Many patients ask their physicians whether they should take vitamins. Since the last Medical Letter article on this subject, more data have become available on the benefits and risks of taking vitamin supplements.

The recent Medical Letter article on vitamin supplements1 included 2 sentences on vitamin E that could be misleading. "Vitamin E in food, which is mostly gamma-tocopherol, acts as an antioxidant. Vitamin E in supplements is mostly alpha-tocopherol, which may block the anti-oxidant effect of gamma-tocopherol and may have a pro-oxidant effect in vivo."Gamma-tocopherol is the most common form of vitamin E in the North American diet, and supplements are mostly alpha-tocopherol, which can, under some conditions, have a pro-oxidant effect. However, there is no evidence that taking supplements can...

Cataracts are the leading cause of blindness worldwide because cataract surgery is not available to most people in developing countries.

Many patients ask their healthcare providers whether they should take vitamins. Since the last Medical Letter article on this subject, more data have become available on the benefits and risks of taking vitamins.

The results of a randomized, placebo-controlled trial of calcium and vitamin D supplements in more than 36,000 postmenopausal women, conducted as part of the Women’s Health Initiative (RD Jackson et al. N Engl J Med 2006; 354:669), have been misinterpreted by some patients to mean that they should stop taking such supplements.At the time of recruitment, the participants in this study had an average daily calcium intake of 1100-1200 mg. They were randomized to take either 1000 mg of calcium carbonate plus 400 IU of vitamin D3 or a placebo for an average of 7 years. Both groups were permitted...

High doses of beta carotene, vitamin C, vitamin E and zinc oxide are now being promoted to the general public to "preserve eye health" (Ocuvite PreserVision), "promote retinal and visual health" (VisiVite) and "preserve healthy vision" (ICaps). Internet advertisements for these products all refer to a clinical trial, the Age-Related Eye Disease Study (AREDS), which was conducted in patients with age-related macular degeneration (AMD).

A nasal spray formulation of cyanocobalamin (Nascobal – Questcor) has been approved by the FDA for maintenance treatment of vitamin B12 deficiency. Nascobal is already available as an intranasal gel. Vitamin B12 deficiency, diagnosed by elevated serum concentrations of methylmalonic acid with or without elevated serum homocysteine and low serum B12 concentrations (<200 pg/mL), is common in older patients.1Since intestinal absorption of B12 may be impaired, the usual maintenance treatment of deficiency is intramuscular injection of the vitamin in doses of 1 mg every 4 weeks (after more...

The US Preventive Services Task Force (USPSTF) has issued a Draft Recommendation Statement saying, in effect, that community-dwelling women and men should not take calcium and vitamin D supplements for primary prevention of osteoporotic fractures because the evidence that they are helpful is insufficient and they increase the risk of kidney stones. The Medical Letter has said previously that there is no evidence that patients with an adequate intake of calcium (1000-1200 mg/day) and vitamin D (600-800 IU/day) will benefit from taking supplements.11. Drugs for postmenopausal osteoporosis. Treat...

The FDA has approved a subcutaneously injected formulation of recombinant human parathyroid hormone (Natpara – NPS) as an adjunct to calcium and vitamin D to control hypocalcemia in adults with hypoparathyroidism. Natpara is an 84-amino acid single-chain polypeptide identical to native parathyroid hormone. It is the first parathyroid hormone formulation to be approved for this indication.

An advertisement in a recent issue of Ophthalmology introduces PreserVision Eye Vitamin AREDS 2 Formula from Bausch & Lomb. No specific indication is mentioned, but the ad states that “…[the new product] builds on the original PreserVision Eye Vitamin AREDS Formula, the only formula proven to slow the progression of moderate-to-advanced AMD.”