Q: I have really high triglyceride levels (over 600). My cardiologist wants me to take fish-oil supplements to get the triglycerides down.
I’m worried, though, because I have read that fish oil could increase the risk of prostate cancer, which runs in my family. I feel torn between my heart health and my prostate risk.
I’d like to know more about this problem before I start taking supplements. What can you tell me?
A: Fish oil and a low-carb diet can help bring down triglycerides, so your cardiologist is justified in this recommendation (Journal of Clinical Lipidology, January-February 2014).
The connection between fish oil and prostate-cancer risk is confusing. There have been studies suggesting that fish oil may protect against prostate-cancer progression (Cancer Prevention Research, January 2014). Other studies indicate that men with higher levels of fats from fish oil are more susceptible to prostate cancer (Journal of the National Cancer Institute online, July 10, 2013).
A review of 36 studies over the past 20 years concluded that there is no consistent evidence of a link between fish oil and prostate cancer (Journal of the American College of Nutrition online, Nov. 23, 2015).
Q: I’ve been told to take my Synthroid first thing in the morning, but I’ve read that coffee interferes with its absorption. I hate waiting an hour after I get up before I have my coffee or breakfast. Is this really necessary?
A: Levothyroxine (Levothroid, Levoxyl, Synthroid) is better absorbed when you have not eaten (Journal of Clinical Endocrinology and Metabolism, October 2009). Food, dietary supplements and coffee can interfere with its absorption (Thyroid, March 2008).
Taking your Synthroid at bedtime is effective, and you don’t need to worry about coffee (Archives of Internal Medicine, Dec. 13/27, 2010). You can learn more about optimizing your treatment for hypothyroidism in our downloadable 25-page Guide to Thyroid Hormones, available at www.PeoplesPharmacy.com.
Q: I have been on tramadol (50 mg three times a day) for a couple of years due to back pain. I had surgery on my back last November and suffered complications.
For a while, I was taking a double dose of tramadol, and now my tremors are so bad that I can hardly type. This email was almost impossible.
In addition to tramadol (my regular dose), I am taking bupropion SR and escitalopram. I have trouble sleeping and cannot get more than three hours of sleep at a time. I’ve been taking mirtazapine or alprazolam to help me sleep.
Last night, I took both to try to get a solid night’s sleep, but I woke with a horrible headache. I almost passed out when I tried to stand up.
Does this sound possibly like serotonin syndrome? My job is clerical in nature, and if I cannot type due to tremors, I’m unable to do my job.
A: You are taking three drugs (tramadol, escitalopram and mirtazapine) that can affect the brain chemical serotonin. The combination might well lead to excess amounts of this neurotransmitter. That could trigger serotonin syndrome.
Symptoms of this condition include agitation, tremor, confusion, uncontrollable muscle contractions and elevated blood pressure. In extreme cases, people may experience hallucinations or fall into a coma.
Do NOT stop any of your medications suddenly, especially tramadol. The withdrawal can be terrifying. Please consult your doctor and pharmacist and ask them to check for drug interactions. They may be able to design a gradual taper for your medications so that you will no longer suffer from tremors.
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