Vitamins, minerals & supplements Archive

Peer into your pillbox: It may be time to streamline your drug regimen.

Medication regimens often start simply, perhaps with a multivitamin and a single prescription drug to treat a chronic condition. But with age and more health problems, a regimen may grow to include additional prescription drugs and dietary supplements (such as vitamin D and calcium), plus over-the-counter medicines to reduce symptoms such as pain or heartburn. In time, you can find yourself facing a crowded pillbox and a complicated regimen.

"Among people age 62 to about 85, a third will take five medications per person. In the higher-risk population that I take care of, those people average 15 medications per person. And some of the dialysis patients take about 20 prescriptions," says Joanne Doyle Petrongolo, a pharmacist at Harvard-affiliated Massachusetts General Hospital.

News briefs

If you'd like to try a vegan diet but can't imagine nixing all animal products, consider two recent findings. One, published online July 22, 2020, by The BMJ, comes from researchers at Harvard and Tehran University. They analyzed 32 studies about protein intake that included more than 715,000 people, with follow-up periods ranging from three-and-a-half years to over three decades. Combining data from multiple studies, the researchers calculated that getting 3% more of total calories in the form of plant protein (like beans, nuts, and whole grains) lowered people's risk for premature death by 5%. Another study, published online July 13, 2020, by JAMA Internal Medicine, looked at the survival rates of more than 416,000 people who'd reported their diet and lifestyle information 16 years earlier (when they were 50 to 71 years old). In this study, shifting just 3% of calorie intake from animal protein (meat, poultry, fish, or dairy products) to plant protein corresponded with a 10% decrease in death from any cause over that period, for both men and women. In particular, replacing eggs and red meat with plant proteins appeared to reduce death risk by as much as 24% in men and 21% in women — especially in people with high intake of eggs and red meat. The new findings don't prove that favoring plant-based proteins will add years to your life, but many other studies have associated high intakes of red and processed meats with shorter life span.

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In the journals

Hold off on taking pain pills to treat a sprained ankle, strained neck, or bruised knee. A new guideline from the American College of Physicians and the American Academy of Family Physicians recommends certain topical (gels, liquids or patches placed on the skin) painkillers as the first line of defense for musculoskeletal injuries in areas other than the lower back. The new guideline, published online Aug. 17, 2020, by Annals of Internal Medicine, was based on a review of more than 200 studies including a total of 33,000 patients with short-term injuries (pain lasting less than four weeks). It recommends using a topical nonsteroidal anti-inflammatory drug (NSAID) with or without menthol (which creates a cooling sensation). Topical NSAIDs come in gel, liquid, or patch forms; diclofenac gel (Voltaren Arthritis Pain) and aspirin cream are available without a prescription. Topical NSAIDs may have fewer risks than oral NSAIDs, which raise risk for stomach ulcers and bleeding, high blood pressure, kidney damage, and heart attacks. However, if topicals don't work, the guideline says you can move to oral NSAIDs such as ibuprofen (Advil, Motrin) or the non-NSAID painkiller acetaminophen (Tylenol); acupressure; or transcutaneous electrical nerve stimulation. The guideline recommends against using opioids such as tramadol (Ultram) except in severe cases.

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Growing evidence shows that intermittent fasting leads to significant weight loss. A recent study contradicted these findings, but the way this study was designed and implemented raises some questions about its conclusions.

Calcium is billed as the bone-building nutrient. But some experts argue that we should pay more attention to exercise and vitamin D.

Starting on your 51st birthday, current government guidelines say you're supposed to consume 1,200 milligrams (mg) of calcium daily. With advancing years, both men and women begin to experience a decline in the density of bones that makes them weaker and more likely to break. In essence, your bone becomes more porous, and calcium supposedly fills in the holes.

But the amount of calcium adults need continues to be debated. The critics say there's little evidence that high intake has more than a marginal effect on bone density and fracture prevention. They say exercise and reversing vitamin D deficiency are not promoted enough and are more important for bone health. Professor Walter Willett, chair of the nutrition department at the Harvard School of Public Health, is one of the leading lights in the critical camp.

Rates continue to rise, but there are ways to protect yourself and even reverse the effects of this dangerous disorder.

Your liver is your largest internal organ and your body's workhorse. Among its many jobs are converting food into fuel, processing fat from your blood, clearing harmful toxins, and making proteins that help your blood clot. Yet this hard-working, supersized organ is susceptible to a dangerous and often hard-to-diagnose condition called nonalcoholic fatty liver disease, or NAFLD.

NAFLD is defined as the presence of fat in more than 5% of liver cells. It is the most common liver disease and affects up to 25% of American adults, 60% of whom are men.

Overall risk is very small, and older women who used hormonal contraceptives many years ago aren't likely to have a higher risk.

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Hormonal birth control — whether it comes as pills, injections, a ring, an intrauterine device (IUD), or an implant — may raise your risk of breast cancer, according to a study published Dec. 7, 2017, in The New England Journal of Medicine.

If you're like many women who currently use one of these contraceptive methods, or if you used one for years in the past, should you be worried?

On call

Q. My feet tingle or feel numb like they are asleep at times, mostly when I am in bed or with my legs elevated. What causes that?

A. The symptoms you describe may be related to peripheral neuropathy, which is nerve damage that affects multiple nerves leading out from the spinal cord to the arms and legs. Symptoms are often equal in both feet. If only one foot, or part of a foot, is affected, this suggests compression of an individual nerve.