Posted by: drrozkaplan | January 26, 2010

The Vitamin Trap

I stood in the vitamin and supplement aisle this morning before coming to work, scanning for the fish oil supplement that I take.  There were so many different forms of fish oil that I had to carefully read the bottles to make sure I got the right one.  Liquid.  Capsules.  Single strength, double strength, triple strength, fish and borage oil, fish oil alone, Fish Oil 1000.  Deodorized, flavored, no-burp….If I have trouble knowing which one to get, how would the average person make a decision?

And what about multivitamins?  There have to be 20 different brands, and each brand has subtypes, such as ‘silver’ (for people over 50), ‘women’s formula’, ‘men’s formula’, and ‘teen formula’.  Not to mention chewables, coated, flavored, gummy bear, gumball, chocolate and other various flavors….And the calcium supplements are no less complicated.  And by the way, should we all be taking CoQ10 and Vitamin C and extra B complex?  Should I buy that glucosamine/chondroitin that my friend swears fixed her achy joints?  Or should I forget everything in this vitamin aisle and buy the supplements from the high-priced line with the little packets that my personal trainer sells?  The ones that he swears I need but mean I’d be taking 43 pills every morning?

Okay, here’s my disclaimer.  I am not any  reader’s personal physician, so I can’t tell any individual what they need.  But I am an Internist who has kept up with the literature on vitamins and supplements, and I can give some perspective on this. 

First of all, there is no known benefit to those fancy, multi-pill packets, or any other complicated supplement regimen unless you have a specific nutritional problem.  If you have a very healthy, balanced diet with your 9 servings of fruits and vegetables, you don’t even need a multivitamin.  But since most of us don’t get that great diet, a multivitamin is a fine idea.  Any branded, basic multivitamin is good.  One without iron, unless you’ve been told you’re iron deficient, because extra iron when you’re not can actually be unhealthy (young menstruating women can usually use the iron, everyone else, forget it). 

Most people don’t get enough calcium and vitamin D.  But ask your doctor, especially if you have ever had kidney stones or other kidney problems, whether you need a calcium supplement.  The usual recommended amount of calcium is 1000 mg/day in 2 divided doses, because you can’t absorb more than 500 mg. at a time.  Take it with food.  And the usual recommended amount of vitamin D is 800-100 IU (international units) daily.  A lot of calcium supplements have the vitamin D in them, so you can kill two birds with one stone.  Postmenopausal women need 1500 mg. of calcium daily.  The average American diet gives us about 600 mg. of calcium daily, but if you have a lot of dairy products, you might get more.

Other than that, I don’t tell my patients to take any supplements, unless I’m trying to accomplish something specific.  Such as with the Fish Oil.  I take it to manage my cholesterol.  It helps.  My favorite one is GNC triple strength, because I can take one daily and get 900 mg of essential fatty acids.  Most of the bottles say ‘1000 mg/capsule’, but they mean 1000 mg. of FISH OIL, which may be only 250 mg of fatty acids.  Then you have to take 4 daily to get enough.  You also have to find one that doesn’t give you ‘fish breath’ and burping.  And fish oil isn’t for everyone.  It can actually increase ‘bad cholesterol’ (LDL) for some people.  So you have to talk to your doctor if you’re using it to manage your cholesterol, and you need to be monitored.

All the other stuff- the vitamin C, the coQ10, the glucosamine- there’s no strong proof anywhere that it’s helping you.  With some things, like high-dose vitamin C, it could be hurting you.  There are spotty, small studies saying both things.  A large, well-controlled trial shot down the glucosamine-chondroitin.  But some people still swear by it.  My rule is, if there’s no evidence of harm, it’s okay to take, but buyer beware- it could be a big waste of your money.  And then there’s some things like magnesium and certain B vitamins that are used for certain conditions, but shouldn’t be used ‘just because’.  That’s why you should have a doctor.  And why you should talk to him or her.  And not your personal trainer or your cousin or someone who sells supplements and therefore has a stake in you spending your money.

It’s hard when all those bottles call out to you promising you relief from fatigue and overweight and aches and pains.  Just remember that if those claims were really true, it would have been broadcast all over creation by now.  Save yourself some money and some disappointment.  Less is more when you’re in the vitamin and supplement aisle.

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