Senior Living: Getting a handle on all of those pills and potions
By Dr. Thomas LaGrelius
In America, age is associated with the use of many pills and potions. Seniors often have a generalist and several specialists, all of whom prescribe medication.
They are taking vitamins and supplements – sometimes recommended by doctors – but usually taken independently because someone thinks it’s a good idea. The media markets FDA uncontrolled supplements expertly, claiming benefits that are in fact usually lacking.
In their youth, many seniors never believed they would be taking so many pills! Some have value. Many do not. Some interfere with each other or are unsafe taken together.
A geriatrician friend of mine, now retired, spent the last 10 years of her career managing a senior transitional care unit and doing hospice work. She recently told me the average patient she encountered was on 11 prescription drugs, not counting supplements. She often stopped more than half of these drugs and most of the supplements. It did not surprise us that when she did so the majority of these patients soon felt and looked much better.
Let’s talk about vitamins.
It may surprise you that I do not suggest patients take a multiple vitamin, nor do I take one myself. There is actually a raft of study evidence to show doing so does no good and may sometimes be harmful. A more targeted approach is best. Take only what you are known to be deficient in.
Many of us are Vitamin D deficient. Vitamin D is important to bone health, blood pressure control, mood, heart health, weight control and fall prevention. Unless supplemented we get almost all our Vitamin D from sun exposure. Dermatologists often tell their patients to avoid the sun because it can cause skin cancer and a skin aging, but this leads to widespread D deficiency. In fact, five to 10 minutes of midday sun exposure to the torso (not the face or arms where we already have sun damage) may be the best daily way to get your Vitamin D. I joke that they we should wear a small bathing suit, cover our faces and arms, go out in the back yard at noon every day and turn on a spit for ten minutes to get our vitamin D.
The darker one’s skin by the way, the less Vitamin D you make from sun exposure and the more likely you are to be deficient. However, the lighter your skin the more likely you are to avoid the sun.
Normal Vitamin D levels are from 30 to 100 ng/ml. Have it measured! If it’s low, get a little torso sun, or supplement with Vitamin D3, perhaps 2,000 Units a day. Aim to get the D levels into the 50s, but not higher. Too much can be toxic. Certain medical issues can make using Vitamin D a hazard. Talk to your doctor!
B12 deficiency is common, especially among Northern Europeans. In an earlier Senior Living column I described a patient who was so deficient in B-12 he became demented, and recovered with supplements. B-12 is especially needed for neurological health, but also it prevents anemia. Since B-12 is found only in animal based foods, not plants, a vegetarian diet can cause deficiency, and such diets are very popular right now.
B-12 is severely deficient if it is below 200 pg/ml, but levels under 400 are bad enough. Try to get your levels up to about 1,000 pg/ml if possible. B-12 is not toxic, so it’s hard to take too much. Again, get tested and talk to your doctor.
Folic Acid (Vitamin B-9)
Deficient is common in those who drink alcohol. Lack of folic acid causes anemia and is very dangerous to the fetus in pregnancy. Again, have it measured.
Don’t take it unless you have been shown to be deficient. Iron overload can and does damage your liver, heart and other organs.
Don’t take it. There is plenty of Vitamin C in a good diet, and too much Vitamin C has been linked to cancer risk in some studies, and it does not prevent colds. (Linus Pauling was wrong.) Vitamin C can also make you absorb too much iron from ordinary foods and cause iron overload.
There are lots of other vitamins and potential supplement, Vitamin E, A, other B vitamins like niacin and thiamine, calcium and other minerals that are of lesser importance, but need consideration in special circumstances. Again, talk to your doctor.
I recently saw a new patient in her mid 80s taking many pills and potions. I asked her to bring them all in a sack. In addition to about six prescription drugs, she brought not one, but three grocery bags full to the top, of vitamins and supplements. She was taking them all, dozens and dozens of bottles of pills, at least 75 pills a day! Many were combinations of vitamins and supplements that duplicated each other to the point of overdose. No one had recommended them. She took them because she believed they would make her feel better. She did not feel better.
An hour was spent with this patient and her family, discussing each bottle and deciding what she should and should not take. It made her anxious to consider stopping any of them, but eventually she was weened off most of these products. She felt no better or worse a month later, but it’s still early. She will do better over time, and she certainly is saving a whole lot of money!
Live Long. Be well.
Dr. Thomas W. LaGrelius, M.D., is a certified specialist in family medicine and geriatric medicine. He is the founder and president of Skypark Preferred Family Care, a primary care/geriatrics practice based in Torrance. He is a staff member at Torrance Memorial Medical Center and Providence Little Company of Mary Torrance Hospital. Email questions to email email@example.com. Visit the website at www.skyparkpfc.com