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  1. #1
    Senior Member Redhed's Avatar
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    Is there a (real) Doctor in the house?

    I was wondering, if you are a doctor, do you take classes/training on vitamins, minerals, supplements in general? I have been doing research on the benefits of taking them, I already do, and I noticed that any doctors that I have ever come in contact with never talk about them. The last time I saw my doctor, I brought in an article about vitamin c, he glanced at it for 2 seconds, handed it back and I said he could keep it to read and he shoved it in my file. Then he wrote out a bunch of prescriptions.

    I know that we (in general) eat horrible foods, loaded with preservatives and chemicals, and we rarely get the type of vitamins and minerals that you should get from eating good food, so why aren't doctors interesting in helping people fill the gaps in their nutrition? Is it lack of knowledge or some crazy conspiracy?

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    I am a doctor and the answer to that is a bit complicated. There is a great deal of teaching of biology, physiology and pathology in medical school. There is some quite limited amount specifically about nutrition and supplements etc. The main reason for skepticism from most physicians when it comes to claims about nutrition or supplements has to do with lack of evidence. Physicians, particularly in the last twenty years, have been extensively taught in the scientific method and in the assessment and need for clinical evidence. We have also seen many examples of drugs that "made sense" from a basic science reasoning approach or from animal studies but utterly failed in human trials. The fact is that there have been VERY few randomized controlled trials of nutritional products or diets and most of these have been negative. Many widely held beliefs about vitamins (Vit C for common cold is one example, Vitamin E for heart disease is another) just did not hold up to clinical trial evidence. A few "non trendy" vitamin examples actually made tremendous differences: folic acid supplementation for example has a big benefit in preventing neural tube defects (nasty birth defects including spina bifida) if given to women of childbearing age.

    The other thing is that I believe it's a myth to think that somehow our diet is missing some magical vitamins and that supplements are a solution. Vitamins are usually "permissive" for physiology - you need a minimum amount of most and more isn't any better. Vitamin C is really important if you have NONE - scurvy was a huge killer in previous centuries, that doesn't mean that more is better. If you think about it we evolved over thousands of years with a vastly more restricted diet than now available. Even our parents generation marvel at the fresh produce and relative cheapness of food available to us. Much food is supplemented for certain vitamins that used to cause issues if deficient (Vit D in milk, iodine in salt for example). Our problem is too much food, not too little vitamins. There are exceptions obviously (Vegans need to be careful about protein and iron for example) but the evidence that most people need vitamin supplementation is fairly weak.

    So if someone comes to me with claims about this or that, I am usually fairly skeptical. I'd like to see real evidence (not anecdotes, rationale or claims). I also let them know that excesses of some vitamins (iron for example) and normal doses of many herbal products can cause harm.

    Just my opinion, I could be wrong.

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    Why not just eat "healthy" foods

    I'm a doc but of the engineering kind so I have no deep knowledge in the science of medicine other than what I've read, seen and experienced but my science has trained me to seek the logic in situations. It seems to me that evolution and a 100,000 years of species survival has provided us an easy fix to many of today's afflictions - keep the excess pounds off, exercise and eat healthy foods. Watch the 7:00 news and virtually every ad is for a synthetic fix me up I suppose humans are predisposed to seek the easy solutions and but it has trapped us into a viscous cycle. The more we bloat up the more the drugs are needed to treat the symptons of being overweight and underexercised and then the more we can eat to the next level of discomfort. Interestingly most of the drug ads are for prescription drugs but promote the idea of the consumer going to their doc to seek the quick fix. Shameful

  4. #4
    Senior Member Redhed's Avatar
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    You can eat healthy and still not get the nutrition in the food, mainly because we rarely eat raw foods (raw as in veggies, fruits) and we cook all the nutrients out of them. As far as the other foods, they are processed and preserved to where there really isn't much value in eating them.

    To lungdoc, I appreciate your honesty. I work with chemists who are very "hard science". One in particular has even tested the vitamins and supplements they take and found that they were worthy of taking. The funny thing is, a study can be slanted to say anything, so I guess I tend to air on the side of caution and take the vitamins. I know I feel a difference when I don't take them. You answered my question though, and that is what I initially thought, that docs tend to believe only in the "hard science" with studies to prove it. I can understand that point of view also. I still go to my doctor, because I have asthma and allergies and when I get to the point where a big dose of vitamin C doesn't work, I know my body well enough to go to the doc. I am guessing that you are a pulmonary doctor? I take one prescription that changed my life with asthma and that is Advair. Excellent drug, even though it costs so much I can't afford it anymore. My doc is a good guy willing to give me samples to keep me going. Is it true that each inhaler costs around 600 dollars a piece????

