Vitamins and Supplements: Separating Facts from Fiction

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Like most conventional physicians, I was taught in medical school that supplementing our diet with vitamins and minerals was just a waste of money, and sometimes a potential health risk. It is true that a few vitamins, namely. The fat soluble ones such as vitamin A should be used with caution. However we clearly benefit from the B vitamins which are water soluble and pretty safe even at high dosages. The vitamin B family is essential for the proper functioning of just about every organ in the body. It is also essential to reduce homocysteine levels which, when left untreated, increase the chance of cardiac disease and Alzheimer’s three fold.

People would be deluding themselves if they thought multivitamins could make up for eating a regular diet of junk food. You cannot replace a healthy diet with a pill or even several. We simply can’t know what ingredient in a balanced diet is responsible for absence of symptoms from one individual to the next. We do know that people who consume five servings or more of fruits and vegetables a day have less disease. We also know that a steady diet of fast food can destroy your health in a matter of months.

Most herbs are not standardized, so it is hard to tell how much of the active ingredient we are getting. Check the label and look for standardized formulas.

There are a few vitamins that everyone should take. The remaining vitamins should only be taken for specific reasons or conditions, ideally under the supervision of a physician or pharmacist who has taken the time to review in detail your medical history. Your current medical condition is a sum total of all your previous medical and surgical problems, vaccination history, drug intake throughout your life, diet, habits, past exposure to different toxins, family medical history and your own genetic profile.

The vitamins and supplements that should be taken by nearly everyone are:

1- Fish oil DHA/EPA: 1-5 grams/day. There is no medical condition that I can think of that may not benefit from good quality pharmaceutical grade mercury-free fish oil. Fish oil reduces death after a heart attack by 30% because of decreased arrhythmias. Fish oil does not change the total cholesterol. That is why it is hard to explain the benefits of fish oil to patients who are fixated on the total cholesterol number which is, believe it or not, a worthless number. Low Density Lipids or (LDL) is the most important number in terms of predicting coronary artery disease. Fish oil again does not change the LDL total measurement but it does increase the bad lipids particle size and decrease their numbers. That is a very important benefit that is not reflected in the total LDL measurement.

Lab results may not show the underlying LDL benefits unless we are measuring fractionated lipids, something that is not commonly available yet at most labs. Fish oil reduces triglycerides by 30%, reduces high blood pressure and stimulates the immune system. In a review of 97 studies published in the Archives of Internal Medicine in 2005, covering 137,000 patients, fish oil was proven to be superior to statin drugs in reducing mortality (13% with statins versus 22% with fish oil, a message that does not seem to be getting through to many cardiologists). The prestigious New England Journal of Medicine published in August 2008 the results of a four year placebo controlled large study proving that fish oil is more effective than statin drugs for patients with heart failure. Fish oil decreases inflammation and repairs the brain. Fish oil contains, like all fat, nine calories per gram yet it enhances brown fat metabolism and may decrease weight! The DHA is what gives fish oil its fishy smell. Some manufacturers use much more EPA, than DHA to claim that their fish oil is less fishy, a truly “fishy” practice. The brain is mostly DHA. DHA is only found in algae and seaweed, which is then consumed by fish. The dose you need depends on your condition. The recommended dose for healthy children is one gram per day of DHA/EPA.

The recommended dose of fish oil for healthy adults is 1-2 grams per day. The recommended dose for patients with elevated lipids or triglycerides or at high risk of forming blood clots is 3-4 grams per day. The recommended dose for fighting inflammation, treating neurodegenerative disease or boosting the immune system is five grams per day. The recommended dose for controlling chronic pain is up to 7-10 grams per day! Fish oil should be stored in the fridge but not forgotten (out of sight out of mind), otherwise it oxidizes and becomes rancid or acidic and smells even fishier. Another way to prevent rancidity is to add Vitamin E to the formulation. For best absorption fish oil should be taken after a meal containing some good fat such as olive oil which provokes the release of the enzyme needed to break down fat and fish oil.

Large amounts of cod oil while containing EPA and DHA may prove toxic due to the high amounts of vitamin A and D in it. Guess what is the richest source of DHA on the planet? Breast milk! That is why breast feeding is so important for the baby in preventing allergies, asthma and colitis.

If you are not eating oily fish rich with Omega 3 at least twice per week, take supplemental fish oil, 2-3 grams per day. Look for molecularly distilled products certified to be pharmacology grade and that it is guaranteed to be free of mercury by a reputable supplier. Taper the statins gradually under your doctor supervision. Never stop your statins abruptly as you may get an acute coronary artery syndrome. Adding fish oil to statins gives you an additional 21% decrease in heart disease even though the LDL number does not change due to decreased inflammation with the Omega 3.

