DEAR DR. ROACH: Experts advised us to “throw out sugar-laden cereals” and eat a healthy breakfast, such as oatmeal. Now we are told that oatmeal contains a significant amount of glyphosate, which they say is an ingredient in Roundup! Are we poisoning our children? — A.D.

ANSWER: There have been traces of glyphosate (an herbicide) found in oatmeal and other cereals. However, as always, the dose makes the poison.

The Environmental Protection Agency has set a level of 30 parts per million, below which the exposure is considered safe. A 2018 study by the Environmental Working Group found levels of glyphosate in oatmeal breakfast cereals to be between 0.5 and 1 parts per million. It is unlikely that consumption of these cereals causes any significant health risks. Nobody likes the idea of eating an herbicide, but these are very low amounts, and some experts have questioned the specificity of the detection method used.

The same EWG report found that organic cereals had less, but often still some, glyphosate in them. Although the levels in both conventional and organic cereals were safe, glyphosate itself is found at generally lower levels in organic products. Unfortunately, there have not been good studies on residual amounts of organic pesticides (some of which are substantially more toxic than glyphosate) that might be found in organically grown food.

I agree with reducing the simple sugars found in many cereals, especially those marketed to children. However, I recommend more protein for breakfast than is found in oatmeal. You can add more with nuts, egg whites or seeds.

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DEAR DR. ROACH: I was diagnosed with high LDL cholesterol 20 years ago. I have been taking higher statin doses and now take Crestor 20 mg. Due to muscle pain, my cardiologist prescribed Praluent injections of 75 mg every two weeks to lower my LDL to below 77. I am 74 and have two heart stents in my right coronary artery, but have never had a heart attack.

Praluent is a monoclonal antibody, and the literature states that it can lower your immunity. I also have low-grade (Gleason 3+3) prostate cancer that has been stable since diagnosed in 2012. Is there a risk that Praluent could cause my prostate cancer to advance? — J.E.

ANSWER: Although taking a statin (such as the Crestor you were taking to reduce cholesterol) was once thought to increase cancer risk, multiple studies have since found no convincing evidence that this is the case.

Praluent (alirocumab) is in a new class of drugs, called the PCSK-9 inhibitors. They have not been used for very long, but I found no evidence that these drugs increase cancer risk either. There was some concern that the increase in bile acids seen in people treated with these drugs might predispose them to colon cancer, but initial studies have not shown any problems so far with either Praluent or evolocumab (Repatha).

I believe that for you, heart disease is a larger risk to your life than your prostate cancer. Since you can’t tolerate a statin, a PCSK-9 inhibitor is more likely to prolong your life by reducing heart disease risk than it is to shorten your life by increasing prostate cancer risk. There is no evidence that it does so.

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Dr. Roach regrets that he is unable to answer individual questions, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.

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