The Risks of Excess Vitamins and Other Nutrients

This is an excellent topic to fit with the last two on supplements and multivitamins. I do not think about it generally because I am aware of the difference between fat and water-soluble nutrients. I do not consciously think about this because of the few supplements I do take, but I do tend to be more careful with fat-soluble because the body does not automatically flush excess out of the body.

The body sometimes does not automatically flush excess water soluble, but in general, it does. Water-soluble excess is generally flushed and not stored by the body. There are exceptions that you need to be aware. Too much vitamin B6 can cause nerve damage. Excess niacin can cause flushing and excess vitamin C may cause kidney stones. A serious problem may be caused by excess folic acid, which may mask vitamin B12 deficiency and is most common in people over the age of 50.

Fat-soluble is dissolved in fat and stored by body tissues for use later. However, fat-soluble is not equal as Vitamin D is a hormone and apparently allows higher tolerances than other fat-soluble vitamins. Vitamin D is one of the more controversial vitamins as many think the Institute of Medicine (IOM) has set the limit too low for the needs of the body. Many are claiming vitamin D has more health benefits than it may have.

Vitamins A, E, and K are also fat-soluble. Because they are stored, over time they can rise to dangerous levels and lead to a condition called hypervitaminosis. This means excess amounts of a vitamin in the body that are unhealthy and can cause health consequences. Excess vitamin A in women can cause birth defects and too much vitamin E may increase the risk of hemorrhaging. Excess vitamin K can reduce the effect of blood thinner medications and prevent normal blood clotting.

Exceeding the recommended daily allowance (RDA) of many nutrients can cause the vitamins to act like drugs and may lead to health problems. Research has shown at what levels nutrients can cause potential problems and these levels do take into account all sources of vitamins and minerals from food, fortified food and supplements.

Fortified foods is a way for people to help fill the nutrient gaps and has resulted in production practices of adding iodine to salt, enriching grains with vitamins B and iron, and milk fortified with vitamins A and D. In combination with whole foods, supplements, and fortified foods is raising concerns from the experts. These concerns are that the supplements may cause the diets of people to exceed the safe upper limits and potentially lead to a toxic buildup of certain nutrients.

Even though the article advises consulting a doctor, I am leery of this because many doctors will advise against supplements without doing any testing to determine if there are deficiencies to be concerned about. Consulting a dietitian is good advice. Even with this, it is still wise to know the upper limit for vitamins and minerals that you are taking, check all labels of your food choices to know which food are enriched with the same nutrients.

Carefully read the article by WebMD and read the previous two blogs on supplements and multivitamins. Here's to your good health!

How to Choose a Multivitamin

Again, WebMd has an article when needed. The last blog about supplements was inline with this. We do need to be aware of supplements and which ones are age appropriate. It appears that the food industry goes out of their way to prevent balanced nutrition with the highly processed foods we are exposed to in the stores. It should not be that difficult to eliminate the highly processed foods, but occasionally they can be substituted with little nutritional damage, but only occasionally.

If you are using supplements to fill in the nutritional gaps, you may want to consider a multivitamin. We do not always use the best eating plans or have a dietitian or nutritionist available to consult on a regular basis, so depending on the test results from your doctor, you may need a multivitamin to fill in the gaps. If so, which one do you chose when you are looking at the large variety on the shelf? I would encourage you to read the WebMd article as it covers many points.

First, make sure that your daily food intake includes a variety to be complete in nutrients as possible. This may eliminate the need for a multivitamin, but depending on the tests done by your physician, do consider supplements or a once daily multivitamin if necessary. “The 2010 Dietary Guidelines for Americans identified calcium, vitamin D, dietary fiber, and potassium as nutrients of concern for inadequate intake in adults and children. All of these nutrients, except fiber, come packaged in a multivitamin. Fiber can be obtained as a separate supplement, but it's still best to try to get all your fiber from the foods you eat.” 

Some pointers to consider while looking over the variety of multivitamins include: reading the label carefully, getting the basic vitamins and minerals, check the percentages of what the multivitamin has listed, look for extras that you may not need or do need, check the formulas for men, women, and age, and do not overdo the multivitamin routine.

