Friday, July 10, 2015

Supplements ... my thoughts and advice

No doubt about it, dietary supplements are big news, and big business.  You’ll hear about various supplements when you are at the gym, around the coffee pot at work, in various columns in the newspaper, and in endless commercials and advertisements.  They are touted as providing near infinite benefits with no risk nor side effects by celebrity pitchmen, and come in a dazzling array of products and forms.  Where did they come from, and are any of them worth the money, sometimes a lot of money, that they cost?

I’m old enough to have been practicing before many of the most popular current prescription pharmaceuticals were developed, and in those days various supplements were often used as a form of treatment.  While I don’t feel that they are nominally potent enough to deal with severe or significant issues, they are typically accepted by patients who fear medications.   Using such products which have been found to be safe, they may, in fact,  provide benefits to a number of patients.  Whether those benefits are based on pharmacologic effectiveness or acceptance and internalization of anecdotal reports of the products’ effects, such benefits can be useful for many in need.  Having a patient acknowledge that there is an issue to be treated, even treated with a supplement, may act as a stepping stone to further therapy if desired goals are not reached.

The most effective supplement I use would have to be Vitamin D, which really is a critical nutrient which is deficient in a significant number of people.  Adding either over the counter or prescription doses of Vitamin D clearly benefits these patients.  Although bone density is a clear marker used with Vitamin D, there are many studies which have suggested much more widespread effects of the vitamin.

In addition, I am likely to look favorably to the use of Glucosamine/Chondroitin products in patients looking to help with knee pain, and have pointed out to those expecting more global relief that there is a some evidence to support such use.  Unfortunately, there is also a growing body of work that points to flaws in former proofs. In addition, studies highlighted in some consumer magazines have pointed out that many preparations of Glucosamine/Chondroitin do not contain the amount of active product advertised on the label.  This may be true for other products, as well, and a word to the wise should be taken under advisement.

And then there’s melatonin.  Although some years ago, there were concerns about trace contaminants in some formulations, this no longer appears to be the case, and melatonin for the most part appears to be a safe product that can be useful for sleep disorders.  It has been used both to induce sleep, as well as to help reset sleep after travel, helping with jet lag.  A businessman patient of mine related to me that he was able to use melatonin with his cross-country flights to lessen the jet lag of the flight, allowing him to be more productive at work.  

If you are looking at supplements, fish oil always seems to bubble up to the surface.  Widely used in years past for a variety of ailments, the product has come under fire lately, with real questions raised as to whether or not the supplement form of fish oil, in capsule, tablet or liquid form, can improve one’s health.  There are studies, though, that say that fish oil that is still in the fish -- eating fish three times a week -- is clearly a healthy thing to do.  Certainly, constraints on types of fish with regards to mercury or other concerns, within reason, may come into play; but it is likely healthier to eat fish than take the processed oil contained in a capsule.  After all, there are many more nutrients in fish than just that oil.

Further, many supplements in popular use, such as Creatine, Vitamin C, mixes of B vitamins, general use of multiple vitamins, caffeine or ginko infused products, or those multi-element mixes often marketed for muscle building or weight loss do not hold any place in my medicine cabinet.  While there are many spokesmen pushing these products, including high profile television doctors, there is no convincing evidence that they offer any positive effect and may, in some cases, do quite the opposite.

Yes, there are micronutrients, also called phytonutrients, in plants, and they are good for you.  But rather than taking a supplement with several hundred of them, better to eat the fruit or vegetable which has them all, numbering in the scores of thousands.  Besides, it’s less expensive and tastes better!

Please understand that these are my beliefs and opinions, and others are free to differ with me, and probably do.  As always, consult your physician or healthcare professional before starting or stopping any medication or supplement, and understand that we are all unique, and what is good for one person may not help another.  Ask questions, look at the evidence, and act in the best interest of your health.

© 2015 - Marc I. Leavey, M.D. - Baltimore, MD - All Rights Reserved

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