I am 75 years of age and my doctor has said I need to be taking some of the above mentioned supplements. Diabetes, high cholesterol, hypertension, and CAD are some of my health issues. Any suggestions would be greatly appreciated. Thank you.

DEAR READER: Dietary supplements, as you have discovered, may carry unwanted side effects. For example, calcium can cause gas and/or constipation in some people and may interfere with the absorption of iron. This is also true of fiber supplements that contain psyllium, narcotic pain medicines, multi-vitamins and iron pills. The recommended daily allowance of calcium ranges between 1000 and 1300 mg depending on age.

Vitamin D supplements can interact with other medications. Side effects can include a metallic taste in the mouth, constipation, diarrhea, muscle pain, fatigue, and a great deal more. The recommended daily allowance of D for those ages one to 70 is 600 IU and for those 71 and over, it is 800 IU. Individuals diagnosed with heart problems or kidney disease should be careful when considering a D supplement. If you are taking a class of drugs known as calcium channel blockers, be sure to speak with your physician before beginning any regimen.

Fish oil is safe for most people when taken in doses of 3 grams or less per day. Amounts exceeding this level could keep blood from clotting and carry an increased risk of bleeding. It might also lower the activity of your immune system and reduce your body’s ability to fight infection. Side effects can include heartburn, nausea, loose stools, belching, excess gas, and nosebleeds. One possible way to counteract potential side effects of fish oil is to take the supplement in the proper amount with meals, or to freeze the capsules and take them in their frozen form.

Vitamin C should not be taken in amounts greater than 2000 mg per day because of the possibility of experiencing stomach upset and diarrhea, easy bruising, painful joints, anemia, dry/scaling skin, and more. The body is not unable to produce vitamin C on its own, nor does it store it. As an alternative, foods highest in C include orange juice, kiwi fruit, pineapple, strawberries, broccoli, tomatoes, winter squashes, spinach, and sweet and white potatoes.

Coated vitamins have a surface designed for several reasons, one of which is to allow ease of swallowing and the prevention of stomach upset. Enteric coatings allow a vitamin to hold up to stomach acids, passing into the small intestine for optimal absorption. Gelatin-coated products are compressed vitamins that make them easier to swallow and protect the stomach from upset. Finally there are time-released compression coatings that may be easier on the stomach.

Incorporate a healthful diet that includes fresh fruits, vegetables, fish, and whole grains. Instead of trying to take supplements, consider including more of the foods that are high in the vitamins/minerals that you are looking for. If you and your physician feel a fish oil supplement is beneficial, try including fresh fish high in omega 3’s (such as salmon, mackerel, etc.) or freezing the capsules before ingesting them and be sure to also take them with meals.

How much of each vitamin or supplement you need will depend on your age, gender, medications you may be prescribed and known illnesses. I can tell you what the Office of
Dietary Supplements recommends; however, as with any drug, over-the-counter or via prescription, you should work with your physician to determine what is appropriate for you.

Readers who would like related information can order my Health Report “Vitamins & Minerals” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to my attention at PO Box 433, Lakeville, CT 06039-0433. Be sure to mention the title when writing or print out an order form from my website www.AskDrGottMD.com.

DEAR READER: Your doctors’ offices have no right to withhold information regarding your health or your medical record from you. You can read more about this online at the US Department of Health and Human Services website, http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html. If you have had the test to determine your blood type, I suggest you return to your physician and/or oncologist and demand that you see the results. If you haven’t had the test, request that it be done. Keep in mind that unless there is a medical necessity, such as a transfusion being needed, the test may not be covered by insurance so you may have to pay out of pocket.

There are several DIY or home blood testing kits available online today, but I cannot attest to their accuracy. In my opinion, your best bet is to get your blood tested at your local hospital or health clinic under a physician’s order.

Also, if you are in good health (http://www.redcrossblood.org/donating-blood/eligibility-requirements), you can donate blood. Before donation your blood will be tested for type, cholesterol level, sexually transmitted diseases, and more. In this way, you will know your type and can potentially help save a life at the same time.

DEAR READER: Congratulations to you and your husband for not only losing the weight, but for taking an active role in improving your health.

