March 6, 2014

Use Care When Taking Vitamins and Minerals

I have to respect this oncologist when he makes a statement about stopping supplements. This is because when dealing with cancer medications and chemotherapy, many vitamins and minerals can conflict with the cancer medications and cause death.

However, Dr. James Salwitz, then goes on to make some statements that shows he does not understand nutrition. For many younger people what he says is true, but when dealing with the elderly and some chronic diseases, I find his statements lacking in factual information. Dr. Salwitz states, “Let us be clear; in the absence of malnutrition, malabsorption and a few uncommon medical conditions, there is absolutely no reason to take a multivitamin. They do not prevent or fix anything. Originally developed for starving populations and hungry soldiers during the Second World War, they have no place in a society with access to a broad range of foods.”

The key word in the above statements is malabsorption, which often happens in the elderly as they loose the ability to properly digest and absorb the nutrients contained in the foods.

In many other chronic diseases, like diabetes, care must be taken and some supplements can be of value. This is true when metformin is taken for an extended period of time, as older patients often are unable to utilize or absorb the foods that can be used by the body. This is especially true of vitamin B12 although many doctors refuse to test for this deficiency. Vitamin D2 can also be problematic for some elderly people with diabetes.

Wait you say, many foods are vitamin D fortified. True, but they are fortified with vitamin D2, which is not often readily utilized by the body. It is man made and does not stay in the body for the time necessary to be used.

Food Sources for vitamin D:
There are two dietary forms of vitamin D:
1. Cholecalciferol - D3
2. Ergocalciferol - D2
These are naturally found in foods and are added to milk. Not all yogurt and cheese are fortified with vitamin D. Food sources of vitamin D include:
1. Cod liver oil (best source). Cod liver oil often contains very high levels of vitamin A, which can be toxic over time. Ask your health care provider about this source of vitamin D.
2. Fatty fish such as salmon, mackerel, tuna, sardines, herring
3. Vitamin D-fortified milk and cereal
4. Whole eggs – egg whites are not a great source of vitamin D, but the whole egg is. Eating 2 or 3 eggs per day has little effect on cholesterol and actually can aid in cholesterol control.

It is suggested that people in need of vitamin D not go to a doctor for a prescription, as most prescribe D2, which is more expensive and vitamin D3 is on the shelves and is much cheaper.

Harsh, yes. But these errors are serious. Even David Mendosa has told me to be careful not to take vitamin-D2, but to take vitamin-D3. What bothers me is that people will go to the doctor for a vitamin D prescription and pay the doctor fee and a higher cost for vitamin-D2, when vitamin-D3 is on the shelves and a lot cheaper. Vitamin-D2 is much less effective in humans than vitamin-D3. D2 is largely human made and added to foods as a fortifier. Vitamin-D3 is also consumed by consuming animal-based foods. So those on non-meat lifestyles, should have their doctor check their vitamin D levels and consider taking vitamin-D3 supplements.

In addition to having markedly lower potency, D2 also has a significantly shorter duration of action relative to vitamin D3. Both forms of vitamin D produce similar initial rises in serum 25OHD over the first 3 days, but 25OHD continues to rise with D3 supplementation, peaking at 14 days, and serum 25OHD falls rapidly in D2 treated subjects.

I would encourage people, especially people over the age of 65 to be tested for levels of vitamin D. When it comes to ranges for vitamin D, deficiency levels below 15 ng/ml and you should not have levels above 80 ng/dl. Many physicians are happy to have people at 20 to 30 ng/dl range.  This is quite unsatisfactory and many people should be above 50 ng/dl.

Please also read the supplement section of this website for the University of Maryland and the vitamins, minerals, and supplements section of the University of Oregon website. Always check the warning section or the safety/toxicity information. Often there may be sections about conflicts with prescription medications. Read these very carefully. If you still have questions, have a talk with your pharmacist about what vitamins, minerals, and supplements to avoid when taking a prescription. 

The last read I would suggest is this by Jon Barron as he discusses the Institute of Medicine (IOM) and the recommendations they make, which are pathetic.

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