Monthly Archives: August 2018

What to look for in a daily multivitamin

Our bodies need many different vitamins and minerals to function properly.

Vitamins and minerals also offer us protection against a host of ailments, including heart disease and some cancers, such as colon and cervical cancer.

The good news is that we can get most of the vitamins and minerals our bodies need daily by choosing the right foods and eating a wide variety of them.

Still, many people take a multivitamin daily as an insurance policy — just to be sure they are getting all the vitamins and minerals that their bodies require.

“A multivitamin is a good idea for the trace elements,” says Donald Novey, MD, an integrative medicine physician with the Advocate Medical Group in Park Ridge, Ill.

“You want a multivitamin for all those little things at the bottom of the ingredients list. The ones at the top of the list are familiar and the ones we can’t avoid if we’re eating enriched foods. It’s the trace elements at the bottom that are the ones often missing.”

Trace elements include chromium, folic acid, potassium, iron, manganese, selenium, and zinc.

Daily Vitamin: Our Needs Change With Age

Vitamin supplements can be particularly important during certain stages of our lives, Dr. Novey says. For example, women in their childbearing years can benefit from folic acid, which decreases the risk of some birth defects. A pregnant woman needs a multivitamin, starting in the first trimester, to ensure that the baby receives proper nutrition. Active and older women can benefit from increased calcium, which can help prevent bone loss and fractures. Vegetarians also can benefit from taking extra calcium, iron, zinc, and vitamins B12 and D.

Does it matter what time of day you take a multivitamin? Not really, says Stephen Bickston, MD, AGAF, professor of internal medicine and director of the Inflammatory Bowel Disease Center at Virginia Commonwealth University Health Center in Richmond. However, he says, some people find it helpful to take vitamins at the same time every day. If it becomes part of their routine, they are less likely to forget. Also, he says, some people feel that if they take their vitamin with food, it is less likely to cause stomach upset. “I often recommend that people take a chewable vitamin,” Dr. Bickston says, “because they seem to be well tolerated, even in people who have serious digestive conditions, which is what I deal with in my practice.”

Help Ease Chronic Fatigue Syndrome

Patients with chronic fatigue syndrome who participated in programs aimed at helping them overcome their symptoms — a combination of exercise and counseling — improved more than those whose treatment was intended to help them adapt to the limitations of the disease, a large randomized trial found.

Mean fatigue scores among patients treated with graded exercise therapy — a tailored program that gradually increases exercise capacity — were 3.2 points lower than scores in patients who received specialist medical care alone, according to Dr. Peter D. White, of Queen Mary University of London, and colleagues.

Furthermore, fatigue scores were lower by 3.4 points among patients receiving cognitive behavioral therapy, in which a therapist works with the patient to understand the disease, alleviate fears about activity, and help overcome obstacles to functioning.

In contrast, among patients who were treated with a program known as adaptive pacing therapy, which emphasizes energy limitations and avoidance of excess activity, scores differed by only 0.7 points the researchers reported online in The Lancet.

In a press briefing describing the study findings, co-investigator Dr. Trudie Chalder, of King’s College London, said, “We monitored safety very carefully, because we wanted to be sure we weren’t causing harm to any patients.”

“The number of serious adverse events was miniscule,” she added.

Another co-investigator, Dr. Michael Sharpe, of the University of Edinburgh, commented that a difficulty in the management of chronic fatigue syndrome has been ambiguity — about the causes and whether these treatments recommended by NICE actually are effective.

“The evidence up to now has suggested benefit, but this study gives pretty clear-cut evidence of safety and efficacy. So I hope that addresses the ambiguity,” Sharpe said during the press briefing.

4 Ways to Save Energy With Chronic Fatigue Syndrome

However, the investigators conceded that the beneficial effects of these treatments were only moderate, with less than one-third of participants being within normal ranges for fatigue and functioning, and only about 40 percent reporting that their overall health was much better or very much better.

“Our finding that studied treatments were only moderately effective also suggests research into more effective treatments is needed,” they wrote.

In addition, they stated that their finding of efficacy for cognitive behavioral therapy “does not imply that the condition is psychological in nature.”

The importance of cognitive behavioral therapy was further emphasized by Dr. Benjamin H. Natelson, of Albert Einstein College of Medicine in New York.

“This approach of encouragement of activity and discouragement of negative thinking should be a tool in every physician’s armamentarium,” he said.

Spreads Outside Hospitals

The dangerous bacteria Clostridium difficile spreads not only in hospitals but also in other health-care settings, causing infections and death rates to hit “historic highs,” U.S. health officials reported Tuesday.

C. difficile is a deadly diarrheal infection that poses a significant threat to U.S. health care patients,” Ileana Arias, principal deputy director at the U.S. Centers for Disease Control and Prevention, said during a morning news conference. “C. difficile is causing many Americans to suffer and die.”

The germ is linked to about 14,000 deaths in the United States every year. People most at risk from C. difficile are those who take antibiotics and also receive care in any medical facility.

“This failure is more difficult to accept because these are treatable, often preventable deaths,” Arias said. “We know what can be done to do a better job of protecting our patients.”

Much of the growth of this bacterial epidemic has been due to the overuse of antibiotics, the CDC noted in its March 6 report. Unlike healthy people, people in poor health are at high risk for C. difficile infection.

Almost 50 percent of infections are among people under 65, but more than 90 percent of deaths are among those aged 65 and older, according to the report.

Previous estimates found that about 337,000 people are hospitalized each year because of C. difficile infections. Those are historically high levels and add at least $1 billion in extra costs to the health care system, the CDC said.

However, these estimates might not completely reflect C. difficile’s overall impact.

According to the new report, 94 percent of C. difficile infections are related to medical care, with 25 percent among hospital patients and 75 percent among nursing home patients or people recently seen in doctors’ offices and clinics.

Although the proportion of infection is lowest in hospitals, they are at the core of prevention because many infected patients are transferred to hospitals for care, raising the risk of spreading the infection there, the CDC said.

Half of those with C. difficile infections were already infected when they were admitted to the hospital, often after getting care at another facility, the agency noted.

The other 50 percent of infections were related to care at the hospital where the infection was diagnosed.

The CDC said that these infections could be reduced if health care workers follow simple infection control precautions, such as prescribing fewer antibiotics, washing their hands more often and isolating infected patients.