Do you have any suggestions for supplements for individuals with myelodysplasia?

Many people with MDS have no symptoms when they are diagnosed (usually following the discovery of abnormalities that show up on routine blood tests). When symptoms do appear, they usually include anemia, weakness, fatigue, headache, bruising, increased bleeding, rash, fevers, mouth sores and lingering illness. The disorder is often confirmed with additional blood tests and a bone marrow biopsy. The greatest concern about MDS is that it can progress to acute leukemia, but this happens in less than one third of all cases.

I discussed your question with Randy Horwitz, M.D., medical director of the Arizona Center for Integrative Medicine. He told me that MDS is a difficult condition to treat and noted that since it is often regarded as a "pre-leukemic" state, many conventional oncologists either observe the patient or treat the symptoms until leukemia develops and then treat that with chemotherapy. Unfortunately, response rates to chemo are low and remission periods are brief. However, some of these cases can be cured with a bone marrow or stem cell transplant.

A stem cell transplant replaces the defective bone marrow with healthy cells. Results depend on the subtype of MDS, the patient's age, and any chromosome abnormalities that may be present. Stem cell transplants have typically been used for patients under the age of 50 but are increasingly being offered to older patients.

Dr. Horwitz said that mind/body approaches, especially hypnotherapy, have been useful in his MDS patients. He also recommends a traditional Chinese medicine herbal approach, a good anti-inflammatory diet, an exercise program emphasizing stamina (as much exercise as patients can tolerate) and a good multivitamin with adequate antioxidants. The goal is to optimize general health and keep the condition stable.

Andrew Weil, M.D.

I have heard that orange peel extract, taken for 20 days, will completely cure heartburn for up to six months with no side effects. Is it safe? How does it work?

Almost everyone occasionally experiences heartburn or acid reflux, the backflow of acid from the stomach into the esophagus. Heartburn usually occurs after eating and is felt behind the breastbone. When reflux is frequent and severe enough to damage the esophagus or interfere with normal activities, it is called gastroesophageal reflux disease (GERD).

I have no experience using orange peel extract (d-limonene) for heartburn so I checked with Tieraona Low Dog, M.D., director of the Fellowship at the Arizona Center for Integrative Medicine, and an authority on botanical medicine. She told me that she does recommend d-limonene for treatment of heartburn and has found it very effective. Dr. Low Dog said that d-limonene stimulates esophageal peristalsis, helping move acid and liquids back into the stomach. She recommends buying it as orange peel extract in 1,000 mg doses (standardized to d-limonene 97-99%) and taking it once a day every other day for a total of 10 doses over 20 days. After that, take it as needed. Note that some orange peel extracts are standardized to synephrine, a stimulant drug that is generally taken for weight loss. Synephrine-containing products can cause unwanted side effects and are not what you want for heartburn treatment. Dr. Low Dog said that she doesn't know of any disadvantages to using the orange peel extract for heartburn, but because safety in pregnancy isn't known, she doesn't recommend it for women who are expecting.

The natural remedy I usually recommend for heartburn is deglycyrrhizinated licorice (DGL). Whole licorice can increase blood pressure; no such effect occurs with DGL. You can buy DGL in powder or tablet form. The easiest way to take it is to chew two tablets slowly 15 minutes before every meal and at bedtime, or take one-half teaspoon of the powder before meals. Allow either form to dissolve in the mouth and slowly trickle down the throat. You can continue to take DGL as long as you have symptoms. You'll find more information on dealing with heartburn and GERD at DrWeil.com.

Andrew Weil, M.D.

Now that a scientific study has found that red rice yeast supplements work as well as statin drugs for cholesterol control I'm wondering if I should switch from the statin I now take. What's your recommendation?

Red rice yeast (Monascus purpureus) is a natural source of statins, but unlike pharmaceutical products, it provides a mix of these compounds rather than a single one. The complex mixture interacts with the body more smoothly and is less likely to cause toxicity.

One active ingredient in red rice yeast extract, monacolin K, is the active component of the FDA approved statin Mevacor. The lead researcher of the new study, David Becker, M.D., of Chestnut Hill Cardiology in Pennsylvania, said that because the dose of monacolin K in the red rice yeast supplement used in the study was five times smaller than the amount in a typical Mevacor prescription, "something else is having a powerful lipid-lowering effect." Healthy lifestyle changes among the study participants probably didn't account for the difference.

This is a valuable study, but I wouldn't recommend switching from a statin to red rice yeast without your physician's approval and supervision. Because supplements are unregulated and the demand for quality ingredients is growing, some products will not actually contain any red rice yeast extract and, as a result, won't be effective.

