Archive for August, 2015

Do You Need Vitamin E?

Q: How much Vitamin E should I take? Is natural Vitamin E any better than synthetic?

Vitamin E is a fat soluble vitamin that works as an antioxidant. An antioxidant helps protect your cells from damage by compounds called free radicals, which are produced by your body during metabolism. It was hoped that Vitamin E’s antioxidant action could decrease the risk of developing cancer, cataracts, heart disease and stroke, but in carefully designed clinical studies Vitamin E supplementation did not provide any benefit. In fact, Vitamin E supplementation was instead associated with an increased possibility of death, hemorrhagic stroke (stroke caused by bleeding into the brain) and prostate cancer.

How much Vitamin E do you need? According to the National Institutes for Health (the NIH), the recommended intake of Vitamin E for adults is 22.5 International Units (IU) daily. Although most Americans get about half that amount from their diet, Vitamin E deficiency is not very common. Vitamin E needs fat for it to be well absorbed, so eating a very low fat diet or having a disease that interferes with digestion or absorption of fat such as Crohn’s disease or cystic fibrosis can increase your risk of becoming deficient. Vitamin E deficiency may cause nerve and muscle damage with numbness in the arms and legs, muscle weakness, and vision problems. Vitamin E deficiency can also interfere with the effectiveness of your immune system.

Should you take a Vitamin E supplement? If most Americans get less than the recommended daily amount of Vitamin E in their diet, would taking it as a supplement make sense?

Most multivitamins  include 30 IU of Vitamin E as alpha-tocopherol, which is considered 100% of the daily requirement for adults by the NIH. High dose Vitamin E supplements of 400 IU contain over 13 times that amount. The most common forms of Vitamin E are alpha-tocopherol and gamma-tocopherol. Gamma-tocopherol is found in foods rich in Vitamin E, with nuts, seeds, oils and green leafy vegetables such as spinach and broccoli the best sources.

Vitamin E as alpha-tocopherol exists in higher concentrations in the body than its cousin gamma-tocopherol, and until recently was assumed to be responsible for Vitamin E’s antioxidant effects. That may not be the whole story. Recent research has uncovered evidence that the key to the antioxidant potency of Vitamin E is the level of gamma-tocopherol, not the amount of alpha-tocopherol in the tissues and blood. Taking a supplement of alpha-tocopherol will actually decrease the level of gamma-tocopherol and suppress Vitamin E’s beneficial antioxidant action. This may explain why alpha-tocopherol supplements have produced negative instead of positive results in controlled research studies.

One study that found high dose Vitamin E supplementation to be helpful was the Age-Related Eye Disease Study, or AREDS. A formula of 5 vitamins and minerals including Vitamin E 400 IU was used in the 5 year study. In the most severely affected study participants, the AREDS formulation of Vitamins A, C and E combined with zinc and copper showed a 25% decrease in the progression of age-related macular degeneration (AMD), a common cause of blindness in the elderly. Those with mild or no AMD did not notice any benefit, however.

Most Vitamin E supplements contain alpha-tocopherol as either the natural form (d-alpha-tocopherol) or synthetic form (dl-alpha tocopherol). The main difference between them is their potency. The natural (d-alpha-tocopherol) form is 1.5 times as potent as the synthetic (dl- alpha-tocopherol) form. Gamma-tocopherol Vitamin E supplements are now available but it’s too early to know if they can prevent  cancers, stroke or heart disease where the alpha-tocopherol form could not.

Unless you have age-related macular degeneration, taking a specific Vitamin E supplement is not only unnecessary but can cause bleeding problems, especially if you already take a blood thinner like warfarin, aspirin, or clopidogrel (Plavix®).  For More information about Vitamin E is available at

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The Ouch of Vaginal Dryness

Q: I’ve had vaginal dryness and burning ever since menopause. K-Y® Jelly doesn’t help much. What else could I try?

