. Without a full medical history no doctor, let alone amateur "experts" on a NG are in a position to give valid advice. To emphasise the point it really is extremly foolish to rely on unqualified advice in the way you are trying to do.
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Peter Crosland snipped-for-privacy@yahoo.co.uk

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writes

Trouble is that even GPs can leave a lot to be desired on the basics.
One I consulted because I could not see my regular GP in less than a couple of weeks and I was in real pain, decided that I had pancreatitis even tho there is a very specific test for that that showed I did not have that. It turned out that the problem was just gallstones, something that almost everyone has, tho they mostly don't cause any particular problem.
And even my regular GP is less than ideal too. Since I have had a heart attack and a stent I see him every 6 months for a routine checkup and he always checks the pulses in my ankles because there is a clear risk of the same problem with the leg arterys as what caused the heart attack.
He can never find any pulse in my ankles and that always concerns him.
When I said that to the cardiologist, he pointed out that some people have arterys quite deep in the ankles and they don't have a feelable pulse there and that the pulse on the top of my feet are fine. When I told the GP that he had said that, and he checked that for himself, he still did the same thing on the next 6 monthly visit and I had to tell him again. Bit of a worry.
When I got some pain in one foot, he decided that it was gout, even tho it did not have the classic episodic effect that you get with gout. When I asked him why it could not just be arthritis, he just said 'yes, it could be'
I've also just recently come across something on our equivalent of the BBC, in the specialist health program, that one of the medications that I am on, Clopidigrel, has a very variable ingestion effect if you eat much grapefruit or limes etc. I do eat a lot of limes in the lemon and lime marmalade that I make myself. Neither the GP who has had a heart attack himself and is on the same medication as me, or the cardiologist even mentioned that at all. http://www.abc.net.au/radionational/programs/healthreport/oral-erythromycin/3428198#transcript
IMO it makes a lot more sense to use as much information as is conveniently available than just relying on what one doctor says, particularly in areas where not all doctors agree.
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That's mad. There is plenty of good info available on anything now.
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Rod Speed wrote:

Except when *you're* giving that 'info' - then it's about as trustworthy as a live politician
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On 03/05/2013 21:41, Tim Lamb wrote:

No idea, but I expect about as bad as any other animal fat.
You could always do a series of experiments on yourself to find out your personal response to it if your doctor is prepared to cooperate - about a month should be enough to reach equilibrium.

That data should be in the clinical trials or MSDS for the specific drug but the dose response behaviour varies wildly with individuals depending on how good their enzyme metabolism for destroying it is and the amount of bergommotin they consume from other sources.
You must not consume grapefruit when on statins. see http://en.wikipedia.org/wiki/Bergamottin

You might be better off asking sci.chem or med.something or other.
Remember that advice on the Internet is worth at most only what you paid for it and in some cases considerably less.
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Martin Brown
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Thanks for above. I was warned about grapefruit but not the actual mechanism.
Somewhere back in my crop spraying days I remember spray can warnings about *anti-choline esterase*. I still wonder what it meant!

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Tim Lamb

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On 04/05/2013 08:30, Tim Lamb wrote:

Nothing is ever simple...
J Pharm Sci. 2011 Sep;100(9):3843-53. doi: 10.1002/jps.22586. Epub 2011 Apr 24. Differential effect of grapefruit juice on intestinal absorption of statins due to inhibition of organic anion transporting polypeptide and/or P-glycoprotein. Shirasaka Y, Suzuki K, Nakanishi T, Tamai I. Source
Faculty of Pharmacy, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kakuma-machi, Kanazawa 920-1192, Japan. Abstract
The purpose of this study is to examine the contributions of organic anion transporting polypeptide (Oatp) and/or P-glycoprotein (P-gp) to grapefruit juice (GFJ) interaction with two statins, pravastatin and pitavastatin, which undergo negligible metabolism in rats. The two statins were found to be substrates of both Oatp1a5 and Oatp2b1, whereas pitavastatin, but not pravastatin, was a substrate of P-gp. The plasma concentration of pravastatin after oral administration was significantly decreased by GFJ and naringin, whereas that of pitavastatin was significantly increased. Naringin inhibited Oatp1a5- and Oatp2b1-mediated uptake of pravastatin and Oatp1a5-mediated, but not Oatp2b1-mediated, uptake of pitavastatin. Naringin also inhibited P-gp-mediated transport of pitavastatin. These results suggested that the decrease of pravastatin absorption in the presence of GFJ is due to the inhibitory effect of naringin on Oatp, whereas the increase of pitavastatin is due to the inhibition of P-gp. These observations are consistent with the results of in situ absorption studies. In conclusion, Oatp and/or P-gp contribute to the intestinal absorption of statins, and the differential effect of GFJ on pravastatin and pitavastatin absorption is at least partly accounted for by the different inhibitory effects of naringin on these transporters.
http://www.ncbi.nlm.nih.gov/pubmed/21520088
There are another 55 papers indexed on PubMed for grapefruit and statin. I believe there may be other issues as well. I rather liked that this one varied by statin.
--
Rod

