This Is Your Life

Who doesn’t know that taking care of your body early on will pay off in the end? How to do that is another story. Seattle doctors answer 30 of the biggest questions you’ll have at every stage of your life.

By Matthew Halverson December 9, 2008 Published in the December 2008 issue of Seattle Met


Preparing & Preventing

I travel internationally for my job. How do I stay healthy while I’m overseas? Congratulations! You’ve been promoted to team leader, which comes with a 12 percent raise, a corner office, and an increased risk for typhoid. The economy being what it is, overseas business travel ain’t what it once was, but if you do have to fly to Mumbai, says Dr. Peter McGough, chief medical officer at UW Medicine Neighborhood Clinics, it’s critical to be “in tune to what kinds of immunizations are going to help you when you’re overseas.” Bottom line: Some of the most common ailments you’ll need to protect yourself against are hepatitis A and B and typhoid, but visit for a country-by-country list.

Based on my family medical history, what conditions am I at risk for? In your early 20s, the only thing you may be suffering from is delusions of invincibility, but that will pass—and may be replaced with something more serious. McGough advises talking to your primary care physician (if you don’t have one yet, it’s time to get a referral) to put your hereditary health cards on the table. Bottom line: By identifying “any genetic traits that we need to be potentially screening for,” McGough says, you’ll be aware of potential problems and what to do if they crop up.

What sexually transmitted disease am I most at risk for getting, and how do I protect myself? Even if you caught the occasional after-school special and paid attention in sex ed class, you may not know as much about STDs as you think. For example, human papillomavirus (HPV), which can lead to cervical cancer, is one of the sneakier infections you’ll encounter because not only can you have it and not know it, condoms aren’t 100 percent effective in preventing its spread. Little revelations like that, says Dr. Mia Wise, who practices family medicine at Swedish Medical Center, are reason enough to talk to your doctor about sex. “The more you know, the better off you’ll be,” she says. “It doesn’t mean you can’t have sex without getting these diseases, but gosh, wouldn’t you rather know your risks and not just get surprised by it?” Another tip: If you were born before 1991, there’s a good chance you haven’t received the vaccine for hepatitis B, another relatively common STD that can cause liver damage or cancer.

Is my weight healthy? It may not seem like the most self-aware of questions—What, you can’t look in the mirror or step on a scale to figure out that you’re headed in the wrong direction?—but it will open up a dialogue about lifestyle choices that does you more good the sooner you have it. “I want to plant a seed for them that healthy lifestyle choices in your 20s can make such a difference in your health,” Wise says. “It’s my opportunity to say, ‘You need to keep your weight below this range, let’s check your cholesterols, and make sure you know what a low-fat diet is.’ ” Bottom line: No matter how much you weigh, now’s the time to start cutting back on the fast food and beer and start eating more fish, fruits and vegetables, and whole grains.

SELF CHECK IN: Am I getting enough calcium? Like a lot of bodily breakdowns, osteoporosis doesn’t start demanding your attention until your chance to prevent it has passed. Get your calcium now (the Institute of Medicine recommends at least 1,000 milligrams a day, or what you’d get from about three eight-ounce glasses of milk), while you’re still reaching your peak bone mass, to reduce the risk of severe bone loss in your 60s and beyond.

SELF CHECK IN: Am I wearing sunscreen? That golden brown tan may look good now, but it’s going to come back to haunt you later. If you want to maintain young-looking skin when you’re in your 40s and 50s, start investing in sunscreen that blocks both UVA and UVB rays in your 20s, says Dr. Annalisa Gorman, a dermatologist at Swedish Medical Center. “The most important thing you can do is just protect your skin from the beginning.”

FOCUS / Nutrition

“It’s never too early to start eating well,” says Minh-Hai Tran, a nutritionist from the local dietary counseling group NutritionWorks and cocreator of Zing nutrition bars. “But the earlier you start, the easier time you’ll have in maintaining these healthy habits.” With that in mind, Tran helped us identify six vitamins and nutrients you’d do well to add to your diet now.

