Doctor Q&A: What is the best time of day to take statins? Dr Renee Hoenderkamp answers all your burning questions

Can nicotine patches really treat long Covid?  

So this is a fascinating question and not the easiest I have had to answer for GB News viewers! Let me start off by saying it's complex.

To understand why nicotine replacement patches may help with long covid it is important to try and understand the theory behind both covid infection and long covid, and re the latter, there are varying scientific beliefs ranging from a typical post viral syndrome through to it not existing. Assuming it is a post viral syndrome of some sort, which for some impedes the ability to function normally and is long standing, we need to look at what covid does once it infects.

It is postulated that the SARs-CoV-2 spike protein attaches to receptors in the body called ACE-2 and this is the entry point in to the body that causes the symptoms of the initial infection. It is also suggested that the virus has a section of DNA that is highly attracted to other receptors for nicotine, nicotinic acetylcholine receptors (nAChRs for short). These latter receptors are responsible for nerve communication and if the virus attaches to them, this nerve communication is impaired and this would explain many of the symptoms of long covid; weakness, memory lapses, pain, breathlessness, mood and cognitive issues and other unspecific physical complaints.

Several scientists are suggesting that because nicotine is 30x more likely to bind to nACHRs than acetycholine (ACh), it is possible that nicotine, in the form of nicotine replacement products, including patches, can be used to aid the symptoms of Long Covid. Some state that they have seen improvements in some patients that includes complete resolution within days of application.

There are several reports covering this and you can see one here and use the links at the side to read others, they are complex so I have tried to break them down!

But in summary, yes there seems to be some theory and case reports for this.

What is the best time of day to take statins?

Statins are the medications given to combat high cholesterol. They are widely used and there are several different types. The available statins in the UK are atorvastatin (Lipitor), fluvastatin (Lescol), pravastatin (Lipostat), rosuvastatin (Crestor), simvastatin (Zocor)

The reason you are reading conflicting reports is that it depends on which one you are taking. So older statins which are short acting and have a short half life and so are excreted reasonably quickly from the body, should be taken at night because your liver produces most of its cholesterol at night. These short acting statins include Simvastatin, Fluvastatin, rosuvastatin and pravastatin and night time is therefore the best time to take them.

However, the more recent addition to the statin family, atorvastatin, is long acting, so in reality it doesn’t matter when you take it but you should do so at the same time every day. The longer acting statin atorvastatin can be taken at your leisure! I hope that this helps.

Are low-alcohol and alcohol-free drinks actually healthy? 

Well it depends what bit of healthy you are looking at! But I think it's great that you are asking because we should all pay more attention to anything we put in to our body!

So non-alcoholic drinks have definitely become more popular in the last decade and people use them for varying reason. Some people feel that UK culture places pressure on them to have a drink when out socialising, some people want to cut down or stop drinking and some can’t drink due to medication, being pregnant or even having had an alcohol addiction that they have overcome.

Are they healthy? Without doubt if you think you are drinking too much, you probably are, and anything that helps you cut down is healthier. And if it helps with a problem, it has to be good.

Certainly not drinking alcohol or just cutting down has health benefits which include lower blood sugar and blood pressure. fewer alcohol-related symptoms, like headaches, heartburn, indigestion and stomach upsets, less fatty build-up around the liver and ultimately, for heavy drinkers, avoidance of permanent liver damage or even cirrhosis.

As with anything manufactured to be ‘healthy’ there are some things to consider however.

It's worth thinking about the nutritional content of non-alcoholic drinks. Sugar content can be quite higher than the comparable alcoholic version. For example, two cans of alcohol free lager can contain 27g of sugar which is just about the daily recommended level (30g). Caffeine can also be an issue with some drinks containing substitutes like guarana, which can have twice the caffeine content of coffee!

If you have had a past problem with alcohol, an alcoholic free substitute that is very similar to the alcoholic version, e.g. mocktails, can act as a trigger to drink again. We hear this often from people who have been through the very difficult task of detoxing from alcohol.

And looking at the actual process of manufacturing non-alcoholic drinks, there is no real data on how healthy or not they are. Some have no alcohol at all at the start and they tend to taste more like grape juice and some go through a process of alcohol removal which makes them taste more like the real thing but the jury is out on the process itself. So bear in mind that it is a process and as an advocate of moving as far away from any food that is processed, I would be cautious.

I guess the message is moderation in everything, and I will leave you with this last stat: Epidemiological studies indicate that moderate drinkers live longer than non-drinkers and heavy drinkers. The reasons are not clear but it seems somewhere in between the two is the healthiest in terms of longevity.

Here is a good summary.