You have a lot of company. According to one survey, 60% of all women past menopause experience vaginal discomfort, yet most don’t ever mention it to their doctor because they consider it just another sign of aging.

Menopause causes a cascade of changes in a woman’s body. As the supply of estrogen dwindles, many women experience hot flashes, sleep disturbances, fatigue, and vaginal changes. Breast cancer survivors and those taking medicines like Aromasin® (exemestane) or tamoxifen experience these changes even earlier.

Without the influence of estrogen, the cells that line the vagina and birth canal begin to shrink, or atrophy. They become thinner, less elastic, and less able to secrete lubricating fluids. This leads to vaginal dryness, burning, and itching along with pain and bleeding during sexual intercourse. Ouch!

Vaginal secretions are important, not just for enjoyment of sexual activity but also for their role in maintaining a healthy vagina. They provide an optimal level of vaginal acidity, also called pH. A pH of less than 5 in the vagina discourages yeast infections and encourages “good bacteria” called lactobacillus, crowding out “bad bacteria” and helping prevent bacterial infections.

The simplest, most effective way to reverse vaginal atrophy is to apply a small amount of estrogen directly to vaginal cells. This locally applied estrogen physically changes the cells that line the vagina into younger cells, restoring elasticity and lubricating secretions, changing the pH toward optimal levels and reestablishing beneficial lactobacillus.

Non-estrogen options include using a long-acting vaginal moisturizer regularly to maintain vaginal pH or a more traditional type of personal lubricant right before sexual activity. Many women with vaginal atrophy find they need a product that’s more lubricating than traditional K-Y® jelly.

Can a breast cancer survivor safely use locally applied estrogen to reverse vaginal atrophy? The evidence says YES. It turns out that you don’t need much estrogen if you can apply it directly to the cells. Researchers have documented how locally applied estrogen reverses the signs and symptoms of vaginal atrophy without affecting other areas of the body. When used at approved doses, locally applied estrogen doesn’t trigger any changes in the cells lining the uterus or create any detectable levels of estrogen in the blood.

Locally applied estrogen is available as several products: estrogen cream with a separate applicator (Premarin®, Estrace®, and generic estradiol), vaginal tablets with individual applicators (Vagifem®), and a gelatin ring that releases estrogen (Estring®). The starting dose for the cream and vaginal tablets is once daily at bedtime for 2 weeks, then twice a week as maintenance. Estring® is a prescription-only vaginal ring that’s inserted and left in for up to 3 months. Estring® only works locally, on the tissue it touches. This is different from another vaginal ring called Femring®. Femring® has more estrogen in it than Estring® and is designed to relieve hot flashes and other menopausal symptoms.

Then there are two non-estrogen vaginal moisturizers: Replens® and Restore®. Replens® is a fragrance-free, long-acting moisturizing vaginal gel that supplies up to 3 days of moisture in between applications. Non-prescription Replens® is available as premeasured doses inside individual plastic applicators or as a tube with one reusable applicator. Unlike estrogen, Replens® doesn’t change your vaginal cells, the pH of your vagina or restore its lactobacillus. It does, however, “clean up” debris from old, dried up cells as it begins to work. The package insert warns about vaginal discharge during the first week of use as old cells slough off and come out, like cottage cheese. After that, any discharge is clear and minimal.

Restore® is a fragrance-free “moisturizing personal lubricant” that is all natural and organic from Good Clean Love. It has no polypropylene and the main ingredient is aloe, with help from Oregon grape and calendula. Restore® is designed to match healthy vaginal acid levels and salt balance. I like the applicator, which attaches to the top of the tube so it’s always available. Like Replens®, Restore® doesn’t require a prescription.

Osphena® is a prescription pill taken daily which works on estrogen receptors in the vagina to reduce the pain of sexual intercourse, called dyspareunia. If your insurance doesn’t pay for it, it may cost up to $160 for a month’s supply. However, Osphena® doesn’t do a very good job at relieving vaginal dryness and is definitely NOT intended for anyone with a history of breast cancer.

