Calcium, Vitamins, Osteoporosis
Dear Dr. Roach: I am a 59-year-old woman. I weigh 116 pounds and am 5 feet, 3 inches tall. Before I go to the office, I am at the gym four or five mornings a week, working out for an hour. My focus is on weight-bearing exercise. I believe my diet would be considered good (limited meat, high in fruits and vegetables, alcohol in moderation). I do have osteoporosis, for which I take a Fosamax generic. My osteoporosis diagnosis was made five years ago. Since taking a weekly pill, the condition has stabilized and even has improved slightly. At my most recent visit, about 12 months ago, my physician encouraged me to take increased doses of calcium and vitamin D supplements, which I have done — and therein lies the question: While I certainly may be misinformed, I continue to hear/read that vitamin supplements really don’t do much and that absorption is minimal, so why bother? — D.U.
Answer: The issue about supplements in general and vitamins in particular is that for people who are healthy and with no symptoms, there is very little evidence that they make you healthier. More importantly, there’s no way to treat symptoms if there aren’t any, so supplements taken to prevent problems from arising should be proven before making a general recommendation. In my opinion, the burden of proof to take a treatment to prevent disease needs to be higher than that for treatment of conditions.
In the case of osteoporosis, the data are clear that calcium and vitamin D improve bone density, and it is probable that this combination reduces fracture rate. Moreover, calcium is needed when taking Fosamax and medications like it, to be effective.
Absorption of vitamin D is very good, and vitamin D improves calcium absorption. Most vitamins are well-absorbed.
Dear Dr. Roach: Your recent article addressed tinnitus as the perception of sound from no external source. Does a similar explanation exist for the perception of odors? — Anon.
Answer: Tinnitus is indeed the perception of sound with no external source, and auditory hallucinations are perceptions of sound that other people can’t hear. Similarly, phantosmia, the perception of smell in the absence of physical odors, can come from several causes. The most common include neurologic conditions, such as epilepsy, Parkinson’s disease and migraine. Psychological disorders, especially schizophrenia but also mood disorders, can cause perception of odor, which are called olfactory hallucinations.
Because abnormal odor perception is occasionally caused by a brain tumor as well, I recommend evaluation by an ear, nose and throat doctor or a neurologist.
Dear Dr. Roach: I’m 61 years old. About seven years ago, I noticed that my stool had taken on a consistency somewhere between solid and a diarrhea state. During my life, I’ve never had any occurrence of constipation, regardless of what I eat. From what I’ve heard, many folks my age (or even 15 years younger) would love to be in my shoes. However, I’m concerned, because my stool used to come out in a normal, harder state, and this current “mushy” excrement signifies a change in my colon’s functioning. Have you ever heard of such a thing? Should I be concerned? I’ve never had a colonoscopy. Am I at risk for colon cancer? (There is no history of cancer in my family.) — A.
Answer: The good news is that this is not a usual warning sign of colon cancer. However, (nearly) everyone over 50 should get a colonoscopy, and a change in bowel function should prompt an evaluation as well. Get the colonoscopy. Most people with colon cancer don’t have a family history.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or write to P.O. Box 536475, Orlando, FL 32853-6475.