The topic of dietary supplements—vitamins, minerals, or herbs—comes up almost daily in my office. In the same week recently, an elderly patient with atrial fibrillation told me he was taking the supplement ashwagandha (Indian ginseng) instead of a prescription anticoagulant as a stroke preventive, and an athletic trainer who came in for lower-back pain told me her list of supplements was too long to relay. Indeed, research has shown that three out of four adults in the United States now consume some type of dietary supplement, and for older Americans, the rate is even higher.
Over the years, I have seen many patients who are convinced that supplements prevent colds, increase stamina, or reduce anxiety. I have also seen patients who have been harmed by their trust in a supplement pill or powder, including a 30-year-old bodybuilder who developed a serious brain bleed after taking a supplement containing arginine nitrate.
Part of the problem is that the supplements market, which is now a $40 billion industry, is not regulated closely by the government, which means you may be taking something tainted or an ingredient that is not what you think it is. The health benefits of many supplements are uncertain at best, as few well-controlled studies have been conducted to support them. For example, the man who took ashwagandha—a supplement with scant evidence to support its use—instead of prescription alternatives backed by science put himself at serious health risk. These are a few of the reasons we feature "The Inside Scoop on Supplements" in this issue.
We hope it will remind you to talk to your physicians about what you are taking so they can raise concerns and alert you to possible side effects and potential interactions with prescription drugs and other supplements. Your doctors also need to understand your preferences so they can recommend supplements that may be beneficial, like vitamin B2 for migraine prevention.
Migraine is the focus of our cover story on singer and actress Kristin Chenoweth, who describes how the disorder affects her life and career. Like many people who live with migraine, Chenoweth had to forgo important events for years, even missing a party to celebrate winning an Emmy in 2009 for her role on the ABC series Pushing Daisies. In many other instances, migraine interfered with her performances, a situation familiar to readers with neurologic disease who continue to work.
In our Take Charge story, we tackle the topic of whether to disclose your condition to your employer. We asked several legal experts to share their experience and help us understand the laws regarding disclosure and accommodations in the workplace.
One thing that is clear is the benefit of a healthy diet. Experts agree it's best to get your vitamins and minerals from food. In our story "Dementia Could Benefit from Cooking" href="/link/2269649d4f014d74aec0a4162633d097.aspx" target="_blank" rel="noopener">The Kitchen Is Open," we illustrate how to do that by preparing nutritious meals safely.
As we enter 2020, I'd like to thank you for your letters, blogs, and stories and for allowing us to learn from you. We have some exciting issues ahead and a lineup of stories we hope you'll enjoy.
Wishing you a wonderful holiday season and a happy New Year!
Orly Avitzur, MD, MBA, FAAN, Editor-in-Chief