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Ask a Best Doctor

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Illustration by R. Kikuo Johnson  

I’m 45 and smoked a lot of pot when I was younger. I’ve only rarely partaken in the last decade, but how worried should I be about the residual health effects?
When you smoke pot, of course, you may experience poor coordination, difficulty with thinking and problem-solving, and trouble with learning and memory. “And obviously it feeds into the brain’s reward circuits,” says Marianne Legato, an internist at New York–Presbyterian/Columbia University Medical Center and St. Luke’s–­Roosevelt Hospital Center. “I shop; other ­people use marijuana.” If you smoke regularly, you’re likely functioning at a suboptimal intellectual level all the time, and these changes persist as long as you continue using the drug. The research on long-term fallout, however, is inconclusive. While some studies have linked regular cannabis use to permanent cognitive effects, a large 2011 study suggested the drug’s impact on the brain was reversible. As for your lungs, inhaling marijuana is clearly associated with coughing and wheezing, and long-term use has been linked with respiratory damage (a link to respiratory cancers is unclear). Legato advises caution. “Chronic substance use has an effect. To think that a joint, if you’re going to smoke all the time, doesn’t have an impact—you’re kidding yourself.”

I know I’m supposed to wear sunscreen and cover myself from head to toe like a Bedouin when I go outside, but now there’s all this concern about vitamin-D deficiency. So, sun or no sun?
Sun is acceptable, but only with proper precautions, says Desiree Ratner, director of New York–­Presbyterian/Columbia’s melanoma center. “There isn’t any scientifically validated ‘safe’ level of UV exposure that doesn’t increase skin-cancer risk,” Ratner says. She stresses the basics: Always wear skin-covering clothing, or apply sunscreen every two to three hours. “It needs to be broad spectrum, meaning that it blocks both UV and UVA rays, SPF 30 or higher.” Here’s the catch: If you follow that advice or, worse, avoid sun exposure altogether, you may inhibit your body’s ability to manufacture vitamin D. Doctors have become increasingly interested in vitamin-D deficiency; the vitamin is needed to maintain bone health and may even help reduce the risk of MS and cancer. So what to do? Over-the-counter vitamin-D supplements are widely available, but there is disagreement about their usefulness. The American Academy of Dermatologists recommends that you derive your vitamin D from dietary sources. Foods that are rich with it include fatty fish like salmon and tuna, egg yolks, Swiss cheese, and fortified milk, orange juice, yogurt, and breakfast cereals.


Illustration by R. Kikuo Johnson  

Which is better: not getting any sleep ever or taking sleeping pills every night?
“Both are bad,” says Lenox Hill Hospital internist Stuart Orsher. Insomnia can cause problems ranging from overeating and weight gain to muscle pain and depression. Frequent sleeping-pill use can not only lead to addiction but can also mask a more serious medical problem. Worse, “if you have a thyroid condition or a respiratory problem that’s keeping you awake, sleeping pills could sedate you and have extra negative effects,” Orsher says. Before trying pills, and after you see your doctor to rule out any underlying conditions, try natural solutions first. Cut back on carbs, sugar, and caffeine close to bedtime, keep your bedroom dark, quiet, and free of distractions, and so on. If that doesn’t work, an occasional sleeping pill, over-the-counter or prescription, is probably fine. But if you find yourself relying on pills to fall asleep more than a couple days in a row, see your doctor to help you break the habit.


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