benefits of supplements

Supplement Benefits: All In the Mind?

It sounds so easy: Pop a pill (or pills) every day and enjoy radiant health. Unfortunately, our concierge doctors have to caution you that it may not be not that simple. And, according to a new study, the claimed benefits of taking supplements might not even be true.

The study, published this month in the journal BMJ, suggests that the perceived benefits of over-the-counter (OTC) vitamin and mineral supplements may largely be due to the power of the mind.

“The effect of positive expectations in those who take multivitamin or mineral supplements is made even stronger when one considers that the majority of them are sold to the so-called worried well,” lead study author Dr. Manish Paranjpe said in a statement. “The multibillion-dollar nature of the nutritional supplement industry means that understanding the determinants of widespread multivitamin or mineral use has significant medical and financial consequences,” he added.

The financial aspect is obvious. Dietary supplements are a $40-billion-a-year business in this country. And if the products don’t work as expected, that’s a huge waste of money.

The medical impact is less well known. Between 2007 and 2012, the U.S. Food and Drug Administration (FDA) received reports of more than 6,300 reports of serious adverse events linked to dietary supplements. These included 115 deaths and more than 2,100 hospitalizations.

What’s the harm in taking supplements?

This may surprise people who think that because these substances are sold over the counter they can’t do you harm. Others believe that the government wouldn’t allow their sale unless they were safe and effective. However, a 1994 law, the Dietary Health and Education Supplement Act, actually prevents the FDA from regulating dietary supplements or removing them from sale unless it can prove a supplement is unsafe.

But indiscriminate use of supplements can produce serious side effects. For example, Vitamin E and beta-carotene supplements can actually increase the chances of developing lung cancer in smokers.

St. John’s Wort is sold over the counter for mild depression. Some of its potential side effects include dizziness, sun sensitivity, insomnia, anxiety and headaches. It can also reduce the effectiveness of birth control pills and some heart medications.

Fish oil can cause nausea and diarrhea and increase the levels of LDL (bad) cholesterol. It can also increase the risk of bleeding. Some people have suffered such severe liver damage with green tea extract that they required a liver transplant.

Niacin, another popular supplement, has been shown to slightly increase the risk of death from any cause. So have calcium supplements, which one study suggested increased the risk of death from cancer when taken in amounts greater than 1,000 milligrams per day.

Little evidence for real benefits

Then there’s the question of whether these products are effective for the reasons we take them. Various studies have been performed on the efficacy of supplements in the prevention of many diseases. All have shown little-to-no benefits of dietary supplements and vitamins.

Those marketed for the prevention of cardiovascular disease (CVD) have, for example, been studied extensively. In 1996, the Physicians Health Study assigned 22,071 men to take either beta-carotene or a placebo for 12 years. They assessed the effect of the vitamin on the prevention or progression of the disease. The results showed no difference in either CVD occurrence or overall mortality.

A Women’s Health Study found a similar result when it looked at the effect of beta-carotene on 40,000 women. It found no differences in the incidence of heart disease between those taking the vitamin and those receiving the placebo.

Another study published in the Journal of the American College of Cardiology that examined multivitamins, calcium supplements, and vitamins C and D, found no measurable advantage in terms of preventing CVD, heart attack, stroke, or early death. A similar study found no CVD-associated benefits for vitamin D.

Yet the belief persists

Despite these findings, many people still swear they notice a difference in their health after taking supplements. The study this month attributes this to the power of belief. Consumers also point to studies that support their faith in these substances.

An article in Harvard Women’s Health Watch, however, explained that the benefits of supplements that often appear in some studies are based on observational research vs. clinical trials. That is, researchers ask study participants to self-report on their daily habits, vs. performing randomized controlled trials. Because observational studies don’t control for diet, exercise, and other variables, they can only suggest an association with better health benefits from particular supplements.

“People who take supplements tend to be more health conscious, exercise more, eat healthier diets, and have a whole host of lifestyle factors that can be difficult to control for fully in the statistical models,” Dr. JoAnn Manson, chief of preventive medicine at Brigham and Women’s Hospital and professor of medicine at Harvard Medical School, told the journal.