2- A good multi-vitamin pill: Taking a pill of A-Z Centrum which contains the Required Daily Allowance (RDA) of most vitamins and minerals is not enough. You need to find a vitamin pill – and there are many of them - that contains 500-1000% of the RDA since the RDA was designed to prevent disease and not to promote optimal health. For men, choose one that does not contain iron unless you are suffering from iron deficiency. For most menstruating women, I recommend one that does contain iron – See iron replacement below.

3- Probiotics, 20 billion units/day. Stress, excessive sugar intake and overuse of antibiotics kill our friendly bacteria which is an important organ in our body responsible for producing all kinds of B vitamins and for preventing the overgrowth of yeast in your gut. The best kind to use is the one that has multiple strains of bacteria, a high bacterial count (at least one billion colonies per unit) and does not need refrigeration (has a long shelf life). I have seen this supplement do wonders for patients suffering from irritable bowel syndrome, a condition that affects 15% of the US population including my wife. She used to get such severe pain that I had to teach her how to self administer Voltaren shots at home. Her attacks occurred at least once a month and lasted 4-5 days. She was treated by several top gastroenterologists and tried many medications over ten years only to get worse.

When I finally learned about the role of probiotics in healing the gut, I started her on 20 billion colonies a day. She got much better within four months. She now gets a mild attack once every 2-3 months. The treatment course requires two pills in AM and two in PM taken on an empty stomach for at least 3-4 months. Should you need to take broad spectrum antibiotics, you should take a course of probiotics for two hours after each antibiotic dose and continue for three weeks after the end of the antibiotic treatment. It is also essential for patients undergoing chemotherapy or radiation therapy. There are no side effects or contra-indications for probiotics. Choose the formulations that have a long shelf life and that do not need refrigeration.

Below is a long list of supplements I find very helpful prescribing to my many vitality-seeking patients once they have completed their 250 question ‘history’ and after the physical exams and targeted lab tests that our treatment team directs them through, in order to confirm our clinical impression. Based on our findings, we select a few additional supplements that suit their individual needs. The list below constitutes those that give the most bang for the buck. It is neither economical nor wise to take vitamins, minerals and supplements blindly, even though they are for the most part very safe.

Coenzyme Q10 30-1800 mg/day. This is an essential enzyme assistant involved in mitochondrial function whenever cell energy is produced. It is depleted with age and with the use of lipid lowering drugs, blood pressure lowering drugs, all anti-seizure medications and some sugar lowering drugs such as Metformin (Glucophage). Induced Coenzyme Q10 deficiency with these drugs may result in chronic fatigue, heart failure, depressed immunity and severe muscular wasting. 50% of patients on cholesterol lowering drugs are deficient in CoQ10 resulting in muscle fatigue, the number one reason why patients stop taking their drugs. Most Co Q10 on the market is poorly absorbed. For best absorption take it with some good fat and use a good quality product.

Di-Indoly-Methane or DIM: 75 mg twice a day and up to 300 mg/day. It is the most active cruciferous substance that can positively influence estrogen metabolism to produce good estrones as opposed to bad estrones in men and women.

B-Complex: is the group of vitamins such as B1, B2, B3, B5, B6, B12, inositol and folate. Although, each one has unique properties they do have a lot in common and can be thought of as one family.

The B vitamins are essential for every step of metabolism and for the function of hundreds of the 10,000 enzymes that facilitate every chemical reaction in our body. They support the immune system and reduce cardiovascular disease, stress, chronic fatigue and psychiatric problems.

Avoid taking high doses of a single B vitamin without increasing all others in the family as they work together and the presence of a high dose on a single one may interfere with the absorption of the remaining B vitamins in the gut. Vitamin K is one of the B vitamin family and is important in clotting function and in bone health. Vitamin K helps calcium attach to bone instead of clogging arteries.

Niacin: 500-1500 mg/day. Study after study, including the ones from the National Cholesterol Education Program have shown that niacin – a B3 vitamin- to be superior to statin drugs such as Lipitor in managing elevated triglycerides and elevated LDL. Many conventional physicians are still too comfortable doing what they have always done: prescribe statins like Crestor, Lipitor or Zocor. You should only take statin drugs if you have other risk factors or had a previous heart attack and not merely an elevated cholesterol or triglyceride lab number. Very few patients on the slow release non flush form of Vitamin B3 develop an elevation of their liver enzymes unless they exceed 1500mg. Monitoring patients three months after starting non-flush niacin may be a wise idea. The immediate release form does not have that potential, but it does cause flushing of the face in 10% of patients. It is 50% more effective than non-flush niacin. Taking it at night and after a baby Aspirin may overcome the flushing. Patients with Polycystic Ovarian Syndrome or PCOS should not take niacin as it makes them more insulin resistant.