Look for the multivitamin that fits your sex, stage in life, and your health conditions. This more than a salesperson's promotion should determine what is appropriate for you. Most multivitamins are sold in capsule form, but they are also available as tablets, powders, chewables, and gummies. Liquids and injectable formulations can be found that can be administered by healthcare providers.

Supplements and multivitamins can lose their potency over time and especially when improperly stored. Also, check expiration dates, store in a cool dry place and avoid hot, humid places like the bathroom. Make sure that the location is secure and out of the reach of children.

It really does not seem to matter when you take the multivitamin, but taking it with food can be an advantage in lessening stomach discomfort. “A measure of safety is to look for the designation "USP" on the label. A multivitamin that meets the requirements of the U.S. Pharmacopoeia (USP) meets the standards and ensures the product is pure and actually contains the listed ingredients.” Always consult your health care provider when taking any supplement or multivitamin to be sure that they will not have conflicts with prescription medications.

Are You Using Supplements for the Right Reasons?

Are you using supplements for the right reason? Many do not and take a cocktail of supplements based on what the salesperson says. This can lead to over taking many of the supplements and creating a toxic effect when the supplements are not needed. Think about it for a while and decide if you are on this path.

The promises of the salesperson and claims on the packages are not the reason to be taking them. We all know that there may be a temporary energy boost, but this will not last long. The supplements will not help with weight loss, reduce stress, or reduce wrinkles. Yet many people take supplements for these reasons and spend money for pie-in-the-sky reasons.

Experts agree that there is a proper place for vitamin and mineral supplements to fill gaps in our nutrition. They should not be used to take the place of real food because they will not replace other important nutrients we obtain from eating healthy meals. Yet it is common knowledge that may people do this and can create other shortages in their diet that real food can meet the needs for and fulfill.

This blogger has the right attitude about supplements and rightly believes in obtaining supplements in their natural state from food. Supplements cannot replace every nutrient and benefits of whole foods. Supplements are meant to do just that, supplement gaps occurring in your diet. It is best to obtain your nutrients from food first and fill the gaps with supplements. A pill does not contain the phytochemicals and fiber necessary that eating whole foods can supply.

Learn that your doctor does many tests to see which essential nutrients you are not getting in the foods you eat. By obtaining copies of your lab tests and tracking them, you will soon learn which supplements to add to your intake and avoid those that have little to no benefit. We all need to keep the levels of calcium, potassium, magnesium, vitamin D and Vitamin B12 at proper levels and your doctor can help determine these with the proper tests. You may need to have a long conference with your doctor as many do not see the value in any supplements and will tell you not to take them. This is where research on the internet may become necessary for some of them.

“Beyond filling in gaps, other studies have demonstrated that supplemental vitamins and minerals can be advantageous. However, the exact benefits are still unclear as researchers continue to unravel the potential health benefits of vitamins and supplements.”


If your doctor agrees that you need supplements, remember to take them. They can do nothing if left in the bottle. Set up a daily routine for taking them and follow it. Remember too if what the salesperson or the packaging advertising says is something that is too good to be true, it probably is. You should avoid those making unrealistic claims. Expect only what it would do for you if you were eating sufficient quantities in your food, not what people want you to believe to make a sale.


Take time to read the WebMD article carefully as it has some pointers not included above.

Why Do You Let Teaching Moments Pass?

I could list many people that write about this, but I am interested in why they let teaching moments for diabetes get away from them. This raises many questions and provides very few answers.

Is it the setting, the time, or the place that stops them? Are they people that want to keep their diabetes a secret to be kept in a closet? Are they too embarrassed to speak up? Or, is this an invisible disease that keeps people tongue-tied?

When compared to breast cancer, awareness on a national level is more recognizable and better advertised. People have ribbon stickers on their cars, have larger, more publicized events and in general have come out of the closet in their battle against breast cancer.

