Dr. Salomeh Keyhani

Should you take Vitamin C tablets?

Many of my patients tell me that they are taking large doses of Vitamin C tablets to boost their immune system. If your diet is balanced, with all the food groups represented, you are likely getting enough Vitamin C without any reason to take additional tablets.

According to the NIH, one medium orange contains more than enough vitamin C, around 117% of what you need daily. Adding oranges, grapefruits and lemons to your diet or broccoli and other fruits and vegetables that are high in Vitamin C, can help greatly. And, you can eat as much of these foods as you’d like without side effects.

With Vitamin C supplements, in extremely high doses, there is a risk of developing kidney stones and severe diarrhea. Vitamin C supplements can potentially interact with your medications in harmful ways. If you take iron pills or have an iron disorder, for example, a Vitamin C supplement could increase iron absorption and be really bad for you.

What you may find hard to believe is that the scientific evidence shows that Vitamin C supplements are not as effective as you think. One reason people often take them is to prevent the common cold. The Natural Medicines Comprehensive Database found that claim lacks evidence and it is possibly ineffective. Other systematic reviews of the Vitamin C supplement also show that it lacks the efficacy that the public believes it has. For example, in a systematic review of 29 studies released by the Cochrane Collaboration in 2013, Vitamin C supplements did not reduce the number of colds of participants in the studies. If you think the Vitamin C supplement keeps you from getting a cold or shortens it, think again.

The one evidence-based reason to take Vitamin C supplements is that they can treat scurvy. Scurvy is a condition caused by an actual Vitamin C deficiency. In all of my years of practice, I have had ONE case of scurvy. You might have heard of scurvy in the past being an ailment of those sailing for long periods of time without a varied diet, but it is not limited to pirates and sailors. To read more about the history of scurvy click here.

If you are worried about needing more Vitamin C, make sure you are eating enough Vitamin C-rich foods, including oranges, red peppers, kale, brussels sprouts, broccoli, strawberries, oranges and grapefruit. Changing your diet could be a simple non-supplement solution. If you still have concerns, discuss them with your doctor before taking any supplements. That’s the smartest way to protect your health and to save money.

[N.B. This post was originally published on January 10, 2017.]

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January 24, 2023

Five ways to ensure the people you love are safe and healthy

At least once a year, every caregiver should engage the older people they love in what can be difficult conversations. No child looks forward to being a parent to her mom or dad; no one wants to have to speak with a spouse about exercising more, rethinking a medication regimen or considering stopping driving. But, that’s often what needs to happen. Here are five ways you can help ensure the people you love are safe and healthy.

Make sure they get an annual flu shot. This should be easy since often the local pharmacy will administer the shot. The shot minimizes the risk that older adults will develop flu-related health problems, including pneumonia and worsening chronic conditions. [Editor’s note: Also make sure they get their Covid-19 vaccine and booster shots.]

Check out what drugs they are taking. And, make a list of them, along with the names and phone numbers of their doctors, both for yourself and for their wallets. If they keep the list on them, and you have a backup copy, it will help ensure their doctors are best prepared to treat them.

Ask them about painkiller prescriptions they take as well as over the counter drugs, like Tylenol. Too much acetaminophen can be dangerous. Prescription painkillers, such as Percocet or Vicodin, can be even more dangerous, particularly if mixed with alcohol, tranquilizers or other drugs.

Try to nudge them to exercise. A brisk walk can reduce the likelihood of stroke and help prolong their lives. If they are not inclined to move, ask them what might get them out of the house. Sometimes, a companion can make all the difference. Anything they can do to move their bodies is great, including in hospital. Sometimes, showing them some easy exercises can work. You can find simple balance exercises that the National Institutes on Health recommends here. For information about free and low-cost exercise programs in your community, visit the eldercare locator.

Talk to them about driving if they are still driving. Many people can drive all their lives. But, both mental and physical reflexes can weaken as you age. The National Institute on Aging offers great advice on when and how you can help someone you love decide to stop driving.

And, if you need help motivating them to change an unhealthy behavior, here are six tips that could help.

Of course, there’s more you can do, including making their homes easier and safer to live in: for example, make sure floor surfaces are smooth to reduce the likelihood of tripping, install ramps and raise toilet seats. More on that in a separate post.

