Supplements
Vitamins and Minerals

"Why should I take vitamins?" "Which should I take?" People ask us these questions regularly. Everyone seems to have a strong opinion when it comes to vitamin supplementation. Diane has always been an advocate for taking vitamins. Years ago, I confidently explained to patients that "there is no role for vitamin supplementation if you eat a balanced diet". I tended to think of vitamins as adding expense, hassle, and that they were, in a sense, just pseudopharmaceuticals producing expensive urine.
Well, I too have changed my mind and am now a vitamin advocate. Both Diane and I supplement our own and our children’s diet. Let me try to explain why my own thinking has changed. It is useful to consider what function vitamin supplementation serves. At a base level, I could elect to use a vitamin as a mere supplement to my diet, in a sense as an "insurance policy" to reach minimal dietary reference intake (DRI) of vitamins and minerals. If, however, I chose to take certain specific vitamins (the antioxidant vitamins for example) in greater than the usually recommended doses, then they may indeed function as natural agents to prevent disease. Remember that the DRI’s are targeted to avoid deficiency states/diseases, and may not be aimed at optimal health. Diane and I are vegetarians and we suspect that by eating lots of fruits, vegetables, and whole grains that we are exposed to enough beta carotene, vitamin E, vitamin C, selenium, and folate. However, our diet can vary from season to season and day to day. If one were admittedly skimping on fruits and vegetables and often relying on refined, processed foods, which sorely lack even these minimal standards for vitamins and minerals, then a supplement becomes all the more appealing. If young, healthy pregnant women must supplement with folate to help prevent fetal anomalies, obviously we might all benefit. Most patients we see do have pretty good diets, but there is wide variation and often some uncertainty. Also, the nutritious value of food can vary widely depending on whether it was harvested before ripe and whether it was grown on good soil. Additionally, we do not know if our trace mineral intake of zinc, boron, chromium, etc, is adequate without a supplement.
Secondly, vitamin supplementation can also be advocated for the purpose of actually preventing disease. This is why the antioxidants vitamin C and E, along with selenium and the carotenoids are commonly prescribed. When cholesterol is naturally oxidized in our bodies, it becomes particularly damaging to blood vessels. The antioxidants then act as scavengers to block the cascade of destruction which otherwise would go unchecked. It is for this reason that many experts recommend antioxidants (particularly for patients with established coronary artery disease), not merely to fulfill minimal DRI standards, but to function as "therapeutic" agents. Folic acid (folate) is a B vitamin present in vegetables and legumes, which may play an important role in disease prevention. It is well known that people who have high blood homocysteine levels (an amino acid)run the risk of premature vascular disease. Folate, vitamin B12, and vitamin B6 are necessary for our body to rid itself of excess homocysteine. There actually exists a theory that arteriosclerosis is in fact a result of abnormal processing of protein in the body (leading to excess homocysteine) due to deficiencies of B vitamins and folate in the diet. While experts try to sort out the ultimate harm of high levels of homocysteine, it makes sense to hedge your bets and take supplements.
Diane and I look at a whole foods vegetarian diet as being our primary source for vitamins and minerals. No vitamin can replace healthy eating. Since medical science cannot tell us which are the essential ingredients in the diet (vitamins, minerals, phytochemicals, others?), we think it is important to eat from a wide variety of available foods. If we eat well then we expect that our minimal DRI’s should be essentially met. Partly as an insurance policy, but mainly to bolster our antioxidant intake, we do personally supplement with the following:

Multivitamin daily.

Our multivitamin contains 500 mg vitamin C, and 400 mcg of folate. Men and non-menstruating women should take a multivitamin without iron. Unneeded, excessive iron acts as an oxidant itself and may be harmful. A standard, store-brand multivitamin is fine. It should say it meets USP standards. Designer, name brand, "all-natural", or mega dose multivitamin formulations are not necessary. Herbal ingredient additions just add cost and unknown, unregulated chemicals. If your diet is marginal and you feel the need for an extra safety net then a multivitamin plus minerals is fine. Multivitamins should not "break the bank". They should be a cheap addition to your diet.

Vitamin E 40 IU daily.

Recent medical research suggests that Vitamin E doses of 400-800 IU may not be heart healty. Anecdotally, we see a relief of cyclic breast pain with this dose of vitamin E, but it should be used only briefly for symptom relief.

Calcium with vitamin D daily.

If your dietary calcium intake is low, a supplement to attain 1500 mg calcium total per day is a cheap, "low-fat" addition. Remember that a glass of milk/soymilk has 400 mg, fortified orange juice 400 mg, and calcium is plentiful in green leafy vegetables.

Flaxseed oil and fish oil.