So whether you’re trying to improve your health or ward off illness, your best bet is to follow the time-honored advice: Consume a balanced diet, including fruits and vegetables, get plenty of exercise, don’t smoke, use alcohol in moderation, and avoid recreational drugs. It really is that simple.

smoking and covid-19

Smoking and COVID-19: What You Need to Know

The annual Great American Smokeout is set for this week, November 19. So our concierge doctors thought this would be a good time to look into what we know about the combined effects of smoking and COVID-19.

This is especially important because there has been some confusing information on the effects of cigarette smoking on the disease, with some early reports even suggesting that cigarette smokers who contract COVID-19 actually fare better than non-smokers. Subsequent studies have found the opposite: that smoking increases the risk that the virus causes more damage in smokers.

Tobacco’s extensive effects

One study, reported in The Guardian, analyzed more than 11,000 COVID-19 patients. It found that about 30 percent of those with a history of smoking saw their conditions progress to a more severe or critical state, versus 17.6 percent of non-smokers. Researchers concluded that “smoking is a risk factor for progression of COVID-19,” with smokers nearly twice as likely to develop severe symptoms.

In addition to the well-known damage to the lungs and cardiovascular system—both of which are compromised by COVID-19—smoking has also been shown to suppress the immune system’s ability to fight infection in the body.

“Tobacco products cause inflammation in the airways and affect lung immunity, which makes people more susceptible to infection in general,” Dr. David Christiani, a professor at the Harvard TH Chan School of Public Health, told the paper.

In a scientific brief released this summer, the World Health Organization (W.H.O.) concluded that “the available evidence suggests that smoking is associated with increased severity of disease and death in hospitalized COVID-19 patients.”

The brief also reiterated that, in addition to the findings on the coronavirus, “Tobacco causes eight million deaths every year from cardiovascular diseases, lung disorders, cancers, diabetes, and hypertension.”

We believe it’s safe to add COVID-19 complications to that list.

Benefits of quitting

If you smoke, you’re not alone. More than 32.4 million people in the U.S. still smoke cigarettes, according the American Cancer Society (ACS). Unfortunately, as a result more than 16 million Americans live with a smoking-related disease.

But it’s never to late to quit.

Here’s a timeline from the ACS showing what happens when you stop smoking:

  • Twenty minutes after quitting your heart rate and blood pressure drop.
  • Twelve hours after quitting the carbon monoxide level in your blood drops to normal.
  • Two weeks to three months after quitting your circulation improves and your lung function increases.
  • One to nine months after quitting, coughing and shortness of breath decrease. Tiny hair-like structures (called cilia) that move mucus out of the lungs start to regain normal function in your lungs. This increases their ability to handle mucus, clean the lungs, and reduce the risk of infection.
  • One year after quitting the excess risk of coronary heart disease is half that of someone who still smokes. Your heart attack risk drops dramatically.
  • Five years after quitting your risk of cancers of the mouth, throat, esophagus, and bladder is cut in half. Cervical cancer risk falls to that of a non-smoker. Your stroke risk can fall to that of a non-smoker in two to five years.
  • Ten years after quitting your risk of dying from lung cancer is about half that of a person who is still smoking. Your risk of cancer of the larynx and pancreas decreases.
  • Fifteen years after quitting your risk of coronary heart disease becomes that of a non-smoker’s.

Ready to quit?

There are myriad ways to successfully stop smoking. What works for one person might not work for another. And studies show that the average smoker tries several times before giving up the addiction entirely.

“No matter your age or how long you’ve been smoking, quitting improves health, both immediately and over the long term,” the ACS says. “Giving up smoking is a journey, and it can be hard, but you can increase your chances of success with a good plan and support. Getting help through counseling and medications doubles or even triples your chances of quitting successfully.”

You can also download numerous quit-smoking apps to help, or find tools and tips at Smokefree.gov. The site also offers live chat help for those trying to quit. In addition, each state has a quit line, which you can access by dialing 1-800-QUIT-NOW (1-800-784-8669).

Of course there are various medications also available, so if you’re trying to stop smoking, please talk with us. We can help find the best path for you.

