Red Wine Reduces Prostate Cancer Risk: In a case-control study of 753 newly diagnosed prostate-cancer patients vs. 703 healthy controls all ages 40-64, men who consumed 4-8 four-oz. glasses of red wine per week reduced their risk of prostate cancer by 50% (60% for more aggressive types of prostate cancer). No significant effects were found with beer, hard liquor, or with white wine. Resveratrol, which is abundant in the skins of red grapes, peanuts, raspberries, and a dietary supplement but much less so in the skins of white grapes may be the factor. It is an antioxidant, anti-inflammatory agent, reduces cell proliferation, and enhances apoptosis. Diet, family history of cancer, screening for prostate cancer and tobacco use were adjusted for. In the less detailed Netherlands Cohort Study, white and fortified wines, but not red wine, increased prostate cancer, although there was not a consistent trend with levels of intake. For red wine, there was an 18% reduction in risk. Janet L. Stanford, Seattle, International Journal of Cancer 10/04. For more, see Prostate Cancer.

NADH No Lasting Benefit for Chronic Fatigue: 31 patients with chronic fatigue syndrome (CFS) were randomly assigned to either nicotinamide adenine dinucleotide (NADH) or nutritional supplements and psychological therapy for 24 months. The twelve patients who received NADH had a dramatic reduction in symptoms the first trimester (p < 0.001). However, scores in subsequent trimesters were similar in both groups. Comparison of oral nicotinamide adenine dinucleotide (NADH) versus conventional therapy for chronic fatigue syndrome. Santaella ML, Font I, Disdier OM. University of Puerto Rico. P R Health Sci J. 2004 Jun;23(2):89-93

Cholinesterase Inhibitor Failed to Help Chronic Fatigue Syndrome: In a large DB PC study of 434 patients in Europe with chronic fatigue syndrome, galantamine 2.5 mg/day vs. 5.0 mg vs. 7.5 mg vs. 10 mg vs. placebo found that after 16 weeks, there were no statistically significant differences between any of the galantamine or placebo groups. Effect of galantamine hydrobromide in chronic fatigue syndrome: a randomized controlled trial. Blacker CV, Greenwood DT, Wesnes KA, Wilson R, Woodward C, Howe I, Ali T. University of Exeter, England. JAMA. 2004 Sep 8;292(10):1195-204

Exercise Helps CFS Significantly as Did Fluoxetine and Education: In an analysis of the five best studies found using exercise to help CFS patients, at 12 weeks, those receiving exercise therapy were less fatigued than controls (SMD -0.77). Physical functioning was significantly improved with exercise (SMD -0.64) but there were more dropouts (RR 1.73). Depression was non-significantly improved with exercise (WMD -0.58).Participants receiving exercise therapy were less fatigued than those receiving the antidepressant fluoxetine at 12 weeks (WMD -1.24). Participants receiving both exercise + fluoxetine were less fatigued than those receiving exercise therapy alone, although the difference did not reach significance (WMD 3.74).When exercise therapy was combined with patient education, those receiving the combination were less fatigued than those receiving exercise therapy alone (WMD 0.70). Exercise therapy for chronic fatigue syndrome. Edmonds M, McGuire H, Price J. Cochrane. 2004;(3):CD003200

Mono Can Cause Chronic Fatigue: 150 Americans with infectious mononucleosis were followed for 2 and 6 months and 50 for 4 years. There were four different groups: most subjects with few symptoms, a few with many symptoms, a group with predominantly mood symptoms and some subjects with fatigue symptoms. Some fatigue was still demonstrable 4 years after onset. The nosology of sub-acute and chronic fatigue syndromes that follow infectious mononucleosis. White PD, Thomas JM, Sullivan PF, Buchwald D. University of London, UK. Psychol Med. 2004 Apr;34(3):499-507

Evidence of Infection or Toxicity in CFS: Many patients with chronic fatigue syndrome (CFS) have symptoms that are consistent with an underlying viral or toxic illness. Neutrophil apoptosis occurs in patients with infection. In a study, the 47 patients with CFS had higher numbers of apoptotic neutrophils, lower numbers of viable neutrophils, increased annexin V binding, and increased expression of the death receptor, tumour necrosis factor receptor-I, on their neutrophils than did 34 healthy controls. Patients with CFS also had raised concentrations of active TGFbeta1 (p < 0.005). Patients with CFS have an underlying detectable abnormality in their immune cells. Increased neutrophil apoptosis in chronic fatigue syndrome. Kennedy G, Spence V, Underwood C, Belch JJ. Dundee, UK J Clin Pathol. 2004 Aug;57(8):891-3