WHAT IT DOES: Good especially for women trying to get pregnant; helps prevent neural tube defects.
YOU’LL FIND IT: Leafy vegetables, beets, citrus fruits

WHAT IT DOES: Helps male fertility
YOU’LL FIND IT: Wheat germ and avocado

WHAT IT DOES: Decreases heart risks, improves brain health
YOU’LL FIND IT: Wild salmon, flaxseed oil, grass-fed beef

WHAT IT DOES: Supports bone health, regulates immune system
YOU’LL FIND IT: Can be found in fish and fortified milk; supplements are best bet

WHAT IT DOES: Linked to lower risk of several cancers
YOU’LL FIND IT: Tomato, watermelon, pink grapefruit

WHAT IT DOES: Promotes eye health
YOU’LL FIND IT: Kale, egg yolks, spinach, corn

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Balancing it all

*I’m in my early 30s and want to have kids, but I’m too busy with work now. Can I put it off for a few more years? *The quality of your remaining eggs begins to decline in your 30s, and by the time you reach 35, your fertility rate can drop by 25 to 50 percent, so if you put it off until your late 30s and have trouble getting pregnant, Swedish’s Dr. Wise says, you should consider fertility drugs or other conception aids. The possibility of complications is only going to increase the older you get. “When someone is over 35, I tell them that, ‘If you don’t get pregnant and you’ve been having intercourse regularly without protection for six months, you don’t wait around anymore.’ ” Bottom line: It’s okay to wait, but your chances of conceiving go down while your chances of pregnancy problems go up.

I have a drink or two almost every night. Am I hurting the quality of my sperm? Good on you for accepting the possibility that you’re just as responsible for successful babymaking. Any doctor will tell you that binge drinking will severely impair your little swimmers, but evidence of moderate drinking’s effect on them is harder to find. Given the lack of attention paid to male fertility by the medical community, though, it’s a good question to ask. Bottom line: Use common sense and cut back if you’re serious about having a baby.

I have a family history of breast cancer—should I start getting screened for it now? Only 5 percent of breast cancer cases occur in women younger than 40, but if your mother or grandmother had it, do you really want to play the odds? “The 50s is when breast cancer becomes a serious issue,” says McGough of UW Medicine. “But we’ve started looking at higher-risk women in their 30s.” Bottom line: If you have a family history of it, start annual mammograms 10 years earlier than the age at which your relative was diagnosed.

Every once in a while I miss a period, but I’m very physically active, so that’s okay, right? Not even remotely, says Dr. Emily Cooper, a physician who treats athletes and other active people at Seattle Performance Medicine. “That’s an indication of being out of balance.” Several things could be contributing to the problem (stress, inadequate nutrition, excessive training), so Cooper suggests conducting a self-assessment to determine where you might be going off the path. And guys, you’re just as susceptible to hormone irregularities if you hit the gym too often. Unfortunately, you don’t have a menstrual cycle that could alert you to the problem, so you have to be even more vigilant. Bottom line: As Cooper says, “If you can’t fuel it, don’t do it.”

I go to the gym after work, when I’m usually a little hungry. But if I eat a snack before I go, won’t I just negate the caloric loss I would have accomplished at the gym? Even though it seems like it should be true, “if you go into a workout hungry or undernourished, when you come out your metabolism will slow down,” says Cooper. “It will be slower than it was before you started.” In other words, you’d burn more calories just sitting at home than you would if you went into an aerobic workout hungry. Bottom line: Look for snacks, like peanut butter and crackers or yogurt, that are heavy on the carbs, with a little fat and protein thrown in for good measure.

SELF CHECK IN: Am I making time for the fun stuff? The 30s can be a busy decade, and it’s easy to get carried away with all of your responsibilities. Bottom line: Setting aside a couple hours here or there to do things that you enjoy can reduce your risks of anxiety-related problems in the future.

FOCUS / Working Out

If you don’t work out regularly, your metabolism can slow down as much as 4 percent per year, meaning—surprise—if your diet hasn’t changed since your 20s, you’re gaining weight. But even worse than not working out is going all Lou Ferrigno and pushing yourself too far on your first trip to the gym. “Then you get hurt and you’re in physical therapy for six months and you’re never coming back,” says David Rae, a physical trainer and owner of Urban Kinetics in Capitol Hill. “You want to push yourself, but not so much that you can’t do it two days later.” With that in mind, Rae suggests testing yourself on a few everyday actions. If you answer no to the following questions, you need to shape up.

Can you stand on one foot and touch your nose with your finger? Balance and stability don’t get nearly as much attention as six-pack abs and a tight butt, but they’ll be even more important as you age. Stand on one leg and practice having someone toss you a kickball.

