DEAR DR. DONOHUE: This is the third time I have mailed you the butter vs. margarine issue. I am sure this is of great interest to many folks. I have been using margarine, and now I prefer its taste. The enclosed item lists the bad effects of margarine, and now I am confused. Your take, please. – M.D.

ANSWER: The enclosure is overblown, to say the least. Let me give you a capsule version of the debate, and you can make your own decision. The issue is: Which – butter or margarine – raises cholesterol more and is, therefore, a less-healthy spread? All the below figures are contained in 1 tablespoon.

Butter contains saturated fat – 7 grams. Saturated fat raises blood cholesterol by stimulating the liver’s production of it. (Most of our cholesterol comes from our own making and not from the food we eat.) Butter has 100 calories. On the good side, butter also has vitamin A and vitamin C, and small amounts of B vitamins.

Margarines have less saturated fat than butter, from 1.5 to 3 grams. They don’t prod liver cholesterol production as much as butter. Their calorie content is between 60 and 100. Many margarines used to – and a few still do – contain trans fats, a form of fat that increases LDL cholesterol, the bad kind of cholesterol, and lowers HDL cholesterol, the good kind of cholesterol.

I took a survey in the local supermarket of margarines. None that I inventoried had any trans fat, but there are brands that do. You must look for the trans fat content to justify margarine use. Margarines don’t offer as many vitamins as butter does.

Newer margarines’ – like Take Control and Benecol – claim to fame is their sterols and stanols, which are efficient cholesterol-lowerers. However, sterols have been found in plaque, the stuff that clogs arteries, so that raises a question about its benefits.

My take is as follows: If you are on a very strict cholesterol-lowering diet or if you have significant heart disease, margarine is probably the better choice. If you don’t need to keep such a close surveillance of cholesterol, then taste determines the choice.

DEAR DR. DONOHUE: I am 78, very active and always exercising or jogging. My doctor says I have a slow heartbeat. What caused it? He threatens me with a pacemaker. How can I speed up my heart? – R.B.

ANSWER: At rest (sitting quietly in a chair) a normal heart beats 60 to 100 times a minute. (An aside: Heartbeat and pulse are one and the same.) Many very healthy people have a heart that beats less than 60 times a minute. A slow heartbeat is not always indicative of a sick heart.

A slow heartbeat is troublesome if it causes symptoms. Symptoms are chronic fatigue, dizziness or feeling like you are on the verge of fainting.

If a person with a slow heartbeat has those symptoms, the cause of the slow pulse could be poor circulation to the heart’s pacemaker. The pacemaker is a little patch of specialized cells that generate an electric current 60 to 100 times a minute. The spread of that current through the heart is responsible for the heart’s contraction and blood pumping. That’s the heartbeat.

Scar tissue can also upset the pacemaker’s function.

If your heartbeat is extremely low or if you have symptoms from a slower-than-normal heartbeat, the answer is a pacemaker, which delivers electric current to the heart. There is nothing you can do on your own to speed the heart. Installing a pacemaker is not a daunting procedure.

DEAR DR. DONOHUE: What causes an itch? Why does scratching relieve it? I am itching to learn the answers. – C.H.

ANSWER: Let me scratch you a brief reply. Itches come from the release of various body chemicals. One of those chemicals is histamine. The chemicals stimulate certain nerves that send the itch signal to the brain. Scratching is a reflex to an itch. It activates other nerves that transmit mild pain signals to the brain. The pain signals temporarily block the transmission of itch signals.

Allergies, mosquito bites, dry skin, inflamed skin (eczema), heat, diabetes, kidney disease, a backup of bile, emotional stress and infections like scabies can all trigger an itch.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.

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