(This post was originally published on April 10, 2015.)

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September 3, 2022

Skip the pills, grab a spoon; why you should likely avoid B6 supplements

Some of you may have heard B6 supplements and may have wondered if you should take them. Instead of taking a supplement, you should be able to get B6 naturally in your diet. B6 deficiencies are pretty rare in the United States. Most individuals get the necessary amount of B6 in their diets.

B6 can be found in a number of foods, including vegetables, cereals, certain meats, and eggs. And, if you have a B6 deficiency, it’s best to change your diet instead of turning to a pill.

One claim that has been made about B6 is that it helps improve cognition in older adults; however, the Cochrane Collaboration found that compared to older people with normal B6 levels or deficiencies, people taking supplements showed no evidence of cognitive improvement.While the benefits of B6 supplements are unclear, high amounts of B6 supplements have been linked to neurological problems in individuals who take them. One symptom is uncontrollable movements called ataxia.

Getting high amounts of B6 naturally from your diet does not seem to hold the same risk as B6 supplements. B6 supplements can also interact with some medications, such as antibiotics or medications taken by epileptics or people with breathing problems.

Certainly, if you’re considering taking B6 supplements, you should speak to your doctor. You should understand potential interactions with other medications you’re taking and whether you are better off saving money and avoiding this supplement.

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This post was first published on December 4, 2014

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August 12, 2019

Opioids can kill you

We all know the pleasures of a good painkiller. We often don’t know the risks. If we’re talking opioids, such as Vicodin, OxyContin and Percocet (hydrocodone, morphine, oxycodone and fentanyl in their generic form) those risks are huge. Opioids can kill you.

According to Consumer Reports, every year 17,000 Americans die from opioid overdoses. And, another 500,000 Americans end up in the emergency room.

It’s relatively easy to become addicted to or heavily dependent on opioids. They ease short-term pain. And, doctors are prescribing them more and more. For sure, it’s unsafe to mix them with alcohol, tranquilizers and other drugs, or to take the drugs for too long.

A report by Express Scripts reveals that almost six out of ten patients are mixing opioids with muscle relaxants and anti-anxiety medications, a dangerous combination. The most frequent cause of accidental deaths from drug overdose stem from mixing an opioid with a benzodiazepine.

There are other drugs such as acetaminophen, ibuprofen or naproxen to treat pain that have substantially fewer risks. For your health, before you take an opioid, it’s important to talk to your doctor about the other drugs you’re taking, including sleeping pills. If possible, you should minimize the use of opioids. And, of course, you should only take them as prescribed.

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July 22, 2019

Finish your antibiotics!

There are two simple ways to get the most out of your antibiotics and avoid promoting antibiotic resistance.

First, if your doctor prescribes an antibiotic, please take the entire course (even if you are feeling better). Finish your antibiotics! When you don’t take the whole course or skip doses, there could still be surviving target bacteria. Surviving target bacteria can develop a resistance to the antibiotic and spread that resistance to other bacteria. If you need to take that antibiotic drug again, it might not be effective, and you will be left with fewer options to fight your infection.
Second, you should only take an antibiotic if you know for sure that you have a bacterial infection that it will cure. Ask your doctor before assuming you need an antibiotic. If you take an antibiotic when you don’t have a bacterial infection, it will only kill the good bacteria in your body, which are part of your natural immunity. Killing your good bacteria can lead to other infections in your body, like a GI problem or yeast infections in women.

Antibiotics have potential drug interactions. So, please be sure to take the correct ones and know which medications you shouldn’t be taking with them. Keep a list of all your medications in your wallet to share with your doctor. Taking the wrong antibiotics will only promote resistance in bacterial communities. Antibiotics continue to be lifesaving. Let’s keep them that way by not promoting antibiotic resistance.

