It is just an over-the-counter supplement - it must be safe

Many of us take dietary supplements such as vitamins, minerals, herbs, or other products to boost our health. Since many supplements contain natural ingredients, it’s easy to assume they are always safe. But “natural” does not always mean safe, especially when combined with medications. Nor does it always mean effective.

Let’s get the “effective” part out of the way first. A law passed by Congress in 1994 restricts the FDA from reviewing dietary supplements before marketing as they do with prescription medications. Most of the claims made by the manufacturers about the benefits of their product have no basis in fact.

If these products were simply useless, you would only be wasting your money, but they are far from guaranteed safe.

Some products have been banned by the FDA after being on the market for extended periods when their side-effects were found to be very dangerous but may still be available by mail-order. These would include ephedra (Ma Huang) and DMAA, used for weight loss and energy, that cause high blood pressure and strokes.

Some are discouraged but still sold. Kava, easily available online, is used for anxiety but can cause severe liver damage. Yohimbe is used for erectile dysfunction and bodybuilding; it can cause high blood pressure, kidney failure and heart problems.

Colloidal silver is claimed to have immune support and anti-bacterial properties but can leave your skin permanently discolored.

Fat-soluble vitamins (A, E, D and K) are not easily removed from the body. While they are safe in low doses, high doses of Vitamin A can damage the liver, as several Texas families following RFK Jr’s advice discovered. High does of Vitamin D can dangerously raise your blood calcium.

Finally, some supplements can interact with prescription medicines you may be taking. St John’s Wort causes a more rapid breakdown of many medications so that they lose their effectiveness. These include birth control pills and anti-depressants.

Calcium supplements interfere with the absorption of many medications, causing them to be less effective. Green tea extracts (but not the amount in a cup of tea) affect the breakdown of many medications.

Finally, there is the serious concern that many supplements are adulterated with inactive and/or toxic ingredients. The under-staffed FDA is unlikely to ride herd on these products unless there is a mass poisoning event that commands their attention.

What should you do?

In general, don’t waste your money. Beyond a daily multivitamin, most OTC supplements are useless.

If you wish to take a supplement, buy it at a legitimate pharmacy or health food store that will be there if there are problems. Look for independent lab testing by the USP (U.S. Pharmacopeia) or NSF (National Science Foundation).

If you are taking prescription medications, ask your doctor to check for possible interactions before you start taking any supplements.


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Leaving the WHO/defunding USAID - penny unwise and pound foolish

President Trump announced on the day of his inauguration that he was withdrawing the U.S. from the World Health Organization, a process that takes a year under a joint resolution of Congress passed in 1948. The stated reason was the WHO’s failure to quickly sound the alarm about COVID-19.

In fact, the WHO’s general director told the world to get ready on Jan 23, 2020, and a week later declared a world-wide public health emergency. It was the Trump administration that down-played the pandemic and delayed the U.S. response, leading to hundreds of thousands of avoidable deaths.

On March 28, the Trump administration announced it was shutting down the US Agency for International Development (USAID), including all its disease-fighting initiatives around the world.

Do either of these decisions help the U.S.?

U.S. foreign aid in all its facets accounts for some 1% of the federal budget, and health-related spending is only a fraction of that.

What do we get for our financial support?

A global vaccination campaign led by the WHO led to the elimination of smallpox from the world. Global efforts have produced a 99.9% reduction in yearly polio cases, with polio now endemic only in Pakistan and Afghanistan. American support has led to a dramatic reduction in AIDS in South Africa. Malaria and tuberculosis deaths will both rise because U.S. aid has been stopped, and American tourists will also suffer.

With the world totally connected by trade and tourism, outbreaks in a distant country will inevitably reach the U.S. and strain our health system. When a few imported cases of Ebola occurred in 2014, 45 health centers here spent over $53 million to gear up. Since the question is not “if” but “when” the next pandemic arises, do we want to fight it alone?

WHO initiatives have directly benefitted Americans. Efforts by the WHO led to the discovery and standardization of oral fluid replacement for children suffering severe diarrhea, and this treatment is now widely used in the U.S.

Cutting American support for the WHO and reducing our support of health efforts around the world will save us a little money in the short-run but at the cost of millions of deaths in less-developed countries and in the long-run will end up costing us more as diseases first spread abroad and then reach American shores.

Write your Representatives and Senators and beg them to reverse this short-sighted decision.


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Avoid the summer itch!

Here comes summer, bringing outdoor barbecues, swimming and sailing, but also sunburn, mosquito-borne illnesses and poison ivy.

Let’s focus today on the itchy rash that plagues so many.

Poison ivy, poison oak and poison sumac share the same sap oil, urushiol, in their roots, stems and leaves. The oil is colorless and odorless, so it may not be obvious that you have it on your skin. You can spread it from one part of your skin to another without knowing it.

About 2/3 of adults develop dermatitis after getting urushiol on their skin, typically 1-2 days after contact, though it may be delayed if a first contact.

The rash is red and bumpy and intensely itchy, and is often in streaks, reflecting brushing against the plant. If severe, blisters may develop. The rash typically clears in 2-3 weeks.