The coronavirus pandemic has had everyone on edge for months, and smoking may be one way you’ve used to cope. But, as with increasing alcohol or drug consumption, it’s unhealthy and ultimately unhelpful.

safely celebrate holidays

How to Celebrate the Holidays Safely

As we head into the holidays, our concierge doctors are concerned that pandemic fatigue might tempt people to throw caution to the winds and just celebrate, starting with Thanksgiving.

The fact is, we’re all fed up with the “new normal.” People want more than anything to return to the way our lives were before this scourge attacked the world early this year. Pandemic fatigue is not only real, it’s totally understandable.

“In the spring, it was fear and a sense of, ‘We’re all in it together,’” Vaile Wright, a psychologist at the American Psychological Association (APA) told The New York Times. “Things are different now,” she said. “Fear has really been replaced with fatigue.”

This led to a sense of complacency and carelessness. While understandable, this caused a wave of increased cases and deaths in the U.S. and around the world.

“Citizens have made huge sacrifices,” Dr. Hans Kluge, the World Health Organization’s (W.H.O.’s) regional director for Europe, told the Times. “It has come at an extraordinary cost, which has exhausted all of us, regardless of where we live, or what we do.”

The high cost of carelessness

A recent report in The Washington Post serves as a cautionary tale for our country. Canada celebrates their own Thanksgiving on the second Monday of October. Despite warnings from public health officials there to limit celebrations to members of the immediate household, apparently that advice went unheeded by many Canadians.

In the weeks after, Canada saw rising case numbers as a result. Ontario, for example, reported a record-high number of daily cases within two weeks of the holiday. A single gathering of 12 extended family members in Toronto resulted in a cluster of coronavirus cases.

“People did not mean to spread COVID-19,” Deena Hinshaw, Alberta’s chief medical officer of health, told The Post. “But it is a reminder that social gatherings where social distancing and masking are not used consistently are a significant risk for spread.”

We can understand the longing to get together for the traditional holidays, beginning with with Thanksgiving. But that is, unfortunately, a recipe for disaster.

“We are set up for just a perfect storm—a conflagration,” Megan Ranney, an emergency medicine professor at Brown University, told The Post recently. “Right now, you can talk about there being lots of little burning fires across the country. And then Thanksgiving will be the wind that will whip this fire up into an absolute human disaster for our country.”

This country’s leading infectious disease expert, Dr. Anthony Fauci, likewise warned that Thanksgiving celebrations could lead to even more cases.

“That is, unfortunately, a risk, when you have people coming from out of town, gathering together in an indoor setting,” he told CBS News recently. “It is unfortunate, because that’s such a sacred part of American tradition.”

Yes it is. But we’d like to suggest some ways to minimize that risk and safely celebrate the holidays.

A few COVID-19 reminders

First, let’s review a few facts.

The SARS-CoV-2 coronavirus is one of the most contagious viruses known to man. It spreads readily through the air and by surface contact, from those who have symptoms as well as those who don’t.

Because of this, areas with high air circulation, such as the outdoors on a windy day, tend to be safer than crowded indoor spaces with poor ventilation.

Far deadlier than the flu, the coronavirus travels through the bloodstream to every part of the body. This is why it’s so difficult to treat, and why many of its victims appear to suffer months-long aftereffects.

How to safely celebrate the holidays

With that in mind, if you’re preparing to celebrate the holidays, here are a few tips.

The Centers for Disease Control and Prevention (CDC) recommends limiting gatherings to those in your immediate household. If you’re going to host a Thanksgiving dinner, the CDC suggests holding it outdoors. It also says to only invite family and friends from your immediate neighborhood.

“Gatherings with more preventive measures, such as mask wearing, social distancing, and hand washing . . . pose less risk than gatherings where fewer or no preventive measures are being implemented,” the CDC says.

Other ways to judge risk, according to the CDC:

  • Indoors is riskier than outdoors.
  • Poor ventilation is riskier than good ventilation (e.g., places with open windows and doors).
  • Longer gatherings are riskier than shorter gatherings.
  • More attendees pose a greater risk than fewer attendees.
  • Local attendees pose less of a risk than those traveling from other areas who may have been exposed at home or during their travels but aren’t yet showing symptoms.