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    In Canada Advair is 60-120$ per device, which is generally for a month. I don't know USA price, it wouldn't be that much more. Of course with any drug the actual cost of the device and meds is probably less than a dollar. Unfortunately it costs a billion or so to make the first pill, pennies for the next ones and they have to average it out. Advair is a good product (combination of two drugs Flovent and Servent in one device), although Symbicort (Pulimicort and Oxeze in one device) is similar and cheaper, better in some ways (can take more when needed). I don't think Symbicort is available in USA yet. Unfortunately asthma meds in the USA have lagged behind Europe and Canada.

  6. #6
    Man of Leisure Ivan Hanz's Avatar
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    I read an article not too long ago from a MD Phd who specialized in nutrition, he said in his 20+ years he had never treated anyone for vitamin/mineral deficiency, with the exception of people with eating disorders (aneroxic, bulimic). I've read many Dr. articles that paraphrase, 'take whatever you like, (with a few exceptions like Lungdoc mentions,) just don't spend too much on it since you just pee it out anyway.'

  7. #7
    Senior Member jazzy_cyclist's Avatar
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    Quote Originally Posted by Ivan Hanz
    I've read many Dr. articles that paraphrase, 'take whatever you like, (with a few exceptions like Lungdoc mentions,) just don't spend too much on it since you just pee it out anyway.'
    That's true with some vitamins (like C), but not all vitamins and supplements. At high doses, some can accumulate and cause problems.

    I agree with lungdoc intellectually, but I still take some extra C - I do feel a difference when I don't.

    No, I'm not a doctor and have never played one on TV.

    -Jim

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    Senior Member Redhed's Avatar
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    Quote Originally Posted by jazzy_cyclist
    That's true with some vitamins (like C), but not all vitamins and supplements. At high doses, some can accumulate and cause problems.

    I agree with lungdoc intellectually, but I still take some extra C - I do feel a difference when I don't.

    No, I'm not a doctor and have never played one on TV.

    -Jim
    You can actually overdose on water and die from brain swelling. Although, it would probably take a whole lot, with no peeing. I agree, there are some vitamins, herbs and some supplements that cannot be taken in large quantities. I would recommend getting a good book as a resource, or, ask your doctor.

  9. #9
    Designated Drinker Wulfheir's Avatar
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    Quote Originally Posted by lungdoc
    (Vegans need to be careful about protein and iron for example)
    Nuts, grains, soy, sprouts, beans and legumes are good sources of both protein and iron. Although plant-based iron is less-easily absorbed as animal-based iron alone, with the introduction of vitamin c (which is more likely going to be present in a vegan meal) the absorbsion level increases as much as 600 times, surpassing the absorbsion levels of animal-based iron.
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  10. #10
    Custom User Title: jallen's Avatar
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    Good post lungdoc, nice to have you aboard.

    I have bad allergies, but not asthma, but I have similar symptoms when I;m out in the woods riding in high pollen count days. I got an inhaler for my first time (Cant remember name of it right now) and I take two hits before I ride.

    It has just about changed my entire riding experience. No longer am I wheezing from working my lungs really hard on my climbs.

    Cool how those things can be helped. Other than riding in bad pollen days, I dont use an inhaler at all, but it's definately earned a spot in my camelback.
    Learning the ropes of mechanics on my Specialized Hard Rock Sport 2004 that I ride a bit too hard.... and upgrading parts that give me trouble on an excellent frame.

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  11. #11
    Name's Ash ...housewares Doctor Morbius's Avatar
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    Quote Originally Posted by Redhed
    Is there a (real) Doctor in the house?
    Well, I'm not a real Doctor, but I did stay at a Holiday Inn Express last night!

  12. #12
    Designated Drinker Wulfheir's Avatar
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    Morbius,
    Is that Bruce Campbell's mug?
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    Name's Ash ...housewares Doctor Morbius's Avatar
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    Quote Originally Posted by Wulfheir
    Morbius,
    Is that Bruce Campbell's mug?
    The name's Ash ... housewares. Remember, shop smart ... shop S-Mart!

    Klato, Verata, Nicto!

