What the reader really wants to know is if he is going to have to limit his intake of champagne and the food he chooses, and go to bed rather earlier than he is used to. On principle this column doesn’t usually discuss an individual’s specific treatment but rather targets replies to the world at large. However this reader’s letter illustrated so many common problems, and the reader expressed them so clearly, that answering his questions in some detail will also answer those of many other readers. Fortunately his letter included a telephone number so I was able to break another rule and ask a few supplementary questions. It sounds as if the reader is lucky to have such a good and cautious doctor who is not only intent on treating disease but in preventing it.

The reader is an unmarried non-smoker. He is at present taking atorvastatin (Lipitor), a drug that lowers cholesterol levels. His mother is still alive at 79, but there is a family history of cerebral aneurysms. His father died at 66 from a cause unconnected with his cardiovascular system, although he developed type 2 diabetes in his early sixties.

Ten years ago only the reader’s blood pressure of 160/90 would have caused adverse comment. The importance of bringing both the systolic blood pressure — the pressure in the arteries when the heart is beating — to below 130, and the diastolic pressure — the pressure in the arteries when the heart is relaxed — to under 80 is now pursued with greater vigour. The lower the blood pressure, so long as the patient is otherwise healthy and has, for example, kidneys that are working well, the better.

Although the reader’s waist is just within the acceptable limit of 40in — waists should preferably be under 37in — his collar size (17in) is at least half a size too big. His father’s type 2 diabetes means that there is a family history of metabolic disorders. This alone should be taken as an indication that the reader needs to strive to obtain better results than the average person. Recent research shows that several minor or borderline abnormalities can be as important as one obvious discrepancy.

The reader’s blood fat levels and cholesterol are borderline. He probably has to thank the statins for this. The old teaching was that overall cholesterol should be under five, but now the guidelines adopted by the appropriate specialist organisations is that it should be under four. Likewise ten years ago doctors would have accepted an LDL of 2.4, but now the objective is to get it under 2. The reader’s HDL at 1.7 is good and may reflect his fondness for good claret. The height of the HDL is now known to be of greater importance than has hitherto been supposed.

The doctor’s advice for lifestyle changes are sound — if they don’t bring the reader’s figures down to the new standards a larger dose of statins might be called for; 10mg of Lipitor daily is a very small dose. His blood pressure should certainly be treated if lifestyle changes, including loss of weight and more exercise, don’t effect an improvement.

What about the champagne? He told me that his gamma GT (an enzyme that, when elevated, may indicate liver abnormality) was 97, a trifle high. Less alcohol would also help his triglyceride (elevated levels indicate heart disease risk), which is borderline.

Another readers wonders if he should renounce turkey for Christmas. Turkey, he has read, is rich in “tryposan” and eating it could undermine his immune system. The reader has had a bladder tumour and doesn’t want to do anything that might decrease his resistance to it. Equally he wonders if, as Christmas time is flu time, the whole country might not be encouraging an epidemic of the virus by enjoying turkey dinners together.

I suspect that the original piece the reader saw referred to tryptophan. This is a protein present in many foods as well as meat, including vegetables, milk, bread and cereals. Surprisingly, there is less tryptophan in poultry, beef and veal than in other meats.

The utilisation of tryptophan is linked to the vitamin niacin, also known as nicotinic acid. Niacin is also found in reasonable quantities in turkey, but only in similar amounts to that found in salmon and veal. Niacin is present in smaller quantities in turkeys than, for example, chicken and sardines.

Although a shortage of tryptophan and niacin was responsible for pellagra — the appalling vitamin deficiency disease that killed so many Far Eastern prisoners of war — tryptophan in gross excess, when taken as a supplement, may cause headaches, light headedness and nausea.

In 1989 there was near panic when cases of eosinophilia myalgia syndrome swept across the United States. The patients’ white blood cell counts were grossly disturbed and they suffered disabling fatigue and muscle pain coupled with multi-organ inflammatory conditions that affected joints, skin, hearts and livers. When the tryptophan supplements were discontinued the patient slowly improved. The outbreak was shown to have been the result of contaminated tryptophan supplements imported from the Far East that had been manufactured by one company. Occasional cases of eosinophilia myalgia syndrome are diagnosed but they have nothing to do with turkeys. Tryptophan supplements should be taken only under medical supervision.

TOPIC OF THE WEEK

Send any queries about food poisoning to Dr Stuttaford at www.timesonline.co.uk/talkingpoint. His answers will appear online at 1pm on Wednesday.

ASK DR STUTTAFORD

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Dr Stuttaford’s replies cannot apply to individual cases but should be taken in a general context.

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