Monday 19 February 2018

I'm in my 60s. Should I take vitamin supplements?

Vitamin supplements
Vitamin supplements

Nina Byrnes

Advice from our GP on the best supplements to take and how to treat Athlete's foot.

Q. I am in my early 60s and retired. I worry about the future and I like to try and stay healthy and well. I'm considering starting a course of vitamins before winter comes. There are so many types available now it's hard to know which ones to choose. I have been getting conflicting advice from my family, friends and the trainers at the gym. Some say I need just one, others advise a whole range. Are there any supplements that are better than others? How do I decide what to take and how long do I need them for? Are there any supplements that could be harmful or detrimental to my health?

Dr Nina replies: It is estimated that one in  four people in Ireland take some kind of vitamin supplement even though strong evidence for the benefit of these is lacking.

There are certain cases where supplementation is advised. All women of childbearing years who are sexually active should take a supplement of 400 micrograms of folic acid. This has been shown to significantly reduce the chance of birth defects such as spina bifida in the baby. As one in two pregnancies is unplanned, taking folic acid regularly provides the greatest protection. Vegans should also supplement their diet as they may miss out on calcium, certain B vitamins and fat-soluble vitamins. Those who suffer with certain medical conditions that lead to reduced absorption of vitamins and minerals in the gut will also need supplements, which may need to be given as an injection.

Vitamin C has long been thought to help keep coughs and colds at bay. This isn't the case. A review of studies going back many years looking at vitamin C intake in over 11,000 people showed that it may simply shorten the duration of a cough or cold in some people by maybe a day or so. Many studies have looked at the role of vitamin E in heart health and no benefit was shown. Some studies actually suggested that high doses of vitamin E could in fact increase the risk of lung cancer. Another supplement B carotene has also been shown to increase the risk of lung cancer in smokers.

High doses of folic acid may be associated with a higher risk of colonic polyps. The Iowa women's study followed a group of women for 22 years. Those taking high-dose supplements of vitamin B6, folic acid, magnesium, iron and zinc actually had a higher risk of premature death.

There are some supplements that may be necessary or beneficial. Vitamin D is one. Sunlight is our main source of this vitamin and as we are so far north we do not get enough sunlight to boost this vitamin from the months of October through March. It is hard to get vitamin D in food although it is present in small amounts in oily fish. Some cereals, milk and yoghurt are now fortified with vitamin D and it is worth seeking these out. All babies under a year should receive a daily vitamin D supplement. It is also advised in children up to five, those over 65 and anyone with dark skin living in northern latitudes. Adequate calcium intake has been linked with better health so if dairy is lacking in your diet, it is worth taking. Calcium and vitamin D work together and are especially important for bone health. Fish oils are beneficial to heart health. The best source of these is eating oily fish twice weekly, but if you can't tolerate this then a supplement is a good idea in those with other cardiovascular risk factors. A certain combination of vitamins has been shown to help in those who have or are at risk of the eye condition macular degeneration.

The best way to prevent disease and improve health is to eat a broad varied diet and to lead a healthy lifestyle.

When the pace of life means diet and lifestyle suffer, a short course of a general multivitamin may help fill the gap. There is no case for multiple high-dose vitamin supplements and they should never be a licence for unhealthy habits.

Athlete’s foot is a common, uncomfortable and sometimes embarrassing problem. A little foot care knowledge can help a lot.

Tinea pedis, more commonly known as athlete’s foot, is the most common kind of fungal infection. It occurs mainly in moist area between the toes but can spread to other parts of the feet. It causes itching, stinging and burning between the toes or on the soles of the feet. There may also be cracking, peeling and dryness of skin on the soles or sides of the feet. Infected toenails may crack or become crumbled and ragged.

Fungus thrives in a moist dark atmosphere (think of mushrooms). Damp socks and shoes or a warm moist environment will allow the infection to thrive. Athlete’s foot is contagious and can spread along the foot or from person to person through direct contact or contact with a contaminated surface. It responds well to many over-the-counter anti-fungal creams and powders, but treatment must be used at least twice daily for at least two weeks.

Once treated it is important to try and prevent further infection. Prevention involves keeping feet cool and dry. Change socks frequently, more than once daily if your feet sweat a lot. Go barefoot, or wear flip-flops and sandals. Choose natural material such as leather and cotton. Foot care is especially important in the prevention and treatment of athlete’s foot. Wash feet daily and dry them carefully. Use anti-fungal powder on your feet and sprinkle some in your shoes. Sharing footwear should be avoided. It is a good idea to alternate between pairs of shoes allowing each one to dry out before wearing it again.

It is thought one of the reasons men get athlete’s foot more frequently than women is that women tend to have more shoes and are less likely to wear the same damp pair several days in a row. If you have recurrent infection visit your GP. Very occasionally prescription tablets are required.

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