Supplements - What are they good for?

Supplements are a multi-billion-dollar business. Pushed by TikTok influencers and TV personalities, they cover everything from vitamins and minerals to a variety of gummies, powders and pills.

Supplements are not regulated the way pharmaceutical drugs are, meaning the FDA does not assess them for efficacy or safety before they are marketed. Only if serious side effects show up does the FDA get involved.

An important consequence of this lack of regulation is that many of these products do not contain what they claim to contain, and there have been many reports of seriously tainted products. A popular protein powder was found to contain lead.

While touted to solve all human ills, no supplement has been found in a scientific trial to prolong life. Resveratrol was all the rage until trials showed no benefit.

Many of the products pushed on-line or on-TV are expensive. I know of people spending hundreds of dollars monthly on supplements, most of which were useless.

Are there any that you should consider taking?

A standard multi-vitamin is safe and inexpensive. There is evidence that it has a modest effect on reducing dementia. The B12 and D included in multivitamins can make up for the reduced B12 absorption that is common is older adults and the lack of sunshine-produced Vitamin D that is common in winter.

Omega-3 is healthy for the circulatory system. The best way to get this is by eating fatty fish 2-3 times a week. If you don’t eat fish, an omega-3 capsule may be useful.

Even safe and useful products can be harmful in large doses. Vitamin D in excess causes elevated serum calcium, which in turn can cause nausea, constipation, kidney stones and bone pain. While 1 multivitamin daily may be good, 5 or 10 are likely to be bad.

When you see a product pushed by a celebrity or “influencer,” remember that they are usually either selling the product or being paid to tout its benefits. Keep your money in your pocket.


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Can we make healthcare affordable?

On January 15, President Trump announced a “great healthcare plan” that seemed to have three components. It would formalize his push for pharmaceutical companies to lower their prices, send funds to individuals to help pay their insurance premiums and mandate price transparency for any hospital or other provider who participates in Medicare.

Will this do any good? Given the sparsity of details, analyzing this “plan” is analyzing air, but probably not much.

Going back to President Nixon, U.S. presidents have decried the high cost of medical care. In 1971 Nixon pronounced health costs as a crisis when healthcare consumed 7% of the Gross Domestic Product (GDP). In 1992 President Clinton said that “healthcare costs are increasing at unsustainable rates.”

Well, here we are in 2026, and healthcare now consumes 18% of the U.S. GDP, roughly double the cost in peer-countries.

In 2025, the average premium for a family plan was $26,993 - roughly 40% of the average worker’s salary. Even though much of this cost is borne by the employer (for those lucky enough to work for a company that offers health insurance), workers contributed an average of $6850 towards the cost.

Moreover, as insurance costs have skyrocketed, employers have tried to slow this by offering plans with high co-pays and deductibles, meaning that out-of-pocket costs have risen dramatically.

Keeping drug costs down is a start, but drug costs make up only 9-10% of healthcare spending.

When it costs $27,000, sending people $2000 to buy health insurance would not allow most lower income people to come anywhere near being able to afford it.

We have had mandated price transparency in law since 2021, and hospitals have proven very adept at making prices visible only to those with a PhD in computer science.

Yes, we MUST make healthcare affordable to all Americans, but this will require bold steps, with some pain for those currently getting rich off our dysfunctional, adminstration-burdened system, not “a concept of a plan.”


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The liver disease no one talks about

If you have diabetes, are overweight or have bad lipids, you may have MASLD: metabolic-associated steatotic liver disease – or fatty liver to be brief.

Most of us know that heavy alcohol use is bad for your liver, and years ago, most patients with cirrhosis (advanced liver damage with scarring and loss of function) were alcoholics.

In 2026, with the world-wide epidemic of overweight and obesity. MASLD has become the commonest cause of liver disease that can progress to cirrhosis. Up to 38% of adults have this! If you have Type 2 diabetes, that rises to 65%!

The first stage is fatty infiltration of the liver. If nothing is done, scarring and replacement of functioning liver tissue with fibrous (scar) tissue can follow. Eventually the liver loses much of its function, and the complications of a scarred non-functional liver ensue. These include jaundice, swelling of the legs and abdomen and bleeding.

Untreated MASLD is also the number one cause of liver cancer.

How can you prevent this cascade of catastrophes?

First, if you fit the risk profile (diabetic, overweight and/or high triglycerides), ask your doctor to check your liver. While most doctors know they should check your eyes if you have diabetes, many do not think about the liver.

Standard “liver function tests” are not routinely done and are not always abnormal in early stages of MASLD. While elevated liver enzymes may offer the first clue to the problem, 20-25% of people with biopsy-proven fatty livers have normal liver blood tests.

