Drastic change in cholesterol numbers can be somewhat disconcerting
Q: I recently had my yearly blood work done. I always check last year’s results against my current results, so I was surprised to see that my total cholesterol levels had dropped from 222 mg/dL to 181 mg/ dL, and my triglyceride level dropped from 174 mg/ dL to 146 mg/ dL. I do not take statins. There have been no remarkable dietary, medication or lifestyle changes. I’ve recently lost 8 pounds of weight.
I was concerned and checked with my doctor. She didn’t seem to care or even want to discuss the changes; she only said that she liked the new numbers. Can you offer any reasons for such drastic changes? I guess I’m worried that something isn’t working right.
A: Weight loss often leads to improvement in cholesterol, but I am also surprised to see a 20% decrease with 8 pounds of weight loss. Cholesterol numbers do go up and down over hours and days, and you may have just happened to hit your low point. If you were to get it rechecked, I wouldn’t be surprised if the numbers went up a little bit (a statistical concept called “regression towards the mean”). It’s also possible that last year’s numbers were taken after a meal, or you just happened to catch yourself at a high point.
I do wonder, though, with no remarkable dietary or lifestyle changes, why did you lose 8 pounds? Unintentional weight loss always gets me concerned that there might be something else going on. Thyroid disease, diabetes, malabsorption and, of course, cancer are on the list, but so are depression and anxiety.
Still, regression to the mean and weight loss are a better explanation for the lowered cholesterol levels than a worrisome metabolic problem. If you continue to lose weight without trying, that deserves further evaluation.
Q: I’m a 63-year-old nonsmoking man, and I’ve been developing skin tags on my arms, neck and abdomen. I even have one in my underarm. What causes them? Is there any way to get rid of them?
A: Acrochordons (skin tags) are outgrowths of normal skin, and they’re not considered to be any kind of tumor. They most commonly occur in places where skin can rub up against itself. I see many in the underarm area, in neck folds, in the groin or under breasts. They seem to be more common in people with insulin resistance, such as those with Type 2 diabetes or prediabetes. If you are at risk for diabetes because of family history, being overweight or high blood pressure, you should consider getting tested.
Skin tags don’t need to be treated, but if they are bothersome, or a person wants them removed for cosmetic reasons, they can be treated surgically in the office. I’ve been cautious ever since I removed one in a patient who came back an hour later still bleeding, requiring a stitch. Although there are over-thecounter preparations I have seen, most of my patients and readers have told me that they are ineffective. Still, others have written to me that the treatment was completely effective for them.
Q: What are your thoughts regarding histamine intolerance when eating high-histamine foods? I am a 65-year-old female who has suffered from sinus problems since my late teens. In my mid-20s, I underwent allergy testing. My results revealed that molds, many pollens and dust were my main culprits. No food reactions were noted.
I underwent six years of allergy injections and was prescribed antihistamines — Seldane, followed by Histmanal, until they were taken off the market. Overall, my high volume of mucus production was reduced, along with the number of severe sinus infections. (Environmentally, I have taken many precautions within my home: radiant floor heating, tile and wood floors, no pets and a clean house.)
What continues is tremendous pressure in my sinus cavities. It is worse after a meal. The pressure can wear me out. (I was puzzled because I eat healthy foods, drink plenty of water, exercise daily, stay on the low end of a healthy BMI calculation and have a nice social community. My regular blood panel results were within the normal range.)
I recently came across information about histamine intolerance when eating high-histamine foods. So many of my “healthy” foods are on the list. Does diamine oxidase (DAO) really help?
A: Although the term “histamine intolerance” is frequently used, there isn’t evidence that there is a deficiency in one of the enzymes that metabolize histamine, such as DAO. Treatment with this has not been proven effective in people with concerns similar to yours.
Since you received benefit from antihistamines, you should try one of the newer antihistamines, such as cetirizine (Zyrtec) or fexofenadine (Allegra, which is very similar to Seldane). From my reading, using one of these along with an H2 antihistamine, such as famotidine (Pepcid), has been helpful to some.
Another approach is Cromolyn, taken as a liquid before eating.
Q: I have had numbness on the outside of my right thigh for several years. At times, the area would feel like it was on fire, but that pain has since subsided. My doctor ordered an MRI, but doesn’t seem concerned with the fact that this area is numb all the time. I’ve talked to several other people who have similar issues.
I am 62 and in good health. Another person I spoke to is in her 30s and experiences the same thing. Someone else said sublingual vitamin B12 is helpful. Do you have any idea what this could possibly be from and how to treat it? Again, my doctors don’t see it as an area of concern, but it doesn’t seem like something that should be ignored.
A: Numbness and burning are cardinal symptoms of nerve disease. Some people will note a pins-and-needles sensation rather than burning, but this is clearly a neuropathy. The fact that it is so localized suggests the compression of a nerve.
In the case of the outer leg, the nerve supplying that area is called the lateral femoral cutaneous nerve, and when it is compressed, the condition is called “meralgia paresthetica.” It can happen to anyone, but it often happens when a person has changed weight or when pressure’s applied to the area (such as a belt).
About 90% of cases will get better on their own or by avoiding compression of the area. I have occasionally had to refer my patients to an anesthesiologist for a nerve block. I have had no luck with vitamin B12, but medicines for neuropathic pain, such as gabapentin, can help with pain (but not numbness).
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@ med.cornell.edu or send mail to 628 Virginia Drive, Orlando, FL 32803.