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Q1: I am 60 years of age, generally of good health a non-smoker, moderate wine/beer drinker, not overweight and play tennis and golf on a regular basis. On the negative side, despite exercise and diet, I have high cholesterol (too much bad not enough good) and have just been put on 40mg dose of statins by my GP. For some years I have been taking the following:

i) Omega3 fish oil capsules but have now stopped due to recent TV piece saying they can increase cholesterol.

ii) Selenium tablets with vit A, C, E. I had seen studies that selenium is an essential micronutrient (no longer readily available in food) in the defence of cancer and both parents died of oesophagus cancer aged 63/75. I have also read that taking statins can interfere with the immune system so again thought selenium a good idea.

iii) Glucosamine tablets for joint care. I have no problems yet apart from occasional stiffness after a hard tennis or golf game and want to keep it that way.

I would much appreciate some clarity, it seems that every day there is some new research on a vast number of issues leaving us poor old consumers confused as to the best way forward. So what do you think Dr Tom, should I keep taking these supplements and why or save my money? Doug Macdonald, Woking, Surrey.

A1: Thank you for your interesting email. A few facts and figures are missing that would have helped to give a definitive answer to some of your problems. I wonder how you define moderate beer and wine drinker. Alcohol in modest amounts, for a man a couple of glasses of wine a day or a pint of beer improves the lipid state. Alcohol tends to put up the proportion of good cholesterol, that is the lipid carried as high density lipoprotein (HDL) and reduces the proportion of the pernicious cholesterol, the low density lipoprotein (LDL). 40mgs a day of some statins, including Lipitor, incidentally the one I take, is a perfectly reasonable dose. Unfortunately there is some evidence that if the dose of Lipitor is pushed beyond 40 the beneficial change in the balance of the good to bad cholesterol that lower doses of Lipitor achieve is lost.

Some doctors, if high doses of statins are necessary, recommend Crestor as an alternative. Crestor is the most powerful of the statins but as a result always need careful monitoring during the introductory phase. Statins are an important constituent of many treatment packages, and if they can be tolerated are essential for those patients with a raised cholesterol or other lipid levels, diabetes, high blood pressure or obesity. Medical opinion is beginning to think that doctors haven't been aiming to bring down the cholesterol levels far enough, especially the low density lipoprotein (LDL) level. The new aim is to have an overall cholesterol of under four and an LDL level around two.

You don't tell us either how tall or heavy you are. The simple way of deciding if you are overweight is to measure your waist round its maximum girth, (not always the same as a man's trousers waist measurement as some men wear their trouser band below a beer belly). The easily remembered figures are that a man should ensure that his waist is under 40 inches and should aim for having one under 37, whereas a woman should be certain that hers is under 34 inches and preferably under 31.

Daily exercise is important. The problem with playing tennis is that very few people do so daily. Golf provides a huge number of advantages for people playing it but it is not a great life prolonger, possibly because some of the exercise is taken with the arms raised above shoulder and hence heart level and the breath is often held while playing a stroke. I always recommend that tennis and golf players should also take at least half an hour's brisk walk every day, providing that the weather is clement.

Omega 3 fish oil if it raises the cholesterol is likely to raise the levels of the good cholesterol and can therefore be beneficial. The statistics showing the longevity of people taking two or three oily fish meals a day or taking Omega 3 fish oil capsules are quite amazing. I would be inclined to continue to take a fish oil capsule daily.

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