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On 04/05/2013 08:30, Tim Lamb wrote:

I hope you are joking...
The short version is "Beware of Nerve Gas". PPE is essential.
They are targeted specifically at insect nervous systems but would do you no good at all if you got contaminated with them. Pinpoint pupils is the first symptom of poisoning and requires urgent treatment.
Insecticide researchers stumbled across a new class of them. ICI's Amiton aka VG was one of the first but was too toxic for safe use.
The very nasty area denial agent VX was a military research derivative and the Germans in WWII were convinced that the allies had similar nerve agents to Tabun and Sarin by the secrecy surrounding DDT.
http://www.aadet.com/article/VX_%28nerve_agent%29
Ones used as insecticides tended to be rapidly degraded in the environment. Malathion and dimethoate among the more common ones. Malathion has relatively low human toxicity for a nerve agent.
Too many insects are immune to them now so neonicotinoids are the new flavour of the day. they are getting a bad rap for harming bees although it is unclear to me if this is fair since many of the crops they are used on are wind pollenated and do not attract bees!
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Martin Brown
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Not really. Apart from a fully closed cab with active air filtering and remote sprayer controls, PPE is difficult to achieve.
Direct contact with actives is simple but diluted volatiles find their way into tractor cabs of my vintage. I'm still here so it can't have been that bad although I still wonder about long term health effects.

I think Dimethoate was withdrawn years ago which was a pity as it was about the only useful chemical for Crane Fly larvae. (Dursban).

I am out of touch now as I have stopped arable cropping. I have an idea that the insecticide is applied to Rape seed so may still be slightly active at flowering.

--
Tim Lamb

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Tim Lamb wrote:

I am not a medical expert, but I've read that only about 10% of the cholesterol in your blood is directly due to your diet, the rest is internally generated. I could be wrong, of course.
--
Tciao for Now!

John.
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Nor I:-)
Apparently cholesterol is largely created by the liver. Some people are genetically disposed to create more than is necessary. My liver function is suspect but an ultrasound check failed to find anything suspicious. Very hard to convince the medical profession that you don't drink so cirrhosis is unlikely:-)

--
Tim Lamb

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On 04/05/2013 07:57, John Williamson wrote:

I believe there is quite some truth in that.
High cholesterol is often related to inadequate thyroid hormone. To the extent that high cholesterol was used as an indicator of hypothyroidism in the days before suitable blood tests were available.
Have no idea whatsoever about the pork slices you eat. At least read the packet and tell us what they contain!
Almost nothing in medicine is strictly linear - so I would tend to assume the response is not linear.
You could do worse than go off and look at some papers:
http://www.ncbi.nlm.nih.gov/pubmed/?term=statin+response+linear
--
Rod

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Ah! Ta. Looks linear over normal dose rates.
If the dietary effect is only 10%, I think I will ignore my wife's mutterings:-)

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Tim Lamb

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On 04/05/2013 08:51, Tim Lamb wrote:

Although _I_ believe that fat in the diet is a relatively small part of the equation, I do not expect anyone to follow my belief! :-)
I am in the luckier position of having low cholesterol levels so my reading is more limited.
--
Rod

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On Sat, 4 May 2013 08:51:38 +0100, Tim Lamb

I've heard the same 10percent-ish thing too.
I went to the surgery for something else and had a while-you-are-here-we-might-as-well-give-you-a bloodtest which proved a little high in the cholesterol stakes.
As it happened, it came after a week of unusual over-indulgence in high-cholesterol stuff so I asked if I could do it again after a more normal spell. Well, I didn't go normal, I went non-cholesterol. I spent an incredibly boring fortnight eating and drinking nothing higher in cholesterol than lettuce, determined to drag the numbers down.
I had another test.
It was higher.
Nick
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Certainly if there is a shortage in your diet, the body will simply manufacture it.
--
Tim

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