I truly believe that my diet plan is really a lifestyle. Because it isn’t highly restrictive, doesn’t involve weighing, measuring, counting or purchasing special foods, and can be adapted to each person’s wants and needs, it is easy to stick with for the long haul. All diets are tough to start; the deprivation of those salty, sugary snacks we all love so much; however, over time, our bodies adjust and the cravings cease. Instead of just needing that cookie after a hard day, our bodies want crisp apple slices, crunchy carrots, or sweet pepper strips. It’s also easy to create delicious meals including desserts without flour or sugar.

Most of my readers who have tried my diet and written in to tell me of their successes have told me that they not only lost weight, but they feel healthier, have more energy and that the diet has truly become something they plan to follow for the rest of their lives.

Thank you for sharing your success and I hope it inspires others to make the choice to better their health and lose weight.

Readers who are interested in learning more can order my Health Reports “Losing Weight: An Introduction to the No Flour, No Sugar Diet” and “Thyroid Disorders” by sending a self-addressed, stamped number 10 envelope and a $2 (for each report) US check check or money order to Dr. Peter Gott, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from my website, www.AskDrGottMD.com.

You can also visit my website to find out how to purchase my books on line, “Dr. Gott’s No Flour, No Sugar Diet” and “Dr. Gott’s No Flour, No Sugar Cook Book” or you can send a $10 (for each book) US check or money order with the title to the above address.

DEAR READER: Vitamin D is fat soluble and found naturally in very few foods (fish liver oil, fatty fish, beef liver, cheese, and egg yolks). It is best known for promoting calcium absorption, but also maintains adequate blood calcium and phosphate levels, is needed for normal bone growth and remodeling, reduces inflammation, and modulates cell growth and neuromuscular and immune functions. The recommended daily allowance (RDA) for healthy children and adults ages one to 70 is 600 international units (IU) a day. For those over the age of 70, 800 IU should be consumed daily. The tolerable upper intake has been set a 4,000 IU daily for healthy individuals ages 9 and up.

Because vitamin D is fat-soluble, excesses aren’t eliminated from the body through urine, but are stored. In normal, healthy individuals, taking more than recommended may lead to toxicity over time, as the levels of the vitamin build up within the body. You are currently taking 10 times more than the highest dose that is still considered safe.

In individuals who have an underlying condition that causes chronic D deficiency, high doses such as what you are taking may be recommended, but only under physician direction and supervision. Vitamin D can also interact with several medications so it is important for people considering this regimen to check with their physician before starting it.

My advice to you is to discontinue the supplementation and see your doctor. You are attempting to treat something without actually knowing what is wrong. I cannot determine what your diagnosis is, but I suspect it is the result of overuse or from an injury. A referral to an orthopedic specialist is in order. He or she can then examine you and order appropriate testing to include blood work, X-rays, and a CT or MRI.

Readers who are interested in learning more can order my Health Reports “Managing Chronic Pain” and “Vitamins and Minerals” by sending a self-addressed, stamped number 10 envelope and a $2 (for each report) US check or money order to my attention at PO Box 433, Lakeville, CT 06039. Be sure to mention the title when writing or print an order form from my website, www.AskDrGottMD.com.

DEAR READER: Systemic mastocytosis (SM) is considered to be an “orphan disease” meaning it is rare and affects a very small number of people. It is an accumulation of mast cells in more than one part of the body. Mast cells are made in the bone marrow, are distributed throughout the body and are though to fight infection, respond to allergic substances, and repair damaged tissue. It is usually diagnosed in adults although children may also be affected.

There are four types, the most common (which also has the best prognosis) is cutaneous (skin) indolent SM. This form is slow to develop and doesn’t appear to affect life expectancy. Beyond that is SM that affects the circulatory system and blood (which presents with several types of blood disorders), aggressive SM which develops rapidly, and the most rare form, mast cell leukemia.

Symptoms depend on the type of SM. Cutaneous presentations can include hives, flushing, and itching. Internal presentations can include swollen/enlarged lymph nodes, an enlarged spleen or liver, abdominal pain, nausea, vomiting, gastro-esophageal reflux disease, diarrhea, anemia, and various bleeding disorders.

Systemic mastocytosis is genetic and autoimmune but no link has been found that it is hereditary; however, given that this condition is rare, research is still on-going, so your daughter may wish to seek genetic counseling before making the decision whether or not to have children.