Treatment is for symptoms, not cure, and includes wet compresses, calamine lotion and topical steroid creams. If it is very extensive or involves sensitive areas like the face or genitals, oral steroids can be prescribed.

Much better is prevention. If you think you have been exposed, wash your entire body with mild soap; water alone will not remove the oil, which penetrates the skin. Use a soapy brush under the nails. Wash any clothing that may have contacted the oil in warm soapy water.

Pets can carry the oil on their fur and pass it to you when you touch them, so bathe them if they have run through the plants.

Best, of course, is to avoid contact!

Poison ivy usually has three broad, tear-shaped leaves. It can grow as a climbing or low-spreading vine that sprawls through grass and often grows along rivers, lake fronts and ocean beaches. It is found everywhere in the continental U.S.

Poison oak has leaves that look like oak leaves and it grows as a vine or a shrub. The plant can have 3 to 5 leaflets per group. It is most common in the western U.S.

Poison sumac has seven to 13 leaflets per stem that are characterized by smooth surfaces and pointed tips. It is most often found in wooded, moist areas of the southern U.S.

Summer will be a lot more fun without the itch!


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Should parents "do their own research" on vaccines?

A few months ago, I was unsure which cabinet member was least qualified for their role, but it is now clear that Robert Kennedy Jr. can claim this dubious distinction. Not only is he temperamentally and by experience unfit to head a massive government agency, but he is actively fighting against the agency’s purpose.

Measles is a highly contagious disease that is 98% preventable by vaccination. Because measles spreads so easily, about 97% of the population must be vaccinated to prevent outbreaks.

The very success of vaccination in reducing childhood diseases has led many parents to worry less about these diseases. Measles, mumps, rubella, chicken pox, and whooping cough were once “the usual childhood diseases” but should now be rare. Polio should be exceedingly rare.

Instead, 2025 has seen 935 cases of measles to date, 121 (13%) of whom were sick enough to be hospitalized, and 3 children have died. 96% of those sickened have been unvaccinated. There have also been outbreaks in Canada, with Ontario and Alberta the hardest hit.

The U.S. has also seen whooping cough make a comeback. In 2024 there were 35,000 cases reported and 10 deaths.

Mr. Kennedy’s solution is to “do research on treatments” for measles, though the remedies he suggests such as cod liver oil have been extensively studied for decades and found worthless.

Kennedy has made himself wealthy from his vaccine-denial activities, earning a large salary from his foundation, Children’s Health Defense, and getting kick-backs from lawyers by sending them parents to join class-action suits against vaccine manufacturers. Children’s Health Defense is an activist group mainly known for anti-vaccine advocacy and is one of the main sources of misinformation on vaccines.

Instead of urging parents to vaccinate their children, as recommended by every medical group that has studied this subject, Kennedy suggested “parents should do their own research.” For most parents, this does not mean careful review of published scientific studies but rather going on Facebook or other social media platforms, where misinformation abounds.

Vaccines, while not 100% perfect, are very effective and very safe. Vaccines do not cause autism. This claim has been studied by numerous groups over recent decades and demonstrated to be false. While nothing we inject or ingest is 100% safe, the risks from vaccines are much less than the risks of the diseases they prevent.

Parents who care about their children should listen to their pediatrician and get their kids vaccinated so these ancient scourges can remain history and not current plagues.


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For Men Only; how does my prostate grow?

Of our many organs, the prostate gland seems to offer the most annoyance to men as we age. The prostate produces most of the fluid that carries semen and so is critical to reproduction. It is located near the bladder outlet and in young men is about the size of a walnut. As men age, the prostate grows. Unlike heart disease, there is nothing one can do with diet or healthy habits that impacts the prostate.

The two major problems that impact men’s health are prostate cancer and blockage of urine flow from a growing gland.

Growth of the prostate, called benign prostatic hypertrophy (BPH), is a normal part of aging, and occurs in essentially all men. Because of the location of the gland, it can impede flow of urine out of the bladder. It is a good rule that a 60-year-old man, however healthy, should not expect the urine flow of a 20-year-old.

What one does about BPH is entirely based on symptoms. The hallmark of BPH is incomplete emptying of the bladder. You may finish urinating and then feel you need to go again. Most older men will get up at night to void. It may cause urgency – the feeling that if you do not get to the bathroom you are going to lose control.

If these symptoms are mild, no treatment is needed. If they are more severe, medication can help. One class is alpha-blockers, that make it easier to void, that were originally developed to treat high blood pressure. They are generally easy to take, though may be a problem if you tend to have low blood pressure.

The more definitive treatment is to take a testosterone-blocker. Finasteride in low dose is used to treat male-pattern baldness (Propecia) and in high dose to shrink the prostate. It has been shown to reduce the need for surgery and the likelihood of complete urinary blockage. The downside is reduced sexual drive and erectile dysfunction (ED).

ED drugs like tadalafil help urinary flow and may be a good option to improve flow while also treating erectile dysfunction. Your insurance may not pay for this, as most still ration these drugs.

