Supplements & Vitamins


When you either come to our office or have a home visit, we ask that you have all medications, over-the-counter (OTC) drugs and remedies, sleep aides, pain killers, supplements and vitamins present.
NO LISTs. BRING THE BOTTLES. Many memory problems are caused or exacerbated by OTC remedies which have little oversight by the Food and Drug Administration (FDA) unlike food or prescription medications.

Many OTC supplements are toxic, have additives and/or are contaminated by heavy metals. Most are made in China are a big cause of death for adolescents in America's ERs. Dr. Elovitz is fond of saying in his 25+ years of working in geropsychiatric inpatient units the most common tongue-in-cheek expression among the doctors and nurses, is
Thank you Tylenol PM for keeping us in business.

A
2015 JAMA review finds an estimated 23,000 ER visits in the US are likely due to dietary supplements. Typically these are heart-related issues due to weight loss and energy products in young people. In older people it was mostly "micronutrients" (vitamins and minerals) caused problems taking seniors to the ER, but herbal and complementary nutritional products are also big contributors.

It May Surprise you to Know
that over-the-counter supplements, vitamin and mineral products are
not regulated by the Food and Drug Administration (FDA) in any substantial way. OTC makers do not have to prove that their products are safe before marketing them, like pharmaceutical companies do. Companies need only notify the FDS before marketing a product and provide a rationale for why they "think" the ingredients are safe, like reporting they've been used before by others in years past. But, who knows if they have caused harm, as almost none of the 90,000 supplements on the market are ever tested in any way.

OTC products are the only product sold in America that do NOT have to indicate where they are made and come from. This is largely due to Senator Orin Hatch's decades of work (it is estimated that about 30% of supplement manufacturers are owned by the Mormons) to prevent any oversight, and he has even been successful in making it illegal for the FDA to directly attempt to regulate a supplement for dangerousness.

A recent large study done by several states Attorneys General found the advertised supplement (e.g., Gingo Biloba) in only 20% of the OTC drugs they bought in many OTC purveyors like GNC, Walmart and the Vitamin Shop. Consumer Reports (CR) has long studied this and advocated for oversight by the FDA to be able to remove harmful supplements from stores.

Pieter Cohen, MD at the Harvard Medical School is an expert on supplements and he states "because of the way they're regulated, you often have no idea what you're actually ingesting." Read this
story about how a fungus tainted probiotic (ABC Dophilus Powder) caused the death of a premature infant at Yale-New Haven Hospital. Doctors there assumed the stuff was safe, and it isn't. As Consumer Reports (CR) says:

Consumers are buying those products in droves. According to the Nutrition Business Journal, supplement sales have increased by 81 percent in the past decade. The uptick is easy to understand: Supplements are easier to get than prescription drugs, and they carry the aura of being more natural and thus safer. Their labels often promise to address health issues for which there are few easy solutions. Want a smaller waistline? There’s garcinia cambogia for that. Bigger muscles? Try creatine. Better sex? Yohimbe. How about giving your brain a boost? Omega-3 fatty acids. Or your energy level? Ginseng. – Consumer Reports, Supplements Can Make You Sick, July 27, 2016.
Two large studies have shown Ginko Biloba to have no value in improving or maintaining cognitive health, and as it thins the blood it can prove dangerous to those taking blood thinners.

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Labels
Companies are forbidding from making claims about a product's ability to prevent or treat disease. That's why the makers of Prevagen are being sued for millions in federal court, but not by the FDA. The suit was brought by the FTC's Bureau of Consumer Protection for lying on TV. To better understand the gibberish on supplement labels, read What Supplement Labels Mean, and Don't by CR.

Seals of Approval

Seals by ConsumerLab.com, NSF International, U.L. and U.S. Pharmacopeia noting the product has been verified, certified or approved may be helpful, but they are nothing like FDA approval for a drug. These seals do not guarantee the safety or effectiveness of the product, but they to attest to lack of contamination by arsenic, bacteria, lead, etc. based on sample testing. CR notes that very few supplements have even gone through this minimal testing; e.g., out of 90,000 dietary products USP has only been asked to verify 139 as of July 2016.
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Liver Damage
An NIH funded study found liver injuries due to OTC dietary supplement-caused liver injury increased from 7% in 2004 to 20% in 2014. CR has reported that bodybuilding and weight-loss supplements seem to cause the biggest risk, and these are prevalent among teenagers and young adults. But other products typically used by seniors are dangerous; green tea extract may account for 10% of all acute liver failure cases. Here's a short CR video on 15 Common Supplements to Avoid.