  14. #14
    Designated Drinker Wulfheir's Avatar
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    Quote Originally Posted by Doctor Morbius
    The name's Ash ... housewares. Remember, shop smart ... shop S-Mart!

    Klato, Verata, Nicto!
    CLASSIC!
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  15. #15
    Around now and then DnvrFox's Avatar
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    Is there a (real) Doctor in the house?
    I'm a REAL doctor, but not a "Medical" doctor.

    In England, Medical types are called "Mr." - not Doctor.

    Doctor originally meant "teacher" or "A learned man" or "The highest degree given by a University" but the term has been appropriated by the medical world and just about everyone else to mean a doctor of medicine!
    DnvrFox - still bicycling, swimming, walking and weight lifting at 74yo is participating a bit in BFN 50+.

  16. #16
    Senior Member Richard Cranium's Avatar
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    Much of the confusion about vitamins or other diet supplementation comes from a misunderstanding of concepts regarding metabolism and human performance.

    The misapplication or misuse of vitamins is caused by a failure to understand that they can only restore the "limiting factors" of a metabolic process to "normal". [much like the Doctor's comment about "giving permission"]

    In "sports nutrition" the concept of "limiting factors" is applied to determining which energy substrates, or their catalysts, such as water and oxygen limit metabolic activity (performance).

    Unfortunately, vitamin supplement marketing campaigns take the results of very specific scientific findings about very specific individual metabolic processes out of context and assign their "sports supplement" as the "limiting factor" to a very complex set of interactions.

    This is indeed a difficult topic to explain because the supplementation concepts: "all you need is enough" and "more is better" are applicable to different situations depending on the individual and the circumstance. And which concept applies to which supplement in which situation, if ever.........
    Last edited by Richard Cranium; 10-29-04 at 08:54 AM.

  17. #17
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    I work with a group of about 25 docs and 5 cardiologists. Some are really into the Vitamin thing, some aren't. You should find a Doc that shows more interest.

  18. #18
    Senior Member Redhed's Avatar
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    What a complicated subject. I would like to find a doctor who is more interested, but it is hard to get a doctor in the first place, insurance limits your choices. I have also never heard of a doctor who would let you "interview" them. I wish I could. They rarely have time to talk during an office visit. So far, I have used the trial and error method. I will just keep reading books for information, and asking questions.

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    Several Dr's I know, have left larger practices to start their practice back up with a different type of idea. I hear them called by different names, they basically scale their practice way back and charge a yearly fee. Many patients love it, they get more time with their Dr, when they call the practice, they get to speak directly to the Dr rather than leaving messages and seeing Physician's assistants.

    You might want to look into physicians in your area with these types of practices.

  20. #20
    Jungle lady cbhungry's Avatar
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    It is called boutique or concierge or retainer medicine. http://www.practicebuilders.com/pdf_...rking_1003.pdf

    The main thing is a high surcharge up front. These doctors limit their practice from having a active pool of patients numbering 5-7,000 to only one thousand. It is a good lifestyle option for the doctor and for those patients who can afford it. However, many docs still see this as abandoning patients (especially in severe shortage areas such as Georgia) and discriminatory against those who cannot afford the fees and further perpetuates the perception that those with the financial wherewithal are entitled to a special type of medical care
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  21. #21
    Senior Member trirmk's Avatar
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    Quote Originally Posted by lungdoc
    Our problem is too much food, not too little vitamins.
    Absolutely - I think it's a combination of too many calories in, too little calories out, with those calories coming in being from the inappropriate foods. I'm an exercise physiologist and am working on my M.S. in sports nutrition, so I'm not a doc, but figured I'd throw in my 2 cents regarding the doc's comments.

    There are exceptions obviously (Vegans need to be careful about protein and iron for example) but the evidence that most people need vitamin supplementation is fairly weak.
    If people have a balanced diet (which, as mentioned originally, people typically do not), then vitamin supplementation is not necessary. However, if they are lacking in any area of their diet, supplementing with a basic multivitamin can be recommended without any negative side effects. But supplementing with "magic pills" such as herbal pills or exclusively Iron pills for example are just not needed. Besides the chance of going beyond the tolerable upper limits set for these various single vitamin supplements to reach toxicity, you are risking inhibiting absorption of other nutrients because of the way these vitamins and minerals/nutrients interact.

