The Upd and Downs of Vitamins

Should you take a daily multivitamin? This seems as obvious as motherhood and apple pie. Our understanding of the health benefits, and even health risks, of taking vitamins has advanced a lot in the past several years. The March, 2008 issue of the Harvard Men's Health Watch (HMHW) (www.health.harvard.edu) has an indepth review of the latest research on vitamin supplements.

There are 13 vitamins, chemicals that cannot be made by the body and are required for the body's metabolism. There are deficiency diseases for each one of them, like scurvy for a lack of Vitamin C. In order to function properly, our bodies need only small amounts of these vitamins, and a healthy balanced diet readily provides them. But, just in case, 35% of adults in the US take a multivitamin on a regular basis.

Vitamin intake rose dramatically in the 1980s and 1990s with evidence that anti-oxidants (Vitamin E, Vitamin C, Vitamin A and beta carotene which is converted to Vitamin A in the body) may help protect against heart disease and cancer. One report in 1999 showed that 39% of cardiologists were taking Vitamin E (not today, more on that later).

A second big boost to vitamin and other supplement intake came in 1994 when the Dietary Supplement and Health Education Act (DSHEA) was passed by Congress. Vitamins and other supplements were removed from the jurisdiction of the FDA and maufacturers could make great health claims without proof. After DSHEA, the sales of supplements in the US soared from $4 billion to over $21 billion dollars.

The early research on vitamins and supplements was observational, a crude type of research that does not prove cause and effect. Maybe vitamin takers were simply healthier people? Careful controlled research trials over the past 10 years have produced new light on taking vitamin supplements, light that shows very little benefit and even the risk of harm.

Careful research shows that taking anti-oxidant supplements do not protect against heart disease or cancer, and may increase the risk. For example, supplementation with Vitamin E may increase blood clotting and increase the risk of a heart attack or stroke. Almost all of those cardiologists have stopped taking Vitamin E. Beta carotene supplements increase the risk of lung cancer in male smokers, excess Vitamin A increases the risk of bone fractures and people who take anti-oxidant supplements may have a higher death rate per year than those who don't (HMHW, November 2007).

What about that great B vitamin, folic acid? We know that it prevents birth defects and lowers homocysteine, an amino acid associated with heart disease risk. Modest amounts of folic acid are helpful, but high amounts (1000 mcg or 1 mg or more) seem to make cancer tumors grow faster, raising the risk of more serious colon, prostate and breast cancer.

The HMHW states that there is one vitamin still standing that when taken as a supplement may provide more benefit than harm - Vitamin D. Vitamin D is important for bone health and taking supplements of 1000 IU or more may reduce cancer risk. Certainly more studies are needed.

Should you stop taking that one-a-day multiple vitamin? There is no evidence that the amounts in most once daily mutivitamins do any harm or good. However, if you take a heavy amount of vitamin supplements, you should take a careful look at current scientific evidence, and not the manufacturer's hype, and reconsider. A double tragedy is spending a lot of money and causing harm.

Younger Next Year

The book "Younger Next Year", by Chris Crowley and Henry S. (Harry) Lodge was recently recommended to me by a friend. He was a recently retired plastic surgeon, somewhat depressed and overweight. He said "this book is changing my life" which tends to get my attention! My wife bought the book and gave it to me that night and, over the next few days, I read it with great interest.

Harry's rules are:

1. Exercise six days a week for the rest of your life.
2. Do serious aerobic exercise four days a week for the rest of your life.
3. Do serious strength training, with weights, two days a week for the rest of your life.
4. Spend less than you make
5. Quit eating crap.
6. Care
7. Connect and commit

This book elaborates on these seven rules, which are a wonderfully simple approach to healthy aging. Although I am a fairly fit 58 year old, I can tell you I had some fine tuning to do after reading the book, and felt inspired to do it! Here is the tangible, near-term result of the book for me:

1. I am committing to trying some new things, such as a yoga class with my wife one or two days a week (I have been to three so far!)
2. Increasing my aerobic exercise duration to at least 45 minutes a day for at least 5 or 6 days a week.
3. Increasing the time and effort of my two times weekly weight workout.
4. Cutting out more fried foods from the diet.
5. Avoiding the temptation to have that third glass of wine at night.
6. Thinking concretely about connecting in my work and social interactions, rather than just going along for the ride.

