Integrating CAM therapies into Mainstream Practice: Part Iv
By M. P. RAVINDRA NATHAN,
MD, FACC
ABC's of Supplemental Vitamins
Do you need to take a multivitamin pill every day? This is a question I get constantly in my practice. Whether you should take nutritional supplements such as vitamins and minerals routinely has been the subject of many discussions. The opinions also vary. As you know, the general nutritional status of your body depends on optimal intake of macronutrients (carbohydrate, proteins, and fats) that gives you enough calories and energy for the body as well as micronutrients (vitamins and minerals) that aids in multiple body functions. So, the answer depends how balanced a diet you are eating and what medical conditions you have if any that interfere with proper absorption and utilization of dietary vitamins.
First, let us understand the role of vitamins in the body. Vitamins are nutrients that help your body to grow, develop and function normally. There are 13 essential vitamins the body needs: A, C, D, E, K and the B vitamins (thiamine, riboflavin, niacin, pantothenic acid, biotin, vitamin B-6, vitamin B-12 and folic acid). Each vitamin serves a specific purpose in the body.
Vitamin A, for example, plays a role in your vision, bone growth, reproduction, cell functions and building immunity to infections. It is also an antioxidant. Antioxidants are substances that protect your cells against the effects of 'free radicals,' the latter being molecules produced when your body breaks down food. It can also result from environmental toxins such as tobacco smoke and radiation.
Vitamin C is necessary for the body to form collagen in bones, cartilage, muscle and blood vessels. We often take Vitamin C to prevent a cold (remember the famous research by Linus Pauling, Nobel Laureate) or speed up recovery if you catch one. There may be some benefit in it. Also, foods rich in Vitamin C tend to lower the risk for some cancers.
Vitamin B group is important and serves multiple functions. B6, Folate and B12 are essential for blood cell formation and any deficiency can lead to anemia. Niacin (B3) contributes to the health of skin and nerves, Riboflavin (B2) for body growth and red blood cell formation, Thiamine (B1) for integrity of body cells and metabolism of carbohydrates and Panthothenic acid for food metabolism, production of hormones and cholesterol. These vitamins help the process your body uses to convert food you eat into energy. Not getting enough of certain B vitamins can cause diseases. A lack of B12, Folic acid or B6 can cause anemia. Folic acid and Vitamin B6 are also vital for cardiac health since they reduce the homocystein levels in the blood. B6 and B12 influence nerve function and cognitive abilities too.
Vitamin E is an antioxidant also known as tocopherol. It plays a role in the formation of red blood cells and helps the body use vitamin K.
Vitamin D, also called 'sunshine vitamin,' is essential for bone health and its deficiency can make the bones soft and brittle, a condition called osteomalacia resulting in bony deformities and fractures. This bone-bending disease used to be common a century ago in slum dwelling children in the United States, mostly from inadequate intake. I used to see them 50 years ago when I was a medical student in India. D is important to prevent Type I Diabetes and hypertension also. D deficiency tends to occur more in areas such as Scandinavian countries where sunshine is a precious commodity.
Vitamin K, although not listed among the essential vitamins, is essential for blood clotting. It may be vital for bone health also. Vitamin K is another key vitamin. If a person does not consume enough vitamin K, he/she may have an increased risk of bleeding.
It is estimated that 2 out of 5 Americans take vitamins or mineral supplements regularly and nearly 50 percent of people over 50 years also take multivitamins. Americans are spending over $10 billion a year for just multivitamins. Is this spending justified? Who should take supplemental vitamins daily? The next column will address these issues.
Dr. M. P. Ravindra Nathan is a Brooksville cardiologist.
KERATOCONUS: Think outside the CONE
By DR. ARUN GULANI
Keratoconus (Kerato means Cornea and Konus means cone shaped) is a genetically programmed condition where the normally round cornea (clear front window of the eye) thins and begins to bulge into a cone-like shape. This cone shape deflects light irregularly as it enters the eye on its way to the light-sensitive retina, causing distorted vision.
As you know from a previous article, the shape of this cornea determines your nearsightedness, farsightedness and astigmatism (Khaasbaat; Nov 2012).
So, as the cornea becomes more irregular in shape, it causes progressive nearsightedness and irregular astigmatism to develop, creating additional problems with distorted and blurred vision.
A common history among early keratoconus patients is changes in their eyeglass prescription every time they visit an eye-care practitioner. This may affect one or both eyes and more than one member in the family tree. Many patients may have high astigmatism or an unusual refractive error that is just never corrected to perfect vision, i.e., "I just don't see great despite my glasses and contact lenses."
This suggests further diagnostic testing to determine keratoconus and address the patient's constantly "not so perfect" vision.
Our cornea is normally made up of collagen fibers and research has revealed that there is any imbalance of enzymes in keratoconus cornea, which makes this collagen more susceptible to oxidative damage from free radicals, causing them to weaken and bulge forward.
In early forms of keratoconus, eyeglasses or contact lenses could help but as the disease progresses and the cornea thins and becomes increasingly more irregular in shape, glasses and regular soft contact lens designs don't provide adequate vision correction.
New-generation, custom-designed contact lenses are used for keratoconus patients today. These could also include hybrid lenses, piggyback lenses, hard lenses and scleral lenses. For more advanced cases, traditionally the treatment has been a corneal transplant. Given the invasive nature of the surgery, new modalities have been devised to rehabilitate these patients with less interventional technology such as INTACS, which are plastic micro-inserts placed into the cornea like a brace to bring the severe cone shape to a normal shape and then be adapted with a contact lens to help patients see.
Recently, a new technology called collagen cross-linking has been available under clinical trials for cases of keratoconus wherein this procedure, often called CXL/CCL/C3R for short, strengthens the corneal collagen to halt bulging of the eye's shape in keratoconus.
With introduction of collagen cross-linking, combination surgeries become a possibility wherein some early cases of keratoconus can also avail of laser vision surgery (not LASIK but LASIK-like laser vision surgery without making a flap) and then be cross-linked in a staged manner.
In summary then, instead of "sentencing" advanced keratoconus patients to a lifetime of "vision imprisonment", we can offer new generation technological advances in laser vision surgery, custom-cataract surgery, Intacs surgery and ICL surgery, including combination surgeries to a truly achievable goal of "vision freedom." "Let's break the "shackles" of limited options and limited vision for Keratoconus patients by indeed "Thinking outside the cone."
Arun C. Gulani, M.D., M.S., is director and chief surgeon of Gulani Vision Institute in Jacksonville. He can be reached at gulanivision@gulani.com or visit www.gulanivision.com