Can you sit up to get out of bed instead of rolling over? You don’t need a rock-hard stomach, but if even this simple abdominal exercise is too tough, that’s a problem. Ease your way into doing crunches by tying a rope to a door handle, holding the other end while lying flat on your back, and pulling yourself up to a seated position.

Can you lie on the floor and lift your legs straight up to 90 degrees? Because we don’t typically do much to strengthen our lower backs, our thighs have to work harder to hold us upright. And that tightens the hamstrings. Loosen them up by standing and bending at the waist, and reaching down to touch your toes.

Can you stand with your back to a wall and lift your arms above your head while keeping them and your back flat against the wall (like making a snow angel)? If not, your back muscles aren’t strong enough to overcome the tightness in your chest. So many day-to-day activities involve moving forward and pushing, while very few involve pulling or moving backward. For every set of chest exercises you do at the gym, do two sets of back exercises.

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Soothing Body & Mind

I don’t want plastic surgery, but I want to maintain a youthful appearance as long as I can. What natural approaches can I take? In a word, sunscreen. “I get that question a lot, and I literally tell patients to invest in sunscreen often and early,” says Swedish’s Dr. Gorman. “Cosmetics folks will tell you that there are tons of antioxidant lotions and there are dermabrasions and lasers and all of that surface stuff, but they don’t have dramatic and lasting results.” In other words, despite what ads for antiaging miracle creams may shout, “rejuvenating” the skin isn’t as easy as it sounds. Bottom line: If you haven’t been slathering on the SPF 15 for the last 20 years, you’re not going to reverse the wrinkling process now, but it’s never too late to start slowing it down.

*I’ve been having a lot of stomach problems lately. It’s not serious, but it’s enough to be annoying. What’s going on? If you’ve been pounding the Pepto lately, says Dr. Nancy Connolly of Virginia Mason, don’t be too quick to dismiss it as just an everyday upset stomach. “If people have chronic abdominal complaints,” she says, “they will often have an underlying anxiety or depression that’s very treatable.” Bottom line: Treat the emotional distress and your chances of feeling better physically will improve.

I’m a relatively active person, and my knees have been acting up lately. What can I do reduce the pain and keep moving? Although your knee pain could be caused by a number of things, Dr. John O’Kane, a team physician at the University of Washington sports medicine clinic, says it could just be a function of age. He compares your knees to 60,000-mile tires, and the older you get—and the more active you are—the fewer miles you’ve got left. You may be experiencing the beginnings of osteoarthritis, or inflammation caused by a gradual loss of cartilage. Start by taking Tylenol or ibuprofen (research results on glucosamine are mixed, so treat lightly) and lead up to cortisone injections or joint-replacement surgery, but regardless of how you treat the pain, modifying your activity to reduce the strain on your knee is a must. “It’s about maintaining a lifestyle that you enjoy and still taking some of the load off your joints,” O’Kane says. Bottom line: Talk to your doctor first to determine whether or not you have osteoarthritis before starting a treatment plan, but avoid the stress of running on pavement by working out on a treadmill or an elliptical.

SELF CHECK IN: Have I had my cholesterol tested yet? Doctors are still fighting over whether you should check cholesterol levels when you’re in your 20s, but they all agree that you should check it now. Need another reason to get screened—aside from the whole “increased risk for heart disease” thing? A new study released last spring by the American Academy of Neurology found that people with high cholesterol in their early 40s are more likely to develop Alzheimer’s later on. Bottom line: Ask your doctor about it at your next screening exam and then every five years from here on out.

FOCUS / Anxiety / Stress / Depression

The 40s can be a stressful time for everyone: You’re raising your family, still fighting for the next promotion at work, and trying to carve out some time for your own interests. But for some, that can all be a little too stressful. Local licensed family therapist Ann Goett counsels a lot of what she calls high performers, who expect so much from themselves that they burn out. “They tend to analyze and analyze, and if they could just figure out the reason that they’re so tired or having an anxiety attack, they think that would take care of it,” she says. “But in many cases, that doesn’t work at all.”

How is the anxiety manifesting itself?
“There’s a whole range of things. Disturbance of sleep is certainly very common. They don’t have the energy. They’re not experiencing the joy that they used to. But you’d never know that they were stressed out because they look really put-together. It’s what’s going on inside them. Other people have no idea that this amazing person is so stressed out.”