I can enthusiastically recommend this approach to you if your life and your health is in a funk and needs a jump start. These guys are seasoned, realistic, optimistic and fun to relate to. They also have a web site http://www.youngernextyear.com.

Check it out. Comments always welcome.

Recent Heart Attack? - Take Your Clopidogrel!

Current guidelines recommend taking Plavix (clopidogrel) for 1 year following a heart attack. But what happens at the end of that period? A recent VA study suggests that there is a sort of "rebound period" at the end of clopidogrel therapy that might increase risk.

Specifically, among 3000 patients split between medical therapy and stenting, analysis showed a nearly twofold increase in risk for adverse events during the first 90 days after clopidogrel cessation. The theory is that platelets may become temporarily re-activated, leading to recurrent risk of thrombosis within the artery. The study has some limitations in that it involved a retrospective review of charts, but it does prompt certain steps to be taken by patient and physician:

First, be sure to complete your Plavix therapy for the full duration and then move seamlessly into aspirin therapy as directed. Second, if you have risks for recurrent arterial clogging, like multiple past stents, diabetes, or other uncontrolled risk factors, ask your doctor if extending Plavix therapy is reasonable. Better yet, control those risk factors as we discuss on the Blog!

What to Do When Valentine's Day Isn't So Sweet

Few Holidays seem to arouse as much emotion, as Valentine’s Day. For many, this very day can be downright depressing and dreadful. You have every right to send Cupid packing and find a way to actively cope. This does not mean that you have to ignore the Holiday, but rather not allow yourself to get caught-up in over-idealized romantic expectations that lead to disappointment and distress.

Here are Tips to Help:

Send the overvalued idea of Cupid packing.
Fire an arrow right through his cherub buttocks, if you have to. Consider how much this “loving” Holiday is based on little more than narcissistic commercialism and obligation that often leads even the most romantic toward disappointment. Go by any florist and you will see how much this Holiday costs. Notice too, that you will see mostly anxious men scampering in the shops. Isn’t that curious?


If you are single, whether you want to be or not, keep in mind that you are far from alone.
Don’t allow yourself to sit on a pity-pot and be caught off-guard this V-Day. Plan a social engagement (sorry) that involves people who simply care about you. Celebrate your whole life, not just because you have that one person to treasure, or who treasures you. Your life can be full, whether you are (or have) that “special” person or not.


Reach out to friends and family and avoid all of the V-Day hype.
For some, this means staying away from public areas, such as restaurants where there can be an over-abundance of partners lollygagging and portraying that perfect relationship. If you go out, take friends or family and celebrate life and independence. Avoid an indulgence that is guilt-prone, and be mindful to avoid excess of spirits or food. Sloth from overindulgence is Cupid’s breeding ground for guilt.

Don’t focus on thoughts of romantic loss, failures or idealism. Reframe, Refocus and Redeux this V-Day.
This is the holiday that can be loaded with self-punishment and guilt, so be cautious NOT to fuel the fire! Plan ahead; it’s OK to keep V-Day very low-key. Many feel an escalating obligation each year when it comes to V-Day. Break this dizzying cycle, and put Cupid in his rightful place. Don’t turn V-Day into Disaster-Day! Keep your expectations clear and avoid the merry-go-round of escalating expectations that creates nausea!


If you are partnered, do something out of the norm.
Haven’t we all seen enough of red roses and chocolate truffles? Do any of us really “need” any more chocolate candy? Hasn’t it all been said in a card before? This could be your year to do something novel, lively and even carefully daring. Real love is an action, not an obligatory habit at the end of flower stem, in a box of candy, or in a piece of jewelry.

