No question about it. Vitamins are hot. Just about every week there seems to be another disease that some vitamin helps prevent. You can't walk past the newsstand any longer without seeing a magazine cover claiming good health through vitamin therapy. Surveys estimate that over 80 million Americans now take vitamin supplements on a regular basis. What is all the fuss about? Should you be taking vitamin supplements? And if you should, which ones should you take?
That is a good question and not that easy to answer. Check out the vitamin section of your local drugstore and you'll find the pickings are anything but slim. Name brands, generic store brands, tablets for men, tablets for women, stress formulas, advanced formulas, antioxidant formulas, and so on. To make matters worse, some companies take advantage of your fear of aging by giving their products misleading names like "Memory" or "Manpower." They are trying to cash in on the general confusion over vitamins. Choosing the right supplement is no simple task.
Lately, many of my patients have expressed frustration and confusion about this whole vitamin question. They ask, "How much of what do I really need?" So, I wrote this article to help you better decide if you should make vitamin pills part of your everyday routine. I also hope to help you sort through all the hype and make you a savvy supplement shopper.
What is a vitamin?
First of all, vitamins are not food. Not in the sense that food provides fats, carbohydrates, and proteins which serve both as sources of energy and building blocks for body growth and repair. On the contrary, vitamins contain no calories and have no nutritional value. They can't make you gain weight. In fact, a typical vitamin tablet contains less than 5 calories. They can't help you lose weight, nor can they cure baldness, increase your brain power, reduce emotional stress, or improve your social skills. Vitamins are merely "co-factors" that help your body function normally by controlling the millions of chemical reactions within your cells. Just like a copilot, they help keep your metabolism on course. In this way, vitamins do play an important role in the health and vigor of every organ in your body, from skin and bones to the brain and immune system. But, they are not food, nor are they magic.
Getting the minimum
For the most part, vitamin's main role is to prevent deficiency diseases. Many years ago, government scientists established the minimum daily amount of vitamins needed to prevent deficiency diseases like scurvy, beri-beri, and pellagra. This Recommended Daily Allowance, or RDA, has been established for most of the essential vitamins and minerals. The percentage number you see on a vitamin bottle label tells you what percentage of your daily minimum needs are contained in one tablet. For example, if a pill contains 50% RDA for Vitamin C, it provides half of your daily minimum needs to prevent scurvy.
Our abundant diet is easily capable of obtaining these minimum levels. Except for special cases of malnutrition and malabsorptive digestive diseases, almost all Americans can obtain the adequate nutrients needed to prevent these now-rare disorders from diet alone.
But is "adequate" all you want to be? The RDA of a vitamin is the minimum necessary to function-- not what you need to perform optimally. The real question is: Do doses which exceed this minimum RDA level have any value? Or are they just a waste of time and money. The answer is yes and no.... depending on which particular vitamin you study.
The three protectors
For most vitamins, the minimum RDA is all you really need. A balanced diet can provide that. But, all vitamins are not created equal. After years of nutritional research, science is beginning to confirm the special role that three specific vitamins play in safeguarding health and fending off disease - vitamin C, vitamin E, and vitamin A (taken as beta carotene). There is a growing body of evidence that suggests when these three vitamins are taken in amounts which exceed the RDA minimum, they help protect against many chronic diseases such as certain forms of cancer, heart disease, and cataracts.
"Rustproofing" your body
How is it possible that simply taking vitamin pills each morning can help prevent such serious ailments as cancer and heart disease? It sounds a little too good to be true. To understand this, you must first learn about free radicals and their role in disease.
Your body is made up of billions of small cells. Each has a special job to do. Bone cells lend support. Muscle cells allow motion and provide strength. Intestinal cells digest and absorb nutrients from your food. Blood cells carry oxygen and fight infection. And so on....
Like tiny engines, these cells must consume fuel (usually as the sugar, glucose) to function properly. Just as your automobile engine generates unwanted exhaust fumes when it burns gasoline, each of your cells creates harmful byproducts as it burns energy. These destructive molecules are called cell oxidizers or "free radicals." It is estimated that your internal organs generate about 10 billion "free radical" molecules every day. Other free radicals enter your body daily in the polluted air you breathe, the water you drink, the additives and preservatives in processed foods, and even cigarette smoke.
Regardless, of their source, these molecular terrorists roam your body stealing electrons from body cells in a process called oxidation. Much like rust attacking an old car, these pirates attack and damage almost any cell surface. This cellular damage accelerates the aging process and can lead later in life to a variety of diseases. When you are young, your body produces the equivalent of "rust proofing" to protect your cells. But as you age, this protection fades and your cells are overwhelmed.
