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Tag: Supplements

  • Exercise may be your best bet for bone health, not calcium or vitamin D supplements

    Exercise may be your best bet for bone health, not calcium or vitamin D supplements

    Calcium helps keep your bones strong and healthy. So, it is wise to incorporate foods with calcium into your daily diet. If you’re not getting enough calcium, exercise may be your best bet for bone health; the evidence is weak that calcium supplements will benefit you.

    The National Institutes of Health recommends eating foods rich in calcium. People over 50 need between 1,200 mg and 2,000 mg of calcium every day. You can get your daily dose of calcium from milk, cheese, yogurt, soybeans and dark, leafy vegetables such as kale or broccoli.

    Calcium supplements are another matter. Increasing evidence suggests that all those years of advice to take calcium supplements for bone health may be turning into one of those reversals of medical advice that seems to come all too frequently.

    Since 2002, the bulk of the evidence indicates that calcium supplements actually don’t decrease fracture risk and may actually do harm, such as increase the risks of kidney stones, heart attacks, prostate cancer, and even stroke. Nor does evidence indicate that eating more foods with calcium reduces fracture risk.

    That said, the Mayo Clinic suggests that if you are a vegan, lactose intolerant, have osteoporosis, or consume a lot of food with protein or sodium, you should talk to your doctor about whether you should take a calcium supplement.

    Vitamin D supplements also seem to be over-rated as far as bone health, as supplements do not lower fracture risk for those living in the community. For those living in nursing homes on the other hand, they do lower the risk of fractures from falls.

    The best bet to promote bone health for those living in the community? According to the evidence: Exercise. Weight-bearing exercises, such as walking, climbing stairs and dancing, are most helpful. These exercises help create new bone tissue, strengthening your bones.

    Exercise has a positive effect on preventing fractures, though in actual controlled studies, the average effect was small. The Surgeon General recommends an exercise goal of 30 minutes a day.

    This post was originally published on July 30, 2015.

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  • If you need nutrition counseling, Medicare may cover it in full

    If you need nutrition counseling, Medicare may cover it in full

    As we all know, what we eat can affect our health in all kinds of ways. And, for the 15 million people with Medicare who have diabetes or kidney conditions, this is all the more true. To help people with diabetes or kidney disease learn to eat right, Medicare covers nutrition counseling in full. (Medicare also covers weight counseling.)

    If you have diabetes, chronic renal disease or have had a kidney transplant and want medical nutrition counseling, so long as you see a doctor, registered dietician, or other Medicare-qualified nutrition professional who “takes assignment”–accepts Medicare’s approved amount as payment in full–you will have no out-of-pocket costs. And, if you’re in a Medicare Advantage plan, so long as you see an in-network provider—you will have no copays, coinsurance or other out-of-pocket costs either.

    Few people with Medicare or their physicians appear to know about the nutrition-counseling benefit even though the benefit has been available since 2002. Only a small fraction of people with Medicare take advantage of it. Kaiser Health News reports that just 100,000 people with traditional Medicare received nutrition counseling in 2017. There’s no data as to whether any of the 20 million people enrolled in Medicare Advantage plans are getting this benefit.

    To benefit from Medicare coverage of dietary counseling, speak with your doctor. You will need a referral from your doctor to a registered dietician or qualified nutrition specialist. Medicare generally pays for three hours of dietary counseling during the first year you receive counseling. Medicare pays for an additional two hours of counseling every year afterwards.

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

    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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  • Can eating more mushrooms prevent cognitive decline?

    Can eating more mushrooms prevent cognitive decline?

    There are hundreds of studies on the benefits of different foods and vitamins for your heart, your brain, your muscles and more. More often than not, these studies recommend eating more green leafy vegetables and nuts. The latest study, out of the National University of Singapore (NUS), finds that eating more mushrooms may prevent cognitive decline in older adults.

    Did you even know that mushrooms could have special health benefits? According to this new study, older adults who eat a half plate (300g) of mushrooms each week could reduce their risk of mild cognitive impairment–memory loss or forgetfulness or attention deficits–by half. The senior research fellow on the NUS study suggests this benefit may stem from the compound ergothioneine (ET), which is found in most mushrooms.