I have put many patients on red rice yeast products with excellent results and have seen only two patients who could not tolerate them because of side effects. Note that anyone taking statins, either as red rice yeast or prescription drugs, should be on daily supplements of coenzyme Q10 (CoQ10). Statins inhibit the body's production of this coenzyme along with lowering cholesterol. CoQ10 is necessary for optimum function of muscles, including heart muscle.

Andrew Weil, M.D.

Can you suggest anything that would restore kidneys or slow down diabetic kidney problems?

Diabetes injures the kidneys by damaging the organ's small blood vessels, depriving it of nutrients and oxygen and limiting its ability to function properly. When this happens, the body retains more water and salt than it should, causing weight gain and ankle swelling. Lab tests may show that you have protein in your urine, and waste materials can build up in your blood.

Diabetes can also damage nerves, which can affect normal signaling to the brain that the bladder is full. If you don't get the message to empty your bladder, pressure can build and further injure the kidneys.

I don't know of any way to reverse kidney damage once it has occurred - there are no miraculous supplements or herbs for that. However, you may be able to slow progression of your kidney problems by keeping your diabetes under good control and having periodic tests of your blood, urine and blood pressure as your health care team recommends. If your blood pressure rises, you need to get that under control immediately. Angiotension (ACE) inhibitors used to control blood pressure can help slow the loss of kidney function.

As far as dietary measures are concerned, you should consider what's called a renal-diabetic diet to keep your diabetes under control and slow progression of kidney damage, and a low protein diet will help take workload off the kidneys. You also should avoid alcohol and certain over-the-counter medications including those for pain and colds. Be sure to tell your health care practitioner about any drugs or supplements you take or are considering taking.

Andrew Weil, M.D.

N-acetylcarnosine (NAC) eye drops are used in Europe to slow or reverse formation of cataracts. NAC is available in this country, but no claims can be made for its effectiveness, so it is listed as an "inactive" ingredient. Is it of any value?

A cataract is a clouding of the lens in the eye that blurs vision, changes the way you see colors (they seem faded) and generally reduces visual acuity. Cataracts usually are age-related and represent accumulated free-radical damage to the protein molecules that form the lens of the eye. Once cataracts form, they tend to grow, clouding larger and larger areas of the lens.

You may be able to avoid cataracts or slow their growth by not smoking, wearing UV protective sunglasses and keeping your blood sugar under control (type 2 diabetes is a leading cause of vision loss). In addition, make sure that your diet includes foods that are rich in the antioxidants lutein and zeaxanthin, carotenoids that can help promote eye health. Good sources are kale, spinach, collard greens, other leafy greens and eggs (choose organic eggs fortified with omega-3 fatty acid, which contains DHA, another nutrient that is good for the eyes). Supplements are available for eye health that provide optimum amounts of lutein and other key antioxidant vitamins and minerals.

The antioxidant glutathione can also help, but it doesn't come directly from foods - the liver manufacturers it after you consume sulfur or certain amino acids. You can get sulfur from onions, garlic, shallots and capers and can boost your intake with supplements of alpha-lipoic acid (ALA) (250 mg twice a day) and N-acetylcysteine (600 mg twice a day).

N-acetylcarnosine, a dipeptide found in muscle and nerve cells, can help maintain protein integrity in the lens and is being studied in eye drop form for treatment of cataracts. It seems to work well in dogs, but according to Robert Abel Jr., M.D., a Delaware-based ophthalmologist and author of The Eye Care Revolution, (Kensington, 2004) the results of human studies to date have been variable and unpredictable. New formulations may prove more reliable and effective.

In the meantime, if cataracts interfere with your vision and are limiting your usual activities, I recommend surgery to replace the clouded lens in your eye with a clear artificial implant. The procedure is very safe, effective, and quick.

Andrew Weil, M.D.

I've recently retired and all the leisure time disturbs me. I think I should seek out new challenges to keep my mind and memory nimble. Any suggestions?

You're right about the need for new challenges as we age. Workouts for the brain are as important as physical activity is for the body. In my new book, Healthy Aging, I describe various ways to keep the mind agile and boost memory and concentration. I've long recommended card games and word puzzles as worthwhile traditional pastimes to exercise the brain.

But if you're looking for truly new challenges for your brain, the best mental workouts I can think of are learning a new computer operating system and learning a new language. If you've used a computer, you're familiar with the frustration of learning a new operating system - it wears you out. But this kind of challenge is exactly what is needed to force change on the brain's neural network so that it will stay flexible and young.