A better test is the “FIB-4” value, which is calculated from your age, two simple liver enzyme tests and the count of your blood platelets. If this is abnormal, an ultrasound test should be done to look for any scarring.

The good news is that getting your lipids and blood sugar under control and losing weight will reliably reduce fat in the liver and prevent you from going on to worse liver disease.

The GLP-1 drug semaglutide (Wegovy) has been proven to improve MASLD and is FDA-approved for this use. Though not studied for this use, the other GLP-1 agents would probably be equally effective.

You cannot live without your liver, so look after it!


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Who will care for me at home?

As birthrates fall and we live longer, western societies are aging. In the U.S., Canada and Britain, almost 20% of the population is over 65, while in Western Europe it ranges from 20 to 25%. Indeed, as baby boomers age, the fastest growing demographic is projected to be those 85+.

While today’s seniors are healthier than the elderly were a generation ago, aging eventually leads to the loss of some ability to live independently.

If an elder can no longer safely take a shower or grocery shop by themselves, what are their options?

As the last resort, moving to a nursing home is an option but, when asked, most seniors strongly prefer to age in their own home.

Besides being unappealing, nursing home care is expensive! In Massachusetts, a high cost of living state, the median cost of a semi-private room in a nursing home is $12,600 per month. Nationally, the median cost is $9555, which translates to $114,660 per year.

Staying at home instead of a nursing home means that help in the home will be needed. This can be provided by some combination of friends, family and paid caregivers.

Long-term, the U.S. must make policy decisions about how to cope with its aging population. In the immediate future, we need to provide more, and more affordable, help at home.

In 2024, some 3.2 million people worked as home health aides and personal care aides. To meet the demand, experts say that another 750,000 will be needed over the next decade.

Who are these people caring for our frail elders? Not surprisingly, almost 90% are women. About 30% are foreign-born, many from low-income countries such as the Dominican Republic, Jamaica, Haiti and the Philippines.

Home health workers are poorly paid, averaging $17/hour, and there is very high turnover. At the same time, the cost to care-recipients is high, averaging $34/hour. The difference is the money made by the agencies that employ the workers.

The agencies play a key role in vetting the home care workers. Given the possibility of physical abuse or theft by unknown individuals in the home of a dependent elder, hiring someone “off the street” is risky, yet keeping half of the cost seems excessive. If you or a loved one needs help at home, what are your options other than going through an agency?

The ideal option would be word of mouth. If a friend or neighbor has had a home aide that has been reliable, hiring them directly is an option. You can pay them more than they would get from an agency and still save money.

A better option would be for your state to set up a registry of vetted home health and personal care aides that individuals could access. The state could assume the responsibility for doing background checks and listing any complaints.

Massachusetts has such a registry, but it is only accessible to employers, not the public. Ask your state legislators to open the registry for public access.

The best fallback would be to call your local Visiting Nurse agency. They will either provide vetted home health aides or be able to direct you to a trusted local agency


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Are you taking too many pills?

90% of Americans 65 and older take at least one prescription medication. Half take 4 or more and 15% take 8 or more. The number of medications taken rises with age.

Add to that the many over-the-counter (OTC) pills such as pain relievers, acid suppressors and supplements that people take, and we are talking about a lot of medications.

While most of these are probably needed, some are not and some are harmful to your health.

There are many reasons people take medication they should not be using. A common reason is that we see many doctors, and each may be unaware of what the others are prescribing. This can lead to duplication – two pills with very similar actions – or to harmful interactions between medications.

Many medications are particularly dangerous to older people. These include muscle relaxants, sedatives and antihistamines, which can lead to dizziness and falls and/or confusion. A very valuable resource in this area is the Beers list of medications that may be harmful to older individuals, maintained by the American Geriatrics Society. It is easily available on-line – just Google “Beers list.”

While medicine has very few “always” or “never” rules, if you find that you are taking medication(s) on the Beers list, ask your doctor about this. You may be healthier stopping them.

I often saw patients taking two different strengths of the same medication. Clearly the dose was changed but the person did not know they were to stop the original pill, and the pharmacy kept refilling both.

There are numerous drug-drug interactions, many dangerous. One pill may affect the way the body handles another, leading to higher than safe levels of one or both. When they are prescribed by the same practitioner, a good electronic record will pick this up, but this will not happen if the prescribers do not share a common record.

If you have a primary care doctor, a valuable visit is the “brown bag visit.” Put ALL your medications, including OTC pills, in a bag and let your doctor review what you are taking. You may be surprised to find how many should be stopped.


