Drugs and Supplements

Will melatonin supplements help with jet lag?

DEAR DOCTOR K: My wife and I are traveling to Europe in a few weeks, and we're already dreading the jet lag. Do you think melatonin will help?

DEAR READER: Many people find that crossing several time zones makes their internal clocks go haywire. Some small studies have suggested that melatonin can help jet lag if taken a few days before and after travel. Melatonin is a natural substance released by our brain to help coordinate our circadian (day/night) rhythm. This rhythm is disturbed when we travel across time zones. Melatonin is more effective in minimizing the effects on sleep of eastward travel.

Are the new statin guidelines better than the ones they replaced?

DEAR DOCTOR K: My doctor put me on a statin in 2013 because the guidelines that came out that year said I should be on them. Are the new guidelines really better than the ones they replaced?

DEAR READER: I'm sorry you asked that question, because any answer I give will be criticized by some of my colleagues on the faculty of Harvard Medical School. This is a very controversial area, and my colleagues all have strong opinions -- just not the same one.

Do daily vitamins help you or hurt you?

DEAR DOCTOR. K: I'm a 35-year-old woman who has taken vitamin pills since I was a girl. Some people tell me they don't help, and may even hurt me. What's the truth?

DEAR READER: I'll never pretend to tell you the "truth" in this column, because I don't always know what it is. And I've seen what people considered to be the truth change. But I will give you my best current assessment of what scientific studies show. First of all, there's no question that you need vitamins. In fact, they are substances all of us need to live. In developing nations, many people are made very sick and even die because of severe vitamin deficiencies.

How can I reduce the risk of side effects of new medications?

DEAR DOCTOR K: I need to start taking a new medication to treat a recently diagnosed condition. Is there anything I can do to reduce the risk of side effects?

DEAR READER: My colleague Dr. Gordon Schiff, associate professor of medicine at Harvard Medical School, says it well: "All drugs have effects -- the ones we want and the ones we don't. The unwanted effects are known as side effects." When you take a drug, it is distributed throughout your body, to all your organs and tissues. The drug may do different things in those different organs.

Are there any medicines that protect against Alzheimer’s?

DEAR DOCTOR K: I've heard that certain common medicines used for other purposes may also protect against Alzheimer's disease. Is there any truth to this?

DEAR READER: You've raised an important question. Unfortunately, research has not so far provided a clear answer. HORMONE THERAPY. For years, doctors believed that hormone therapy might protect women from Alzheimer's disease. This therapy replaces the hormones that a woman no longer makes after menopause. The possibility that hormone therapy might offer protection was raised by studies which found that women who took estrogen were less likely to develop Alzheimer's than those who didn't.

I’m obese. Should I be on a weight-loss drug to lower my heart disease risk?

DEAR DOCTOR K: I take medications for high blood pressure and high cholesterol. I am also obese, which is another risk factor for heart disease. Should I be on a weight-loss drug?

DEAR READER: You're right that being obese can put a heavy burden on your heart. It boosts your heart attack risk by about 60 percent. Diet and exercise are always the first steps toward controlling excess weight and other heart disease risk factors. When lifestyle changes aren't enough, doctors often prescribe medications, like statins for high cholesterol. But the medical options for weight loss are more limited.

Do any supplements effectively lower cholesterol?

DEAR DOCTOR K: My cholesterol is high and my doctor wants me to go on a statin. I'd like to avoid medication. Do any supplements effectively lower cholesterol?

DEAR READER: Statin drugs lower LDL (or "bad") cholesterol and also reduce inflammation. Together, these effects lower your risk of heart attack. Various herbs and supplements have been touted for their ability to improve cholesterol levels. There is one general caveat you should consider. New drugs are tested by the FDA for their safety, effectiveness and purity.

What can I do to prevent migraines?

DEAR DOCTOR K: I suffer from excruciating migraine headaches. What can I do to prevent them?

DEAR READER: Migraines are severe, throbbing, often debilitating headaches. They can be accompanied by nausea or vomiting. It's no wonder that anyone who suffers from migraines would do anything to avoid them. Migraines can be triggered by certain activities, foods, smells or emotions. Common migraine triggers include:

How can I get my elderly mother to take her medications consistently?

DEAR DOCTOR K: My mother is supposed to take several medications each day, but she doesn't take them consistently. What can I do to get her back on track?

DEAR READER: I'll bet when you were a kid and your parents were hounding you about taking your medicine, you never imagined a day would come when you'd be doing the same to them. Nearly three out of four Americans report that they do not always take their medication as directed. So there are a lot of people who are in the same position as your mother. And, obviously, for the medicines to work, a person's got to take them.

Are there any new treatments for lowering cholesterol, besides statins?

DEAR DOCTOR K: I have high cholesterol, but I can't tolerate statins. Are there any new treatments for lowering cholesterol?

DEAR READER: I assume you're taking statins because your low-density lipoprotein (LDL) cholesterol (so-called "bad" cholesterol) is high. If so, that does increase your risk of having a heart attack or stroke. Lowering LDL cholesterol reduces that risk. Some people can bring down their cholesterol levels with diet and exercise alone. But many people need medication to get to their target levels.