This is where three special vitamins enter the picture -- vitamin C, vitamin E, and beta carotene. They are antioxidants, or molecules which destroy free radicals. They destroy the destroyers and thus protect your cells from aging effects of free radicals.
What is the evidence?
Some of the most exciting new nutritional research centers on the health-protective powers of these antioxidant vitamins beta-carotene, vitamin C, vitamin E.
Heart disease and stroke
In one clinical study done at the Brigham and Women's Hospital in Boston, nearly 90,000 female registered nurses ages 34 to 59 were evaluated over eight years. Again, after taking other risk factors and multivitamin use into account, the study found that women who took vitamin E supplements (100 I.U. or more per day) had a 22 percent reduction in their risk of heart attack and a 40 percent reduction in stroke compared with low intakes.
Additional recent research from the same Nurses' Health Study shows that even women already diagnosed with heart disease may also dramatically improve their chances of survival by loading on fruits and vegetables for breakfast, lunch, and dinner. Five servings a day lowered future stroke risk by 71% and future heart attack risk by 33%. Foods high in vitamin E seemed to play the leading role in cutting heart attacks.
Vitamin C may be the hardest working antioxidant as far as damage from cholesterol is concerned. People over 60 with intakes of vitamin C (over 180 mg. per day) have higher blood levels of HDL (good cholesterol associated with a low risk of heart disease. At UCLA, a long study of over 11,000 people found that men who get lots of vitamin C in their diets have a 45 percent lower death rate from heart disease. Women in the high-C group had a 25 percent lower death rate. The high C'ers also have just half the risk of high blood pressure.
Over 300 male doctors who already had signs of heart disease were divided into two groups. Half took beta carotene daily. The others unknowingly took a look-alike but inert "sugar pill" for six years. At that point, scientists discovered that those on beta carotene supplements had half as many strokes, heart attacks, and cardiac deaths at the other men. Similar, but reduced, findings have been shown in studies involving women.
Cancer
Another large project known as the Western Electric Study followed the dietary habits and eventual fate of 1,851 middle aged men from 1958 to 1992. After factoring out other risk factors such as smoking, researchers found that men who consumed more vitamin C and vitamin E were least likely to die from lung cancer.
Cataracts
New research shows that vitamin C has another valuable function: It helps prevent cataracts. A recent study done in Canada and another at Tufts University both found a reduced risk of cataracts in those who supplemented their diet with vitamin C pills.
Immunity
A recent Canadian study sponsored by the World Health Organization found that even a modest multivitamin supplement of vitamins and minerals improves laboratory measurements of immune function and led to reduced sick days due to colds, sinus infections, bronchitis, and pneumonia.
All of these new studies look very promising and suggest a new means of prevention and even possible cost savings. At the recent 20th anniversary conference of the Council for Responsible Nutrition in Washington, DC, it was predicted that the U.S. health care system could save $8.7 billion annually from reduced hospitalizations if Americans consumed optimal levels of the antioxidant vitamins C, E, and beta-carotene. These projections were based on reduced risk of heart disease, cataracts, and cancers of the lung, breast, and colon.
I was skeptical
I must admit that up until a few years ago, I was skeptical. I felt, as did most physicians, that a general balanced diet was all you needed. I felt that the expense and bother of extra vitamin supplements was an unnecessary waste of money. But, as more and more scientific studies validated the beneficial effects of extra vitamin supplements, it became hard to ignore the evidence. Scientific studies have now demonstrated to my satisfaction that vitamins are beneficial. Like many physicians, I have also come to accept the fact that few Americans eat the ideal "balanced diet." Despite our best intentions, the typical American diet is still laden with too much fat and protein, and not enough fiber, vitamins and minerals. Nutritional surveys consistently show that less than 10 percent of adults consume the three or more daily servings of vegetables and two or more servings of fruit recommended for a healthy nutrient-packed diet. In fact, on any given day, half of us eat no vegetables at all.
All those missing servings of fruits and vegetables are the major sources of the protective antioxidant nutrients -- beta carotene, vitamin C, and vitamin E, and folic acid. When you consider that this poor showing comes after a major push towards healthy eating, it is hard not to conclude that the goal of achieving protective levels of vitamins from our diet is at present beyond the grasp of most of us. Because of this I now make vitamin supplements part of my daily routine and recommend them to my patients.
A balanced diet is still important
This is not to say that we should lessen our efforts to eat a better diet. Eating a balanced diet is still important. The new US Dept. of Agriculture guidelines stress the importance of eating more grains, fruits, vegetables, and low fat dairy products with little dabs of meat, fat, and sugar. A wide variety of foods is best.