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Oh, my aching knees

About 20% of Americans 45 and older have osteoarthritis of the knees, a condition which does not kill you, but which decreases your quality of life.

Osteoarthritis, by far the most common form of arthritis, is more than simple “wear and tear.” It does involve wearing away of the cartilage, the smooth “cushions” that cover the ends of the bones. It also involves the bone itself and the synovium, the lining of the joint.

Obesity is a risk factor for osteoarthritis of the knees and hips, but recreational running is not – it may even be protective. Both sedentary lifestyle and very high volume competitive running do increase the risk.

If you have it, what can you do to decrease your pain and be more active?

Rule number 1 is to stay active. Exercise such as walking lubricates the knees and lessens stiffness. If you enjoy running, keep at it. You may find that running on grass is easier than pavement, and be sure to experiment with different shoes.

In addition to aerobic exercise, strengthen your quads. Exercises such as straight leg raises with ankle weights and squats will build up the muscles that support the knee.

Tai chi has also been found to decrease pain and increase quality of life.

Weight loss, however you achieve it, helps.

Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen can be very helpful, but have side effects on the stomach, kidneys and heart. If you use them, use the lowest dose that works for as short a time as possible.

If you find yourself needing NSAIDs daily, ask your doctor for a prescription for a topical (gel or cream) NSAID, which is much safer. The only one available in the U.S. is diclofenac.

If these measures are not adequate, injection of cortisone-type drugs into the knee will usually give quite a bit of relief. The problem with “cortisone shots” is that the relief is temporary, rarely lasting more than 2-3 months, and repeated injections contribute to worsening of the underlying arthritis.

Hyaluronic acid injections are controversial. There are many trials comparing it to placebo injections and while the majority show benefit, many show no advantage of hyaluronic acid. Insurance companies may cite lack of proven benefit and refuse to pay for these injections. It does appear to be safe should you opt to try this.

If nothing works and you are willing to have surgery, knee replacement is the ultimate choice. This has good results for most people, but not all. Before opting for surgery, it is critical that you are willing to commit to a vigorous physical therapy program. The surgery is the start, but not the end.

To get the optimal benefit from a “total knee” (or a partial one), expect to spend 4 to 6 months of demanding PT; if you are half-hearted with your exercise program, you will be left with a so-so result. You will still probably have less pain than pre-surgery, but you will not have full knee motion.


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Cannabis - what is it good for?

While cannabis (marijuana) is still classified as a Schedule I drug at the federal level, meaning it has no legitimate medical use and a high potential for abuse, the same is not true at the state level. Forty states plus the District of Columbia allow licensed health professionals to prescribe cannabis products for medical use.

(24 states allow recreational use of cannabis – no prescription required.)

One consequence of the federal classification is that the NIH is not allowed to fund studies of medical marijuana use, and this has greatly limited good research on such use. Despite this, 27% of U.S. adults have tried marijuana at least once for medical purposes.

There are FDA-approved cannabis-like products (dronabinol, nabilone) which are approved for nausea and vomiting due to chemotherapy and for severe anorexia due to HIV/AIDS. Another, cannabidiol, is approved for rare pediatric seizure disorders. That, according to the FDA, is that.

Advocates, however, claim that cannabis can do wonders for just about every ailment. Are any of these claims valid?

Chronic pain is a common reason for cannabis use, and a recent study found that chronic pain patients using narcotics were able to reduce their narcotic use after using cannabis. Certainly marijuana is less dangerous than narcotics.

Most of the other reasons cannabis is used have limited or no good data supporting this use. Anxiety may improve but may get worse. Cannabis is used for insomnia, but the sleep it induces is often poor quality. Some PTSD sufferers report help.

Inhaled marijuana lowers eye pressure, but this effect wears off within a few hours, making it of minimal benefit for glaucoma.

Migraines, inflammatory bowel disease and fibromyalgia are often treated with cannabis, but again, there is little solid evidence of lasting benefit.

Why not “just give it a try”?

Cannabis is not harmless. Acute side effects include heart racing, drop in blood pressure, dizziness, impaired coordination and slowed reaction time. Driving after cannabis use is as bad as driving under the influence of alcohol.

With chronic use, particularly daily use, there is evidence that cannabis increases the risk of heart attacks and strokes. Use by adolescents and young adults is associated with cognitive defects and lower IQ scores in adulthood. Regular users can have a severe vomiting illness requiring emergency department visits. Susceptible individuals can develop psychosis and/or increased anxiety.

If you are considering using cannabis for a medical condition, discuss it with your doctor. If what you have been using is not working, there may be better options. Marijuana should be a last choice, not your first.


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