If you can’t control the environment, the attendees, or their behavior, you need to ask yourself whether one holiday is worth the risk.

“Staying home is the best way to protect yourself and others,” the CDC says.

As we noted above, we’re all tired of the precautions necessary to reduce the spread of the novel coronavirus. But parents, for instance, remain on high alert to ensure the safety of their children for eighteen-plus years. If you think of it in these terms, a year or two of vigilance might seem more acceptable.

Remember, the fastest way for this thing to be “over” is to deny it new hosts. This includes the bodies of you and your loved ones. Please follow these tips in order to safely celebrate the holidays.

flu shot twindemic

Flu Shots Can Help Avert a ‘Twindemic’

The U.S. Centers for Disease Control and Prevention (CDC) recommends all adults and children older than six months receive a flu shot by the end of this month. The CDC says it takes at least two weeks for the vaccine to become effective. Then it won’t reach its peak effectiveness until another week after that. And children who are being vaccinated for the first time need two vaccines spaced a month apart to become fully protected.

Therefore, our concierge doctors suggest you get your flu shot for the 2020-21 influenza season as soon as possible. While there have been scattered reports of shortages around the country, The Washington Post recently reported a record number of flu vaccine doses—between 194 million and 198 million—have been ordered. Because the vaccine is shipped in stages, more is on the way.

“This year I think everyone is wanting to get their vaccine and maybe wanting it earlier than usual. If you’re not able to get your vaccination now, don’t get frustrated. Just keep trying.”

The CDC’s Dr. Daniel Jernigan, to the Associated Press (AP).

COVID-19 and flu overlap: a ‘twindemic’

We were fortunate the 2019-20 flu season was winding down this spring as the coronavirus crisis began to hit the country. This year, however, we’ll be looking at the possibility of a “twindemic”—both waves hitting at once.

So it’s especially important that as many people as possible get vaccinated for the flu this year. The flu shot won’t prevent COVID-19, but it can help reduce the strain on our already overburdened health care system.

“Since hospitals and doctors’ offices are going to be very busy caring for COVID-19 patients, a flu vaccine can help decrease burdens on the health care system and make sure that those who need medical care are able to get it.”

Dr. Susan Bailey, president of the American Medical Association (AMA) and an immunologist in Fort Worth, Texas, told CNN.

Last year, the CDC estimated that the flu killed 22,000 Americans, and resulted in hospitalization of an additional 400,000. By contrast, at least 215,000 Americans have died of COVID-19 since March.

Hopeful signs

Health experts are hopeful the precautions we’ve been taking to avert COVID-19—hand washing, social distancing, and wearing masks—will mean this season’s flu won’t take as severe a toll as in previous years. But they all insist that widespread vaccinations are necessary.

Even if the flu vaccine isn’t 100 percent effective in preventing influenza, it has been shown to reduce the length and severity of the illness in those who contract it. In addition, if you’re unlucky enough to contract COVID-19, you won’t want your body’s defenses to be weakened by a prior bout with the flu.

This is already present in the Southern Hemisphere, where each season’s flu strikes over the summer. From South Africa to Australia, public health experts reported remarkably low levels of influenza among their populations. They attributed this partly to coronavirus lockdowns and to extremely high participation in influenza vaccinations.

One pharmacy in Cape Town, South Africa, for example, reported that the demand for flu shots was four times higher than in previous years. People were trying to avoid the co-morbidity (simultaneous presence of two or more diseases) of contracting the flu in addition to COVID-19.

“People were lined up outside the pharmacy down to the corner of the street waiting to get their injections. We had to prevent people from coming into the store.”

Ellis Henen, owner of Sunset Pharmacy, told The Post.

Additional benefits of the flu shot

We hope Americans will have the same attitude to this year’s flu shot.

Some people think they’re still protected from the one they received last year. But having received a flu shot last year won’t protect you from this season’s strains of the virus. This is because your immunity from a year ago has deteriorated by now. In addition, manufacturers create a new vaccine each year based on which strains the World Health Organization (WHO) expects to be predominate. This is based on which strains were seen over the summer in the Southern Hemisphere. So this year’s shot will include strains different from those in last year’s inoculation.