Angiotensin-Converting Enzyme Gene Polymorphism Much More Common in Gulf War CFS: In a study of 49 Gulf War veterans and 61 nonveterans with chronic fatigue syndrome (CFS) or idiopathic chronic fatigue (ICF) and 30 veterans and 45 nonveterans who served as healthy controls, increased risk for CFS/ICF was associated with alterations of the insertion/deletion (I/D) polymorphism in the angiotensin-converting enzyme gene within the Gulf War veteran sample only. Veterans with the DD genotype were eight times more likely to develop CFS/ICF than were those with the II genotype (OR, 8.30; P = 0.009). Association of medically unexplained fatigue with ACE insertion/deletion polymorphism in Gulf War veterans. Vladutiu GD, Natelson BH. State University of New York at Buffalo. Muscle Nerve. 2004 Jul;30(1):38-43

Depression and Fatigue Tend to Lead to Each Other: 3,201 adults in 14 countries were followed for 12 months. Patients with depression were found to have an increased risk of developing a new episode of unexplained fatigue at follow-up with an adjusted odds ratio of 4.15. Unexplained fatigue had an increased risk of developing a new episode of depression with an OR of 2.76. Temporal relations between unexplained fatigue and depression: longitudinal data from an international study in primary care. Skapinakis P, Lewis G, Mavreas V. University of Ioannina, Greece. Psychosom Med. 2004 May-Jun;66(3):330-5

No Relationship Dental Mercury Amalgam and CFS: In a retrospective cohort study of New Zealand Defense Force covering 20 000 young adults, 84% males, of conditions allegedly associated with amalgam, multiple sclerosis had a slightly increased risk: an adjusted hazard ratio (HR) of 1.24 (P = 0.06), but neither chronic fatigue syndrome nor kidney diseases were associated at all with amalgam. Further follow-up of the cohort will permit investigation of diseases more common in the elderly. Health effects of dental amalgam exposure: a retrospective cohort study. Bates MN, Fawcett J, Garrett N, Cutress T, Kjellstrom T. Porirua, New Zealand. Int J Epidemiol. 2004 Aug;33(4):894-902. For more, see Chronic Fatigue Syndrome.

Gas, Foam Pillows, Dampness Bad; Cotton Quilts, Fruits, Veggies Good: 10,902 schoolchildren, all age 10, were tested. Factors during the first year of life and currently that were significantly associated with wheeze were cooking with gas (odds ratio 2.04), foam pillows (2.58), and damp housing (1.89). Factors protecting against wheeze were cotton quilts and the consumption of fruit and raw vegetables. Factors associated with difference in prevalence of asthma in children from three cities in China: multicentre epidemiological survey. Wong GW, Ko FW, Hui DS, Fok TF, Carr D, von Mutius E, Zhong NS, Chen YZ, Lai CK. University of Hong Kong. BMJ. 2004 Aug 28;329(7464):486

Foam Mattresses Bad for Asthma: The homes of 152 schoolchildren in Northern Norway with dust samples from 24 foam mattresses without covers, 68 foam mattresses with covers, and 24 spring mattresses were studied. Mite feces were found in 40% of dust from foam mattresses without covers and 26% from foam mattresses with covers and 12.5% from spring mattresses. Signs of dampness, age of mattress, cleaning of mattress, frequency of vacuuming the bedroom, mechanical ventilation, bedroom temperature and bedroom relative humidity were associated with the presence of mite feces. After adjustment for these, the risk of finding mite feces was four times higher in foam compared to spring mattresses (odds ratio 4.0), and eight times higher for the foam mattresses without cover (OR 8.1). House-dust mites and mattresses. Schei MA, Hessen JO, Lund E. University of California, Berkeley. Allergy. 2002 Jun;57(6):538-42

Foam Pillows Bad for Asthma; Feather Pillows Good: 486 children with 12 or more wheezing attacks in the past year were compared to 475 similar children without attacks, all living at the same address for at least 3 years. Severe wheeze was more common with non-feather bedding, especially foam pillows (odds ratio 2.78), and the ownership of furry pets now (1.51) and at birth (1.70). These estimates were family not making changes in the bedroom or pet because of allergy. If the foam pillow association is causal, it accounts for 53% of the severe asthma in the study. Parental smoking, use of gas for cooking, age of mattress, and mold growth in the child's bedroom were not significantly associated with wheezing. Home environment and severe asthma in adolescence: a population based case-control study. Strachan DP, Carey IM. St George's Medical School, London. BMJ. 1995 Oct 21;311(7012):1053-6. For more, see Asthma.