We should all strive to get as much benefit from our diet as possible. Cut back on fat and protein. Stress whole grain foods and eat plenty of green leafy vegetables and deep-orange foods such as squash, apricots, peaches, carrots, and sweet potatoes. Remember when it comes to fruits and vegetables, deeper color usually means more vitamins.
But is diet enough?
Again, there is a difference between getting the absolute minimum daily amount of vitamins to prevent a deficiency disease like scurvy and going for higher levels that are now felt to help prevent chronic diseases like heart disease, cancer, and cataracts. Even if you are able to eat the recommended balanced diet, you will likely achieve only a little above minimum RDA levels of essential vitamins. In particular, diet alone can not usually provide the higher protective levels of the three antioxidant vitamins. So, in today's fast paced world, I believe that supplements are the only practical way to make sure that you are getting all the vitamins and minerals that you need.
Nutrient insurance
You should know that there is not total agreement on this. The American Medical Association and American Dietetic Association still officially say that unless you are pregnant, breast feeding, a vegetarian, or have a digestive disorder, you can get all the nutrients you need from food alone.
Still, privately, many nutritional researchers and physicians (including myself) now believe there's nothing wrong with hedging your bet by taking a general multivitamin/mineral supplement and extra doses of the three antioxidants which exceed the RDA minimum. Having done my best with diet, I feel that it is wise to fill in any gaps in my nutrition with supplements. I just consider it a little "nutrient insurance."
What are the risks?
The risk of side effects from vitamin pills is extremely small and such cases usually involve truly massive doses, or "megadoses", which you should avoid. As with all other things in life, it is possible to get too much of a good thing. When you take too many vitamins, they can act like drugs and produce toxic side effects - especially vitamin A and vitamin D. To be safe don't take more than the RDA of these two vitamins.
I feel the main risk of taking daily vitamin supplements is that you may be wasting your time and money. While more and more information is accumulating daily to suggest that supplements are beneficial, the jury is still officially out. You must consider vitamins an "educated gamble." They probably do help and probably don't hurt. Just a simple way to hedge your bet. In my opinion, it's a winning bet.
What should you do?
Since the scientific community is still struggling with this question, I can't tell each of you exactly what to do. You basically have five choices:
1. Ignore all of this and continue doing whatever your doing. That's what most people do.
2. Eat defensively with a nutritious diet. With the possible exception of vitamin E, which is found in relatively few foods, it is possible to get the minimum nutrients you need - if you are willing to spend some time on careful menu planning. Pay special attention to foods rich in antioxidants (beta carotene and vitamins C and E) and (if you are female) calcium, folic acid, iron, and vitamin D.
3. Eat a nutritious diet and supplement your diet with RDA quantities of all the vitamins using a general multivitamin /mineral supplement tablet daily. Centrum, Theragram-M, and Unicap-M and their store brand "knock-offs" are fairly complete. But, realize these lack the higher protective levels of antioxidants being studied and usually don't contain full amounts of minerals such as calcium.
4. Eat a nutritious diet and take a general multivitamin/mineral supplement daily plus extra antioxidants. Even if you eat a terrific diet, it's hard to get the high doses of antioxidants that help protect against disease--especially vitamin E. If you do decide to take antioxidants, a typical daily regimen would include 15 mg. (same as 25,000 IU) of beta-carotene, 400 IU of vitamin E, and 1000 mg. of vitamin C. These levels are felt to be generally safe for adults. (To obtain these levels of antioxidants from diet alone, you would have to eat 12 carrots, one whole head of broccoli, and 7 oranges each day.)
5. Eat a nutritious diet and take a complete array of nutrients in a bottle. This can be an effective way to get 100 percent of all nutrients, but you'll have to swallow many large tablets each day, and they're expensive. I don't recommend this.
What do I do?
You must decide what is best for you. For me, I have chosen #4. I decided to make some changes in my eating habits about two years ago and placed myself on a high-fiber low-fat diet. This has led to a gradual weight loss and a nice decrease in my blood cholesterol. At the same time, I began taking a generic multivitamin/mineral supplement daily.
Last year, I added extra doses of the three antioxidant vitamins which exceed the RDA. At present, I take 400 I.U. of vitamin E, 15 mg. of beta carotene, and 1000 mg. of vitamin C each morning.
What works best for me is an inexpensive 7-compartment "pill box" that holds a week's worth of supplements. I keep my main supply in a cool dark place. Then on Sunday morning, I fill each of the seven compartments with a general multivitamin, and a 400 I.U. vitamin E, 15 mg. beta carotene, and 1000 mg. vitamin C tablet. Then each morning, it is a simple matter to pop open that day's compartment and down the hatch they go.