If medicines fail, surgery will usually work.

Prostate cancer occurs in the same organ, but otherwise is unrelated. Cancer occurs in small glands and huge ones equally. As men age, prostate cancer occurs more often and at the same time becomes less aggressive. If a 50-year-old has prostate cancer, unless it is surgically cured, he will probably die of this cancer. If an 80-year-old has prostate cancer, he will almost certainly die of something else, with his cancer but not due to his cancer.

I must also note that African-American men have almost twice the risk of white men.

While prostate cancer can be detected on a rectal exam, by this time it is usually advanced. Early detection is done with a blood test, the PSA (prostate-specific antigen). To say that PSA testing is controversial is an understatement; arguments for and against have raged in the medical literature for years.

I can best sum up the thousands of pages written by saying that screening men with regular PSA testing modestly reduces death from prostate cancer but has minimal effects on overall death rates. There is also consensus that PSA testing should stop at advanced age, though exactly when is debated. I would suggest 75.

If the PSA is elevated, in 2025 the best next step is an MRI of the prostate to detect and quantify any cancer. In low-risk patients, “watchful waiting” is a very viable option. In high-risk men, complete removal of the prostate offers the best chance for cure, with radiation therapy an acceptable alternative. Both treatments have significant side-effects, including bowel and/or urinary incontinence and loss of erection, hence the idea that not all cancers should be treated.

Prostate disorders are clearly conditions in which dialogue between the patient and doctor are key and second opinions critical. Do not accept the first option offered.


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It's a matter of balance

Falls can have very serious consequences as we age. Every year more than 25 percent of adults 65 or older have a fall, and 3 million are treated in emergency departments for fall injuries, according to the CDC.

Several things increase your risk of falling. Blood pressure that falls when you get up is a common culprit, and this in turn can be due to medication you take. If you feel light-headed when getting up, have your BP checked sitting and standing and if there is a fall of more than 10 points, discuss this with your doctor.

Poor vision, particularly when combined with poor light, can lead to a fall. Be sure that you have adequate light in your bedroom if you get up to go to the bathroom.

Be wary of electric cords that are everywhere and can easily trip you. Tape them down or to the wall.

Inadequate leg strength and poor sensation in the feet can lead to falls, as can vertigo from inner ear problems.

What can you do to reduce your risk of falling in addition to the above suggestions?

Doing specific exercises regularly will help. Start with three simple ones:

1. Stand with your feet shoulder-width apart for 10 seconds, increasing this to 30 seconds

2. Next, stand with feet together for 10 increasing to 30 seconds

3. Stand on one leg then the other

If these are too easy, do them with your eyes closed. (Be sure there is a sturdy surface you can touch such as a kitchen counter available.)

Walk heel-to-toe near a wall that can offer support.

Sit on a sturdy chair; get up without using your hands if possible. Sit down. Repeat, aiming for 10 times.

Do these exercises twice a day.

When you are going up or down stairs, hold on to the railing!

Finally, three points of contact are much more secure than two. If you are concerned about falling, a walking stick can be a great safety device.


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Is there calcium in my coronary arteries?

For many decades, doctors have used the traditional coronary disease “risk factors” to predict an individual’s risk of developing heart attacks or other major coronary events. These include smoking, diabetes, high blood pressure and elevated cholesterol.

These factors can be plugged into various formulas to predict the likelihood of a coronary event occurring in the next 10 years, and are used to decide if a person should be started on lipid-lowering therapy.

If the calculated risk is very low or very high, no other information is needed. Many people, however, fall into an intermediate risk range. In some instances, even those with high risk of coronary disease may not want to start a statin drug because of feared side effects (which are uncommon).

Such situations suggest the use of a coronary artery calcium (CAC) score.

As plaque (cholesterol deposits) builds up in coronary arteries, calcium is also deposited. A low-dose CT scan can measure the amount of calcium. Ideally, you would have a score of 0, and the higher the score, the higher the risk of developing symptomatic coronary disease.

Who might benefit from this testing?

If your doctor has recommended you start a statin but you are hesitant, a zero score would allow you to postpone the drug while a score over 100 would strongly suggest you take it.

If your calculated risk is intermediate, a zero score would suggest you do not need to begin cholesterol-lowering therapy while a non-zero score would push you to do so.

If your cholesterol is not bad but you have other risk factors for coronary disease, a CAC score will give useful information. If several family members had early heart attacks, a non-zero CAC score suggests that even if your cholesterol is not high, a statin might be a good idea.

If you have not tolerated a prescribed statin and stopped it, a CAC score may help you to decide whether to try a different statin or one of the newer injectable cholesterol-lowering drugs.

Who should not get a CAC score done?

If you are under 40, a zero score is expected and will not impact decision-making; use the traditional risk factors to guide your thinking. If you are over 80, and not on a statin, the results are unlikely to change recommendations to begin.

If your risk for coronary disease based on the traditional risk factors is high, a CAC is a waste of money: take a statin. If you are on a statin and doing well, be happy and do not get a CAC test.

Finally, if your score is zero, repeating the test can wait at least 3 and probably 5 years.


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