Doctors “Just Say No”?
Supplements in Urine
Ask Dr. J: Silymarin
Ask Dr. J: Surgery Supplements
In the Health News
Diet and Disease
Recipe of the Month: Curried Potatoes (with
A recent Wall Street Journal article said some doctors were
increasingly reluctant to recommend many drugs, both prescription
and over the counter, based on their lack of benefit, potential
risks, and fear of antibiotic resistance. They appear to be
doing this in spite of patients’ desire to receive treatments
that they have heard about on TV or read about in other media.
The doctors have good reason to resist patient pressure to
prescribe drugs for their everyday illnesses, and especially
The article noted that doctors are offering other options
for cough and congestion, headaches, constipation, and infections.
Although interest in alternative medicine is increasing, the
report on conventional doctors shying away from drugs was
a pleasant surprise. I was not so encouraged when I saw the
chart of “alternatives” to pain pills, decongestants,
cough medicines, and others.
They included “steam showers and fluids” for
congestion, “hot tea with lemon and honey” for
coughs, “cut back on caffeine and chocolate” for
headaches, “increase fiber and fluids” for constipation,
and “wait and see...” for infections. While these
are not bad recommendations, they are either inadequate (except
for the fiber and fluids), or they ignore all of the natural
remedies that are available. (Although most infections are
viral, “wait and see” is insufficient for patient
satisfaction, and ignores all the natural treatments that
Here are some examples of natural remedies: N-acetyl L-cysteine
(NAC) is useful for congestion. It helps loosen secretions
and enhances the ability to clear mucus from the lungs, ears,
and sinuses. Vitamin C is valuable for immune support, and
as an anti-inflammatory, and you can also add echinacea, vitamin
E, beta 1,3 glucan, and elderberry extract, shown to fight
viruses, including flu. I have reported on zinc lozenges to
help manage viral sore throats and shorten infections.
For headaches, elimination of caffeine and chocolate are
sound recommendations, but in addition, other food allergies
or alcohol might be precipitants of migraines, and dietary
sugar may be one of the culprits. Supplements of riboflavin
or standardized feverfew can prevent migraines. Ginkgo biloba
may help, as can 5-hydroxy tryptophan (5-HTP), as well as
stress management and biofeedback.
It is good that highly-promoted and expensive drugs are getting
a reappraisal, as well as older, inexpensive drugs such as
aspirin. The new ones are frequently ineffective, and no better
than older, less expensive drugs for the same conditions.
With effective natural remedies available, the drugs are often
unnecessary. I am hoping that these doctors who are realizing
the shortcomings of their current treatments will investigate
further into alternatives, and take some of the courses in
this field, such as those offered by the American College
for Advancement in Medicine (ACAM).
“Taking dietary supplements is useless and costly, and
it only creates expensive urine.” It is incredibly frequent
that I hear this criticism of taking vitamins and other dietary
supplements. It is a meaningless comment from a scientific
perspective for a number of reasons.
The assumption behind this statement is that if you take
supplements of nutrients that are only needed in extremely
small quantities, they will be mostly excreted, and therefore
not of value in promoting health and preventing or treating
disease. This is not simply naive; it reveals a profound ignorance
of the medical literature on the value of supplements, or
a biased agenda on the part of supplement antagonists.
It is true that a percentage of some high-dose supplements
is excreted in the urine. It is also true that not all of
the vitamins that you take get absorbed into the bloodstream.
This does not at all mean that they are not useful. It is
not so important whether you excrete some of the various nutrients;
what is important is what they do on their way through the
body (or on their way through the digestive tract if they
do not get completely absorbed).
One way to look at this is by comparison with water. Of course
you excrete all of the water that you consume (otherwise you
would blow up like a water balloon). You excrete some through
the urine, some through the intestines, some through sweat,
and some as moisture vapor in the breath. But the fact that
you excrete it does not mean that you do not need to drink
Nutrients have benefits through their effects on cellular
metabolism, through antioxidant activity, and through detoxification
of harmful chemicals and metabolites. They may pass through
cells, but they help those cells on the way.