If you haven't used a computer very much, now's the time to learn. It may drive you crazy for a while, give you headaches and make you wish you never decided to take up the challenge. But it will open a new world for you once you learn all its complexities and give your brain a good workout in the process.

Learning a language is another perfect challenge to take on now that you've retired. Some people have a natural ear for language and learn quickly, but anyone who can hear and imitate sounds can learn a new language at any age. And you don't have to master it; it's the attempt to learn that gives the benefit. This type of learning draws on "fluid intelligence," the ability to stay focused and manage attention while ignoring irrelevant information. Fluid intelligence is one of the first aspects of brain function to suffer as age takes its toll on the mind. Learning another language should be more protective than any supplements or smart drugs designed to stave off cognitive decline.

I speak Spanish and used to speak German. I'm determined to brush that up and one day learn Japanese.

Andrew Weil, M.D.

What can you tell me about L-carnitine? It sounds like a wonderful supplement based on what I heard on the radio.

L-carnitine is an amino acid synthesized by the body and found in a variety of foods. It is manufactured by supplement makers in a more bioavailable form called acetyl-L-carnitine, also known as ALCAR and it can be a wonderful supplement, if you need it. Amino acids are the building blocks of protein molecules. They're relatively simple natural substances that are the first breakdown products of protein in digestion. If you eat adequate protein (and most people in this country get more than enough), you will have all the amino acids you need and probably more. There is no need to take pricey mixtures of amino acids as often recommended by fitness instructors, bodybuilders and athletes to build muscle mass.

Single amino acids are another matter. To achieve a beneficial effect, take one on an empty stomach in order to build up high levels in the blood and brain. A number of individual amino acids, including ALCAR, are available in health food stores. ALCAR is heavily promoted for use as a supplement to increase muscle strength and energy, to burn fat (for weight loss), for multiple sclerosis, Parkinson's disease, diabetes, chronic fatigue and a host of other problems. It is true that ALCAR aids in muscle metabolism and protects heart muscle. Because L-carnitine is involved in cellular metabolism, acetyl-L-carnitine can increase energy production in the mitochondria, the "power plants" of all cells, and thereby may generally boost physical and mental energy.

As a dietary supplement, ALCAR is utilized to help improve memory, and it has been studied as a possible treatment for Alzheimer's disease. ALCAR may also alleviate depression, may be used in the treatment of Parkinson's disease, stroke, and Peyronie's disease, and may have a protective effect on the central nervous system and may benefit the heart. There is also some evidence that ALCAR can enhance visual memory and attention in people with Down syndrome, and clinical data indicates that it also may slow age-related mental decline that is not associated with Alzheimer's.

To offset any temporary gastrointestinal effects it may have, take ALCAR with food. If you have gastroesophageal reflux disease, also known as GERD, consult your health care professional before taking ALCAR. Pregnant and lactating women are advised not to consume it. As for dosage if you choose to take it, I recommend 500 to 1,500 mg per day.

Andrew Weil, M.D.

I have heard extraordinary claims for acetyl-L-carnitine for anti-aging. I know you don't believe in a "fountain of youth," but have you any thoughts on this supplement?

Acetyl-L-carnitine is a combined form of the amino acid L-carnitine. It occurs naturally in the brain and has been studied as a possible treatment for Alzheimer's disease. Supplements of acetyl-L-carnitine may have a protective effect on the central nervous system and, like L-carnitine itself, may benefit the heart. (I don't recommend taking L-carnitine except as an adjunct to other treatments for serious heart conditions.)

Some preliminary research has suggested that acetyl-L-carnitine may help slow the progression of Alzheimer's disease, particularly among younger patients. There is also some evidence that this compound can enhance visual memory and attention in people with Down Syndrome, and clinical data indicates that it also may slow age-related mental decline that is not associated with Alzheimer's. However, the results of all of these studies must be considered preliminary - there is no hard evidence that supplements of acetyl-L-carnitine will reliably deliver the improvements noted. In general, I would urge you to be skeptical about extravagant advertising claims for any supplement.

That said, I checked with anti-aging and Alzheimer's disease expert Dharma Singh Khalsa, MD, about the potential benefits of acetyl-L-carnitine. Dr. Khalsa is president and medical director of the Alzheimer's Prevention Foundation International and author of the book "The Better Memory Kit" to be published later this year. He tells me that supplemental acetyl-L-carnitine can increase energy in the mitochondria, the power plants of all cells, and thereby helps generally boost physical and mental energy. He describes acetyl-L-carnitine as a superior antioxidant that promotes the production in cells of glutathione, perhaps our most potent free radical scavenger. If you decide to try it, Dr. Khalsa recommends taking 500 to 1,500 mg per day along with 100 mg of coenzyme Q10.

