Symptoms
Kenneth was shaking and couldn’t sleep. Maybe two cups of coffee a day was too much at 88 years old, he thought. He completely stopped drinking coffee and the one square of chocolate he savored in the afternoon but continued to tremble.
Kenneth told his son about his shaking on a couple of occasions, so they followed through with a visit to his primary care physician. Dr. Johnson asked deeper questions and reviewed his medications: a blood pressure pill, a statin, and a stool softener. She expressed doubt that these were contributing to his new symptoms.
On physical exam, the tremors didn’t appear to be from a serious chronic cause, so she dove deeper into anxiety and depression. While Kenneth had always struggled a bit with anxiety, he wasn’t having more stress. She checked his thyroid function and other blood tests, all of which were normal.
He continued to shake.
Discovery of the enemy
One morning, his daughter-in-law, Sue, dropped off cinnamon rolls and chatted with Kenneth and his wife at the breakfast table. In front of Kenneth stood an army of plastic bottles of varying sizes. Sue noted Vitamin C, Vitamin D, Calcium, B Complex, Prevagen, Glucosamine-Chondroitin, St John’s Wort, and more. While Sue knew that Kenneth took many vitamins, the total number assaulted her that morning.
Later, she described her discovery to her husband Mitch, who initially nodded and smirked. But then, as if a light bulb went off in his head, he snapped upright and exclaimed, “Do you think the supplements are making him have the tremors? I am so used to Dad taking supplements for years, it didn’t occur to me.”
The next day, son and daughter-in-law gathered at Kenneth’s home to attack the arsenal of pill bottles. After pulling bottles from the kitchen cabinet onto the dining room table, they interrogated Kenneth. How many of each one was he taking and why? Then, they looked up side effects. Digestive problems and drowsiness came up, but didn’t seem to be a likely culprit at the doses he was taking.
They did, however, find that Kenneth had been consuming a multitude of supplements to treat and prevent symptoms they weren’t aware of. Aches and pains, sinus drainage, low energy, memory loss, anxiety, and weight gain. “Weight gain?” Mitch queried, “You’re taking Raspberry Ketones to lose weight? And you’re taking six a day?” Kenneth sheepishly responded that the doctor’s notes from his physical last year noted that he fell into the range of “overweight,” and he wanted to maintain the best health he could. Mitch eyed his father up and down. “Has your weight changed?” “No,” answered Kenneth, “I’ve weighed one hundred and eighty pounds for years.”
Side Effects
Raspberry ketones can cause insomnia, heart palpitations, high blood pressure, anxiety, and jitteriness. The internet summary is followed by an injunction to consult a healthcare provider before starting raspberry ketones. Kenneth and his kids agreed he should stop these. It wasn’t long before his shakiness abated and he started sleeping better.
Prescribed medications are more likely to be carefully controlled and evaluated for side effects, but other substances may fly under the radar, including recreational drugs and over-the-counter supplements. In fact, Kenneth’s PCP had asked about additional supplements, and Kenneth reported some of those he took, but wearied of reporting all of them. And, it would have been difficult to get an accurate list because promising results from advertising and his friends led him to regularly adjust his intake.
Targets are different with age
Kenneth’s PCP explained that the BMI (body mass index, which is a calculation of weight and height) has standard designations for “overweight” and “obese.” Medical records regularly report these. However, these designations do not apply to everyone, and in fact, statistics of BMI and mortality in older adults point to a higher mortality with low BMIs and the lowest mortality rates associated with BMIs that are higher than recommended for younger adults. Dr Johnson reassured Kenneth that his BMI of 28, considered overweight for younger adults, is within the target range for someone his age.
An Ounce of Prevention
The lessons here are taking over-the-counter supplements can cause ill effects. Those taking them, as well as health care providers, should delve into discussions of these supplements, including potential drug-drug and drug-disease interactions. And health concerns for younger adults may not be pertinent for those who are older. The regular treadmill of health care should be run much more cautiously in those with advancing age.
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