Originally published January 15, 2015

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November 12, 2018

Five ways to avoid heartburn without drugs and what to do if you cannot

Heartburn and Gastro-esophegial reflux disease (GERD) can be awful conditions that are quite common. More than four in 10 Americans (44 percent) reported experiencing heartburn at least once a month and almost 20 percent experienced it at least once a week. How do you treat heartburn? If possible, avoid drugs. According to Consumer Reports, many people with heartburn do not need drugs. You can often avoid heartburn in these five ways:

Be careful about what you eat and drink. Many foods and drinks can trigger heartburn, including alcohol, oranges, onions, coffee, spicy foods and chocolate. If you are getting heartburn after you eat, isolate the foods that are causing it and try not to eat them. Or, eat smaller amounts of them. And wait a couple of hours after you eat them to go to sleep.
Quit smoking.
Stay fit and lose excess weight.
Wear loose clothes and don’t tighten your belt as much.
Raise the head of your bed six or eight inches and get a good night’s sleep.

Try antacids like Rolaids and Tums or, if those don’t work, try an H2 blocker like Pepcid AC or Zantac.

If you are suffering from heartburn twice a week or more for many weeks and need stronger drugs, try to take the lowest possible dose for the shortest period of time. Often proton pump inhibitors (PPIs), like Prevacid and Nexium, are not necessary, and they are expensive. You want to avoid them because in high doses, over a long period of time they can lead to a higher risk of bone fracture, muscle spasms, irregular heartbeats and severe diarrhea.

Studies also suggest that PPIs might also increase people’s risk of dementia.

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November 5, 2018

Is the flu shot worth it?

[Editor’s note: The CDC recommends injectable flu vaccines. It recommends Fluzone high-dose flu shots or FLUAD, for people 65 and older. The high-dose vaccine has four times the amount of antigen in a regular flu shot, creating more antibodies and boosting the immune defenses of the people who get it. It provides better protection from the flu for older adults. In 2017, more than 900,000 people were hospitalized and more than 80,000 people died as a result of the flu, according to CDC estimates.]

My patients often ask me if they should get a flu shot. My answer is yes. Absolutely, yes. And, yes, I get the flu shot and so does my 4 year-old daughter. The flu shot works. And, it’s safe. If you don’t want to catch the flu, you should get the flu shot. The flu virus is …a virus.

Antibiotics will not help you if you get the flu. The best way to prevent the flu is with a flu shot.The Centers for Disease Control, the government agency that studies disease, recommends the flu shot for anyone over 6 months old. So, if you’re over 65, you should absolutely get the flu shot. The only reason not to get they flu shot is if you are allergic to the vaccine or have other contraindications. Most people are not allergic to it, but if for any reason you think you could be, talk to your doctor.

I tell my patients to get the flu vaccine for two reasons: to protect themselves and to protect others. Consider it your civic duty. If almost everyone gets the flu shot, the population as a whole becomes less susceptible. A study in Japan, demonstrated that with higher childhood vaccination rates, elderly mortality decreased. Why? Fewer kids got the flu and it could not spread as widely to others.

So you know, the flu vaccine cannot and will not give you the flu…or a cold for that matter. They are different viruses. Bad luck is the only reason you might get the flu right after you get vaccinated because you don’t yet have the immunity. Or you may get a cold around the same time by chance. But, there are no real side effects according to the research. You would have the same reaction to a salt-water solution as you would from a flu shot.

OK. Here’s the rub. Even if you get the flu shot, you still might get the flu. That’s because occasionally, the flu vaccine does not match the seasonal flu type. If you get a type that is not in the vaccine, you might catch the flu. If the vaccine matches the seasonal flu type, as it generally does, you should not get the flu. But, if your immune system is not good, the flu shot is less effective but still beneficial.

You really don’t want to get the flu. It could be very bad for your health. Older adults are at an increased risk of developing flu-related health problems, including pneumonia as well as worsening chronic health problems. If you are over 65, you should seek medical advice if you get the flu. You might need antivirals because of age-related risks.

Help yourself and your community and get a flu shot. And, if you have Medicare, Medicare covers it.

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October 10, 2018

Do you need a bone scan?

I want to talk today about bone scans . Here’s my basic advice: for the 40 million people with osteoporosis, this test is critical to diagnose and start treatment. It is good to develop a bone density baseline, but there is generally no reason to do it until you’re at least 65. It’s recommended for women over 65 and those under 65 only if they have a fracture or arthritis or family history or other indications that demonstrate a need for a scan. Men over 70 should consider the test if there is an indication such as, steroids or low testosterone, for it. (Medicare covers a bone scan every two years for people at risk of osteoporosis with a referral from your doctor.)