Who Really Needs Supplements?
Your doctor knows if you need vitamins or supplements based on routine lab results and your symptoms. Your pharmacist knows which products are likely to be safest. There are really only a few conditions that need and benefit from supplements for people eating a balanced diet, according to CR. For seniors:

• If you rarely get out in the sun: 800 IU of vitamin D3. Sources include eggs, fortified milk, soy beverages, mushrooms and salmon. 10 min. of sunshine on bare skin a day would also produce enough D.
• If you are strictly vegan (no meat, fish, eggs or dairy) consider: a daily B12 supplement.
• Osteoporosis: ≥ 800 IU of vitamin D3 + 1000-1200 mg of calcium from foods like dairy and green leafy vegetables. Weight bearing aerobic activities also appears to slow bone loss.
• Age-related macular degeneration: An AREDS blend of vitamin C & E + copper, lutein, zeaxanthin & zinc daily.
• GI disorders (IBS, celiac disease) or cancer or HIV/AIDS: discuss nutritional supplements with your doctor.


Note that, above, calcium should be obtained from food not supplements. However, it makes sense to take additional vitamin D which you need in order to metabolize calcium from food. It also seems to help prevent falls (maybe due to reducing muscle weakness). While taking calcium pill daily can increase bone density in people over 50 by 1 to 2 percent–that is not enough to prevent fractures according to a review of 59 randomized trials reviewed in the British Medical Journal in 2015. The authors conclude that taking calcium is not worth the risk of increased heart disease, kidney stones and GI problems.

In our testing feedback with patients we discuss anecdotal evidence suggesting omega-3 fatty acid may be beneficial in reducing risk and possibly progression of dementia. Real benefits would require eating oily fish throughout life. Decades ago there was little dementia in Japan, where people outlive us by five years or so! However, dementia increases may be related to the gradual westernization of diet, reducing fish products. The idea is to compensate for not having eaten fish daily for decades by ingesting high quantities of omega 3 fatty acid via Krill oil pills (about 1200-1500 mg twice daily). This is just theory, but the potential benefit seems to outweigh any risk. Krill oil is made via a Norwegian process and never gets to China, so most is pure but expensive. Still you can get it on Amazon, BJ's, Costco, Walmart, etc. As for whether you memory will improve, 2012 data based on over 3,500 people over 60 who took fish oil for six to 40 months did not improve on measures of cognitive function. For any benefit in reducing risk of dementia, it should be started as early as possible and considered a preventive strategy rather then an effort at treatment.

We also advise flavonoids, which are antioxidant vitamins like those in red wine that seem to keep the French living forever, despite cholesterol-rich diets and low levels of exercise. We suggest getting it from pure cocoa-based chocolate. Sugar should not be among the top ingredients, only cocoa and avoid any processed with alkali (to cut the acidic taste of pure cocoa). Your best bet is to buy it from Trader Joes and use at least 8 gm daily (one square from their standard size bar), and buy the darkest chocolate you can enjoy.

Here's an interesting article about how easy it is to make and sell your own supplement on the internet or anywhere:
We Made this Weight-loss Supplement. It also shows just how dangerous this can be. Finally, if you still want to use supplements, watch this FRONTLINE investigative report: Supplements and Safety.

Here's an interesting article about Alex Jone's
Infowars Supplements. He sells many millions of dollars of this stuff on his website.
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For example he markets Super Male Vitality and Super Female Vitality liquid supplements that sell for $69.95 and $59.95, respectively. The good news is that independent testing shows them likely to have no harmful substances. The bad news is their ingredients (mostly bark, fruit, leaf/stem and root extracts) probably do nothing for you. In any case the amounts of the ingredients are too small to have any effective benefit according to independent lab test results.

The best way to reduce risk and progression of dementia is through aerobic (cardiovascular) exercise ideally 30 min to 1 hour per day, at least five days per week. To do it regularly join a health club and enlist the help of a coach to set up a safe routine–cost of a monthly health club membership is about the same as buying Prevagen.

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