    ET (ergothioneine) is an antioxidant and anti-inflammatory. People cannot synthesize ET on their own. But, you can find ET in a variety of mushrooms, including golden, oyster, shiitake, white button mushrooms, dried and canned mushrooms. Keep in mind that there is no evidence that taking supplements containing ergothioneine is beneficial; it is not the same as eating mushrooms, and supplements have risks.

    Moreover, there is not enough evidence to say definitively that eating mushrooms forestalls cognitive decline. Still, there’s no harm in eating more mushrooms. If you don’t like mushrooms, there are other evidence-based ways to forestall cognitive decline.

    Keeping mentally and physically healthy may prevent cognitive decline and dementia, according to other research. Managing high blood pressure, having a social network , exercising, keeping a healthy weight, managing hearing loss, not smoking and drinking only small amounts of alcohol all may help.

    The NUS study was conducted between 2011 to 2017.

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  • Why you want magnesium in your diet

    Why you want magnesium in your diet

    You rarely hear tell about the need for magnesium in your diet. But magnesium plays an important role. And, according to the National Institutes of Health, most people in the US, including men older than 70, do not eat foods that meet their magnesium needs. Why do you want magnesium in your diet?

    What does magnesium do and how can it help? Magnesium helps your muscles contract. It enables nerves to send and receive messages. It allows your heart to beat at a steady rate. And, it contributes to a strong immune system.

    Magnesium also helps ensure your body breaks down sugars, lowering the risk of insulin resistance.Some studies show that having the recommended level of magnesium reduces the risk of developing type 2 diabetes. Moreover, it helps to keep your bones healthy, providing higher bone mineral density, and lowering your changes of osteoporosis or bone fractures.

    What are the symptoms of magnesium deficiency? You generally will not see short-term symptoms from a shortage of magnesium in your diet. If you are otherwise healthy, your kidneys compensate and retain magnesium that would otherwise be lost in your urine. But, over the long-term, you could end up with a deficiency in magnesium. And, that can mean you lose your appetite; it can also cause nausea and fatigue, muscle cramps, tingling, numbness or, in some cases, seizures or an abnormal heart rhythm. Older adults are more likely to not have enough magnesium in their diets.

    How much magnesium do you need in your diet? If you are an adult man, you need 400 to 420 mg If you are an adults woman, you need 310 to 320 mg. Children under 13 need far less.

    Which food contain a good amount of magnesium? If you eat spinach and other leafy vegetables, you should be getting a good amount of magnesium in your diet. Legumes, baked potatoes with skin, dry roasted almonds, seeds, and unrefined grains also contain a lot of magnesium, as do milk, yogurt and some other dairy products. Some cereals are fortified with magnesium, but they tend to have a lot of sugar, which is not good for your health.

    Can certain health conditions affect your ability to absorb magnesium? Yes. People with Crohn’s disease or celiac disease, as well as people with type 2 diabetes or who take diuretics, often cannot retain as much magnesium as healthy people. People who take proton pump inhibitors might also not retain enough magnesium. Their kidneys do not retain as much magnesium, and they lose it through their urine.

    Can being older affect your ability to absorb magnesium? Yes. According to the NIH, older adults may absorb less magnesium from the foods they eat and their kidneys also may not be able to retain as much magnesium as they need. Moreover, older adults are more likely to have chronic diseases or take prescription drugs that affect their magnesium levels and can increase their likelihood of losing needed magnesium.

    Can you get too much magnesium? Not from the food you eat. But, it could be dangerous to take magnesium supplements, so you should not do so without speaking with your doctor. You do not want to take more than the recommended amount. Among other things, taking too much magnesium can cause or worsen diarrhea. Moreover, magnesium supplements can have harmful interactions with other drugs you are taking, including antibiotics, diuretics, drugs for acid reflux and peptic ulcers.

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  • Avoid memory supplements

    Avoid memory supplements

    Today, there are about 80,000 dietary supplement products on the market, up from 4,000 25 years ago. Of those, some 500 are memory supplement products. The US Government Accountability Office (GAO) tested three of the most popular memory supplement products to determine whether they contained the ingredients listed on their labels. It found that two of the three did not and warns that they could be dangerous for older adults. Avoid memory supplements as they might contain unsafe ingredients.

