“Hey doc, how much omega-3 should I take?” Is it just me, or do the rest of you know everything about vitamins and alternative remedies? Everyone, including some physicians, seems to jump on the bandwagon and encourage patients to try this vitamin or that treatment, often on some apparent expert advice. For example, saw palmetto was supposed to relieve symptoms of prostatism until a double-blind randomized trial reported in 2000 (in our lesser-known sister journal, the New England Journal of Medicine) blew that out of the water—forgive the metaphor.

How many of you, like me, were recommending vitamin E for heart disease until the HOPE trial came around? So, okay, it isn’t good for the heart but maybe it protects against cognitive decline. Egad, what you say, the meta-analysis suggests that at about 400 IU of vitamin E per day mortality increases?

Recently vitamin D supplemen­tation has been touted as a cure for everything, including prostatism (just kidding, but as I age this topic becomes dearer). I wonder how long before some study proves that vitamin D supplementation causes erectile dysfunction or some other malady. The tendency to measure vitamin D levels appears to be catching on. Instead of comparing their PSA or cholesterol levels over bridge, seniors will soon be boasting of their supernormal ergocalciferol counts.

Itchy physician pens have turned away from scrawling homocysteine on lab requisitions. Speaking of homocysteine—how much do you think that one cost us? Now, not all vitamin therapies should be painted with the same brush. Folic acid has been shown to lower the incidence of neural tube defects if taken by pregnant woman during their first trimester. Also, a combination of antioxidant vitamins and zinc has been shown to reduce the progression of age-related macular degeneration (ARMD). Interestingly, there isn’t evidence that these same vitamins lower the risk of ARMD in individuals at risk but not yet affected.

How about other supplements? I now routinely ask patients what supplements they take. Not only is it good medicine, it’s another opportunity to amuse myself. When a patient tells me they take cod liver oil I nod knowingly and ask, “Why not halibut liver oil?” Sometimes I will ask, “Why not trout liver or perch liver oil? Why pick on saltwater fish?” Has anyone else wondered where they get all the cod liver oil from? I thought there was a moratorium on the cod fishery. Is there a new “catch–take a liver–and release” program I haven’t heard about?

You will find patients who take almost anything: green algae pills, for instance. After asking them the obvious question of why they don’t take blue algae pills, I mention they could save money and lick the inside of their fish tanks. Zinc, selenium, silver colloid, flax seed oil, silica, milk thistle, garlic, shark cartilage, melatonin, gingko, ginseng, and more are being consumed in large quantities by our patients. Alternative professionals often recommend so-called natural treatments for a whole host of conditions. I ask you, is it natural to consume a handful of pills at every meal? The concept that these are natural treatments leads me to believe that our medicines must be unnatural. Personally, I would rather consume the active compound synthesized under sterile conditions in a laboratory versus chewing on some leaf. I like the term “natural” about as much as I like the term “organic,” as in “organic foods.” I want to go to the supermarket and ask where the inorganic vegetables are. Remember, horse manure is organic.

I think I will continue my habit of truthfully answering, “I don’t know,” when faced with such questions. I often add, “I’m not sure if supplement Y or vitamin X will help, but I do have a natural, organic treatment that will make almost 100% of people feel better. Do you want to know what it is?” I ask. As they nod furiously I continue, “A diet low in animal fats, high in fruit and vegetables, moderate caffeine and alcohol intake, no smoking, and regular exercise.”

“Come on Doctor Dave, everyone knows that,” they invariably reply. “What about that omega-3?”

—DRR