January 18, 2018
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Vitamins, Food Supplements and More

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As a 69-year-old with macular degeneration in one eye, I am uncomfortable taking high doses of “eye vitamins” as suggested by my ophthalmologist. (Of course, Bausch & Lomb wants us to pop these pills.) I am interested in your take on vitamins, food supplements with hidden sugars, etc., especially related to the elderly. Thanks. Questioning

Dear Questioning:

I place vitamins, food supplements, and other dietary aides in the category of biologically-based complementary medicine. I label it complementary or alternative because these practices do not adhere in many respects to the principles and teachings of traditional Western medicine.

Even so, complementary and alternative medicine and nontraditional health care practices is all the rage in this country. It is not surprising. Many people are looking for alternatives to potent drugs that can interact dangerously with each other and have many severe side effects. And, why not. It has been argued that we are an over-medicated society given prescription drug use, misuse, and abuse are at all-time highs. And it is predicted that prescription drug abuse among older adults will be increasing rapidly as baby boomers, by the tens of millions, continue to celebrate their 65th birthdays over the next 15 years. The fact is, aging boomers are known to have higher substance use levels than prior generations of older adults.

I have heard too many horror stories, for example, of older adults prescribed benzodiazopines (meant for short term use) for anxiety and trouble sleeping only to discover after years of use that they can’t stop taking them even if they wanted to because of the severe physical and psychological consequences that accompany withdrawal. Plus, older adults are at increased risk of adverse effects in both the long term and short term when taking benzos (especially in combination with other drugs) including what has been argued to be an increased risk of dementia.

On the matter of dietary supplements – including herbs, minerals, vitamins, enzymes, and amino acids – evidence strongly suggests they can enhance physical and mental functioning in later life when the right ones are taken in the correct dosage. Recommended vitamin supplements for persons over 50 include vitamin B12, and for people over 60, vitamins C and D as well as calcium if you don’t drink milk daily. Because there are limits to how much of a vitamin supplement your body can absorb, more is not necessarily better. For example, too much vitamin A can adversely affect bone health. Consider also fish oil and Omega-3s, the most commonly used natural products in the U.S. Even though some physicians are skeptical about the advantage of take fish oil supplements – our bodies cannot make omega-3s and omega-6s. And, there is some evidence that omega-3s can decrease inflammation and joint pain and positively impact autoimmune and mood-related issues.

By the way, diet and nutrition can help protect aging eyes. Dietary guidelines suggest that healthy fats (omega-3s), eating whole grain and low sugar cereals, avoiding saturated fats from red meats and dairy products, avoiding too much salt, and keeping your body hydrated improves your chance of healthy vision as you grow older.

The bottom line, of course, is to be an educated and smart consumer – keep a list of all your complementary and alternative therapies and make sure to inform your primary care physician and pharmacist what vitamins and supplements you are taking.

So, I believe that complementary, alternative, and holistic medicine practices can be great additions to your overall practice of good health. While Western medicine can treat most ailments, the healing approaches based in other traditions and schools of thought are worthy of consideration including those that are part of some of the world’s oldest health systems – China (acupuncture, reflexology, and qigong), Japan (energy medicine), India (Ayurvedic medicine), and Germany (homeopathy). The words of Henry David Thoreau are instructive: “A man may esteem himself happy when that which is his food is also his medicine.” All this talk has me famished – and the multivitamin/multimineral supplement, calcium, vitamin D, and probiotic I take every day has done nothing to satisfy my hunger. I think I’ll grab some antioxidant rich foods – dried small red beans, wild or cultivated blueberries, red kidney beans, and pinto beans (all high on the USDA’s top 20 list of foods that pack a punch). Now that is food for thought!

Want to know more about complementary and alternative medicine? Check out the National Center for Complementary and Alternative Medicine (NCCAM) at www.nccam.nih.gov and the American Holistic Medical Association (AHMA) at www.holisticmedicine.org.

Be well. Len

Dear Questioning:

I agree with what Len has said, but as a physician, I have a slightly different perspective to share. Yes, we are over-reliant on medications for chronic conditions that are preventable or may improve with other approaches. I actually believe most healthcare providers make an effort to discuss alternatives (or adjunctive) measures to prescribed medications. Conversations about diet, exercise, stress reduction, meditation, sleep hygiene and supplements are commonplace, even if time-constraints limit the discussion. And the evidence supporting the benefits of non-drug treatment for many conditions is growing. For example, the benefits of antioxidants and omega-3s for joint, heart, eye and brain diseases are supported by placebo-controlled trials, although the magnitude of effects may be modest. But the same may be said for some of our prescribed medications for chronic conditions. And the benefits of exercise, diet, meditation, cognitive-behavioral therapy and physical interventions (chiropractic, osteopathic manipulation, physical therapy, yoga, massage) can be dramatic.

All that said, we have to maintain skepticism about claims of “miraculous cures”. For example, coconut oil is currently popular as a preventive and therapeutic measure for Alzheimer’s disease. There is a scientific basis for this enthusiasm, but cognitive decline in old age is a complicated process and scrutiny of therapies in placebo controlled trials rarely shows benefit from such therapies. There are exceptions. Vitamin E supplementation has been shown in two studies to slow functional decline in persons with Alzheimer’s disease. And evidence is strong that exercise and cognitive activities slow cognitive decline in healthy older adults. Periodic, brief fasting may delay some age-related health conditions. In my own research career, I’ve been involved in studies proving bright light exposure can help people with winter depression and melatonin supplements can help some people with sleep disorders.

Overall, a balanced approach is best. Use of prescribed medications for diagnosed conditions in conjunction with exercise, meditation, sleep, modest calorie restriction (20-30%) in a well-balanced plant-based diet, social interactions and play are the tickets to health. But for certain conditions, including macular degeneration, high doses of antioxidants and anti-inflammatory supplements as in your “Ocuvite” vitamins, can be helpful at slowing progression of degenerative diseases.

Thanks for asking! Cliff