Jun 17, 2023

Dear Doctor: Are fruits and vegetables in capsule form as good as fresh?

Dr. Keith Roach is a physician at Weill Cornell Medical College and New York Presbyterian Hospital. He writes an educational column on infectious diseases, public health and sports medicine.North America Syndicate

Dear Dr. Roach: My TV is inundated with commercials touting the benefits of encapsulated fruits and veggies. Seems they’re good for everything from dementia to erectile dysfunction. What is your take on them? -- W.C.H.

Answer: Encapsulated fruits and vegetables take some of the micronutrients from fresh fruits and vegetables and concentrate them into capsules. There is evidence that these are effective at raising levels of the nutrients in the blood when taken, and preliminary evidence that they reduce inflammatory markers in the body and improve circulation in the skin.

However, I’m still not recommending them, since actually eating fresh fruits and vegetables has robust data that shows benefit. Further, people who eat more fruits and vegetables are less likely to eat less-healthy choices. Encapsulated fruits and vegetables are not a substitute for healthy eating patterns and don't negate the harms of unhealthy choices. These products are typically expensive, and a person can buy a lot of fresh or fresh-frozen vegetables for less money.

There is strong evidence, for example, that eating lots of fresh fruits and vegetables does reduce the risk of dementia and, at least in men with diabetes, erectile dysfunction. Good health isn't in a bottle. Eat good food.

Dear Dr. Roach: I have spinal stenosis and degenerative disc disease, along with scoliosis from childhood polio. A few weeks ago, I developed sciatica and started a course of physical therapy, but quit halfway through because it seemed to make the pain much worse. The therapist recommended I try a TENS unit. Does a TENS unit help with sciatica? -- J.S.B.

Answer: I am sorry to hear the physical therapy did not help, as that is usually the most effective treatment. It isn't unusual for things to get worse despite the physical therapy at the beginning. I would urge you to reconsider therapy if things aren't better on their own.

If you continue to have pain, it is time to get a more thorough evaluation from a person with expertise in back pain. With your three problems, it can be very difficult to identify the exact source of the pain, and a specialist has more advanced diagnostic tools than a general doctor to identify the source of the pain and recommend the best treatment plan.

In the meantime, TENS units --transcutaneous electrical nerve stimulation -- are devices placed on the skin that send stimulating electrical signals to the nerves. They have been used to relieve pain. A few people get very good relief, most people get some relief, and some get no benefit at all.

A recent review of all published trials on TENS units found that they were more effective than no treatment, only during the first six weeks of treatment. After six weeks, there was no additional benefit to using them. That said, results for a large group of people do not predict an individual's response, and some people seem to do very well using TENS units for a longer term. They are safe, so I think it's fine to keep using them as long as they bring you pain relief.

More advanced implantable nerve stimulation devices seem to have better promise than the devices placed on the skin. Contact an expert in pain management of back issues for consideration of these newer devices.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected] or send mail to 628 Virginia Dr., Orlando, FL 32803.

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