Dear Dr. Roach: I鈥檓 a 47-year-old woman in good overall health. About six months ago, I began to take several supplements, one of which was vitamin E (200 international units). I had no noticeable adverse reactions to any of the supplements. About 10 days ago, I started taking 400 IU of vitamin E. I began having painful stomach cramps, diarrhea, nausea and tiredness. After a week of this, someone suggested that the vitamin E might be the cause. I have stopped taking it and have even avoided foods high in vitamin E. Three days later, I鈥檓 still having the diarrhea and other symptoms. If the vitamin E was the cause of the symptoms, shouldn鈥檛 they have gone away by now?
K.B.
Vitamin E is a fat-soluble vitamin, so it is possible for levels to build up in the body if it鈥檚 taken in high doses for long periods. However, toxic effects are unlikely at less than 1,500 IU daily, which is far higher than what you have been taking. Bleeding is one risk at high doses, as is a theoretical deficiency of vitamin A and D.
I think it is far more likely that you happened to get a case of gastroenteritis 鈥� inflammation of the stomach/intestines often caused by a virus. It鈥檚 unlikely to be due to the vitamin E. However, since vitamin E supplementation hasn鈥檛 been shown to improve any of the many conditions it has been studied for, I don鈥檛 recommend that you continue to take it.
Go easy on eating for a few days after gastroenteritis. The time-tested BRAT diet (bananas, white rice, peeled apples and dry toast) is effective. You can get enough fluid through water or apple juice, along with some salt from chicken or vegetable broth.
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Dear Dr. Roach: My doctor prescribed 600 mg of ibuprofen twice a day, as needed, for arthritic pain in my knee. I understand that there is new concern regarding possible damage from the long-term use of ibuprofen, such that there will be new warning labels for this drug.
Is this also a concern with acetaminophen? I am confused, because I purchased a bottle that says to see the new warning label on it regarding liver damage with long-term use. If it is safer, how much acetaminophen can be substituted for the ibuprofen on a long-term basis?
L.H.
Both acetaminophen (Tylenol) and ibuprofen are very safe for the vast majority of people in long-term use. However, both have risks.
The 鈥渘ew concern鈥� you allude to is probably a warning from the U.S. Food and Drug Administration in July that 鈥渘on-steroidal anti-inflammatory drugs (NSAIDs) can increase the risk of heart attack or stroke in patients with or without heart disease or risk factors for heart disease.鈥� The FDA did not state the magnitude of this increased risk, citing varying estimates, but the best estimate I can find is that, at most, one to two people will have a heart attack or stroke for every 1,000 people taking the medication for a year. NSAIDs have other risks, including stomach ulcers and kidney damage.
Acetaminophen is probably safer for most people than NSAIDs. However, it, too, might cause problems.
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