Supplements, Substitution, and Substance

Dear Doctor Littleton: Do believe supplements really help any?  My wife has me on fish oil, vitamin C, red yeast rice, flack seed oil, St. John's Wart, ginseng (she says the Korean is the best), acetyl L-Carnitine, coenzyme Q-10, vitamin D, magnesium, psyllium husk, probiotics, glucosamine, reservatrol, and saw palmetto.  It takes me thirty minutes in the morning to take all these things because I'm tired of arguing with her about it. 

Sounds like she loves you and wants you to live well. 

However, if she read a recent study, she might be trying to kill you.  You might ought to ask her. 

The alternative medicine industry is enormous, estimated at $5 billion a year.  I would guess that at least 50% of my patients are on some supplement of some type.  Either by their choice or their spouse's. 

Two important questions have to be answered, though: does it work and how pure is it? 

I believe there are probably more answers to the conditions that ail us in the plant and herbal world than we even know. Ancient texts from Assyria mention the medicinal qualities of the leaves and bark of the willow tree.  We now know that molecule is the precursor of aspirin. 

Sitting on my desk as I write is a hot beverage extracted from beans (coffee, not lima). Standing outside this building are some folks setting fire to a plant and inhaling it.  A commonly used cream for arthritis is from a hot pepper (capsaicin) and causes real trouble for folks who confuse it with their hemorrhoid cream. 

A report in BMC Medicine and cited in the New York Times last month, however, casts a long shadow over the actual product in the bottle purchased on the shelf. 

Canadian researchers tested 44 bottle from 12 companies of popular supplements purchased over the counter.  They tested the components using DNA barcoding, a sort of fingerprinting for plants that detects the unique presence of a plant in a mixture.  Think of it as a facial recognition for plants. 

One-third of the supplements tested showed complete substitution of the intended product with another product. 

The most common replacement products were ingredients from other plants not listed such as soybean, rice, and wheat. In bottles of echinacea, a product many use for treating colds,  the bitter weed, Parthenium hysterophorous, noted as invasive plant in Australia and India, was also present in high enough concentration to cause rashes, nausea and flatulence (a troubling side effect when sneezing and coughing.)

Most troubling was the presence of some nut products not listed on the label.  This could be a real issue for those with nut allergies, even potentially fatal in an extreme case.  

The standard for purity and quality are much higher for prescription medicine companies, even to the point of creating shortages due to the tight regulations on production of generic prescription medicines. The F.D.A. is the agency responsible for regulating the supplement industry and does audit a small number of companies every year.  The supplement industry attempted to dispute the findings, but even admitted there are some quality control issues in the their industry.  

Essentially, prescription drugs are known to be safe (pure product) before selling.  Supplements are considered safe (pure) until proven otherwise.  

The point is that there are likely many benefits to vitamins and herbs that we have not even discovered.  Hopefully, solid research will confirm many of these.  My guess is the Chinese, who have been using natural products for over 2,000 years, have more insight into this than traditional western medicine.

 

But, if you don't feel right, or you stomach is feeling strange, or you are just not sure where that rash is coming from, consider looking at everything going in your mouth from prescription medicines, to supplements, and to your diet.  As always, discuss it with your physician and do your research on the companies you are trusting.   

Eric J. Littleton, M.D. is a Family Physician in Sevierville, TN.  He will be relocating to his new office at 958 Dolly Parton Parkway in January 2014. Topics covered are general in nature and should not be used to change medical treatments and/or plans without first discussing with your physician.  Send questions to askdrlittleton@gmail.com. 

Low 'T' or Too Much Sweet Tea? What is the 'T' in your Fatigue?

Doc Littleton – I am a middle aged male, working hard, but feel tired all the time.  Do I have low-T?

 

It might be low-‘T’ (testosterone).

 

It might be sweet ‘tea’ (diabetes).

 

It might be‘t’ as in time to think about something more serious than the commercial suggested.

 

This is a very common question I hear from a lot of middle aged men who are working hard in their business and then feel like old men when they get home.  The recent advertisements on TV and radio have caused more men to actually go to their physician and ask.  Their wives have usually been telling them to do that for a year or more.

 

One of the biggest challenges for men to accept is that they may not be able to control every area of their lives.  Especially fatigue. 

 

Low Testosterone can be a source of fatigue in men and can easily be checked with a blood test.  There are risks of taking supplemental testosterone including upsetting the liver, fueling an undetected prostate cancer, a suspected increase in heart attacks, and in extreme cases, possible liver cancer. 

 

It is extremely important that the testosterone gel never come in contact with a young female or pregnant woman. 

 

It is the other causes of fatigue that should be focused on in the majority of patients.

 

Is there a heart condition that is undiagnosed? 

 

Or is it the sweet tea (diabetes)? The great actor Tom Hanks recently revealed he is diabetic in spite of appearing to be in reasonably good physical shape.  It can happen to anyone.

 

Or is it an undiagnosed tumor in the colon? Liver? Pancreas? Kidney? Lung? Maybe even the brain?

 

Or maybe the snoring has reached the point of causing significant sleep apnea and poor sleep.  The strongest most resilient person can be reduced to depression and fatigue from the lack of sleep – whether it be from sleep apnea or simply staying up too late with their computer, tablet or TV. 

 

There are many other causes which may also be checked, but the one I see often is simply the stress, worry and frustration that seems so prevalent in men who are trying to be good husbands, fathers, and business men in this modern digital world.

 

It has never been so easy to see the apparent wonderful lives of others and wonder why our own life is so difficult and frustrating.  What isn’t seen, though, is that everyone, without exception, faces challenges everyday either from that day’s events, or events from their past which still haunt them.

 

Some people will allow this thought process to weigh them down, either with worry, or fear, or anxiety, or simply a smoldering anger of “Why me?”

 

The chronic process of this negative thinking will lead anyone into feeling tired, fatigued and any of a number of physical ailments. I have seen this countless times. 

 

And it can be treated - many times without medication, sometimes with a few months of medication. Yes, sometimes with a lifetime of medication and lifestyle changes.

 

But wouldn’t it be worth it to wake up everyday feeling better physically and mentally? Wouldn’t it be worth knowing what the cause is, even if serious or life threatening, and be able to face it directly?

 

Isn’t an unknown cause of fatigue more frustrating than a known cause? Even if it is a cancer?

 

Fatigue shouldn’t be simply accepted as part of the normal day, nor should it be diagnosed by a thirty second commercial trying to sell a $250 a month product.  Ask your physician.

 

Then think about listening to music and reading at night instead of TV. It’s good medicine, too.

Eric J. Littleton, M.D. is a Family Physician in Sevierville, TN.  He will be relocating to his new office at 958 Dolly Parton Parkway in January 2014. Topics covered are general in nature and should not be used to change medical treatments and/or plans without first discussing with your physician.  Send questions to askdrlittleton@gmail.com.