Why these amounts?
These doses are similar to those used in clinical studies for the prevention of heart disease and cancer. Although they exceed the mimimum RDAs, they have been shown to be safe levels for long term use.
Research laboratories are just developing methods to test individuals for their ability to scavenge free radicals. This represents cutting-edge technology in preventing disease. Experts predict that such testing is likely to become available in about 3 to 5 years. Doctors might then be able to more accurately determine which patients would benefit the most from supplements of antioxidant vitamins such as vitamin C, vitamin E, and beta-carotene and the optimum dose for that particular person.Until then, I believe the above doses are in the range of safety and effectivness.
How about cost?
Of course, everything worthwhile has its price. Eating properly requires extra time and effort on your part.....time spent on planning a weekly menu, shopping for more nutritious fresh foods, and preparing some meals from scratch. If you decide to take vitamin supplements, another factor is added, cost. But with careful shopping, you should be able to control the extra financial burden. Look for the best value for your money.
Higher priced supplements are not necessarily better. Whether you buy your vitamins at your drug store, K-mart, or a health food store, you're really getting the same ingredients. Contrary to what supplement makers would like you to believe, they all buy most of their raw vitamins and mineral ingredients-dirt cheap-from the same small group of multinational firms. Most store brand vitamins contain exactly the same amounts of the same vitamins and minerals as national brands, but often cost much less. If you want to save money by purchasing a cheaper store brand, just make sure you stick to a large national retailer or a store with a reputation for quality. Store brands of Thrift drug, PharMor, Wal-Mart and Kmart are known for their high standards of quality.
Don't be lured into buying expensive vitamin supplements. Most experts say if you are spending much more than $10 per month for all your supplements, you are spending too much.
Shopping tips
Don't pay more for "natural" vitamins. They are not more healthful than synthetically produced vitamins. In most cases, the human body can't even tell the difference. The one exception seems to be vitamin E which is slightly more active in the natural oil-based form.
Get the most beta carotene and the least vitamin A acetate or palmitate. Many supplements now boast "with beta carotene" on their labels. But beta carotene is often lumped together with vitamin A with no indication of how much of each is present. Your best bet is to look for a supplement that provides vitamin A as beta carotene only. Of the two, only beta carotene--not vitamin A--acts as an antioxidant in your body. It also is converted into just the right amount, and not too much, of vitamin A for your body which reduces the risk of overdosing on vitamin A.
While high doses of vitamin A can be toxic, beta carotene isn't. The body turns it into vitamin A, but stops when you've got enough. You don't need any non-beta carotene vitamin A. (It's listed as acetate, palmitate, or fish oil) And if your supplement does have any, be sure it's not more than the US RDA which is 5000 IU. Higher doses can be toxic and have been linked to birth defects.
Ignore high doses of thiamine, riboflavin, and niacin. Think of them as the "three B's" you probably don't need. Thiamine (vitamin B-1), riboflavin (vitamin B-2), and niacin (vitamin B-3) are plentiful in the food supply, largely because they are added to "enriched" white flour that goes into breads, pasta, crackers, cereals, and dozens of other grain products.
Look for extra vitamin C in your multivitamin unless it's expensive. It's worth taking more (250 to 500 mg.) but not worth paying a premium price for a high potency "multi" when you can buy your vitamin C separately for pennies a tablet. More than 1000 mg. a day causes diarrhea in some people. Because most vitamin supplements provide their vitamin C in the form of ascorbic acid, a significant number of people suffer from diarrhea or acid indigestion when taking the vitamin. If you are one of the sensitive who is upset by formulation, look for brands that contain the non-acid form ascorbate as their source for vitamin C.
Vegetarians need vitamin B-12. If you eat no dairy or animal products, take a supplement with the US RDA for B-12. A deficiency can cause permanent nerve damage, so don't take chances. Since older people sometimes have trouble absorbing vitamin B-12, they should also be sure to get the RDA in tablet form.
Vitamins lose their potency over time. Since the FDA doesn't require expiration dates on supplement bottles, many companies don't include them. If a bottle of supplements has no expiration date, you may want to pass on that brand. Never buy a supplement that is past its expiration date. In fact, it is best to avoid supplements with an expiration date less than 6 months into the future since they have probably been in the bottle for several years.
There is no advantage to buying "chelated" supplements, those with bioflavonoids, or those made without sugar or starch. Despite what all the supplements ads say, these are gimmicks. While chelation may enhance absorption of certain minerals, there is no good evidence that any processing improves absorption enough to matter for most people. Don't worry about tiny amounts of sugar or starch. They help disperse the nutrients within the intestinal tract and may help mask the unpleasant taste of some minerals. One exception may be the sugar lactose which is often used as a filler. Individuals who are sensitive to milk products (lactose intolerant) may note digestive distress from such products.