Treatment is available but is based on the signs and symptoms that each patient presents with and may include antihistamines, chemotherapy, and more. Most patients are advised to carry an Epi-Pen at all times.

I urge your daughter to sit down with her doctor for an in-depth discussion about what the diagnosis means, what her treatment options are, and what she may be able to expect in the future. She may also benefit from seeing a top-notch specialist at a teaching hospital or someplace such as one of the Mayo or Cleveland clinics. This is a rare diagnosis so a second opinion will be beneficial.

DEAR READER: A high white count represents an increase in leukocytes, the disease-fighting cells that circulate in the blood. The condition is known as leukocytosis and usually indicates an infection, immune system disorder, medication reaction, or bone marrow disease.

There are a number of causes to consider such as stress– either emotional or physical, a bacterial or viral infection, the habit of smoking, an allergy, rheumatoid arthritis, damage to skin tissue such as from a burn, and the use of some prescription drugs such as corticosteroids and epinephrine. Then we get in to conditions such as leukemia, tuberculosis, polycythemia vera and a whole host of other possibilities.

Unless the individual to which you refer had a well-patient examination that included laboratory testing, it is likely the abnormality was detected because of symptoms experienced for which he initially consulted a doctor. Perhaps he lost his job or a loved one that caused great emotional stress, had a relatively minor bacterial infection, or was placed on a corticosteroid for a painful shoulder. The possibilities for an abnormality are endless.

It would be extremely helpful to know if there were any other abnormalities in his lab work that might shed some light onto his elevated white blood count. Were this information known, it certainly might help zero in on the possible cause.

I recommend the gentleman revisit his physician for repeat blood work. One reading alone isn’t enough to push the panic button. If we can use an automobile as a comparison, there are many conditions such as a simple tune up, spark plug replacement, or carburetor adjustment that can be made that will allow the individual to be back on the race track or in the game of life. However, if the condition continues, he and his physician should have a frank discussion regarding possible causes that could be more serious and which might mandate further investigation with X-rays, CT, MRI or other sophisticated testing. If questions remain and a cause cannot be readily identified, perhaps a referral to a hematologist/oncologist is in line. Be sure to bring all labs and X-ray results to allow either specialist a clear picture of what might be going on.

Readers who would like related information can order my Health Report “Consumer Tips on Medicine” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to my attention at PO Box 433, Lakeville, CT 06039. Be sure to mention the title when writing or print out an order form from my website www.AskDrGottMD.com.

DEAR READER: Graves’ disease is hyperthyroidism, a disorder of the immune system that causes the overproduction of thyroid hormones. Normal thyroid function is regulated by a hormone released by the pituitary gland. The antibody associated with Graves’ disease, thyrotropin receptor antibody (more simply known as TRAb), has the ability to mimic the action of the pituitary hormone and essentially overrides normal regulation of the thyroid gland, resulting in overproduction of thyroid hormones.

The more common signs of the disorder include a goiter (enlargement of the thyroid gland), an irregular heartbeat, fatigue, anxiety, irritability, bulging eyes, and more. Almost half of all people with Graves have some sign of what is known as Graves’ ophthalmopathy with excess tearing, double vision, and light sensitivity, painful eyes that may be dry and irritated, with excess tearing.

Having a goiter doesn’t always indicate the thyroid gland isn’t working as it should. Your thyroid gland may still be producing normal amounts of hormones; however, the gland may be producing too much or insufficient thyroxine and T-3, hormones that circulate through your bloodstream to help regulate metabolism. These hormones control the rate at which your body uses carbohydrates and fats, are in charge of the production of proteins, they control body temperature and even have an impact on your heart rate.

There are several reasons why the thyroid gland might enlarge, to include iodine deficiency, Hashimoto’s disease, the development of fluid-filled nodules in both sides of the thyroid gland that result in over-enlargement of the gland, a single nodule that develops in one part of the gland, thyroiditis, and more.

Iodine deficiency can occur in some people who reside in high elevations or who have a diet high in hormone-inhibiting foods such as cauliflower, broccoli and cabbage. Either situation can cause goiters to develop as the gland enlarges.