What is it going to take to get the diabetes community to come out of the closet? The International Diabetes Federation (IDF) is trying to lead the way in a color and a symbol. But the American Diabetes Association (ADA) is determined not to become part of this effort. They want their own color and their own symbol and seem to downplay the efforts of the IDF.

However, let the IDF have some success and the ADA will find a way to either hog the credit or say they had a large part in it. Sometimes they have a legitimate claim to a little of the credit, but they seem to want to have it all. Not a very professional or humanitarian thing to be doing is the way I view this.

The ADA does little to promote coming out of the closet and using education to promote the prevention of diabetes or giving the support to adult patients with diabetes. The ADA does not promote discussing diabetes to help people understand this chronic disease to the general public. They do not promote many activities for the cure of diabetes. The ADA is basically an association of and for doctors and this they do poorly. Why else would there be so many doctors that will not aggressively work to diagnose diabetes and try to stem the rising epidemic of obesity.

The only claim that the ADA can make is their enforcement of laws on the books protecting children and their rights in the public school system. They do also use the Americans with Disabilities Act laws to protect the rights of people with diabetes. This is their only claim to fame. While medical professionals look to the ADA for guidance in the field of diabetes, the ADA is very much behind the times in its pronouncements and guidance about the types of diabetes and effective ways to treat diabetes. Often this is five to ten years after the medical professionals have made the decision on their own.

There is research available and verifiable, but the ADA keeps looking for more on which to base a directive or issue guidance. This in turn leaves the patient with little to rely on in discussions and trying to make sound decisions for their own health.

Therefore I lay the fault of why patients avoid educating others about diabetes on the steps of the ADA and the medical profession. They wish to be the ones controlling the patients and having patients totally rely on them. The ADA feels that patients are incapable of learning about this chronic disease called diabetes. Before you think I am totally against the ADA (which I am), they are responsible for American Diabetes Month, but do little to promote education within this month.

Now that the American Association of Clinical Endocrinologists (AACE) has a web site of approved and vetted diabetes sites (this is still in the formative stage and more sites need to be added), will the ADA follow and claim credit. I can see the press release about how they have had all the information available on their site. Yes, it may be there, but finding it and having access to it are two different things, both equally difficult and often costly, as they will not offer much freely, but for a fee. The AACE did think to include the ADA on their list of approved and vetted sites.

Another First in Patient Care

Apparently, with changes in the health care system and the likely decrease in Medicare funding projected for the next year, changes are happening especially in medical offices that now have electronic record systems in place and operating. On Tuesday, I was in the lab for tests and on the wall was a sign asking patients to notify lab personnel of any lab work done in the last 30 days in the hospital and hospital clinics.

I did this and the person headed for the computer and pulled up the lab results and said that makes only the A1c test left. Therefore, that was the only test that needed to be performed before seeing the endocrinologists. Before, this would not have stopped duplicate tests. Times are changing.

A1c was the same as my last visit. This was better than I had expected considering the surgery and my blood glucose results since then. Maybe my extra care in the two preceding months helped. I would like to think so and hopefully it would have been under 6.0 if not for the surgery.

I did comment on this to the endocrinologist and she stated this was a new policy and that yes they were doing this to avoid duplication of tests performed within the last 30 days. I asked how they liked the computer system. It is saving money and making communications between doctors, labs, clinics, and the hospital much easier. They are still keeping the manual records and updating them as fast as possible into the computer.

I am sure what they are all waiting for is the Medicare payments to come faster and the savings to be distributed. I cannot say I blame them with the proposed cuts that may take place unless our Congress gets their act together. Does not seem likely considering the status of affairs. Yet, the Department of Transportation keeps awarding millions almost weekly for this project and that project.

November Is Past – Big Sad Sigh

This November was a big disappointment for an American Diabetes Awareness Month and World Diabetes Day. Number one, none of the US diabetes groups or organizations seems to want anything to do with the International Diabetes Federations blue circle. This is a disappointment for many in the DOC. This should mean that we will need to lobby the entire year to convert any organization.