Also avoid substances such as lecithin, hesperidin, and rutin. They do little more than increase the tablet size and cost. The same goes for "stress" formulas. Physical stresses, such as broken bones or surgery, can increase the need for B vitamins and vitamin C, but there's no proof that the emotional stresses of daily living do. Steer away from "time-release" products--a good idea in theory, but there is no evidence that dispersing nutrients slowly is any better, and it is certainly more expensive.
How about minerals?
This discussion mostly refers to vitamins, but there are 9 minerals that may also play an important role in nutrition and general body metabolism:
Don't be concerned if your supplement lacks iodine or phosphorus. You probably get enough of them in your diet. Also, you probably do not need supplements of potassium unless your are on a diuretic ("water pill") for high blood pressure. Some diuretics deplete your body of potassium. Your doctor can order a blood test to find out.
There is some evidence that many of us lack enough zinc, chromium, magnesium, and selenium in our diets especially as we age. You might as well include these if you plan to take a multivitamin/mineral supplement.
Women also have special needs --calcium and iron. All women need adequate calcium throughout their lives to help prevent crippling osteoporosis in later years. This is especially important during bone development before puberty. Younger women need to build up bone mass so they can sustain some loss as they age. The best source of calcium is low-fat dairy products. Young men need calcium also. A recent nutritional survey of young adults found that about three-fourths of women and half of the men fall short of their daily allowance for calcium.
Calcium is bulky and multivitamins are not the best place to get it because you have to take too many to get a bone protecting dose. Four servings of low-fat dairy products per day is advisable. If you don't eat dairy products, Tums-Ex tablets are an inexpensive source. Two tablets twice daily with meals helps calm your stomach and provides plenty of calcium.
Premenopausal women should be sure to get enough iron in their diet, especially if pregnant. Besides red meat, iron is found in dark green leafy vegetables. But, be aware that except for menstruating or pregnant women, too much iron may cause health problems. There is some recent evidence that too much iron can increase the risk of heart disease. For the one percent of Americans afflicted with iron overload (hemochromotosis) and the ten percent genetically prone to it, taking iron supplements can cause organ damage. Don't be afraid to eat iron rich foods or to take a supplement containing iron. Just don't exceed supplements of 100% of the RDA (15mg.) daily. If you have any concerns about too much or too little iron in your diet, ask your doctor to perform a simple blood test to see if your iron levels are truly low.
Storing your vitamins
Because they are fragile substances that break down with heat, light, and air, vitamin supplements need the protection of a dark, dry, and cool environment. Most manufacturers help by enclosing their products in opaque containers. It is logical to keep your supplements handy in the kitchen or bathroom -- but safely out of the reach of children. The refrigerator or freezer, while dark and cool, is not a good storage place because it often accumulates damaging moisture.
The best advice...
I feel the best advice is to adopt a healthy lifestyle. Don't smoke and try to make some form of regular exercise a part of your normal routine. Good health habits and eating the right foods should be your number one priority....less fat and more fiber. Strive for a minimum of three servings every day of vegetables and two of fruits. That's the "defensive eating" diet I recommend to all my patients and the one that I have been on for over two years.
But, I see no harm, and much possible good, in hedging your bet with a general multivitamin/mineral supplement to guarantee that you meet all of the minimum RDA levels. I also believe there is sufficient evidence to add protective levels of the three antioxidant vitamins -- 400 units of Vitamin E, 15 mg. (25,000 units) of beta carotene, and 1000mg of vitamin C. I feel this is a safe and sensible level supplementation that I plan to continue until I find evidence to the contrary.
Remember, however, taking a multivitamin/mineral supplement can't make a bad diet healthier, nor totally erase the effects of an unhealthy lifestyle. Even the best vitamin studies only show a partial risk reduction of disease. Vitamins are not magic. No pill will let you smoke, drink, or eat whatever you like with abandon and still stay healthy. Vitamins are like a seat belt. Seat belts reduce the risks of injury for most people in car accidents--though they don't guarantee you won't get hurt if you drive at a hundred miles per hour on a crowded road. Similarly, while there's nothing to prove that vitamins can prevent chronic disease in any particular individual, they can reduce the risk.
Well, that's it in a nutshell. I hope this article helped clear up some of the confusion about vitamin supplements. If you have any questions about your personal need for vitamin and mineral supplementation, discuss this with your doctor.