Coronary Heart Disease: Meat, Margarine, Poultry Bad; Vegetables, Wine, Whole Grains Good: In a small case-control study of 200 cases of coronary artery disease and 255 controls from the Coronary Risk Factors for Atherosclerosis in Women (CORA) Study, a high score for the dietary pattern of high intakes of meat, margarine, poultry, and sauce and low intakes of vegetarian dishes, wine, vegetables, and whole-grain cereals, after adjustment for known CAD risk factors, the relative risks from the lowest to the highest quintiles of the pattern score were 1.0, 1.1, 3.6, 6.2, and 12.3 (P < 0.0001). A dietary pattern derived to explain biomarker variation is strongly associated with the risk of coronary artery disease. Hoffmann K, Zyriax BC, Boeing H, Windler E. Bergholz-Rehbrucke, Germany. Am J Clin Nutr. 2004 Sep;80(3):633-40. For more, see Coronary Diet.

Raloxifene (Evista) Doubles Thromboembolisms: In the 3.3-year MORE study of 7,705 postmenopausal women with osteoporosis, raloxifene 60 mg/d or 120 mg/d was associated with an increased risk for venous thromboembolism (relative risk [RR] 2.1). The excess event rate was 1.8 per 1,000 woman-years affecting 1 in every 170 women during the study. The thromboembolism occurred during the first two years. Raloxifene did not increase cataracts (RR 0.9), gallbladder disease (RR 1.0), endometrial hyperplasia (RR 1.3), or endometrial cancer (RR 0.9). Safety and adverse effects associated with raloxifene: multiple outcomes of raloxifene evaluation. Grady D, Ettinger B, Moscarelli E, Plouffe L Jr, Sarkar S, Ciaccia A, Cummings S. University of California, San Francisco, California. Obstet Gynecol. 2004 Oct;104(4):837-44. Ed: Evista is an expensive way to prevent or treat osteoporosis. Vitamins D and K with calcium are better, safer, and far less expensive.

Highly Biased Study Promotes Alendronate (Fosamax) for All Post-Menopausal Women: In a 6-year, industry-funded, poor-designed study of 1609 healthy, early postmenopausal women, fractures occurred in 11.5, 10.3, and 8.9% of women taking placebo, 2.5 mg alendronate, or 5 mg alendronate daily. The authors claimed that alendronate is "an effective and promising strategy for the prevention of postmenopausal osteoporosis." Prevention of postmenopausal bone loss: six-year results from the early postmenopausal intervention cohort study. McClung MR, Wasnich RD, Hosking DJ, Christiansen C, Ravn P, Wu M, Mantz AM, Yates J, Ross PD, Santora AC 2nd. Portland, Oregon. J Clin Endocrinol Metab. 2004 Oct;89(10):4879-85. Ed: This is another extremely biased study designed to make sure the sponsor’s medication looks better. 40 women had to take Fosamax for 6 years to prevent one fracture as a cost of $230,000 of medication per fracture prevented. If the controls had been given vitamin D 1000 IU, vitamin K 500 mcg. and calcium 1000 mg/day, it is virtually certain the controls would have done as well or better with many other added health benefits (less cancer, less heart disease, etc.) and an annual cost of $60 vs. $1000. For more, see Bisphosphonates and Cost-Effectiveness.

Low Vitamin K Associated with Low Bone Mineral Density: In a study of vitamin K status and BMD at the hip and spine in 741 men and 863 women ages 32-86 who participated in the Framingham Heart Study (1996-2000), among men, low plasma K(1) was associated with low BMD at the femoral neck (P = 0.009). Among postmenopausal women not using estrogen replacements, low plasma K(1), phylloquinone, was associated with low spine BMD (P = 0.007). There were no significant associations between biochemical measures of vitamin K and BMD in either premenopausal women or postmenopausal women using estrogen replacements. Associations between Vitamin K Biochemical Measures and Bone Mineral Density in Men and Women. Booth SL, Broe KE, Peterson JW, Cheng DM, Dawson-Hughes B, Gundberg CM, Cupples LA, Wilson PW, Kiel DP. Tufts University. J Clin Endocrinol Metab. 2004 Oct;89(10):4904-9. For more, see Osteoporosis.