Which option is best for you? If you have had or are at high risk of breast cancer, I suggest you talk to your doctor about prescription-only vaginal tablets. Some women combine vaginal tablets with estrogen cream applied to the outside tissue. If this isn’t enough to relieve your symptoms, adding a non-prescription lubricating gel like Replens® or Restore® may help. If you don’t have a high risk of breast cancer, using an estrogen cream vaginally is also an option. Please tell your doctor about your discomfort and explore the options of locally applied estrogen for vaginal dryness.

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How to Select a Motion Sickness Medicine

August 16th, 2015. Filed Under: consumer information, medicines, side effects, Travel.

When my daughter came home to visit last week, she ran into a little trouble with motion sickness. This week’s tip shows you how to avoid this happening to you:

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Aren’t All Blood Thinners The Same?

August 3rd, 2015. Filed Under: consumer information, Medicine dangers, medicines, Warfarin.

Q: My father takes a blood thinner called warfarin and my husband takes aspirin.  My father says he has to have blood tests all the time but my husband doesn’t. Don’t all blood thinners work the same?

Blood thinners can work in different ways because our body uses two different ways to stop us from bleeding. One type of blood thinner works on one of those ways, and the other type works on the other way.

Warfarin and aspirin are called blood thinners because they work to make it harder for our blood to clot, and that causes more blood to leak out of cuts and scrapes. By slowing down the clotting process, a blood thinner makes us bruise easily if we bump ourselves and to bleed more freely and longer when cut or punctured.

Your body has a special system to call for help when you are injured. There is a trigger chemical that lies right underneath the lining of each of your blood vessels, covered up like a bedspread covers up the sheets on a bed. Blood will flow smoothly through your blood vessel as long as the lining of your blood vessel (the bedspread over the sheets) is not disturbed.

When your blood vessel is cut, crushed or torn, it’s like pulling the bedspread up off the bed and showing the sheet underneath. The trigger chemical (the sheet) comes in contact with the blood and starts a chain reaction designed to stop blood from leaking out from that damaged area, eventually forming a clot.

There are 2 stages to this reaction: a rapid response and a slower one. The rapid response slows down the blood flowing through the damaged area and blocks the hole so less blood leaks out. This occurs rapidly from contact with the trigger chemical, which makes clear cells in your blood called platelets get “sticky” and clump together around the damaged area. Like rocks in a stream, these clumps of cells work to slow down the flow of blood and decrease the amount of blood leaking out of your cut or puncture.

The clot is formed by the slower process which eventually stops the bleeding completely instead of just slowing it down. There are 10 or so compounds in your body called clotting factors that work together to seal up leaks in your blood vessels. Until they are needed, these clotting factors just float around in your blood in a form of storage. They are always available but not active until something triggers them to change.

When one of your blood vessels is cut or torn, the trigger chemical inside its lining is in contact with your blood and starts a chain reaction of your clotting factors. As they flow by the injury they change into an active shape and work together to form a secure seal or blood clot over the leaking blood vessel. This takes about 12 seconds in most people.
Aspirin works as a blood thinner by permanently changing the platelets in your blood so that they can’t clump up. You must make new platelets without being on aspirin for its effect to wear off, which takes about a week. This is why many surgeons instruct you to stop aspirin 1 week before an upcoming procedure or a colonoscopy.

Warfarin also works as a blood thinner, but in a different way. Instead of affecting your platelets, it interferes with the way your clotting factors work together to seal up the leak in a blood vessel. Warfarin dosing is complicated and regular blood tests need to be done to make sure you are getting the right amount for you.

The higher the dose of either warfarin or aspirin the more they slow down the clotting process and the higher the chance you could experience serious bruising or life-threatening bleeding. Taking both aspirin and warfarin at the same time can be dangerous and should only be done if directed by a physician or medical provider and under their regular supervision.

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