Unless the test shows evidence of osteoporosis or serious bone loss or you have other indications, you should be able to avoid scans in the future. You shouldn’t get your bone density tested repeatedly if there’s no evidence you need it. If test results show minimal bone loss, also called osteopenia, you might want to forgo repeated scans.

As you age, it’s natural to suffer some bone loss. Osteopenia has a much lower risk of fractures than osteoporosis and since bone density does not change rapidly, you probably can wait to get scanned again. Similarly, medication generally should not be taken to treat osteopenia. These drugs can carry some risks (as does any medication) and, the clinical benefit for those with osteopenia appears minor at best. Moreover, medications can be costly and lengthy.

So, if you are diagnosed with osteopenia and your doctor recommends regular bone scans or medications, you should ask your doctor whether you can avoid them. Medications alone could cost you between $38 and $148 each month, depending upon whether you take the generic or brand-name drug.

Instead of undergoing extra tests and getting another prescription, focus on how you can influence your health and reduce your chance of these and other tests. Make sure your diet is balanced and contains Calcium and Vitamin D. Avoid excessive drinking and smoking and medications that promote bone loss. Perform weight-bearing exercises. Finally, make your house and work safe by removing fall hazards.

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October 8, 2018

Know the signs of stroke

Around three-quarters of the 795,000 strokes suffered annually happen to people over the age of 65. I want to help you know the signs of stroke and when it’s critical you go to the hospital. Bottom line, if you or someone you love has a stroke, it is of utmost importance you call 911 immediately and get to the emergency room as soon as possible. You must act quickly or the consequences can be severe. Time is tissue and your brain is the tissue at stake. In many cases, you need to get to the hospital within an hour of symptoms beginning to receive helpful treatment or risk disability.

Believe it or not, the signs of stroke can seem like little things that are off, such as sudden difficulties in normal functioning, including loss of coordination while walking. Or, you might have trouble with your vision. Talking might become harder or you might become confused. Numbness or weakness in limbs is common for people having a stroke, many times on one side of the body. You might notice a face droop. If there’s no simple explanation for why you are experiencing these symptoms—do not hesitate and seek help!

Keep in mind that some people don’t experience typical stroke symptoms. If you feel anything is off, go to the doctor! Do not underappreciate your symptoms or ignore them. Remember, timing is very important in treating strokes. In an article published by Circulation, a journal of the American Heart Association, “even in communities with highly organized and active stroke programs, less than 10% of stroke victims receive immediate treatment.” If you don’t get treatment quickly, certain therapies are simply not available and the damage can be irreversible. Help those numbers by recognizing the signs and getting help right away. Speedy treatment can stop damage to the brain and make all the difference.

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September 10, 2018

Hearing loss common for older adults

Just about everyone experiences hearing loss as they age. In fact, the National Institute on Deafness and Other Communication Disorders reports that half of people over 75 have difficulty hearing. I want you to know that hearing loss happens naturally and often can be treated.

If you work or worked at a job and were exposed to repetitive noise, you’re likely to have hearing loss. Not surprisingly, if you’ve gone to a lot of rock concerts or have blasted loud music regularly at home or in your headphones, there’s also a good chance you have hearing loss.

But, many people do not realize they have hearing loss. And, many people who do realize it do nothing about it. There are lots of signs of hearing loss. You might feel like sounds are muffled or you might have a hard time figuring out what someone is saying in a loud space. I once had a patient, whose wife thought his memory was going because he wouldn’t remember things she had said to him. As it turned out he just couldn’t hear her!

For both your happiness and your safety, when you notice that your hearing is changing, and it is harder to hear things as well as you did before, you should see a hearing specialist. Your hearing loss can’t be reversed, but your hearing can be helped.

If you go to the doctor, make sure you explain all your symptoms as well as any medical history that is ear-relevant, such as occupational noise or a history of ear-infections. Additionally, veterans tend to have a higher exposure to noise from the duties while serving.

To determine how much hearing loss you are suffering from, the doctor will generally perform a hearing screening test and discuss your options for hearing aids. You might also get a referral to an audiologist to help work with you to create the best course of treatment.

Seek help if you notice changes in your hearing before it continues to get worse.

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August 27, 2018

Author: Dr. Salomeh Keyhani