    So if someone comes to me with claims about this or that, I am usually fairly skeptical. I'd like to see real evidence (not anecdotes, rationale or claims). I also let them know that excesses of some vitamins (iron for example) and normal doses of many herbal products can cause harm.
    Me too. I can't stand hearing people make anecdotal claims about why they're popping 14 different pills 3 times per day when they could simply take a Centrum or something similar. (((Down with the media! )))

    My 2 cents

  22. #22
    Senior Member trirmk's Avatar
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    Quote Originally Posted by Redhed
    What a complicated subject. I would like to find a doctor who is more interested, but it is hard to get a doctor in the first place, insurance limits your choices. I have also never heard of a doctor who would let you "interview" them. I wish I could. They rarely have time to talk during an office visit. So far, I have used the trial and error method. I will just keep reading books for information, and asking questions.
    Why bother with a doc for this stuff anyway? From the sounds of it, some will actually read the article you had on Vitamin C, and some will toss it the second you walk out of the room. MD's have a lot of other stuff to deal with besides vitamin supplementation (maybe toxicity in some cases though?) and not too much to worry about as far as vitamins/minerals go day to day. They have to worry about things like drugs that need to be prescribed to people, and orthopedic issues, and psychological problems that many people suffer from during times of disease or injury....and the list can go on. These seem like the more important things for docs to worry about.

    So forget about your doc...let him treat you for those specific things. When it comes to nutrition, go to a sports nutritionist or an RD (registered dietician). These are the people who can tell you what's out there currently in the research and can give you evidence-based answers that will help you. Nutrition is their life and they are all about prevention first. They will tell you exactly what you need and what you don't need and why.
    Last edited by trirmk; 11-05-04 at 08:14 AM.

  23. #23
    Roadie otoman's Avatar
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    Quote Originally Posted by Ivan Hanz
    I read an article not too long ago from a MD Phd who specialized in nutrition, he said in his 20+ years he had never treated anyone for vitamin/mineral deficiency, with the exception of people with eating disorders (aneroxic, bulimic). I've read many Dr. articles that paraphrase, 'take whatever you like, (with a few exceptions like Lungdoc mentions,) just don't spend too much on it since you just pee it out anyway.'
    Then this guy was not looking hard enough. I am an Otolaryngologist (Ear, Nose & Throat surgeon) and I have come across several deficiencies in my practice, most commonly B12 and iron deficiencies.

    Lungdoc is spot on with his assessment of why most M.D.s pay little attention to vitamin supplementation. Most will tell you that Vit. B and C are fine to supplement as much as you want because they are water soluble - you will pee out the excess. Vitamins A, D, E and K are fat soluble, so the excess will be stored in your fat cells. This can lead to toxicities with long-term, excessive usage.

    I take a 500 mg Vit C, 400 I.U. Vit E, and a multivitamin without iron every day, in addition to my regular meds. Why do I take the E? Some studies have shown that taking up to 800 I.U. of E a day cuts the risk of cardiac ischemic events by almost half. I have treated high cholesterol, so I do everything I can to reduce my risk even though my cholesterol is now normal.

    to DnvrFox, I remember when I graduated from medical school, we were the last graduate school to receive our diplomas. The Deans of the other schools had all asked their students to stand up by saying, "will the doctors of philosophy please stand up", or "will the doctors of jurisprudence please stand up." When it came to our turn, the Dean of the Medical School said, "will the DOCTORS please stand up."
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  24. #24
    Around now and then DnvrFox's Avatar
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    Quote Originally Posted by otoman
    I take a 500 mg Vit C, 400 I.U. Vit E, and a multivitamin without iron every day, in addition to my regular meds. Why do I take the E? Some studies have shown that taking up to 800 I.U. of E a day cuts the risk of cardiac ischemic events by almost half. I have treated high cholesterol, so I do everything I can to reduce my risk even though my cholesterol is now normal.
    Interesting - that is pretty much what I take, but I add glucosamine, chondroitin and Calcium w/D.


    Quote Originally Posted by otoman
    to DnvrFox, I remember when I graduated from medical school, we were the last graduate school to receive our diplomas. The Deans of the other schools had all asked their students to stand up by saying, "will the doctors of philosophy please stand up", or "will the doctors of jurisprudence please stand up." When it came to our turn, the Dean of the Medical School said, "will the DOCTORS please stand up."
    DnvrFox - still bicycling, swimming, walking and weight lifting at 74yo is participating a bit in BFN 50+.

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