Another disappointment for me is the total lack of promoting diabetes month or diabetes day on the HealthCentral website. We were regaled about Alzheimer's National Alzheimer's Awareness Month on the home page and Alzheimer's page. Only one diabetes blogger, Amylia Grace mentioned the diabetes day or month with no mention of anything by Health Central.

The bloggers that decided to write a blog each day, well that was somewhat better, but those that followed other's guidelines for daily topics, it was a little disappointing. There were some excellent blogs and I applaud those that took on the challenge. I like writing, but definitely happy that I choose my own topics and did not write for 30 days on topics of little interest to me.

I had hoped that the American Association of Clinical Endocrinologists would have added to the approved and vetted type 2 diabetes resource sites. Since the original publication on September 27, 2011, nothing has been added to the list of 15 sites.

To pass out grades on the American Diabetes Month would be unfair. Activities are so disjointed and each organization has its own agenda. Forget about finding a common ground for increasing diabetes awareness, everyone wants to think their way is the best. So as a group, nothing of value is generated to aid in the fight against the increasing rate of diabetes diagnosis.

Until the people start demanding action and the medical communities realize that the diabetes pandemic will not go away, little will be accomplished. The divided we fail signs seem to have no meaning to the diabetes community. In addition, since diabetes seems to be such an invisible disease, people in general tend to ignore our cries for help.

I fear that until there is a change in culture, one that can get past the politics, uncaring people within the medical community, and the handouts and influence of the large pharmaceutical companies, there will be little accomplished in the near future. I hope that I can be proven wrong. At present, everyone is so enamored with his or her corner of the world; they seem to accomplish little for the education awareness about diabetes or making a change in the culture of diabetes.

How to Educate Those That Do Not Want to Learn

I am going to start this topic and maybe others will be able to help me along the way.  Yes, how do you educate people with type 2 diabetes that refuse to learn, or for that matter tune you out? I have had minor successes along the way, but few as difficult as one gentleman that just refused to listen or pay attention to anything I said for almost a year. He told me point blank that if he wanted information, he would ask his doctor.

Okay, a small crack in the armor was showing itself. I started asking him questions about what his doctor was telling him. How often does he see the doctor? Answer: once a year. What medications was he taking? No Answer. How old was he? Answer: 73. Did he feel like he was seeing the doctor often enough? Answer: No. How often did he think he should see the doctor? Answer: at least once a quarter. Was he getting his questions answered? Answer: No. How long had he had diabetes? Answer: almost 4 years.

I kept the questions flowing and got very short answers, but I had him talking and thinking and I came back to some of the above questions and got mostly the same answers. I then asked him if he would like some of his questions answered? Surprise, he answered yes. So, I asked what he asked that he never had answered. Again a surprise. He asked what he should be eating with diabetes? Now we were getting somewhere.

I again asked him if he had seen a dietitian on referral from the doctor? Answer: No. Had he ever asked for a referral? Answer: No, and he asked was this possible and would his insurance pay for it. My answer, it should be possible and Medicare does cover it in most cases. Now the tables turned and he was asking the questions. I answered them to the best of my ability and did get a question in. Did he use a computer? He looked at me surprised and said, yes. I asked him if he did any research on the computer? Now I had a questioning look and no for an answer. He stated that all he used it for was emails with his children and grandchildren.

His three children had purchased a computer for him and only showed him to use email. I asked him if he wanted to learn more. He asked, like what? At that point, I asked him if this was something his children wanted him to do. So we went to his home and he sent them an email. The answers back were yes, that is what they had hoped he would do on the computer and find answers he was not getting from his doctor.

Now he was full of questions and wanted answers. So I examined the computer and found out what he had and how much storage he had. Plenty, I could only dream about this for a computer. I asked him if he had finances for a few tools and he answered yes. So we started looking and I found several programs he should be able to use, a virus checker, and several other tools. I explored what he had on the computer for programs and found several programs that he could learn and set them up so he could access them and at least explore and become familiar with them. I downloaded a free program and set that up for him to use. I also showed him several sites and he did bookmark them to go back and look at them and possibly subscribe to their free newsletters.