Folic Acid: The usual dose is 400-800 mcg per day. We may need higher doses (2000-5000 micrograms) along with Vitamin B1, B6 and B12 to lower elevated homocysteine. Homocysteine levels should be part of all comprehensive checkups, especially for smokers.

L-Carnitine 2-4 grams/day is an amino acid vitamin like structure related to the B vitamins. It is important in replenishing neurotransmitters in the brain and increases Co Q10 availability and improves cardiac metabolic function. Carnitine decreases LDL oxidation and coronary artery disease. For best absorption, take it in divided doses and on an empty stomach.

Theanine 50-300 mg/day. Theanine is an extract from green tea without the caffeine, a great brain non-sedating anti-oxidant that reduces LDL oxidation with nerve calming anti-stress and anti-anxiety properties. It is frequently effective in relieving PMS but results may take a few weeks. Digestive Enzymes 2-3 tablets/day. The pancreas and certain vegetables contain different enzymes to break down carbohydrates, fat and protein before they can be absorbed into the blood stream. Too many patients suffering from indigestion and bloating are in fact suffering from insufficient digestive enzyme production by the pancreas. This is especially true with people who drink a lot of milk and eat a lot of dairy products while not eating enough vegetables. Dairy products are the richest in calcium but you may need help with digesting them, especially milk, to avoid bloating.

Vitamin D: is not a true vitamin in that our body manufactures it when exposed to sun and is a hormone like substance that targets dozens of vitamin D receptors in many tissues. Vitamin D3 is the active form and is critical in preventing cardiac disease, high blood pressure, osteoporosis and type 1 diabetes in children. It is essential in helping your body absorb calcium. Vitamin D is also critical for memory and immune system functions. Vitamin D supplementation may cut the risk of pancreatic cancer, a leading cause of cancer death, by half. Aluminum toxicity and xeno-estrogens which come from frozen food wrapped in plastic depletes your vitamin D. Do not exceed 800mcg/day as it is fat soluble and can accumulate and become toxic.

Iron 20 mcg/day. Iron deficiency is the most common single nutrient deficiency in the world. To uncover it early, we need to check iron blood levels and not merely wait for anemia to develop later. B12 and folic acid deficiency may also cause anemia. Unexplained anemia may be a sign of a silent cancer or chronic infection. Symptoms of anemia include hair loss, fatigue, poor attention span, recurrent headaches and heart palpitations. Iron is an essential supplement for vegetarian, menstruating and pregnant women and men suffering from anemia. Too much iron in the body has a pro-oxidation effect (iron plus oxygen equals rust) and must be balanced with enough anti-oxidants. It is hard to get enough iron from red meat and diet to treat anemia. The inexpensive form of iron, iron sulfate is very constipating and irritating to the stomach. All other forms such as iron glycinate are better. Avoid taking iron at the same time as your calcium supplement as iron interferes with calcium absorption.

Cat’s Claw 500 mg/day of the standardized form is very effective in treating mild cases of yeast overgrowth or candida in the gut. For stronger overgrowth or for quicker results, I advise Nystatin by mouth, a local antifungal antibiotic that is relatively not absorbed into the body. It can be very effective in chronic bowel inflammation, although, we may have to increase the dose gradually as the gut may be too sensitive.

Artichoke Extract. 250 mg of the standardized form/day. Artichoke is a primary liver detoxification remedy. It also soothes stomach acidity and irritable bowel and opposes bad estrogen metabolism.

N-Acetyl-Cysteine (NAC) 600mg twice per day. NAC is a sulfur containing amino acid that helps with the second phase of liver detoxification and does stimulate the production of glutathione the king of detoxification and antioxidants. In 2007, UCLA researchers found NAC to be a key ingredient in controlling auto-immune diseases as it helps the liver get rid of heavy metals and other toxins.

Bitter Melon: 300 mg twice per day may lower your insulin resistance and the need for anti-diabetic drugs. One major drawback is that it is expensive.

Cinnamon Extract: 1-2 teaspoon of this popular spice daily increases glucose metabolism and reduces your need for anti-diabetic medications.