Are there certain things that people can do to cope a little?
“For starters, I often recommend that they get a massage. It’s very healing, and they don’t have to do anything—in fact, they have to lay there and not do anything. But a lot of people feel selfish about taking better care of themselves, so they actually have to be given permission.”

If going to a therapist makes them feel inadequate, what else can they do?
“These people aren’t good at asking for help, but they may have a good relationship with their primary care practitioner. They’re the front line, and a lot of times people feel more comfortable talking to them. So if you can’t figure it out, consult your doctor.”

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Putting Yourself to the Test

Do I need to get screened for prostate cancer? More than 180,000 men were diagnosed with prostate cancer last year, and you can get screened with the PSA (prostate-specific antigen) test, so maybe it’s good to get checked out. Maybe not. “There’s never been a study that has shown that doing routine screening for prostate cancer with PSA reduces our chances of dying from prostate cancer,” says Dr. Michael Soung of Virginia Mason. Prostate cancer may be prevalent, but it’s not nearly as deadly as other forms because it rarely leaves the prostate. “Sometimes people will end up with treatments for prostate cancer that might not have ever caused them any problems,” Soung says. And those treatments, which include removing the prostate, can lead to incontinence and impotence. Bottom line: Instead of blindly getting screened, Soung says, weigh the pros and cons with your doctor.

I know the sun is a good source of vitamin D, but Seattle’s overcast more than 200 days a year. What do I do? This may be one of the few times your doctor will vigorously encourage you to take a supplement—and living in Seattle might not have anything to do with it. Thanks to its benefits for bone health and cancer reduction, nutritionist Minh-Hai Tran calls vitamin D “one of the hottest vitamins right now.” And yes, the Northwest cloud cover makes it difficult to get enough of this ultraversatile vitamin, but Soung says anyone who’s adhering to current recommended daily allowances isn’t getting enough. “Right now, they recommend that adults take in 400 units a day,” but studies have shown that much higher doses—between 800 and 1,200 units—are more effective in preventing hip fractures and falls, he says. “Costco sells it in 1,000-unit doses, and it’s cheap.” Bottom line: Vitamin D supplements are easy and affordable, so add them now to your daily pill-popping routine.

Friends have mentioned getting direct beam tomography or CT screens for heart disease. Should I? Like prostate cancer rates, the numbers on heart disease are intimidating (629,000 people died of heart-related illnesses in 2006), which might be enough to make you run to the screening room. “The problem is, there are multiple tests out there to look for heart disease, and a lot of patients will say, ‘Gee, should I have one?’ ” says Dr. McGough of UW Medicine. “But there’s really not good evidence that supports that [those tests] should be widely introduced.” In fact, in 2004 the U.S. Preventive Services Task Force recommended that screening asymptomatic people without a family history of heart disease could cause more problems than it solves; false positives could lead to medications or invasive procedures that would have otherwise been avoided. Bottom line: Unless you smoke or have diabetes or high blood pressure or cholesterol, you might want to hold off.

SELF CHECK IN: Am I taking care of myself? Sure, you’ve got all kinds of blood tests and screenings—some more reliable than others—that can tell you whether you’re sick, but at the risk of sounding all self-actualized and new agey, you’ve got some power over what happens to your body, too. And even if you’ve lifted more beer bottles than barbells over the last 20 years, it’s never too late to start getting in shape—as long as you keep your expectations in check. David Rae of Urban Kinetics says, “People come in expecting to lose 30 pounds, and if they don’t after a month,” they get discouraged and quit. “But if you give people a small goal and they attain it, it’s like gold.”

FOCUS / Skin Cancer

Chanting “at least all those clouds are protecting me from skin cancer” may be the only thing keeping you from moving to Arizona, but those red blotches on your face beg to differ. Washington has the country’s fifth-highest rate of melanoma incidence and the seventh-highest rate of melanoma fatality. Part of the problem, says Dr. Gorman, is that as much as 80 percent of UV rays can punch through the clouds. She taught us some other surprising facts about skin health.