Hashimoto’s is an autoimmune disorder that causes the gland to produce too little hormone, causing the pituitary gland to produce more TSH to stimulate the thyroid, causing the gland to enlarge.

Multi-nodular goiter growths can result in overall enlargement of the gland, while single nodules develop in one part of the gland only.

Thyroiditis is caused by an attack on the gland that ultimately results in swelling and damage to thyroid cells. Most forms of thyroiditis are the result of antibodies used to fight off various viruses and bacteria.

With another thought in mind, many symptoms of subclinical hypothyroidism mimic those of hyperthyroidism. This condition results when the pituitary gland produces excess TSH to stimulate the thyroid to maintain a normal level of thyroid hormones. Over the course of months to years, the thyroid gland can no longer respond to the elevated levels and that subclinical hypothyroidism turns in to overt hypothyroidism. Diagnosis using blood tests to measure thyroid hormone levels and TSH are necessary; an elevated TSH without a decreased level of thyroid hormone will indicate the presence of subclinical hypothyroidism. This condition can be treated with a medication known as thyroxine taken in pill form daily. You might speak with one of your three endocrinologists to determine if this might be your problem.

Your symptoms can be seen with other problems, as well. With normal thyroid tests from three separate endocrinologists, it may be time to look at other causes. You deserve some direct answers. They may not be the ones you want to hear but you have the right to know why everyone thinks you don’t have something you are pretty sure you have. Get to the bottom of the problem so you can get on with your life.

Readers who would like related information can order my Health Report “The Thyroid Gland” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to my attention at PO Box 433, Lakeville, CT 06039. Be sure to mention the title when writing or print out an order form from my website www.AskDrGottMD.com.

I’m not alone on this – other people I know who read your column say the same thing. Just a little friendly advice. Hope this gets to you but it probably won’t.

DEAR READER: The short answer: If I only answered questions with adequate information or those that only ask general questions, such as “What is alopecia?”, I would end up writing about the same topics each week and that would get very boring very quickly.

The long answer is somewhat more complex. Most individuals don’t including past health history but many others don’t realize that even something minor or seemingly unrelated can make the difference in getting an accurate diagnosis or treatment recommendation. This not only holds true in my column, but in real life as well.

All too often patients request help for a problem they are having but leave out other things that may be going on, either because they are embarrassed or don’t believe they are related. A physician isn’t a mind reader and if a patient isn’t totally honest or forthcoming with symptoms, signs, concerns, questions, etc., providing that help can be somewhat difficult.

I have said many times in the past, that it is important that a physician, even a primary care physician who you’ve seen since you were 14, be aware of all your health concerns, medications, over-the-counter herbs and supplements, and lifestyle habits. This is especially true if you see multiple physicians. Each must be aware of what the others are prescribing or recommending so that the risk of cross-interactions, side effects and other unwanted reactions are kept to a minimum. For example, if you drink three glasses of grapefruit juice a day, but didn’t tell you’re cardiologist who prescribed a statin drug, you are at risk of developing toxic levels of that drug because the enzyme that aids digestion and absorption of both cannot handle both substances at once.

All that being said, you do have a point, so I (not, I personally, of course because I am still a technophobe and prefer putting pen to paper) will have my staff make some changes to the contact page on my website and will include some suggestions on how to get the best answer, should the question be chosen for publication. These changes should appear before this article is even posted to my site. Thank you for writing.

DEAR READER: A bursa is a fluid-filled sac whose function is to reduce friction between moving tissues of the body. Major bursae are found next to the tendons near all large joints such as the hips, elbows, knees and shoulders. Other areas that can be affected include the heels of the feet, base of the great toes and between the toes. When inflammation occurs, a person is known to have bursitis.

Repetitive motion during work and physical exercise are commonly to blame for the condition to occur. For example, playing a musical instrument, kneeling, gardening or working with your arms over your head for extended periods of time can trigger an attack. Beyond that, medical conditions such as rheumatoid arthritis, diabetes and gout can also increase a person’s risk for developing bursitis.

There are two bursae of the hip known as the trochanteric and ischial bursa. Inflammation in those areas can cause the stiffness and pain you are experiencing. Trochanteric bursitis commonly affects the outer hip area, making it difficult to walk, climb stairs and exercise. Ischial bursitis can cause pain in the buttock area, most noticeable when walking up an incline. The condition may occur following periods of prolonged sitting. The most common causes for your problem to manifest in the hip area are either from an injury (such as banging up against a table) or trauma to the soft tissue (perhaps from a fall).

