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This week we respond to questions about cholesterol and sleep aids.

Dear HOUSE Calls,  

What is worse in your diet for heart disease, cholesterol or carbohydrates?

This is a tough one.  Good for you for paying attention to the details. Basically, the most important life style issues for heart disease are: 1) quit smoking (if you smoke), 2) safe levels of aerobic activity, 3) controlling your body weight.

There are a number of fad diets, and the extremes seem to be an apparent contradiction. The Ornish diet is a heart healthy low fat, low cholesterol diet. The Adkins diet is a low carbohydrate diet. And if you avoid carbohydrates and fat, there is not that much left to eat.

We preach moderation and sustainable changes. Cholesterol is not as bad as was once thought, but a diet high in saturated fats is a bigger problem. Good fats such as those you find in olive oil, canola oil, and almonds are healthy for you. Carbohydrates come in ‘good’ and ‘bad’ types too. Basically processed carbohydrates (flower, sugar) and high glycemic foods which increase blood sugar (potatoes and corn for example) should be consumed in moderation. Whole grains are an important part of your diet.  Sorry for avoiding your question, but it’s complicated.

Work with your doctor and a nutritionist. Make life long changes that promote a healthy body. Good luck.

Dear HOUSE Calls,    

I was given a prescription for Ambien from my doctor. The pharmacist warned me of all these side effects.  Should I follow the orders of the doctor or the advice of the pharmacist?

What is interesting here is the way you perceive the information from the doctor and the pharmacist. Why is advice from the doctor an ‘order’ and advice from the pharmacist advice? These are both highly trained members of your clinical care team. Ideally, you might be cared for in an environment where these two actually communicate effectively and are therefore members of the same team.

That is probably the exception. Getting them to talk together may alleviate some of this confusion.

A second choice would be to talk to your doctor about the side effects and your concerns.  We wonder if the pharmacist really discuss side effects or merely slip a paper in your bag with scores of side effects.  Did the pharmacist advise you not to take the medicine (that would be unusual) or merely want you to keep an eye out for potential side effects?

To get back to your question, we would need to understand what side effects your are worried about, how common or severe they might be, how bad your sleep is, and what else you have tried. In general, if you decide not to take a prescribed medicine, it is a good idea to let your doctor know.

HOUSE Calls is a weekly column by Dr. Adam Zolotor, Dr. Adam Goldstein, and Dr. Cristy Page on behalf of YOUR HEALTH and the UNC Department of Family Medicine.

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