If you waited until now, you waited too long 
A lot of Gorman’s patients got really diligent about applying sunscreen in their 40s and 50s but ended up getting cancer anyway. “They don’t take into account the burns that they received in their early years,” she says. In other words…

Your skin has memory 
Skin cancer is typically the result of incremental accumulation of sun exposure over time. “It remembers every sunburn that you received, from infancy and beyond.” Now, that being said…

One bad burn is all it takes 
How’s this for sobering: If you’ve blistered and peeled even once, you’re at higher risk for skin cancer. But don’t freak out and buy a case of sunscreen with SPF 45, because…

Anything above SPF 30 is useless 
“You’re never going to hurt yourself by using a higher number,” Gorman says, “but you’re not getting much benefit beyond 30.” And if you weren’t as good about using sunscreen as 
you should have been, it’s not the end of the world, because…

Ninety-five percent of skin cancers are treatable 
If you find something that looks suspect, see a doctor. And even if you don’t, get screened regularly. “I don’t hold patients responsible for knowing all the manifestations of skin cancer,” Gorman says. But she does expect you to 
wear sunscreen.

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Preparing & Preventing, Part 2

I’ve heard about a vaccine for pneumonia. Should I get it? This is an easy one. “It’s called Pneumovax,” says Dr. McGough of UW Medicine. “If we could, we’d be putting it in the water.” Bottom line: Yes.

I have friends who have had shingles, and they’re still in pain years after it went away. Why is that, and what can I do to prevent it? Remember when you and all your first-grade classmates got chicken pox and got to stay home from school for a week? That virus can stick around in your body for decades and reemerge—just in time to ruin retirement—as the painful rash called shingles. It typically only lasts for a few weeks, but residual, localized pain along one nerve, called postherpetic neuralgia, can last for years afterward. Luckily, you picked a good time to hit your 60s: The FDA just approved the first shingles vaccine in 2006. “It cuts your chances of developing shingles by about half,” says Dr. Soung of Virginia Mason. “And if you get shingles, it cuts your chances of having postherpetic neuralgia by two-thirds.” Bottom line: If you get one vaccine this decade…get the one for pneumonia. If you get two, get the one for shingles. Ask your doctor about both.

Do I really need to take all these medications? If you could ditch some of the pills you’re taking now, wouldn’t you do it? There’s a good possibility you might be taking more than you need, says Dr. Sam Cullison of Swedish. As you age and start seeing more doctors—and seeing them more often—the likelihood goes up that one of them might prescribe something that another will indiscriminately refill even after you no longer need it. It’s not a negligence thing; just chalk it up to a lack of communication. Bottom line: It’s perfectly acceptable, Cullison says, “to ask the question and make sure that we don’t have one on the list that we can get rid of.”

Do I still need pap smears and mammograms? Let’s face it: Unless you’re still leading a, shall we say, active social life, your chances of catching HPV and thereby setting yourself up for a potential run-in with cervical cancer go down considerably once you hit your 60s. (Of course, Dr. Cullison of Swedish did diagnose a 68-year-old woman with herpes a few years back, so there are exceptions.) As long as you’ve been monogamous and have a history of normal pap smears, you can cut them out altogether after 65. As for mammograms in this decade, Cullison says, “there’s a great debate whether they should be done every one, two, or three years, and if so, how long they should be continued.” Bottom line: You may be able to cut out the pap smears, but it’s too early to quit mammograms.

SELF CHECK IN: Have I started planning for end-of-life care? No one wants to think—or talk—about it, but making decisions now about a Do Not Resuscitate order or how and where you want to spend your final days will help everyone involved. “Unless you’ve communicated that to, usually, your children,” Soung says, “then there’s no way for them to know it if you lose the ability to communicate.” Bottom line: Talk to your doctor about your options for advance directives.

FOCUS / Vision

Bad news first: There’s really nothing you can do to stave off age-related eye conditions like glaucoma, cataracts, and macular degeneration. “That’s like asking if we have something that will stave off gray hair, wrinkles, low-back pain, and arthritis,” says 
Dr. Harry Geggel, an ophthalmologist at Virginia Mason. You can do things, though, to minimize the damage to your vision—if you start getting screened in your 60s. Geggel helped us take a closer look at three of the most prevalent predators of good eyesight.

If you live to be 90, you’ve got about a 90 percent chance of developing this clouding of your lenses. But, thankfully, treatment is a breeze. “Today, cataract surgery takes 20 minutes,” Geggel says. “You’re on eye drops for three weeks, and you get back to work within three days.”

As pressure in the eye builds, it can damage the optic nerve. Although it’s often caught too late to treat, glaucoma can be prevented with biannual checkups after 60. But, Geggel points out, “if there’s a family history, you should get your pressure checked once a year after 50.”