I knew I had a book for one of the programs, so I offered to lend it to him. He accepted and said it would be a big help. I promised to return and help him on another day. I left him with my email address and telephone number. He is now full of questions and I will admit I am enjoying my time with him and educating him about diabetes, via email, at his home, and on the telephone.

Yes, he is now a willing student, and set to see his doctor quarterly. He has an appointment with a dietitian knowledgeable about diabetes. I know my method worked this time, but I have not been able to get it to work on any other persons. I keep hoping to find a way, but of the several tactics I have tried, none have succeeded. So if anyone has other suggestions, please let me know. One person does not have a computer and as such, I am working on getting him to work with my first friend, but he does not want to do this.

Outpatient Care – The Good and Bad

On 15 November, I experienced what I consider to be both sides of outpatient care, the good and bad. I was pleasantly surprised to be told when scheduled for my surgery that I must bring my own sleep apnea equipment. In my blogs before this, I had warned people that they may need to get prior approval from the hospital to use their own equipment. At least in my case this is no longer necessary.

I had to think about this for some time, but I think I can answer this now. With the new health care laws and the fact that Medicare is clamping down on expenses, it makes good sense for hospitals to have people bring their own sleep apnea equipment. First, because they are familiar with the equipment and know how to use it, and second, the hospitals can avoid using expensive equipment and maintaining it, having people knowledgeable in setting the equipment requirements for different patients. This means cost savings. It also means cost savings because people generally do better and leave the hospital sooner when they use their own equipment.

This is a positive for the hospital and the patient. Did I need the equipment with me? Turns out, I did not, but this is now a standard for outpatient surgeries to have the equipment present in the event that you are admitted to the hospital or have troubles in the recovery area. A few years ago, this was seldom considered and is good procedure saving the patient problems and requiring someone to make an extra trip to locate and bring the equipment back.

Now the not so positive side. The reception area for the incoming outpatients was almost too friendly, like they were trying to put you at ease so you would forget and not keep your wits about you. Yes, indeed and in the following hours, I could see why. Talk about like being treated like cattle and the impersonal nature in which you were treated. I have been a patient for very few hospital stays or even outpatient surgeries not counting colonoscopies, but this was one experience I do not want to repeat unless there are some changes in the way I am treated as a patient.

From the patient in processing room to the recovery room, I felt like the more they could keep from me, the better off for them. Why? That probably will never be answered. I do know I made some statements that I did not want an intern or new resident doing the procedure. I also asked that the IV not contain any dextrose because I was a diabetic. Can I say with any certainty that these requests were followed? Maybe and definitely no.

The anesthesiologist was around and said he would be the one administering it, but did I see him in the surgery – again no. There were several people in the surgery room, but no one wanted to introduce themselves and explain what they would be doing. I forced the issue, but never was allowed to complete it as they opened the spigot on the IV tube and put me under very quickly. I remember six people in the room and could not identify any of them other than the first person who would only admit that he was a nurse. My doctor was there, but other than this, I felt like I was being ignored.

Then when things went blank, I do not remember anything until I was seeing several nurses around the cart I was on. Next thing I was wheeled into the room where my wife was waiting and a nurse rapidly asking questions and giving me a pain pill and saying I could get dressed. Dismissed and that was it. Sort of had the feeling of being on a belt moving me through the system.

Now comes the part where I became very angry. I was assured that the IV was dextrose free and that I would receive a minimum of two doses. Well from the meter test results after being shuttled out and in the vehicle, my blood glucose reading was over 300 mg/dl. Therefore, from a reading of 106 mg/dl at entry to 309 mg/dl after leaving, I would conclude that one or both IV's had dextrose in them. Not a comforting thought about how they are concerned about patient safety. I would rate them a flunking grade for several reasons.

The previous time I had the surgery, I was introduced to all people in the room and made to feel like they were interested in the outcome that would be best for me. This time was very impersonal and like they were herding cattle through the vaccination chute and could care less about the outcome. True, the first time for this surgery was before diabetes, but even when I have had colonoscopies since diabetes, I still knew who was in the room, their names, and given reassurances. There will be some changes made before I will willingly submit to surgery in the future.