You might want to supplement if your dietary fat content and omega-3 fatty acid intake are not in good balance - which means almost all of us- (see "Foods To Embrace" and "Good Fats").Diane and I supplement our diets with 2 teaspoons of flaxseed oil or 2 tablespoons of ground flaxseed. We simply look for ways to add this "good" fat to the foods we eat. Alternatively one could supplement with 2 flaxseed oil capsules daily. Also, if your fish intake is irregular we would recommend adding fish oil 1 gram capsules 1-2 daily. One can get flaxseed oil at most grocery stores. We buy flax oil made by Spectrum and flax meal by Bob's Red Mill, both in Cub Foods health food section. Keep them refrigerated, and remember that heating flax oil above 200 degrees destroys the omega-3 fatty acid (you can add it to cooked foods).

Biotherapeutic Supplements

Probiotics Supplements to our diets are not necessarily just "nutritional". Microorganisms, primarily bacteria, are also naturally present in our foods. They contribute both positively and negatively to the health of the gastrointestinal tract and the entire body. Just as we have nutritional needs for protein, carbohydrate, and even fat, optimum wellness also depends on a healthy intestinal bacterial flora. Supplements that contain these beneficial and health supporting microorganisms are generally termed "biotherapeutic agents" or "probiotics". They are readily available in supplement, capsule form as well as in fermented dairy products like fermented milk and yogurt. The most commonly found "friendly" bacteria include Lactobacillus acidophilus, Bifidobacterium bifidus, Bifidobacterium longum, Lactobacillus casei, and Saccharomyces boulardii. Several recent studies suggest that fermented milk and certain bacterial cultures that are used to ferment the dairy products possess anti-mutagenic and anti-carcinogenic properties (mutagens are agents that cause damage to chromosomes and carcinogens are agents that cause cancer). Mutagens are found in foods such as broiled fish and meat. Carcinogens are produced in our bodies in the process of metabolizing the creatinine, amino acids, and sugars found in meat and fish, as well as other dietary sources. Research data suggests that the presence of a healthy intestinal flora (and use of biotherapeutic agents) in fact decreases the presence of carcinogens in the intestine, liver, and mammary tissues of the body. Of course many microorganisms reach the intestinal tract and cause illness and disease. Some intestinal bacteria are known to help produce carcinogens in the colon. The very common bacterium, E.coli, can cause traveler’s diarrhea in one individual (a mild annoyance), or full blown hemolytic uremic syndrome in another (deadly disease effecting the intestines and kidneys in young, old, and fragile individuals). Clostridium difficile can be an innocuous inhabitant of the colon – but after antibiotic exposure it then overgrows the normal intestinal flora and causes colitis (inflammation of the colon). Interestingly, Clostridium difficile makes up a greater proportion of colonic bacteria in the elderly and C. difficile colitis affects the elderly with greater frequency. It makes sense that the "friendly bacteria" of biotherapeutic agents have in fact been shown to decrease the incidence and severity of antibiotic-associated diarrhea, traveler’s diarrhea, and C. difficile diarrhea and colitis. Viruses can cause gastroenteritis (stomach flu) with symptoms of nausea, vomiting, diarrhea, and abdominal cramping. Several studies have demonstrated that biotherapeutic agents decrease the incidence and severity of viral gastroenteritis. AIDS-associated diarrhea has improved when treated with biotherapeutic agents. The health of our intestinal tract clearly involves an appropriate balance of the "good" and "bad" bacteria. The maintenance of this balance is due, we believe, in part to one’s personal genetic make-up, but also to other influences, mainly antibiotic ingestion. We are all exposed to antibiotics through either what our doctor prescribes or what today’s agricultural/meat producer uses. This intestinal bacterial balance is clearly important, for when the flora is disturbed, symptoms appear! A good example of how the balance of microorganisms in the gut effects the body is Irritable Bowel Syndrome (IBS), also known as spastic colon. This condition is very common in our medical practices and a complex of symptoms that is related to the microorganisms that live in the bowel. Diane has a unique understanding of IBS due to the fact that she has lived with IBS for the past twenty years. It is from her review of the medical literature, personal trials of various regimes, and experiences in treating this condition in her medical practice that our understanding of biotherapeutic supplements has grown. Typically the person with IBS has some degree of abdominal bloating, cramping, gas/flatus, constipation and/or diarrhea- the symptoms most often have been occurring for years, worse during times of stress. The therapy traditionally is to increase the fiber content of the diet. Adding Metamucil is a good common first suggestion. Probiotics can also help some people with IBS tremendously. To intentionally enhance your "friendly" bacterial intake we recommend something simple like chosing Stonyfield Farm's organic yogurt, a good source of live active bacteria. The specific brand name Probiotic product we use is Florajen. Florajen is a reliable source of Lactobacillus and Bifidobacterium- most of the store bought brands are actually not good sources as their bacterial cultures are not live. Florajen makes two products (Bifidoblend and Florajen 3) which are excellent. Ideally one would take a single capsule of either Florajen (kept refrigerated) and a capsule of FOS (one brand name is Nutraflora, also kept refrigerated) before breakfast daily. The FOS is the fructo-oligosaccharide- or the sugar- that these "friendly" bacteria thrive on. By simply improving one's colonic bacterial flora the IBS symptoms will often improve or resolve! Diane and I have found Florajen sold at The Wedge and at Whole Foods.