It’s important to remember, even if you contract influenza after receiving the shot, it’s likely to be less serious than if you’d skipped being inoculated. And the flu vaccine offers additional benefits, especially among the elderly. For older people and those with chronic health conditions, recent studies show the extra benefits of a flu shot. It’s as effective in preventing a heart attack as quitting smoking, using cholesterol-lowering drugs, or taking blood pressure medications.

So be sure to let us know if you’re interested in getting a flu shot. If you encounter a shortage, we may be able to help you locate a supply nearby.

coronavirus covid19

How Viruses Work and How to Stop COVID-19

Our concierge doctors thought this would be a good time to tell you about viruses in general, especially the novel coronavirus known as SARS-CoV-2, aka COVID-19. SARS-CoV-2 is the name of the virus; COVID-19 is the disease it produces. This nomenclature is similar to the human immunodeficiency virus (HIV) and its resulting disease, acquired immune deficiency syndrome (AIDS).

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Important Message

A Covid-19 Update from Dr. Poncy & Dr. Lubarsky

So much has happened in the last few weeks. Finally, though, it seems as though we can see a faint light at the end of the tunnel. There is so much conflicting data on how to move forward that we thought we would try to help you parse through it.

As I’m sure you have noticed, there has been noticeably less talk about hydroxychloroquine. Unfortunately, some recent studies have shown no positive effect with its use, and possibly increased risk. It’s too early to say since there are larger ongoing studies, but for now hydroxychloroquine doesn’t seem to be recommended for treatment of Covid.

There has been exciting news from Gilead in regards to their drug Remdesivir. Their most recent studies showed significant improvement in a vast majority of critically ill patients. That’s one to definitely keep an eye on and may be one to help us come out of this crisis.

There are recommendations that have not changed, and, frankly, ones that should continue indefinitely. Those include staying active, exercising, eating well, sleeping well and avoiding excessive alcohol use. Although we would discourage outdoor activities at peak sun exposure (10-2), we would strongly encourage you to go outside for walks, bike rides, etc. This helps build Vit D levels which are helpful for your immunity, improves physical fitness which has shown to correlate with improved Covid survival, and can have a significant positive impact on your mental health.

There is a lot of confusion about testing and test results. And, to be honest, the picture is not clear. Rapid Immunoglobulin testing has gained significant traction. Several of you have already had the test. While the accuracy of the testing nationwide is under investigation, we still have to make certain assumptions based on the information we have. If you have a positive IgM it suggests that you have had a recent exposure to Covid. IgG antibodies develop later following infection, and generally do not begin to appear until 7 – 10 days after infection. When IgG antibodies are present it often indicates a past infection but does not exclude recently infected patients who are still contagious, especially if detected with IgM antibodies. It is unknown how long IgM or IgG antibodies to SARS-CoV-2 will remain present in the body after infection and if they confer long term immunity. Therefore, we suggest, if you are positive for IgM (with or without IgG) that you follow strict isolation guidelines for 2 weeks assuming you can be contagious. If you are positive for IgG only, then hopefully congratulations is in order. We do not suggest letting your guard down and encourage you to follow statewide mandates. However, there is a good chance you have some degree of immunity which could have implications going forward. There are several options for testing for active Covid infections. If you have symptoms that are concerning please call (561) 642-1000 to schedule a test at FITTEAM ballpark of the palm beaches. Another option, while a little pricey, is a home test provided by Access labs in Jupiter. If interested please go to https://accessmedlab.com/covid19.

Some of you who have tested positive have generously volunteered to donate plasma. While the protocol is not exactly clear, we have been made aware that Oneblood is taking plasma donations at their center in Pompano. If interested, please check their web site at Oneblood.org.

We are very thankful to you, our wonderful patients, for your patience and understanding during these difficult times. Although we are encouraging you to stay away from the office to avoid unnecessary exposure, we are still available and ready to take care of any issues, Covid related or not. We look forward to seeing you face to face in the near future when things settle down.

 

Sincerely,

Morgan and Amir

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