Diagnosis can often be made by a physician listening to the history of events that occur prior to an attack, with attention paid to the specific pain site. Should questions remain, laboratory testing, an ultrasound or MRI might be appropriate.

Treatment begins on the conservative side — rest, over-the-counter pain relievers and ice. On occasion, aspiration of the bursa fluid might be necessary for relief, a procedure that can commonly be performed in a physician’s office. A cortisone injection might also be provided for pain relief and might be given at the same time as the aspiration.

My guess is that you received prednisone in pill form, a wonder drug that should only be taken short-term. That is why you felt so great until your prescription ran out. Therefore, I recommend you return to your primary care physician or rheumatologist to determine if the workouts you are undergoing at the gym are too strenuous for you. Ask if a break of a week or longer might allow the pain to subside, or if you should consider a physical therapist who can recommend specific movements that will not aggravate your condition. This will allow you to continue to work out several times a week without putting undue stress on your painful joints. Consider using an over-the-counter pain reliever such as ibuprofen. Sleep with a pillow between your knees and avoid aggravating the pain site. Ask if a pain clinic or physical therapy might be appropriate next steps in managing your pain.

On the home front, be sure to warm up by stretching slowly prior to physical exercise. Keep your weight down if appropriate and wear proper footwear, especially when exercising. Avoid movements that aggravate your condition, such as stair climbing and sleeping on the affected side. Perhaps your bursitis cannot be eradicated completely and you may experience future flare-ups, but a few simple steps might make things more manageable. Good luck.

Readers who would like related information can order my Health Report “Managing Chronic Pain” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to my attention at PO Box 433, Lakeville, CT 06039-0433. Be sure to mention the title when writing or print out an order form from my website www.AskDrGottMD.com.

DEAR READER: Bilirubin is a yellowish bile pigment. It is formed when the liver breaks down old red blood cells. Elevated levels of bilirubin can cause jaundice, a condition most often associated with newborns.

Jaundice and elevated bilirubin can occur when more red blood cells are broken down than normal. This can be caused by erythroblastosis fetalis (a condition that affects fetuses and newborns), a transfusion reaction, hemolytic anemia (the premature destruction of red blood cells), certain liver or gallbladder problems, and certain medications.

If elevation or jaundice is caused by the liver, it may be due to cirrhosis (liver scarring), hepatitis, or Gilbert’s disease (a genetic condition which typically causes jaundice during periods of stress, infection or exertion and doesn’t require treatment). The gallbladder can cause jaundice or elevated levels due to gallstones, biliary stricture (narrowing of the common bile duct that moves bile from the liver to the small intestine) or pancreatic or gallbladder cancer.

To the best of my knowledge, diet will not affect bilirubin levels. As long as your diet is nutritionally balanced and you are getting the required amounts of vitamins and minerals, you should be fine.

As for your osteoarthritis, irritable bowel syndrome (IBS), and fibrositis (more commonly known as fibromyalgia), I imagine you are on medication for these conditions. If the elevated bilirubin began after beginning a new medication, you may have your answer. If not, further investigation is necessary.

As for your concern about future problems, I cannot say. Without knowing the cause of your elevated bilirubin, there is no way to know if it could or will pose a problem. I urge you to speak with your physician about testing to find the cause and, if necessary, taking steps toward correcting it. Because this situation has been going on for some time and you state that your physician is seemingly unconcerned, you may be better served by requesting a referral to a specialist. In my opinion, your physician has dropped the ball, but if you haven’t thus far expressed your concerns to him, you are somewhat to blame, as well. Patients are just as responsible for their health as are their physicians, if not more so.

Readers who are interested in learning more can order my Health Reports “Fibromyalgia”, “Irritable Bowel Syndrome”, “Osteoarthritis”, and “Medical Specialists” by sending a self-addressed, stamped number 10 envelope and a $2 (for each report) US check or money order to Dr. Peter Gott, PO Box 433, Lakeville, CT 06039. Be sure to mention the title(s) when writing or print an order form from my website, www.AskDrGottMD.com.