Today is Friday
May 16, 2008
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The great supplement debate |
| | Posted on Thursday, January 03, 2008 | | | By Wendy J. Meyeroff
THE ERICKSON TRIBUNE
Although the majority (70%) of adults age 50-plus have been taking vitamin, mineral, or herbal supplements for years, now there are companies and doctors touting special vitamins if you’re on various prescription drugs. Do you need any supplements—let alone special ones—if you take medication? There’s great debate, with supporters on both sides.
Fight loss of bone density
Although he isn’t a great supporter of supplements in general, Mark Holden, M.D., does recommend one nutritional add-on for older adults: a combination of calcium and vitamin D for fighting osteoporosis (loss of bone density), which increases as people reach age 65 and older. There’s an added emphasis on vitamin D’s role in bone strengthening. The dose recommended for people over age 65 has risen over the last few years from 600 international units (I.U.) to 800 I.U.
“Taking a calcium-vitamin D supplement is important if someone is already taking a drug like Fosamax for fighting osteoporosis,” says Holden, Erickson Health physician at Eagle’s Trace, a retirement community in Texas built and managed by Erickson. “If your doctor has prescribed a drug like Fosamax, it’s usually because tests have already shown you have reduced bone density.”
Holden notes that when it comes to vitamin D intake, some adults even need 1,000 I.U. but also notes one exception: “There’s a form of Fosamax called Fosamax Plus D that contains vitamin D. If you’re taking Fosamax Plus D, check with your doctor about any additional D supplementation.”
Watching cholesterol-fighting drugs
Today the medicines most frequently used to lower cholesterol are those known as statins (familiar brand names include Lipitor and Zocor). Since statin drugs are commonly taken by older adults, there are questions as to whether these people need special supplementation. One of the major supplement debates focuses on the pros and cons of statin users needing more of an enzyme called CoQ10. | |
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“It’s a very important enzyme for energy, particularly to protect against muscle strain in the heart,” says Hyla Cass, M.D., a physician practicing in California, and author of Supplement Your Prescription, who has become a strong proponent of nutritional supplementation. Because another enzyme, one that makes cholesterol, also produces CoQ10, “a lack of CoQ10 may play a role in muscle weakness related to taking statins,” says William Russell, M.D., vice president and regional medical director for Erickson Health. “The jury’s still out as to whether taking CoQ10 supplements will prevent muscle weakness caused by statins,” he says.
CoQ10: Supplement needed?
Some experts doubt that CoQ10 is readily absorbed from a supplement, but Cass disagrees. She points out that if a nutrient knows how to get where it’s needed from food, why not from a supplement? Russell is extremely dubious of such claims.
Some products claim to contain the right amount of CoQ10 (and other nutrients) for statin users. One contains 100 mg of CoQ10. But do you really need that much— if any? That’s where the debate comes in.
Richard Harkness, Pharm., CDM, newspaper columnist and natural medicines specialist (author of Mosby’s Handbook of Drug-Herb and Drug- Supplement Interactions ), suggests physicians might wish to try CoQ10 in patients who think it might help prevent statin-related muscle problems, particularly those with compromised heart function.
“There is evidence that people on statins do better with an additional amount of CoQ10. I’d look for a product containing 50 mg,” says Daniel Fabricant, Ph.D., vice president of scientific and regulatory affairs for the Natural Products Association.
Do you need a B-12 supplement?
“Vitamin B-12 is tied directly to your metabolism; if you’re feeling sluggish you may need B-12,” Fabricant says, but Russell adds a caveat: “Fatigue, along with anemia, dementia, and thyroid problems, are among the reasons a doctor might consider doing a work-up of someone’s B-12 levels. However, B-12 deficiency is rarely the cause of these problems,” he emphasizes.
One area everyone agreed on is that proton pump inhibitors (PPIs)—acid blockers like Nexium and Prilosec—can indeed be a cause of B-12 depletion. “B-12 requires an acid environment to work, so if you’re blocking acid production with certain medicines, there’s concern you may be depleting B-12,” Holden says. But he adds, “B-12 is watersoluble, so past a certain point you’re essentially flushing any extra down the toilet.”
So when—if ever—do you need a B-12 supplement? “A true B-12 deficiency can be devastating to an older adult and of course needs to be treated,” Russell says. He adds, “If your B-12 work-up has shown you’re not absorbing B-12, you will need a supplement, either an injection or a high-dose oral form. If you are absorbing B-12, you probably don’t need much from a supplement.”
Harkness adds this advice. He says even if they’re not taking an acid blocker, people over 50 may not produce enough acid for proper B-12 absorption from food. He recommends at least 25 mcg of supplemental B-12 for older adults. “You won’t find that dose in a general multi-vitamin; look for one specifically designed for seniors,” he says.
Working with your doctor
You need to be straight with your doctor about what nutritional changes you have made through supplements. Otherwise you’re skewing the information on which your doctor’s prescriptions are based.
Do specific medications require taking special nutritional supplements? There’s little evidence right now. The 80-year-old on multiple medications might need nutritional help. Should that help come through supplements or prescription changes? Or do you need companionship to help you eat better? The answer is still unclear. For now, it’s a decision probably best made by you and your doctor discussing your specific needs.
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