Vitamin C is a good example. If you take above about 200
mg per day, you will probably excrete some in the urine. This
does not mean that your maximum need is 200 mg. Linus Pauling
had the following interpretation:
Your body expends energy to conserve vitamin C in the kidneys,
a waste of energy if you don’t need that much (wasted
energy leads to evolutionary failure of a species). Above
200 mg, your body recognizes that you have met the minimum
for the day, and after that if some is lost in the urine it
is not so critical. Pauling concluded that about 200 mg is
the minimum that your body wants, not the most it can use.
Aside from the theoretical analysis, numerous studies show
that vitamin C supplements are beneficial for prevention and
treatment of illness, even in doses higher than 200 mg. For
example, 2000 mg of vitamin C can prevent exercise induced
asthma in young adults (20 patients were studied, and 9 of
them had significantly reduced symptoms). Vitamin C is the
major antioxidant substance in the lining of the lungs.
Similar doses of vitamin C have been shown to reduce the
frequency of colds and reduce symptoms in those who do become
ill. With doses of 1000 mg, the subjects in the active group
also recovered faster than those on placebo.
In another trial in 1977, 500 mg of vitamin C weekly and
1500 mg at the start of a cold reduced the severity and days
lost to illness, but not the frequency of colds. The authors
noted that higher doses were unnecessary to achieve the reduction
in symptoms, but they did not consider that higher doses might
also have reduced cold frequency and helped to further alleviate
Vitamin B2 (riboflavin) is another example of a high dose
vitamin having benefit, despite urinary excretion. In a randomized,
double-blind study of 55 migraine sufferers, a daily dose
of 400 mg of riboflavin significantly reduced the incidence
of headaches. It is clear that this dose leads to some B2
excretion (turning the urine a bright yellow), but it still
has therapeutic value.
Even nutrients that are excreted have value on their way
throught the kidneys, bladder and urethra. Magnesium and vitamin
B6 help to reduce the formation of kidney stones. Vitamin
C helps prevent inflammation, infection, and cancer. In one
study, high doses of vitamns A, C, E, and B6 cut the recurrence
rate of bladder cancer in half. Those on the supplements had
double the average survival time.
Have no concern about biased and unscientific comments when
deciding on what nutrients to take. “Expensive urine”
is good !
Q. Can I take silymarin for my liver continuously, or do I
need to take breaks as with some other herbs? EJN, England,
A. Silymarin is an extract of milk thistle, and it is valuable
as protection for the liver under the stress of alcohol damage,
hepatitis, and toxic chemical exposure. It comprises several
potent antioxidant flavonoids, and supplements help to regenerate
damaged liver cells. (It appears that much of the damage to
the liver in disease states is due to oxidative stress.)
Silymarin also helps immune function by protecting the white
blood cells (lymphocytes) from toxins, and increasing their
production. Cirrhosis patients may have altered immune function,
and this immune enhancement may be one of its mechanisms of
action. Silymarin also appears to help as a topical antioxidant
to protect against UV and oxidative damage (along with other
topical antioxidants, vitamins C and E, selenium, zinc, and
I have seen no evidence that silymarin causes any side effects
or loses value with regular use, even if taken consistently
for the long term. In fact, it is likely that for someone
with hepatitis, cirrhosis, or toxic exposures, it might be
a good idea to take silymarin indefinitely. The usual dose
of standardized milk thistle (80 percent silymarin extract)
is 500 to 1000 mg.
Q. How should I alter my supplements for my upcoming surgery?
JM, Lexington, MA, via Email
A. I wrote about nutrients for healing from trauma and surgery
last month, but several readers asked me to translate that
into practical guidelines before and after surgery. (Herbs
For about 7 to 10 days before surgery, I suggest eliminating
supplements of ginkgo biloba, garlic, and more than 400 IU
of vitamin E because of antiplatelet effects, delaying blood
clotting. After surgery, add back the extra vitamin E.
