Ask the Experts November 2004

Father and sons

Your health questions answered by leading doctors and nutritionists

‘One of my friends takes both glucosamine and MSM. I am just taking glucosamine chondroitin. Is there any particular reason for taking MSM with glucosamine? And what are the additional benefits?’
N Masterton, Shropshire


The beneficial effects of glucosamine may be improved by combining it with other substances needed during regeneration of cartilage such as chondroitin, MSM (methyl-sulphonyl-methane) and vitamin C. In general, each of the main supplements taken for joint problems helps two out of three people, and it is a question of trying one for, say, 3 months, to evaluate your response. Many people respond well to taking glucosamine alone and, as this is the cheapest option, I usually suggest someone starts with this first. Then, if they are not entirely happy with the response, they can move up a level and combine glucosamine with chondroitin, or MSM, or both. MSM helps to stabilise the connective tissues found in cartilage, tendons and ligaments and also appears to have an anti-inflammatory action to reduce pain and swelling. If you are satisfied with glucosamine plus chondroitin alone, then there is no particular need to take MSM too. If you are feel there is still room for improvement you could add in MSM to see if this provides additional benefit. If inflammation is a particular problem, you might also consider omega-3 fish oils, green-lipped mussel extracts or devil’s claw. It is not always obvious which supplements will suit which people so you may need to experiment with combinations to find the right one for you. This will not always be the same combination that suits your friends and neighbours.
Dr Sarah Brewer

‘I have read that fat-soluble vitamins including A, D and E, where excess intake is stored rather than excreted, can be harmful if too much is taken. I now see that in your 50 Plus product, each tablet contains well over 100% RDA of these three vitamins. Surely this, plus more taken via, one hopes, a healthy diet, gives too high a daily level of these vitamins?’
L Sargent, Middlesex


One would hope that an individual would get all the nutrients they need from a healthy diet; however, this ideal is not often a reality. Sometimes a healthy diet doesn’t provide the RDA of a particular vitamin. The recommended daily amount is the quantity of a nutrient that is needed to keep most people fit and healthy and to help them avoid nutrient deficiency. This is where supplements come into play, to ensure that someone is getting enough of the nutrients they need. Looking at vitamins A, D and E it is true that when taken in excess they may cause problems. However, long-term daily intake from supplements of 2300mcg of vitamin A, 10mcg of vitamin D and 800mg of vitamin E is believed to be safe. In fact the safe upper limit is even greater for the intake from diet and supplement combined. Using vitamin E as an example, a normal diet provides on average between 7.2 - 9.9mg; the safe maximum supplement intake is 800mg. However, the total amount from both diet and supplement believed to be safe is 1000mg. The amounts contained within the 50 Plus multivitamin are within the safe upper limits even, if hopefully, you eat a healthy diet.
Dr Rob Hicks

‘I am 77 and have been taking Retinex for sometime as an aid to macular degeneration. I have recently been diagnosed with arterial fibrillation and prescribed a beta blocker and aspirin (75 mg p/d). Is it alright to continue with Retinex tablets. The Retinex has considerably helped my eyes and I should be extremely grateful for your advice.’
M Anderson, London


Retinex contains lutein and zeaxanthin - two pigments found naturally in yellow, orange, red and dark green fruits and vegetables such as sweetcorn, spinach, pumpkin and tomatoes. Lutein is also found in egg yolk, contributing to its rich yellow-orange colour. Lutein and zeaxanthin are vital for healthy vision and to help protect against age-related macular degeneration and cataracts. They protect the eyes partly because of their antioxidant activity (which neutralises harmful chemical reactions involved in light detection) and partly because their yellow colour filters out harmful light at the blue end of the spectrum. There do not appear to be any significant known drug interactions with either lutein or zeaxanthin.
Dr Sarah Brewer

Senior couple enjoying a paddle

‘I have heard that taking evening primrose oil helps with PMS. What daily dose should I be taking and should I be taking an increased dose at certain times of the month. Is there any other supplement that might help?’
Sally Gethings, Wiltshire


EPO is a natural source of essential fatty acids, specifically the omega-6 fatty acid gamma linoleic acid. This fatty acid is involved in the manufacture of prostaglandin E1, which can reduce the activity of prolactin - a hormone which may be responsible for symptoms of PMS. Research confirms that EPO can relieve the symptoms of PMS. For example, one British study found that 67% of women with PMS treated with EPO became symptom free, while another 22% had significant relief. In another study abdominal swelling and breast discomfort were eradicated in 95% of those treated. But you need to take EPO for at least 6 to 8 weeks before you can expect to feel improvements. The usual dose is 500mg twice daily, throughout the month. Another natural supplement which may inhibit the secretion of prolactin is Agnus Castus or Chasteberry. Recent research from Germany showed a 52% reduction in PMS symptoms with a dried extract of this plant. You should also make sure that your diet is rich in magnesium, calcium and potassium, which are important in keeping PMS at bay. Finally Vitamin B6 can reduce general PMS symptoms and particularly depression. The recommended dose is up to 100 mg/day
Dr Trisha Macnair

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Dr Sarah Brewer

Dr Sarah Brewer 

Sarah Brewer graduated as a doctor from Cambridge University in 1983. She was a full-time GP for five years and now works in hospital medicine. She is the author of 40 books and writes widely on all aspects of health including complementary medicine. 

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