    For two of the three memory supplement products the GAO tested, the GAO found they did not contain Ginkgo biloba, even though it was listed as an ingredient on their labels, or the product contained far less than its label indicated. Rather, both memory supplement products contained an unknown substitute, and the GAO could not therefore vouch for the products’ safety. The third memory supplement product tested contained the fish oil and other ingredients listed on its label.

    The GAO warns that heavy-metal contaminants in supplements, such as arsenic, cadmium, chromium, lead and mercury, can be dangerous to people’s health. They may cause cancer. Indeed there are many ingredients in supplements that can cause harm.

    Notwithstanding the fact that supplements are largely unregulated, and they may contain ingredients that are dangerous to people’s health, supplements are a multi-billion dollar industry. Memory supplements, which are a tiny share of the supplement market, generated $643 million in sales in 2015.

    Curiously, the government claims that it does not allow importation of prescription drugs because they may be unsafe, yet it allows the unfettered sale of supplements, which are likely to be more unsafe than drugs bought from verified pharmacies abroad.  Moreover, though the FDA has authority to regulate dietary supplements, generally the FDA tends not to do so and, when it does, it is only after they go to market. The FTC has authority to regulate advertising of supplements but does precious little in that regard to ensure truth in advertising.

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  • If you take supplements, beware of potentially serious supplement-drug interactions

    If you take supplements, beware of potentially serious supplement-drug interactions

    Millions of seniors that take herbal supplements in addition to prescription drugs may be at risk for potentially serious supplement-drug interactions.

    Researchers in the UK polled older adults 65 and older, finding that about one-third of them take at least one supplement in addition to their regular medications. Based on an evaluation of those supplements and drugs, researchers say that one-third of that group are at risk for potentially serious adverse events, they reported in the British Journal of General Practice.

    Some of the adverse events are a risk of bleeding, an increase in blood sugar concentration and reducing the effectiveness of the medication an individual is taking.

    Researchers identified three supplement-drug combinations they say pose a “significant” hazard: calcium and the underactive thyroid drug levothyroxine; peppermint and Prevacid (lansoprazole), which is used for acid reflux; and St. John’s wort and amlodipine, a blood pressure-lowering medication. In the first combination, the efficacy of levothyroxine can be reduced by calcium. Antacids like Prevacid can eat away at protective coatings on peppermint oil pills, potentially leading to nausea and heartburn. And St. John’s wort can reduce the levels of amlodipine in the blood.

    Other potentially serious combinations include fish oil pills and bisoprolol, a beta blocker, as well as glucosamine, a supplement used for arthritis relief, and the diabetes drug metformin. The first combination can lead to a potentially unsafe lowering of blood pressure, while the second can increase blood sugar.

    The study authors conclude that doctors should ask senior patients about supplement use to potentially avoid interactions with medications.

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    This article originally appeared in medshadow.org.

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  • Do not take supplements on blind faith

    Do not take supplements on blind faith

    As a primary care doctor, I come across several interesting situations, challenges and experiences. Some are inspirational and some are eye opening. As I have become increasingly aware of the potential dangers of supplements, I have started asking my patients if they are taking any. Many of my patients are taking supplements on blind faith, assuming that they are helpful to them, when they may be harming themselves.

    Some of my patients tell me that they are taking supplements because they can get a good deal on them.  Some tell me that they are encouraged to take supplements by their family members and friends who work in stores that sell supplements. Some mistakenly believe that supplements will help them live longer.

    But, most of the supplements you take have not been checked for drug interactions and are probably not safe for people older than 65. Moreover, places and companies who sell supplements don’t know what prescription medications you are taking and cannot warn you about harmful drug interactions.

    According to the National Center for Complementary and Integrative Health (NIH),  the “natural” label on supplements does not always mean “safe.” Be aware that an herbal supplement may contain dozens of compounds and that all of its ingredients may not be known. The regulations for dietary supplements are not the same as those for prescription or over-the-counter drugs.

    For example, the Centers for Disease Control and Prevention (CDC) reports that castor oil is a stimulant laxative that may cause thorough evacuation of the bowels within 2-6 hours of ingestion; this strong result of taking castor oil also can cause dehydration and electrolyte imbalance. Long-term use of castor oil may reduce your ability to absorb nutrients.

