Family feud: Is the best bug spray natural or chemical?

Q: Please settle a family dispute. My husband insists on using highpotency DEET mosquito repellent when we go hiking. I prefer a natural approach like lemon eucalyptus, which he says is worthless. Who’s right?

A: You’re both right. Consumer Reports rates 15 to 30 percent DEET as highly effective (Ben’s, Off Deepwoods VIII and Repel Scented Family). Of the natural repellents, Repel Lemon Eucalyptus (30 percent) was roughly comparable to DEET, keeping mosquitoes away for up to seven hours.

Another effective option is picaridin 20 percent, which is a synthetic version of a chemical in the black pepper plant. Brands include Sawyer Picaridin and Natrapel 8 Hour.

Q: My husband’s doctor prescribed niacin for cholesterol control. His HDL was too low, and the doctor said niacin would improve that.

After taking the niacin, he had terrible tingling, itching and flushing. On his doctor’s advice, he started taking an Alka-Seltzer a half-hour before taking the niacin (Niaspan). He has had no symptoms since.

A: Niacin can raise HDL as well as lower total cholesterol, but many people can’t tolerate the uncomfortable symptoms you describe. Using an extended-release formulation such as Niaspan helps a little. Doctors have long known that taking aspirin (an ingredient in AlkaSeltzer) with niacin or half an hour earlier cuts down on the flushing (International Journal of Clinical Pharmacology and Therapeutics, February 2007).

We are cautious about recommending use of Alka-Seltzer or other aspirin-containing antacids on a regular basis for older people. The Food and Drug Administration has just issued a warning about a “serious bleeding risk with over-the-counter antacid products containing aspirin.”

Another option to control the niacin flush is apple pectin. One placebocontrolled trial found that 2,000 mg of apple pectin taken half an hour before niacin reduced the duration of flushing about as well as aspirin ( Journal of Clinical Lipidology, March-April 2013). You can buy apple-pectin supplements or eat an apple.

Q: I was recently diagnosed with asthma. After six weeks of steroids that didn’t help much, I went to the emergency room and found out I had a lung infection. This misdiagnosis was by a well-known pulmonologist who should have ordered an X-ray.

A: Many people (including doctors) are not aware that adult-onset asthma can sometimes be triggered by a lung infection that may be difficult to diagnose ( Journal of the American Board of Family Medicine, July-August 2012). David Hahn, M.D., M.S., has written about diagnosis and treatment in such situations in his book “A Cure for Asthma? What Your Doctor Isn’t Telling You — and Why.” (People’s Pharmacy Press published it, and it is available at www.PeoplesPharmacy.com.)

Q: I’ve been on tamsulosin for a year to reduce urinary symptoms from an enlarged prostate. I am experiencing sinus swelling, eye discomfort, no interest in sex and poor ejaculation. I am still getting up three times a night to pee. I will soon be seeing my urologist. Are there other drugs for benign prostate enlargement?

A: Ask your doctor about tadalafil (Cialis). Most men think of this as an alternative to Viagra for treating erectile dysfunction, but the FDA has approved it to ease symptoms of prostate enlargement. Another prescription option is either dutasteride (Avodart) or finasteride (Proscar), though these drugs also may have sexual side effects.

Q: I have severe diabetic neuropathy. The pain is intense, but it lasts only a short time and can occur anywhere: on the left big toe one time, right little finger the next, left testicle, right earlobe, etc.

None of the drugs my doctor prescribed worked very well, and they all took weeks or months to have any effect. Even then, the dosage had to be increased, and the side effects worsened.

Someone suggested I try something that never occurred to me — marijuana. I took two puffs, waited about 20 seconds, and the pain was gone for three days. That was the fastest and longest relief I have ever gotten. More research is needed, but it’s very promising.

A: Sixteen people with painful diabetic neuropathy that had not responded well to other treatments participated in a placebo-controlled trial of inhaled marijuana at various doses ( Journal of Pain, July 2015). This small study showed that their neuropathy pain was significantly reduced at several doses.

We agree that more research will be very helpful. People interested in learning about research that has already been done on medical marijuana may wish to listen to our hourlong interview with David Casarett, M.D., author of “Stoned: A Doctor’s Case for Medical Marijuana” (available at www.PeoplesPharmacy.com).

Q: I have suffered from moderate to severe plaque psoriasis for more than 40 years. I have tried every possible remedy and medication, with at best short-term success from steroid creams.

Recently, I read that the vitamin biotin is good for skin, hair and nails. Biotin combined with resveratrol has completely cleared my skin of all plaques and psoriasis. (I was already taking resveratrol.) This took place over a period of about 30 to 45 days.

I have been on this regimen for more than six months, with no recurrence of psoriasis. My nails also are very strong now. I wanted to share this discovery of good fortune with others who may benefit.

A: Thank you for an intriguing testimonial. We have not been able to find studies demonstrating that biotin improves psoriasis.

There are other natural products that have been studied, however, including resveratrol (PLOS One, May 12, 2015), glycyrrhizin from licorice (Cellular Physiology and Biochemistry, March 2015) and curcumin from turmeric (PLOS One, June 25, 2013). One study found that taking oral curcumin (Meriva) improved the response to topical steroid treatments (BioMed Research International online, May 18, 2015). Perhaps biotin improved your response to the resveratrol you were already taking.

Q: My doctor told me to drink eight glasses of water each day now that the weather is hot. Is that really necessary? I prefer coffee, tea or beer. Does that count?

A: All the fluid you drink counts. There is a popular belief that drinking eight glasses of water daily is essential for good health, but thirst is a good guide to how much water you should be drinking.

Athletes who exercise long and hard (marathon runners, for instance) often concentrate on getting enough water so they don’t become dehydrated. Drinking too much also is a danger because body sodium levels can drop too low. Here again, thirst is the good guide, and electrolytes may be helpful.

Thirst is not always as reliable in older people, so they may need to pay attention to fluid intake, especially during hot weather.