Duloxetine (Cymbalta) Some Benefit for Fibromyalgia: In a 12-week DB PC study of 207 fibromyalgia sufferers, duloxetine 60 mg twice a day improved slightly more (P = 0.027) on the total fibromyalgia score, but not for pain (P = 0.130). Duloxetine-treated subjects had greater reductions in Brief Pain Inventory average pain severity score (P = 0.008), Brief Pain Inventory average interference from pain score (P = 0.004), number of tender points (P = 0.002), and FIQ stiffness score (P = 0.048), and had significantly greater improvement in mean tender point pain threshold (P = 0.002), CGI-Severity (P = 0.048), PGI-Improvement (P = 0.033), and several quality-of-life measures. A double-blind, multicenter trial comparing duloxetine with placebo in the treatment of fibromyalgia patients with or without major depressive disorder. Arnold LM, Lu Y, Crofford LJ, Wohlreich M, Detke MJ, Iyengar S, Goldstein DJ. University of Cincinnati. Arthritis Rheum. 2004 Sep;50(9):2974-84. Ed: This apparently industry funded study’s abstract doesn’t give any actual figures of improvement. With large studies, small benefits can be statistically significant but less significant clinically. It is very likely that other much less expensive and better tested anti-depressants like amitriptyline and nortriptyline do as well or better. For more, see Fibromyalgia.

Fluoxetine (Prozac) Helped Minor Depression: In a 12-week DB PC study of 162 patients with a minor depressive disorder, fluoxetine was superior to placebo for the Inventory of Depressive Symptomatology, the 17-item and 21-item Hamilton Depression Rating Scale, the Beck Depression Inventory, and the Clinical Global Impression severity scale. Randomized, placebo-controlled trial of fluoxetine for acute treatment of minor depressive disorder. Judd LL, Rapaport MH, Yonkers KA, Rush AJ, Frank E, Thase ME, Kupfer DJ, Plewes JM, Schettler PJ, Tollefson G. University of California, San Diego. Am J Psychiatry. 2004 Oct;161(10):1864-71. See Minor Depression.

Ziprasidone (Geodon) As Good As Olanzapine (Zyprexa) with Fewer Side-Effects and Lower Cost: In a 6-week DB study of 269 inpatients with schizophrenia or schizoaffective disorder, the mean daily doses were 130 mg for ziprasidone and 11.3 mg for olanzapine. Both antipsychotics were effective in improving symptoms. They did not differ significantly in primary or secondary efficacy measures (BPRS, CGI, PNSS, Depression). Body weight, total cholesterol, triglycerides, and low-density lipoprotein cholesterol significantly increased with olanzapine but not with ziprasidone. Olanzapine, but not ziprasidone, was associated with significant increases in fasting insulin level. No patient in either group exhibited a corrected QT interval >/=500 msec. Randomized, controlled, double-blind multicenter comparison of the efficacy and tolerability of ziprasidone and olanzapine in acutely ill inpatients with schizophrenia or schizoaffective disorder. Simpson GM, Glick ID, Weiden PJ, Romano SJ, Siu CO. LAC + USC Medical Centers. Am J Psychiatry. 2004 Oct;161(10):1837-47. Ed: I prefer Geodon due to its lower side-effects and lower cost. For more, see Ziprasidone.

