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Doc: Kidney stones, supplements may not be healthy mix

August 5, 2018

Dear Dr. Roach: I have been taking a multivitamin for years, and now one of my physicians wants me to take a vitamin that has NO vitamin D or calcium. He just removed kidney stones in two separate procedures. I can’t find any vitamins like that.

D.A.S.

Dear D.A.S.: I completely agree that people with kidney stones should avoid calcium supplements. The transiently high levels of calcium after taking one cause the kidney to excrete a lot of that calcium, and that can cause a calcium crystal to grow, eventually forming a stone. Calcium that comes from the diet, on the other hand, does not induce such a spike in blood levels. Also, part of the calcium bonds with oxalate, preventing that chemical — a major part of many kidney stones — from being absorbed. High dietary calcium reduces the risk of stones.

The effect of vitamin D isn’t as clear. It seems having low vitamin D is a risk for stones, so many experts will treat low vitamin D levels in people with kidney stones. I don’t know your exact situation. It may be that your vitamin D level is normal or high, and you just don’t need supplementation.

The most recent studies have consistently shown that most of the vitamins in a multivitamin tablet (with the exception of vitamin D) do not improve health or prevent illness, so I don’t recommend multivitamins anymore. I would encourage a healthy diet with plenty of fresh fruits and vegetables. Save your money on the vitamin tablets.

Dear Dr. Roach: I saw your recent column on enlarged prostate, and I have the same problem. I have no history of cancer, but I do have a high PSA and symptoms of frequent urination. Because of other medications, I cannot take ibuprofen, so I am curious if Tylenol has the same anti-inflammatory effect. I do occasionally use Tylenol for headaches and arthritis pain.

J.B.

Dear J.B.: The exact mechanism of how Tylenol reduces pain remains a mystery. However, it is not an anti-inflammatory drug like ibuprofen, so would not be expected to have the benefit in prostate symptoms that some men get from taking an ibuprofen at bedtime.

Dear Dr. Roach: What is your opinion on screening for ovarian cancer in a woman with a family history (in my case, a sister)? One gynecologist stressed an annual ultrasound, while the other discouraged me from doing so. I am worried that if I wait until symptoms develop, the cancer might be pretty advanced.

W.

Dear W.: I really understand why people with increased risk for ovarian cancer are interested in screening. Unfortunately, we still don’t have any screening tests, such as an ultrasound or CA-125 blood test, that are good enough to recommend yet. I hope this changes soon. Promising work is progressing.

Consider genetic testing for a familial cancer syndrome, such as BRCA or Lynch syndrome. People with one of these cancer syndromes are at high enough risk that screening may be of benefit, and there are ongoing studies to help identify the best strategy. Talk to a gynecologist about a referral to a genetic counselor. If you test negative for these syndromes, you are at lower risk (but unfortunately, even low-risk women still may get ovarian cancer). You certainly should be vigilant for even mild symptoms of ovarian cancer; these are nonspecific and may include abdominal discomfort, bloating or swelling. Urinary urgency (a sense of needing to get to the bathroom right away) also should prompt a visit to your gynecologist, more so than in people without a family history.

Email questions to ToYourGoodHealth@ med.cornell.edu.

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