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Doctors Answer: What One Pill Should You Be Taking?

by Dr. Sharon Orrange on July 24, 2017 at 3:41 pm

Doctors are often asked what ONE pill or supplement they would recommend, or take themselves. The answer to this, I have learned, depends on perspective—based on which specialty the physician practices. So, after 20 years of being surrounded doctors in many fields at an academic medical center, here is the one pill you should be taking, by specialty.

Cardiologist

Aspirin, but not for everyone. Studies of aspirin for primary prevention of heart disease suggest about a 22% reduction in risk for non-fatal heart attack. Because aspirin increases the risk of gastrointestinal bleeding it’s not for everyone. The greatest benefit is seen in adults ages 50 to 59 with moderate to high cardiovascular risk, and those with risk factors like high blood pressure, high cholesterol, diabetes, family history of early heart disease, etc.

Runner up for this answer from a cardiologist would be a statin drug. Large clinical trials have shown statin therapy (atorvastatin, simvastatin, rosuvastatin) to be effective and safe for prevention of atherosclerotic cardiovascular disease (clogged arteries). Again, this holds true for adults ages 40 to 75 years, and in those who are eligible based on 10 year risk calculators—NOT everyone.

Gastroenterologist (“GI” Doctor)

Probiotics. Whether you struggle with lactose intolerance, irritable bowel syndrome, traveller’s diarrhea, Clostridium difficile (C. diff) diarrhea, or mild colitis symptoms, your GI doc will likely recommend probiotics in the form of fermented milk products (yogurt, kefir) or probiotic capsules (VSL #3, Align). Start with active culture yogurts or kefirs, but if you can’t tolerate dairy and need a supplement, look for one that contains multiple species (Lactobacillus, Bifidobacterium, etc) with high colony counts.

Runner up. For GI doctors who treat colon cancer patients, a daily aspirin may be recommended for the prevention of colon cancer. Two recent large studies have shown that the use of aspirin for 6 years or longer led to a 19% decreased risk of colorectal cancer and a 15% decreased risk of any type of gastrointestinal cancer. Again, given some of the risks associated with a daily aspirin, this isn’t for everyone.

Neurologist

Aspirin, but again, not for everyone. Stroke kills 133,000 Americans a year. For moderate and high-risk patients, studies of aspirin for prevention of stroke show it lowers your risk by approximately 14%. That’s pretty good given that aspirin costs pennies a day.

Runner up here would be a recommendation by neurologists who treat headache patients to try the supplements riboflavin 200 mg/day, magnesium 200 mg/day and CoQ10 75 mg/day which are available together as one supplement in Migrelief, Dolovent, or Migravent. The American Academy of Neurology recommends vitamin B2 (riboflavin), magnesium, and coenzyme Q10 for migraine prevention as alternatives to prescription drugs, given the desire for more natural treatment options and evidence that this supplement may reduce the number of headache days per month.

Ophthalmologist (Eye Doctor)

AREDS 2 vitamin. Taken once daily in those with intermediate to severe macular degeneration, the most common cause of blindness in the United States, an AREDS 2 combo vitamin available over the counter reduces the risk of progression of macular degeneration by as much as 19 percent, and of vision loss by 25 percent. Say what?! The AREDS 2 supplement is one of the only available treatments proven to be effective for intermediate-to-severe dry macular degeneration. What’s in AREDS 2? Lutein, zeaxanthin, vitamins E and C, zinc, and copper.

Dermatologist

Skin doctors will say, in answer to the ONE thing their patients should be taking, a vitamin D capsule. Why? Because your dermatologist does not want you in the sun. Instead, they want you to get adequate vitamin D through a supplement (maintenance dose of approximately 2000 IU per day). Skin cancer is by far the most common type of cancer in adults and sun exposure is your major risk factor. They don’t want you to get that.

Orthopedic Surgeon

Vitamin D, again, but only in those with low vitamin D levels (hypovitaminosis D). Low vitamin D is associated with more severe osteoporotic hip fractures, and vertebral/spine fractures. Simply put, your orthopedic doctor wants you to have normal vitamin D levels, and to take vitamin D supplements to normalize them if you don’t.

Runner up would be a glucosamine plus chondroitin supplement in folks with knee osteoarthritis, though there have been conflicting results about whether or not they work.

Obstetrician/Gynecologist

A daily folic acid supplement for the prevention of neural tube defects is recommended for all women planning pregnancy or capable of becoming pregnant. The body of evidence from randomized trials and large studies supports a folic acid supplement of 0.4 mg taken once a day to decrease the occurrence of neural tube defects.

Endocrinologist

Metformin, and not only for the treatment of diabetes. Metformin in prediabetics helps prevent the onset of diabetes, improves weight loss, regulates ovulation in patients with polycystic ovary syndrome (PCOS), and may help you live longer. Not kidding. Animal studies (and ongoing studies in humans) have focused on metformin to reverse aging since it may influence fundamental aging factors that underlie multiple age-related conditions. Metformin 1000 mg a day is commonly embraced by endocrinologists and internists for those reasons.

Urogynecologist/Urologist

Vaginal estrogens. For postmenopausal women with recurrent urinary tract infections, urinary incontinence, or atrophy, most urologists and urogynecologists will advise starting on a vaginal estrogen (Estrace cream, Premarin cream, or Vagifem tablets). Excluded from this advice will be women with a history of estrogen-receptor-positive breast cancer.

Pediatrician

A helmet. It’s not a supplement, but a pediatricians mantra is: wear a helmet, wear your seatbelt, don’t ride a motorcycle, and don’t smoke. Unintentional injuries are the number one cause of death in the pediatric population and a helmet is your one thing in this case . . . not a pill or a supplement.

What did I miss?

Dr O.


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