If you, or someone you know has recently lost a partner for whatever reason, be sensitive to how this V-Day can impact them.
Do something helpful or meaningful for someone who might be feeling a recent loss. Your sensitivity and pro-action can be an experience that will not wilt, melt, add pounds or disappoint.

For the interestered, here are some Valentine's day statistics: http://www.census.gov/Press-Release/www/releases/archives/facts_for_features_special_editions/003147.html


Comments Always Welcome!

Women: Age Gracefully -- Protect Yourself from Stroke

Studies show that one-third of strokes in women occur early -- that is, before the age of 65. Indeed, in the age group 45-54, women are twice as likely as men to suffer a stroke. A recent study of 17,000 patients attempts to define predictive risk factors among such women. The information is simple, straighforward, and quite practical. Importantly, it provides a quick checklist of features to review and correct.

Specifically, strokes were more prelelant in women with a large waist circumference, known heart disease, or recent migraine headache with aura. Other risks for stroke include cigarette smoking, high blood pressure, high cholesterol and diabetes.

Overall, these risks are similar to those we've discussed on the Blog many times in reference to prevention of heart disease. Younger women, however, may feel somewhat protected. Studies like this one should serve as a wake up call of sorts. We're prone to regard stroke as a disease of prevention. Accordingly, if you have more than one of the risks listed and you are a gracefully aging female, ask your doctor what you can do to stay that way.

More On Patient Internet Searches

Since my last post on potential dangers of searching the internet, I've learned of some potential problems and biases in the CMPI study that was quoted. Suffice it to say that the data from this study needs to be more thoroughly analyzed before it is taken seriously. While some patients certainly can be subjected to information that misleads or harms, it is equally clear that others are well informed, discriminating and intelligent. Moreover, many patients use other patients to review and validate data and benefit greatly from this.

I still believe that patients and physicians teaming up both in the office and in review of health data on the internet, as well as interacting on line about this data is a great, possibly optimal, model.

But, if you are a patient who has learned to use the internet successfully, by all means, don't be dissuaded or alarmed by the conclusions of my last post. However, if you are a patient who has difficulty knowing what to believe from web searches and you don't have a good support group to help you validate this information, interaction with a physician is a great way to get started sorting out what to do.

Your comments are always appreciated.

Searching the Internet on your own can Cause Serious Problems

The US Center for Medicine in the Public Interest (CMPI) recently released a report documenting that patients who search the internet on their own, looking for answers to health questions can make medical decisions that are potentially dangerous to their health. They note in their report that some patients have replaced their trusted physician with "google" or other search engines, but note that the medical information they find there always appears to be authoritative and accurate, but often isn't. They note examples of lawyers posing as medical experts, plaintiff firms searching for people willing to testify in lawsuits, and many groups or individuals selling alternative medical products of various sorts.

The authors further note that 65% of the first three pages of search results came from sites that were biased or contained unverified information. Nearly half of the first three pages of search results belonged to lawyers and attorney referral services seeking plaintiffs for class action law suits. Finally, they noted that no official regulatory pages or professional medical organizations appeared in the inventory of results.They note that persons who use the internet to obtain health information will find little that is reliable upon which they can depend and, worse, can get confusing, contradictory or dangerous advice or suggestions.

We have frequently noted on this site that we believe that the best model (other than working directly with your own personal physician) is to have a trusted physician who can either refer internet based information to you that relates to your particular issue, or send a site that you have found to a physician to review and verify its validity.At eDoc, the physicians almost always search the net and attach one or more relevant web sites to expand or illustrate our answers and comments. This provides patients with the best of both worlds: direct interaction with a trusted physician AND reliable, verified information from the vast resources of the internet.

Have you had frustrating experiences conducting your own searches? If so, I'd like to hear from you!