Macular Degeneration
The macula only accounts for about four millimeters of your retina, but if it goes, you’ll be left with a debilitating hole in the center of your vision. Treatments are available to reduce the effects of both wet and dry forms of macular degeneration, so start getting annual screenings now.

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The Big Payoff

Do I really need to keep exercising? You’ve made it this far, so you think you’ve earned the right to cancel your membership to the gym. Well, that all depends. How much longer do you want to live and how good do you want to feel? The better question might be, How hard should I be working out? Strenuous exercise in your 70s might not be the best idea, but there are appropriate ways to keep the heart pumping. For example, “patients with severe arthritis can probably head to the city pool, where they won’t have to bear weight on their joints,” says Swedish’s Dr. Cullison, who is board certified in geriatrics. Bottom line: Regardless of the shape you’re in, you’ll feel better if you do something more active than watching reruns of The Joy of Painting with Bob Ross.

How often should I see a doctor for nonsymptomatic care? We’ll answer your question with a multiple choice question: Why do you go in for an annual physical?
A) Because you need that once-yearly affirmation that everything’s in good working order.
B) Because you’ve been doing it for so long now that quitting would feel weird.
C) Because you have a crush on your doctor.

If you answered A, then you can skip the rest of this; no one’s going to discourage you from being vigilant at this age. If you answered B, though, Cullison has some advice. “We say that every one to two years the patient should come in for health care screening, but where’s the evidence to support that?” he asks. “Actually there isn’t any.” Your health may make it necessary to come in every year, but if you feel good and you’ve been doing it “just because,” a conversation about the pros and cons of annual exams might be in order. And if you answered C, may we prescribe a cold shower?

I’ve been taking aspirin every day for the last 20 years—should I keep it up? Your doctor my have started you on daily aspirin treatment decades ago to prevent heart attacks and stroke, but unless your risk factors are still high (you have a family history, high blood pressure, or cholesterol), it may be time to start weaning yourself off of it. Because daily aspirin use increases your chances of developing a bleeding ulcer and the stomach wall naturally weakens after you reach 70, aspirin’s beneficial heart-related effects might not be enough to outweigh those potential complications. Bottom line: It’s time to ask your doctor.

Is my forgetfulness a sign of Alzheimer’s, or is it just a natural part of getting older? With everyone living longer these days, the incidence of Alzheimer’s is rising. A report released last year by the Alzheimer’s Association showed that nearly 5 million Americans suffer from the incurable form of dementia and predicted that number to double by 2050. So worrying about your recent bouts of forgetfulness is understandable, but it’s not necessarily time to panic, either. “Everyone, as they age, forgets more stuff than they used to,” Cullison says. “But that and Alzheimer’s are two entirely different things.” Bottom line: Losing your keys isn’t a big deal. Getting lost while driving to and from the grocery store is.

SELF CHECK IN: Whom would I turn to if my spouse or partner died? Like living wills and end-of-life preparation, planning for what to do after a spouse dies isn’t exactly pleasant. But the alternative is worse. “Trying to maintain personal relationships is crucial” to adjusting to life after a spouse passes away, Cullison says. Bottom line: Taking walks with a friend, adopting a pet, or just calling a family member can help keep you from shutting yourself off from the world.

FOCUS / Vitamin Supplements

As you look for ways to supplement your diet with beneficial vitamins and nutrients, be careful not to overdo it. Not only are some vitamins not as helpful as doctors once believed, they may actually be harmful in high doses.

“People used to recommend it because it might prevent Alzheimer’s, or we thought it might help with heart disease, but whether it’s been actually shown to be helpful for anything is pretty unclear,” says Dr. Soung of Virginia Mason. In fact, a 2004 study by researchers at Johns Hopkins found that high-dose vitamin E supplements may increase your risk of dying.

Researchers are also questioning the benefits of high doses of this product of beta carotene, once thought to help with lung cancer treatment. Now they believe it may even increase the risk for lung cancer among smokers.

Evidence still suggests that, for young women, taking folic acid while you’re trying to get pregnant can reduce birth defects, but its presumed ability to prevent heart disease in adults has been thrown into question. “It’s not necessarily harmful,” Soung says, “but it doesn’t appear to help.”
Bottom line: Be open with your doctor about what—and how much—you’re taking.

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