Dear Dr. Roach: You recently wrote that you do not recommend healthy people take supplements. What about training athletes? I’m thinking creatine for weightlifters, coenzyme Q-10 and B vitamins for endurance sports. I also have read newspaper reports citing vitamin D deficiency as “epidemic” in the general populace. For someone training one to two hours per day, is diet sufficient?
Dear C.G.: The jury is still out on vitamin D. Although at least 40 percent of Americans and 32 percent of Canadians have vitamin D levels below the recommended level, most authorities don’t recommend testing unless they are at high risk (dark-skinned, very overweight, taking medicines that affect vitamin D, in a chronic-care facility, those who rarely go into sun and who wear protective clothing or consistently wear sunscreens, and people with known osteoporosis or malabsorption, such as inflammatory bowel disease or celiac disease). Similarly, most authorities do not recommend giving vitamin D to nonpregnant healthy adults. Further recommendations will be guided by ongoing studies of the effect of vitamin D.
Creatine is very commonly used by weightlifters, and several studies have confirmed that weightlifters who use creatine improve high-intensity, short-duration exercise and improve maximum lifting weight. This effect was seen only in young men, not in older men or in women. There is no evidence that creatine helps endurance athletes. The National Institutes of Health states that coQ-10 is “likely ineffective” at improving endurance performance.
If your goal is overall health, feeling and looking better and improving performance, then supplements are not necessary. For young men looking to improve their personal best or who are in competition, creatine likely helps. There are innumerable supplements purported to up performance: There may be some that are safe and effective, but no other nonprescription medications have good evidence or proof they are safe and effective, to my knowledge.
Dear Dr. Roach: Do varicose veins in the leg still return blood? Does circulation diminish if they are removed? Should the elderly avoid removal? What if a vena cava filter exists for a one-time DVT 25 years ago?
Dear S.S.: Varicose veins are dilated veins. They are very common, especially as we get older, and they seem to run in families. They often come because of leaky valves inside the veins. A previous blood clot is a risk factor, and a filter may make varicose veins and clots more likely.
They do continue to function, returning blood. They should be treated conservatively, with leg elevation, exercise and compression, such as using pressure stockings. I rarely recommend more-aggressive therapy, but if they are symptomatic (pain, tightness, skin irritation) despite a good trial of conservative treatment, they can be treated with laser or radiofrequency ablation, by injecting medication into or around them, or by vein stripping. A vascular surgeon is the expert on these treatments.
Email questions to ToYourGoodHealth@med.cornell.edu.