    Curcumin (turmeric) is among the most popular supplements. It is  believed to be an antioxidant, anti-inflammatory and anti- carcinogenic. But, a recent multicenter, randomized double blind, placebo-controlled study by Lang et al. reported that the combination of mesalamine and curcumin may have a beneficial effect in mild to moderately active ulcerative colitis. It may cause liver toxicity and stomach upset specifically in larger doses for longer duration.

    Curcumin can also lower blood glucose levels so diabetics should be cautious taking this supplement. Last but not least, curcumin does interfere with blood-thinners such as aspirin, Coumadin and Plavix. I had one patient who developed worsening of acid reflux symptoms with curcumin. And, it is reported that curcumin interferes with antacids like ranitidine which is available over the counter.

    My advice is to talk to your doctor before buying any over-the-counter medications or supplements. Do not waste your money on something that you don’t know for sure will be beneficial for your health. With the tsunami of social network, comes the chaos of information which can confuse us all. This is where your primary doctor can guide you in making smart choices.

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  • Are fish oil supplements just another red herring?

    Are fish oil supplements just another red herring?

    There appears to be precious little evidence of the benefits  to individuals of fish oil supplements, according to research out of the University of Auckland in New Zealand and, more recently, a US study published in the New England Journal of Medicine.

    The researchers at the University of Auckland found that if you’re hoping to help your heart by consuming fish oil supplements, you might want to stop hoping and switch to eating fish rich in omega-3 fatty acids. But, you should do so in moderation. Researchers analyzed the results of 18 randomized clinical trials between 2005 and 2012 and found essentially no basis for recommending people take fish oil supplements.

    The US researchers tested whether fish oil supplements help people with dry eye, a common condition in which the eye is inflamed, causing vision problems and pain. In their study 500 people received either fish oil supplements or a dummy pill every day over a year.  They found that people who took the supplements had the same symptoms at the end of the year as people who took the dummy pill.

    So, instead of taking fish oil supplements, eat mackerel, herring, tuna, halibut and salmon, which all provide omega-3 fatty acids, otherwise known as fish oil. Eating broiled or baked fish could reduce your risk of cardiac death. But, beware, if you eat fried fish, you likely increase your risk of heart disease.

    Eating fish also may increase your exposure to methylmercury. Swordfish, king mackerel, shark, or tilefish have high levels of methylmercury. Higher mercury consumption is associated with a higher risk of cardiovascular disease; however results are mixed. As always, the key is moderation and a balanced diet.

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  • Should you be taking vitamins?

    Should you be taking vitamins?

    Liz Szabo reports for the New York Times that older Americans are popping supplements like candy. Doctors may recommend certain vitamins like vitamin D and folic acid, and dozens of others are marketed widely. But, the evidence suggests that most of these supplements offer no health benefits for otherwise healthy individuals and that some ingredients in some supplements do harm. Should you be taking vitamins?

    If you are otherwise healthy, speak with your doctor. You should likely skip the vitamin pills and instead eat a balanced diet. The preponderance of independent studies on almost all supplements suggests that the benefits are at best negligible and the dangers, at times, significant. For example, the biggest studies show that  vitamin E and folic acid supplements do not promote heart health. What’s worse, the studies show that too much vitamin E can mean you are at higher risk of heart failure, prostate cancer and death from any cause.

    Still, nearly seven in ten older adults take at least one vitamin and nearly three in ten take four or more vitamins.  There appears to be a misplaced belief that you can get more of the nutrients you need from vitamin pills and that more vitamins in your system is better for your health. But, pills are generally no substitute for eating a healthy diet, some ingredients in some vitamins can cause serious health risks, and taking more vitamins can be harmful to your health.

    Before believing the “experts” and spending your money on a supplement, you might want to review the scientific evidence on www.Cochrane.org. Cochrane is a global independent network of researchers, professionals, carers, patients and people interested in health. The people at Cochrane “gather and summarize the best evidence from research to help you make informed choices about treatments.”

    You can read the independent research findings about these vitamins on Just Care:

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