Dear Dr. Roach: I am an 85-year-old man. I am in good health, and I exercise and swim at the gym for 3 hours every other day. I am not overweight, and the only prescription I have is a nose spray. I do have mild idiopathic neuropathy, but I am still quite agile and mobile. I have a hernia in my lower abdomen. I had one just like it on the right side that was repaired 35 years ago.
My family doctor seems to think that having surgery at my age could be riskier than living with the hernia. The pain isn’t terrible, but it is frequently uncomfortable. Should I be considering surgery?
C.E.K.
You should consider it to the point where you consult a surgeon. The operative risk is relatively small, and despite your age, it sounds like you are in good shape. However, after consulting with a surgeon, you may decide against surgery. The most important factor is how much the pain from the hernia bothers you. In general, we recommend surgical repair for symptomatic hernias, as the pain tends to gradually increase over years.
No surgery is without risk, and your family doctor is right that it is riskier to have the surgery than to live with the pain. But the risk is not enormous, so if the pain is bothering you a lot, it is certainly worth discussing the risks and benefits of surgery with an expert surgeon.
Dear Dr. Roach: I saw a post somewhere saying we should throw away all vitamins or supplements with magnesium stearate, titanium dioxide or microcrystalline cellulose. This means I would need to discard vitamins, antacids, and even my glucose tabs that I occasionally need for reactive hypoglycemia. Do you have any guidance on this?
L.D.
In 1538, a Swiss physician with the pseudonym “Paracelsus” articulated the basic premise of toxicology: The dose makes the poison. This remains critical today.
Magnesium stearate is commonly used in foods, cosmetics and medicines. It is generally regarded as safe at doses below 175 grams for an average-sized adult. A typical supplement might contain as much as 20 mg. It would take well over 8,000 doses at once for a person to reach a dangerous level.
Titanium dioxide is used as a food colouring, in sunscreen, and in medications like styptic pencils. It has long been considered safe in the United States and Canada, but its status in Europe has recently been changed. So, it is no longer recommended as a food additive. The tiny doses of it in medications and dietary supplements are very unlikely to cause harm, but many manufacturers in the U.S. are beginning to stop using it, more due to perception than proven harm (which there is no evidence for).
Microcrystalline cellulose is simply an indigestible fibre source made from wood pulp. It is not absorbed. It is used in many foods and as a filler in tablets and capsules. You can also buy it as a supplement or use it as a thickener in cooking.
I don’t have any concerns with magnesium stearate or microcrystalline cellulose at the kinds of doses used in pharmaceuticals and supplements. I also don’t have any concern with food-grade titanium dioxide as a colouring agent in food or supplements.
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