DHEA 25-50 mg/day. This hormone declines with age yet contains anti-aging properties such as strengthening the immune system, inhibiting cancers, decreasing insulin resistance and heart disease It may help relieve menopause symptoms and erectile dysfunction. It is classified as a supplement but is a truly powerful hormone that should, in my opinion, be used only under medical supervision. As with all hormones, obtaining DHEA levels through a lab test allows for more accurate replacement. Women should not exceed 10 mg/day.

Melatonin (1-3 mg) is another powerful hormone that stimulates the immune system and helps with sleep and jet lag. Some people taking Melatonin experience opposite effects, such as, anxiety and restlessness. Overdose may lead to depression. Sleeping pills such as Ambien or Dormicum do not allow the brain to go into the deep Rapid Eye Movement or REM stage when dreams occur. Patients using these drugs do sleep but wake up tired or not rested. Adding one mg of Melatonin allows for deeper sleep and better rest.

A Word About Minerals. Lack of minerals is more commonly found than lack of vitamins. Magnesium and calcium are the leading cause of lack of minerals. But other smaller minerals, also called trace minerals, may be deficient as well.

Magnesium: 400-800 mg/day. Magnesium is a key mineral involved in more than 300 functions in our body. Magnesium promotes good daily bowel activity – the ideal is having two well formed bowel movements per day. It is also beneficial in decreasing hypertension, painful menstrual cycles, restless leg syndrome, migraines and seizures. Finally magnesium lowers the blood pressure, reduces platelet aggregation and decreases cardiac arrhythmias and seizures.

About 70% of Americans were found deficient in magnesium to the point that some government scientists are considering adding it to tap water. The reason it is so low is due to over-cultivation of our soil which results in a lower quantity of certain essential minerals such as magnesium, zinc and selenium in our food.

Too much coffee and too many phosphorus-containing sodas leech out minerals including magnesium from our bodies. Magnesium is the number one mineral deficiency in body builders who sweat and take excessive protein supplements.

Start at 400 mg and keep increasing the dose gradually to 800 mg, should your stools get too loose back off by 20%. The best absorbed forms of magnesium are magnesium glycinate. The most powerful for fighting constipation or loosening stools is magnesium citrate. The best form to fight irregular heart beat is magnesium taurate. The best form for chronic fatigue and migraine headaches is magnesium malate. Magnesium carbonate and magnesium oxide are not as effective at replenishing magnesium stores. Low magnesium inside the cells is not revealed with simple magnesium blood levels. Low blood levels indicate severely advanced magnesium depletion.

Calcium: If you are not drinking enough skimmed milk or low fat yogurt, take 900 grams per day of supplemental calcium, preferably as calcium citrate and malate, calcium glucinate or calcium hydroxyapetite. If you do not mind the extra expense avoid calcium bicarbonate found in many calcium pills as its absorption is variable and may cause constipation. Calcium plus magnesium and Vitamin D3 is a good combination because of their absorption synergy.

Zinc and Selenium. There are also trace minerals that are essential for body function. Chief among them are zinc, chromium, and selenium. Both zinc and selenium stimulate the production of mature white blood cells in the thymus gland. Zinc has more than 300 functions in the body. Zinc deficiency results in loss of the sense of taste and wound healing ability. Diabetics are frequently low on Zinc. Indiscriminate use of trace minerals can result in toxicity. The dose for zinc is 25 mg every other day. Exceeding 100 mg of zinc/day increases prostate cancer. Exceeding 400 mcg of selenium can also be toxic.

Zinc-Selenium-Iodine combinations and or thyroid tissue extracts are beneficial for thyroid support in patients with sub-clinical hypothyroidism or sluggish thyroid function. This condition is reaching epidemic proportions and is rarely picked up by looking at normal thyroid lab tests. I rarely recommend high dose iodine supplementation beyond what is found in a good multi-vitamin pill. An alternative is sea salt enriched with iodine. Nothing works in the body when the thyroid is not functioning.

Chromium 100-200 mcg/day. Chromium is a trace mineral naturally present in the body. Broccoli is the only food that is truly rich in chromium. Patients trying to lose weight, especially those suffering from insulin resistance (most breakfast skippers) and sugar cravers should consider taking 1000-2000 micrograms twice a day for 2-3 months. Chromium is also essential for thyroid function. Thyroid controls metabolism which accounts for 40% of the obesity factors. The best chromium is chromium poly-nicotinate and the maintenance dose is 200 mg/day. Athletes and pregnant women suffering from temporary diabetes benefit from chromium. Exceeding 800 mcg per day over a long time may lead to toxicity.

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