DEAR DR. DONOHUE: I am a 66-year-old man under cardiac care. After reading a medical newsletter, I substituted nattokinase for my daily aspirin. I understand nattokinase has fewer side effects.

I also started taking Co-Q10 to offset the depletion of this nutrient by the statin drug I take to lower my cholesterol. I am reluctant to run these changes past my cardiologist. Could I have your opinion on these changes? – M.C.

ANSWER: Lose your reluctance and run this information by your cardiologist. It’s reckless to make major medicine changes without first discussing them with your doctor.

Nattokinase is an enzyme extracted from Natto, a fermented, cheesy food used in Japan for hundreds of years. It appears to have properties that prevent clots from forming in blood vessels. Such an effect is the reason why aspirin is given to heart patients – to keep their heart arteries free from clots. However, there have not been large, rigidly controlled comparisons between Natto and aspirin for their ability to benefit heart patients. It’s foolish of you to toss away your aspirin for a substance that has not been proved to be as effective in preventing heart attacks.

Co-Q10 – Coenzyme Q10 – is a natural substance found in all body cells. It promotes energy production in cells. It is also an antioxidant. Antioxidants stop the degradation of LDL cholesterol (bad cholesterol) into a waste product that clings to artery walls and can eventually dam the flow of blood through the artery. Co-Q10 has been used in Japan since 1970 for the treatment of heart failure, and it is also used in Europe for the same condition. It is probably not harmful, so your cardiologist should not object to its use.

Let me add something. Some statin drugs lower Co-Q10 levels in the body, but so does aging. No one is certain if lowered Co-Q10 causes any trouble.

DEAR DR. DONOHUE: Why hasn’t a cure been found for Alzheimer’s disease? My mother has it. Do you recommend using the medicines now available for Alzheimer’s? They’re not curative. – C.S.

ANSWER: Aricept, Exelon and Razadyne are medicines that increase the level of acetylcholine in the brain. It’s a chemical important for transferring information from one brain cell to another. All three drugs can lessen Alzheimer’s symptoms in some patients, but they do not stop the progression of the illness.

Namenda is another Alzheimer’s medicine, and it works in a different way. It protects memory cells, but it cannot undo damage already done, and it can’t stop Alzheimer’s in its tracks.

You’re correct. There is no cure. However, I wouldn’t hesitate to try any of these drugs for whatever benefit they might produce.

The booklet on Alzheimer’s describes this illness in detail. To order a copy, write: Dr. Donohue – No. 903, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I have arthritis and neck problems. Naproxen (Aleve) is the only medicine that works for me. Will it hurt my stomach even if I take it with food? Ads for Tylenol say you can have stomach problems from it or aspirin and not know it. Is that true? I cannot take Tylenol. It gives me a rash. – C.K.

ANSWER: Aleve and the many other related drugs, such as aspirin, Voltaren, Motrin, Indocin, Advil and Orudis, can irritate the stomach and can give rise to ulcers. Ulcers can be silent – no pain – whether they are caused by medicines or whether they occur for other reasons.

You can lower the risk of stomach irritation and ulcers by taking the lowest dose of these medicines that still provides relief. Or you can take, along with these drugs, medicines that stop the production of stomach acid. Nexium, Prilosec, Prevacid, Aciphex and Protonix are examples. They can prevent stomach irritation and ulcer formation. Cytotec is another drug that provides the same protection. It cannot be taken during pregnancy. Ask your doctor if it’s a good idea for you to use one of these products so you can take Aleve. Food doesn’t offer reliable protection.

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.