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Spokane, Washington  Est. May 19, 1883
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Doctor disagrees with stance on statins

Q. As a doctor who treats heart patients, I am thwarted by your unbalanced reporting about cholesterol-lowering drugs. In your column, you repeatedly emphasize the negative perceptions people have of statins rather than highlighting the benefits. These medications have a benefit-to-risk ratio of 400-to-1.

Muscle complaints were rare when these drugs were introduced, but now patients blame every ache and pain on their cholesterol drugs. And they tell all their family and friends about their problems. The vast majority of aches and pains that are blamed on statins are not due to the drugs themselves, but rather to mass public hysteria, fed by word of mouth and fueled by the media.

A. Many people take statin-type drugs such as Crestor, Lipitor, Zocor and generic formulations (lovastatin, pravastatin, simvastatin, etc.) without problems. These medications are very effective for lowering cholesterol.

Side effects may not be as rare as you suggest, however. A review in the Annals of Internal Medicine (June 16, 2009) states that muscle pain affects up to 10 percent of those who try statins.

You believe that most people with statin-associated muscle pain are mistaken about the source of their discomfort. Research in the Canadian Medical Association Journal (July 7, 2009) reveals that many patients with muscle pain from statins have structural muscle injury identifiable in biopsies. The usual blood test for muscle breakdown is inadequate to detect this damage.

Readers who would like more information on the pros and cons of statins and other ways to lower cholesterol may wish to download our Guide to Cholesterol Control and Heart Health, available online at for $2.

Q. You wrote recently about using milk of magnesia as an underarm deodorant. My husband uses the antimicrobial skin cleanser Hibiclens. He puts it on his armpits for 10 minutes each morning, then washes it off. This has solved his body-odor problem.

Hibiclens does not require a prescription. In some drugstores, you do have to ask for it.

A. Since underarm odor is largely the result of skin bacteria fueled by sweat, getting rid of the bacteria each morning seems like a logical approach. Hibiclens is an antibacterial cleanser containing chlorhexidine. Health care workers often use it to avoid spreading germs from patient to patient.

Q. One thing that I have not seen in the discussions of vitamin D relates to sun exposure. You have said that people who get 10 to 15 minutes of sun exposure at one time can make enough vitamin D in their skin.

On what percent of the body is it necessary to get that exposure in order to convert the sun into 10,000 IUs/day? Just the face? The hands? Bare-butt naked? It’s a very obvious omission from the data that needs to be explained.

A. The exact amount of sun exposure needed varies according to the time of day, the season of the year, the latitude and the color of the individual’s skin. (Darker skin needs more time in the sun to make the same amount of vitamin D.)

The usual average of 10 to 15 minutes a few days each week applies to the face and hands of a light-skinned person in the summer. Winter exposure (even if one could tolerate it) in places like Boston or Milwaukee won’t provide enough sun for the skin to make vitamin D. An oral supplement will be needed.

In their column, Joe and Teresa Graedon answer letters from readers. E-mail them via their Web site:
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