DEAR DR. DONOHUE: What is your opinion of the C-reactive protein blood test? Is it a definite indication of heart disease? I am a 70-year-old woman, overweight but otherwise in good health. For the past year and a half, my result on this test has varied from a normal of 3 to as high as 10. Currently it is 9.3. One year ago, I had an ultrasound of my carotid arteries as well as an echocardiogram of my heart. Both tested great. My family doctor and my cardiologist decided that I must be one of those people for whom this test does not ring true. I am interested in your opinion. – Anon.

ANSWERS:
Readers who are not aware of the C-reactive protein – CRP – blood test will undoubtedly be confronted with it soon. It’s not a new test. It’s been around for many years, and it is used to detect inflammation in the body. Artery inflammation is a key ingredient in causing plaque buildup on artery walls and artery clogging. Therefore, inflammation is also involved in heart attacks and strokes. The newer version of the CRP test is a more-sensitive test called high-sensitive CRP and is the test I’m talking about. CRP, therefore, can be an indicator of heart disease.

What makes the test even more attractive is the interesting discovery that statins, the drugs most often used to lower cholesterol, lower CRP too. The doctors who linked CRP to heart disease have now shown that lowering CRP with Crestor (a statin) provides protection against heart attacks. And this protective effect takes place even in those with normal values for LDL cholesterol – the bad cholesterol and the reason why most people take statin drugs.

A bit of restraint should temper enthusiasm for this test and for this new indication for prescribing statin drugs. We are a pill-popping nation, and promoting another indication for taking a medicine has to be met with reservations. Things other than artery inflammation can elevate CRP – rheumatoid arthritis, minor infections, trauma, tooth disease and even sleep disturbances. Secondly, a large number of adults have a somewhat elevated CRP. For the present, sticking to previous indications to gauge heart disease and its treatment seems a reasonable course, the course your doctors have taken. Let’s wait and see what happens with CRP. By the way, weight loss lowers CRP.

The booklet on heart attacks describes the proven methods of detecting coronary artery disease and its treatment. Readers can obtain a copy by writing: Dr. Donohue – No. 101, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: Our daughter had her first baby, our first grandchild. She is concerned about my wife, who is a smoker, holding or touching the baby without her first showering, brushing her teeth and wearing clothes she hasn’t worn when she smokes. My wife doesn’t smoke in the baby’s presence or in the house when the baby is there. The baby’s doctor advises against physical contact with smokers because nicotine could be absorbed through the baby’s skin. Is my daughter being overly concerned? – D.H.

ANSWER:
Your daughter and her doctor are taking matters to the extreme. I have never heard of such precautions. I don’t think they’re necessary. If others have evidence to the contrary, please send it to me, and I’ll have it published.

DEAR DR. DONOHUE: In your article on artificial sweeteners, you didn’t mention maltitol, used in sugar-free chocolates. Any comment? – J.I.

ANSWER:
Maltitol isn’t an artificial sweetener. It’s a sugar alcohol, as is sorbitol, xylitol, mannitol, lactitol, erythritol and isomalt. “Sugar alcohol” is an unfortunate name, since they are neither sugars nor alcohols. They’re used as sweeteners in many products, and those products can legitimately be labeled as being sugar-free. You find them in chewing gums, candies, cookies, low-calorie drinks and many other edibles. They’re obtained from fruits and vegetables. They don’t raise blood sugar as high as sugars do, and they are absorbed more slowly. In excess, they can cause gas, bloating and diarrhea.

DEAR DR. DONOHUE: Please enlighten me about thyroid hormone. I am 73. On routine blood work my TSH was elevated, so I was put on thyroid hormone. I have none of the symptoms of hypothyroidism. My doctor says I can stop the medicine if I want. What problems am I going to run into if I discontinue it? – D.B.

ANSWER:
Two hormones indicate how well the thyroid gland works. One is thyroid hormone, made by the gland. The other is TSH, thyroid stimulating hormone, made by the pituitary gland. When thyroid hormone output is low, the TSH hormone – the stimulating hormone – does just that: It stimulates the thyroid gland to make more thyroid hormone. A high TSH, therefore, indicates a low output of thyroid hormone.

People like you, who have a high TSH but no symptoms of low thyroid hormone output – hypothyroidism – are said to have subclinical hypothyroidism.

On this matter, doctors are in two camps. One camp says to treat with thyroid hormone even though the person has no symptoms, because around 5 percent of such people will develop obvious hypothyroidism in a year. Furthermore, thyroid hormone is cheap and has few side effects. The opposing camp says giving these people thyroid hormone might promote osteoporosis and might send the heart into the rhythm disturbance atrial fibrillation.

Your doctor says you can make the choice to take or not to take thyroid hormone. You know the pros and cons. I’m not positive what I would do if I were in your shoes.

Thyroid illnesses – quite common conditions – are discussed in the booklet on this topic. Readers can obtain a copy by writing: Dr. Donohue — No. 401, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

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. Readers may also order health newsletters from www.rbmamall.com.


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