Andrew Weil, M.D.

A friend has been touting NT Factor to combat fatigue. What do you think?

NT Factor is a dietary supplement promoted for reduction of fatigue. Proponents claim that it bolsters cellular energy and promotes healthy function of the mitochondria, the cell structures that convert nutrients into energy. NT Factor is said to be a nutrient complex containing probiotics, growth factors, and phosphoglycolipids, substances that supposedly replace damaged mitochondrial membrane phospholipids. The idea is that by preventing damage to the mitochondria, NT Factor reduces the risk of age-related diseases and might even slow the aging process itself.

I've come across a few human clinical trials of NT Factor for treatment of fatigue. One was a very small study published in the fall, 2003, issue of the Journal of Chronic Fatigue Syndrome. It included only 20 participants between the ages of 61 and 77, all of whom used NT Factor for 12 weeks. The supplement didn't do much for those with mild fatigue (as measured on a special test designed to evaluate fatigue) but was reported to reduce fatigue by about 35 percent among participants whose test scores rated their fatigue as "moderate." The researchers also noted a "significant" increase in mitochondrial function in this group of older subjects.

Another slightly larger human study with 64 participants with high-moderate and severe fatigue who were treated with NT Factor for eight weeks showed a reduction of fatigue by 33 percent. The study was published in 2003 in The Journal of the American Nutraceutical Association (JANA). And a third one, published in a 2001 issue of JANA, included 36 chemotherapy patients who took NT Factor for 12 weeks. The researchers reported that the supplement significantly reduced fatigue, vomiting, nausea, and diarrhea.

I'm not convinced by the scant literature on the subject that there's anything to recommend taking NT Factor for fatigue. What's more, the supplement is expensive: up to $130 for a month's supply if you take it as directed (one to three tablets three times a day). If you're suffering from fatigue, concentrate on getting adequate rest, be sure to get some exercise daily and do my breathing exercises. In addition, you could take Siberian ginseng (Eleutherococcus senticosus), coenzyme Q10, the Ayurvedic herb ashwaganda or cordyceps, a traditional Chinese medicinal mushroom that may help fight fatigue and boost energy levels.

If you have chronic fatigue syndrome, the best thing you can do for yourself is 20 to 30 minutes of aerobic exercise at least five days a week. A few years ago, a British study found that 55 percent of the chronic fatigue patients who took part in a 12-week exercise program rated themselves "much" or "very much" better as a result, and even a year later 74 percent still considered themselves improved. As for enhancing mitochondrial function to reduce risk of age-related disease, I would first look at Juvenon, a product developed by nutritional biochemist Bruce Ames that combines two better studied supplements: acetyl-l-carnitine (ALCAR) and alpha-lipoic acid (ALA).

Andrew Weil, M.D.

I’m in my sixties, and I sometimes seem to temporarily forget the most ordinary things … names, phone numbers. My doctor says not to worry, but I’m concerned that my memory is failing, and of course, I worry about Alzheimer’s. This also happens to some of my friends. What do you think?

What you've been experiencing is common, and these temporary lapses aren't a sign that your memory is waning or your brainpower is declining. In fact, just the opposite may be true. The latest news from the neurological front on this matter is actually quite encouraging. Recent research suggests that as we age, our brains actually work somewhat better than they did when we were younger, despite the occasional frustrations of forgetting a name, phone number or other bits of information. In all likelihood, when you can't place a face or when you mislay your keys, you soon recover the information. With Alzheimer's, memory lapses are more disturbing and tend to interfere with daily life.

An interesting article in the May 20, 2008 issue of the New York Times reported on studies showing that older brains take in more information and are able to draw on it and use it better than younger brains. For example, the article described studies where college students and adults 60 and over were asked to read text that is interrupted with unexpected words or phrases. The students read through the passages at a consistent speed while the older people slowed down when they reached the out-of-place words. This suggests that they were taking in and processing the information. Later, when the two groups were asked questions about what they had read, the older adults were better able to respond than the students when the answers concerned the out-of-place words.

According to the Times article, current neurological thinking now holds that over time, older brains may be better able to make use of seemingly irrelevant information - an ability that seems to equate with wisdom or with superior problem-solving skills. In essence, older people seem to take in more detailed information and observations, which they're able to integrate with all the stored up knowledge they already possess and eventually draw on it when needs arise. The studies that led to these conclusions are analyzed in a new edition of a neurology book, Progress in Brain Research, the Times reported.

None of this explains why you may not immediately remember a name or phone number, but it is comforting!

Andrew Weil, M.D.