Sex Dysfunction: Impotence Helped  in Diabetic Men: In a DB PC study of 40 men with erectile dysfunction and diabetes, when compared to patients using sildenafil 50 mg. Twice weekly, those taking an additional 2 g/day of propionyl-L-carnitine for 24 weeks had much better erectile dysfunction scores: 4.25 and 3.95 vs. 2.9 and 2.7 (p < 0.01). The percentage of patients with improved erections (GEQ 68% vs. 23%) and successful intercourse attempts (76% vs. 34%) was significantly increased. Two patients reported mild gastric pain on PLC. Preliminary observations on the use of propionyl-L-carnitine in combination with sildenafil in patients with erectile dysfunction and diabetes. Gentile V, Vicini P, Prigiotti G, Koverech A, Di Silverio F. University 'La Sapienza', Rome, Italy. Curr Med Res Opin. 2004 Sep;20(9):1377-84

Acetyl Carnitine Helped Rat Anxiety: Acetyl-L-carnitine showed anti-anxiety effects in a rat model of anxiety. Effect of intraperitoneal acetyl-L-carnitine (ALCAR) on anxiety-like behaviours in rats. Levine J, Kaplan Z, Pettegrew JW, McClure RJ, Gershon S, Buriakovsky I, Cohen H. Ben-Gurion University, Israel. Int J Neuropsychopharmacol. 2004 Sep 20. For more, see The Carnitines.

Aphthous Stomatitis (Canker Sores) Helped by Adhesive Magnesium-Citrus Oil Tablet Somewhat: In a DB PC study of a new mucoadhesive tablet, which releases citrus oil and magnesium, half of 248 volunteers who had canker sores and were given the active tablet did better. Adhesive tablet effective for treating canker sores in humans. Mizrahi B, Golenser J, Wolnerman JS, Domb AJ., the Hebrew University of Jerusalem. J Pharm Sci. 2004 Sep 29;93(12):2927-2935. For more, see Medical Diseases A-C.

Mammal Meat Causes Diabetes: 37,309 women over 44 in the Women's Health and free of cardiovascular disease, cancer, and type 2 diabetes were followed for 8.8 years. 1,558 developed type 2 diabetes. After adjusting for age, BMI, total energy intake, exercise, alcohol intake, cigarette smoking, and family history of diabetes, there were positive associations between intakes of red meat and processed meat and risk of type 2 diabetes. Comparing highest vs. lowest quintile, the relative risks (RRs) of type 2 diabetes were 1.28 for red meat (P < 0.001 for trend) and 1.23 for processed meat intake (P = 0.001 for trend). For frequent consumption of total processed meat (RR 1.43, P < 0.001 for trend) including bacon (1.21 for >/=2/week vs. <1/week, P = 0.004 for trend) and hot dogs (1.28 >/=2/week vs. <1/week, P = 0.003 for trend). These results remained significant after further adjustment for intakes of dietary fiber, magnesium, glycemic load, and total fat. Intakes of total cholesterol, animal protein, and heme iron were also significantly associated with a higher risk of type 2 diabetes. A prospective study of red meat consumption and type 2 diabetes in middle-aged and elderly women: the women's health study. Song Y, Manson JE, Buring JE, Liu S. Harvard-BrighamWomen's Diabetes Care. 2004 Sep;27(9):2108-15. For more, see Meat and Health and Diabetes Risk Factors.

Magnesium Helped Sudden Hearing Loss: In a DB PC study of 28 patients with idiopathic sudden sensorineural hearing loss, those given magnesium and steroids had significantly more hearing improvement that those on steroids alone. Magnesium is a useful for the improvement in hearing, especially in the low-tone range, in patients with sudden sensorineural hearing loss. Magnesium treatment for sudden hearing loss. Nageris BI, Ulanovski D, Attias J. Rabin Medical Center, Israel. Ann Otol Rhinol Laryngol. 2004 Aug;113(8):672-5. For more, see Magnesium.

Fluoxetine or Cognitive Behavioral Therapy Helped Social Phobia; but Cognitive Behavioral Therapy No Added Benefit: In a 14-week DB PC study of 295 adults with social phobia, those given fluoxetine 10-60 mg/d did as well whether they received weekly cognitive behavioral therapy or not. Those receiving cognitine behavior therapy for 14 weeks did as well as those on fluoxetine. Notwithstanding the benefits of treatment, many patients remained symptomatic after 14 weeks. Fluoxetine, comprehensive cognitive behavioral therapy, and placebo in generalized social phobia. Davidson JR, Foa EB, Huppert JD, Keefe FJ, Franklin ME, Compton JS, Zhao N, Connor KM, Lynch TR, Gadde KM. Duke University. Arch Gen Psychiatry. 2004 Oct;61(10):1005-13. For more, see Social Anxiety Disorder.

