Drugs and Supplements
Dietary supplements are big business, even though few of the 85,000 products on the market have proven benefits. An article in JAMA Internal Medicine highlights a bizarre case of supplement overuse: a man, worried about memory loss, was spending nearly $3,000 a month on more than 50 supplements recommended by his “anti-aging” physician, plus hundreds of dollars more on other products he chose himself. Most of the products had no proven benefit on memory, and some may have contributed to the memory loss he was so worried about. had possible negative effects on brain function. People often assume that dietary supplements are effective, because of the claims they make, and are harmless, because they are “natural.” Not so. Unlike pharmaceuticals, which undergo extensive testing to prove they’re effective and safe before they can be sold, dietary supplements can be sold with without proof of effectiveness, safety, or purity.
For women with osteoporosis who are embarking on a “holiday” from taking a bone-building drug, the message from a study released today is “Bon voyage—see you in two years or so.” After menopause, loss of bone (osteoporosis) can lead to crippling fractures of the hip and spine. Drugs called bisphosphonates—alendronate (Fosamax) was the first on the market in the mid-1990s—slow bone loss. But after taking these drugs for a number of years, the balance can begin to tip from help to harm. A new report from the Fracture Intervention Trial Long-term Extension (FLEX) shows that measuring bone density after one year added no information that would have helped doctors identify who was at risk and perhaps should start taking a bisphosphonate again. Waiting two years is a good option for most women.
If you are a baby boomer, the U.S. Centers for Disease Control and Prevention (CDC) recommends that you be tested for infection with the hepatitis C virus. The virus can live in the liver for decades, often causing silent damage that leads to liver failure or liver cancer. But wide-scale testing has proved to be a hard sell. One reason is that treatments to eliminate HCV infection have required weekly injections of one drug and oral doses of others. Treatment could take up to a year. Typical side effects of the injected drug required to clear the virus, called peginterferon, include depression, anxiety, irritability, anemia, and fatigue. Two drug studies published today in The New England Journal of Medicine mark the latest advance in making treatment for HCV easier and more effective. Researchers report that combining several oral antivirals—drugs taken in pill form, not as injections—clear the virus from the liver in more than 95% of people in just 12 weeks. One big obstacle is cost—oral therapy tops $80,000.
For the past few years, vitamin D has been gaining a reputation—not entirely earned—as a wonder vitamin that offers protection against some cancers, bone-weakening osteoporosis, heart attack, Alzheimer’s disease, and other chronic conditions. Not so fast, caution two reports in the journal BMJ. One concluded that “highly convincing evidence of a clear role of vitamin D does not exist for any outcome.” The other showed a link between low blood levels of vitamin D and increased risks of dying prematurely from cardiovascular disease, cancer, and other causes. But it isn’t clear if low vitamin D causes chronic conditions, or whether chronic conditions cause low vitamin D levels. To play it safe, get the amount of vitamin D recommended by the Institute of Medicine: 600 IU of vitamin D a day for everyone ages 1 to 70 and 800 IU for those 71 and older. Eating foods rich in vitamin D or getting a few minutes of sunshine a day can do the trick.
Taking supplements of selenium or vitamin E, once thought to prevent prostate cancer, seems to do just the opposite. A new report shows that men who take vitamin E or selenium are at higher risk for developing prostate cancer. Bottom line: men shouldn’t take selenium or vitamin E as a way to prevent prostate cancer, or anything else for that matter.
Mass marketing of testosterone therapy may have men eager to try this seemingly simple fix. But the latest science should have them scratching their heads and putting away the credit card—at least for now. A new study published in the online journal PLOS One shows an increase in the risk of having a heart attack in the months after starting testosterone therapy. The potential for danger was highest in older men. A report in the November 6, 2013, issue of JAMA showed that men who used testosterone therapy didn’t fare as well after artery-opening angioplasty as men who didn’t take testosterone. Neither was the type of study that can prove cause and effect. They can only show associations, or links. That means there’s no smoking gun here that testosterone therapy is harmful. But the studies do suggest caution. Given the uncertainly over the benefits and risks of testosterone therapy, what’s a man to do? Take a cautious approach, advises the Harvard Men’s Health Watch.
Stroll the aisles of any pharmacy or “health food” store and you’ll see a multitude of herbs and other supplements that claim to boost energy. Yet there is little or no scientific evidence to support such claims for most of these substances. The fact is, the only thing that’ll reliably boost your energy is caffeine or other stimulant—and their effects wear off within hours. Substances commonly touted as energy boosters include chromium picolinate, coenzyme Q10, creatine, dehydroepiandrosterone (DHEA), ephedra, ginkgo biloba, ginseng, guarana, and vitamin B12. Instead of relying on a supplement for energy, try switching to a healthful diet—more vegetables, fruits, whole grains, nuts, lean protein, and unsaturated fats—and exercising more. That’s truly a better way to beat an energy shortage, and it’s one your whole body will appreciate.
Aspirin has many uses, from easing a headache or cooling a fever to preventing heart attacks and the most common kind of stroke. It may be time to add “preventing colorectal cancer” to the list. New results from the Women’s Health Study, a clinical trial that evaluated the benefits and risks of low-dose aspirin and vitamin E among nearly 40,000 women, show that aspirin reduces the risk of developing colorectal cancer by 20%. The effect isn’t immediate, but instead takes ten to 20 years to be seen. Aspirin isn’t without its drawbacks, including gastrointestinal bleeding and ulcer formation. Both occurred slightly more often among women taking aspirin. Although the Women’s Health Study results sound promising, don’t go reaching for the aspirin bottle just yet. Taking aspirin—and any other drug—is really a balancing act between benefits and risks.
News out of Seattle is sure to fuel confusion about fish oil supplements. A study by scientists at the Fred Hutchinson Cancer Research Center in Seattle linked eating a lot of oily fish or taking potent fish oil supplements to a 43% increased risk for prostate cancer overall, and a 71% increased risk for aggressive prostate cancer. Fish oil loaded with omega-3 fatty acids, which play important roles in health. Deficiencies in them have been linked to a variety of health problems, including cardiovascular disease, some cancers, mood disorders, arthritis, and more. But that doesn’t mean taking high doses translates to better health and disease prevention. Despite this one study, you should still consider eating fish and other seafood as a healthy strategy. Twice a week is a good goal.
An old, aspirin-like drug called salsalate could help control blood sugar in people with type 2 diabetes. In the TINSAL-T2D trial, 286 volunteers took pills containing either salsalate or a placebo for nearly a year. Over the course of the trial, those in the salsalate group had lower blood sugar levels, and some were even able to reduce dosages of other diabetes medications they were taking. Experts aren’t exactly sure how salsalate helps control blood sugar, but its effectiveness supports the idea that inflammation plays a role in type 2 diabetes. Although the results are promising, what we really need to know about salsalate (or any new or repurposed drug) is how its long-term benefits and risks stack up against each other. The trial was too small and too short to determine those risks. According to the researchers, such “outcomes require continued evaluation before salsalate can be recommended for widespread use” by people with type 2 diabetes.