Ask the Doctor: Herbal Insights; Relief for Hemorrhoids; Protein Needs

Q: I take some herbal supplements, but often wonder if they are safe and effective. How can I find out?

A: An excellent source for learning about herbs is the National Center for Complementary and Integrative Health’s (NCCIH) robust website called “Herbs at a Glance.” You can find it at The site has a series of brief fact sheets that include findings from recent studies and safety information. This content is also available through an app you can use on your cell phone or tablet, making it easy to get information while shopping. While there is an abundant amount of information about supplements on the internet, it isn’t always obvious if the information is unbiased or research-based. The NCCIH’s mission is to define, through rigorous scientific research, the safety and usefulness of herbs and other integrative health approaches. It’s always wise to have a conversation with your physician before using supplements, especially if you are taking medications. Some supplements may increase a drug’s side effects, or cause the drug to become too strong or ineffective. For example, herbs that decrease blood sugar may interact with anti-diabetes drugs, causing blood sugar to drop too low.

Q: This past year, I have suffered through several episodes of hemorrhoids. How can I best treat them and prevent recurrence?

A: Unfortunately, hemorrhoids can become more common as people get older, so you’re not alone with this irksome malady. While it’s not entirely known what causes them, constipation is a major risk factor because of the straining used in the effort to expel the stool. The force creates pressure on the veins, which causes them to enlarge and bulge inside or outside of the anal canal. Adding more fiber (fresh fruits and vegetables are excellent sources) as well as more water to absorb that fiber can help you stay more regular. Other risk factors include obesity, sitting for long periods of time, and frequently lifting heavy objects. Other at-home treatment options include taking a stool softener, sitting in tub of warm water several times a day to help relieve the pain, and using over-the-counter hemorrhoid cream or suppositories. Most hemorrhoids clear within a week or so. But, if symptoms aren’t relieved, talk with your doctor. If you have severe pain and bleeding, particularly with pain in the abdomen, diarrhea, or fever, seek medical care right away.

Q: How much protein is needed daily?

A: The general recommended daily allowance for protein is 46 grams per day for women and 56 grams for men. For a more personalized measure, you can use this formula: 0.8 grams x weight in kilograms. There are 2.2 kilograms per pound. For example, a 135-pound person would divide that by 2.2 for the calculation (0.8 g x 61 kg = 49 grams of protein per day). Research suggests that spreading protein intake across all meals may be helpful in protecting against sarcopenia, age-related muscle loss. A daily meal plan for a 135 pound person could be as follows: an egg for breakfast (6 g), 6 ounces of plain Greek yogurt at lunch (18 g), a quarter cup of nuts as a snack (4-7 g), a cup of milk (8 g) and two ounces of cooked chicken for dinner (14 g). Be cautious, however, if you are using protein powders. These products are considered supplements and therefore are not FDA regulated. As such, the products may or may not contain all they claim on labels. Research from the nonprofit group the Clean Label Project reported earlier this year that some protein powders contained heavy metals, BPA (used to make plastic), and pesticides. According to the report, of all the products tested overall, powders with egg as the protein source tested cleanest. Products with plant-based protein ranked worst. On average, certified organic protein powders had twice the heavy metals contaminants compared to non-organic products. Search for products at

—Editor-in-Chief Jonathan Wanagat, MD, PhD, Assistant Professor, Division of Geriatrics

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