For promotion of the healing process, it depends somewhat
on the specific operation and organs involved, but in general,
for the week before the procedure, I recommend increasing
vitamin C intake to 8-10 gms daily, plus 2-3 gms of mixed
bioflavonoids. Take L-arginine and L-glutamine (4-8 gms of
each) to promote repair and wound healing, continuing after
the operation for several weeks, or more if the surgery is
Increase coenzyme Q10 for its antioxidant value and immune
support. Usually 200 mg is enough, but it depends on the surgery.
Curcumin (600-1200 mg) and silymarin (500 mg) are antioxidants
and anti-inflammatory (and silymarin helps the liver detoxify
the anesthetic.) Bromelain (pineapple enzyme) hastens tissue
repair (10,000 -20,000 MCU) before and after surgery.
Make sure your multi has zinc (30-50 mg), selenium (200 mcg),
manganese (10-20 mg), and other trace elements as antioxidant
cofactors, and for immunity and tissue repair.
Before and after serious surgery, such as on the heart: increase
coQ10 to 400-800 mg, add L-carnitine (3-6 gms), N-acetyl cysteine
(1-2 gms), lipoic acid (300-600 mg), and proanthocyanidins
(100-200 mg), all to protect the heart and brain, and D-ribose
(10-30 gms), a small sugar molecule that is important for
heart muscle energy.
• A new study shows that menopausal women who smoke
cigarettes or are obese (body mass index (BMI) over 30) are
much more likely to have moderate or severe hot flashes than
women who have a normal BMI (under 25) and are non-smokers
(Whiteman MK, et al., Smoking, body mass, and hot flashes
in midlife women. Obstet Gynecol 2003 Feb;101(2):264-72.)
Women who never smoked had about half the risk of hot flashes
compared to women who were current smokers. The statistics
were similar for obesity. High BMI doubled the risk of hot
flashes. Supplements can help relieve hot flashes, and some
women need natural hormones, but losing weight and stopping
smoking are risk free and inexpensive, and may make a big
• Sadly, only 16 percent of Americans eat the recommended
five to nine servings of fruits and vegetables per day. A
survey done in Minnesota (DeBoer SW, et al., Dietary intake
of fruits, vegetables, and fat in Olmsted County, Minnesota.
Mayo Clin Proc 2003 Feb;78(2):161-6.) showed that the vast
majority eat too much fat and far too few healthy fruits and
vegetables. Education, especially through setting a good example,
is one way the medical community can help improve public health.
• The above statistic is particularly important in
light of a recent review of the value of phytochemicals from
vegetables, fruits, whole grains, beans, nuts, and seeds,
and both flax and olive oils. (Kris-Etherton PM, et al., Bioactive
compounds in foods: their role in the prevention of cardiovascular
disease and cancer. Am J Med 2002 Dec 30;113 Suppl 9B:71-88.)
These beneficial compounds provide important protection against
heart disease and cancer, and they reduce excessive blood
clotting and inflammation, preventing other diseases as well.
I love curry dishes for their flavor as well as health value.
This is a simple and quick meal or snack. Boil, bake (or,
optionally, microwave) potatoes for as many servings as you
want. Slice them open in a crisscross pattern and drizzle
some flaxseed or olive oil into the crevices. Sprinkle in
curry powder and thyme to taste (I use a lot, and I also add
extra cayenne). You can then spread chopped cilantro over
the top, and other herbs if you like (fresh dill is also excellent).
You can serve this with some sliced tomatoes and cucumbers.
I also poach some organic eggs (not just free range, as these
may only see the outdoor light for 10 minutes per day!), lay
them on top of the potatoes, and slice them to mix with all
the other flavors.
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