ACE Inhibitors Better Than Angiotensin II Receptor Blockers (ARB) for Diabetics: From Medline, Embase, the Cochrane controlled trials register, conference proceedings, and contact with investigators, 36 of 43 identified trials compared ACE inhibitors with placebo (4,008 patients), four compared ARBs with placebo (3331 patients), and three compared ACE inhibitors with ARBs (206 patients). ACE inhibitors significantly reduced all cause mortality (relative risk 0.79) compared with placebo but ARBs did not (0.99), although baseline mortality was similar in the trials. Both agents had similar effects on renal outcomes. Reliable estimates of the unconfounded relative effects of ACE inhibitors compared with ARBs could not be obtained owing to small sample sizes. Effects of angiotensin converting enzyme inhibitors and angiotensin II receptor antagonists on mortality and renal outcomes in diabetic nephropathy: systematic review. BMJ  10/9/2004;329:828. 

ARB Candesartan Reduces Death in Heart Failure: In the 37-month Candesartan in Heart failure Assessment of Reduction in Mortality (CHARM) study of 7,599 patients with heart failure, candesartan reduced both sudden death (HR 0.85; P=0.036) and death from worsening heart failure (HR 0.78, P=0.008). Effect of Candesartan on Cause-Specific Mortality in Heart Failure Patients. The Candesartan in Heart failure Assessment of Reduction in Mortality and morbidity (CHARM) Program. Solomon SD, Wang D, Finn P, Skali H, Zornoff L, McMurray JJ, Swedberg K, Yusuf S, Granger CB, Michelson EL, Pocock S, Pfeffer MA. Harvard-Brigham and Women's Hospital. Circulation. 2004 Oct 4. Ed: ACE inhibitors look still better and less costly.

Treatment of Systolic Hypertension: In a MEDLINE search of English-language literature from 1966-2004, 1064 studies were analyzed. The authors conclude that there is strong evidence to support the treatment of older persons with systolic blood pressure (SBP) of at least 160 mm Hg. Large-scale trials to assess the value of antihypertensive therapy for older patients with SBP of 140 to 159 mm Hg have not been performed, and recommendations to treat these patients are based on observational studies that show a graded relationship of cardiovascular risk with increasing SBP. Systolic hypertension in older persons. Chaudhry SI, Krumholz HM, Foody JM. West Haven Veterans Affairs Medical Center, Connecticut. JAMA. 2004 Sep 1;292(9):1074-80

High Blood Pressure: Obesity, Salt, Low Exercise, Low Potassium, and Low Magnesium Causes: In a review of risk factors on blood pressure by meta-regression analysis of randomized trials, published between 1966 and March 2001 in nationwide surveys in the five countries, being overweight made the largest contribution to hypertension, between 11% (Italy) and 25% (USA), 5-13% for physical inactivity, 9-17% for high sodium intake, 4-17% for low potassium intake and 4-8% for low magnesium intake. The impact of alcohol was small (2-3%), for inadequate intake of calcium (2-8%), coffee (0-9%) and fish fatty acids (3-16%). Impact of dietary and lifestyle factors on the prevalence of hypertension in Western populations. Geleijnse JM, Kok FJ, Grobbee DE. Wageningen University, The Netherlands. Eur J Public Health. 2004 Sep;14(3):235-9. For more, see High Blood Pressure.

Vitamin A, Beta-Carotene Increase GI Cancers: The Cochrane Hepato-Biliary Group reviewed all randomized trials that compared antioxidant supplements with placebo for the prevention of gastrointestinal cancers. These 14 randomized trials covered 170,525 participants. Vitamins A, C, and E; beta-carotene; and selenium (alone or in combination) had no protective effects compared with placebo against esophageal, gastric, colorectal, pancreatic, and liver cancers. Antioxidant supplements were associated with increased mortality in some trials. Seven studies showed a small but significant increase in mortality with antioxidant supplements (relative risk 1.06). And a combination of beta-carotene and vitamin A was associated with a 30% increased risk of death while combined beta-carotene and vitamin E was associated with a 10% increased risk. Selenium had a beneficial effect on the incidence of gastrointestinal cancer in four trials, although three of these were considered to have inadequate methodology. Except for vitamin C and selenium, regular use of antioxidant supplements does not prevent gastrointestinal cancer. Lancet 2004;364: 1219-28. Ed: Middle-aged and older adults should not take vitamin A or multivitamins.  For more, see Vitamin A and my Recommendations for Healthy Living.