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This is the second of our educational newsletters intended to educate our patients. Our emphasis is on how Prevention First can help our patients with disease prevention and on our increasing services. This month’s subject is vitamins. Non-vitamin nutritional supplements will be the topic of a future newsletter. We hope you find this newsletter helpful.

Vitamins Overview

The term "vitamins" refers to a group of compounds essential for normal metabolism. Of these essential compounds, only vitamin D can be made by humans. Therefore, vitamins must be included in our diets. Inadequate amounts of dietary vitamins results in certain disorders, depending on the vitamin that is deficient.

Vitamin deficiency in America is more common than was previously thought. This is especially true in the elderly. Those with a predominance of "fast food diets" also have problems. Alcohol consumption and pregnancy can increase the nutritional needs for some vitamins. Subtle deficiencies can increase the risk for degenerative diseases such as osteoporosis, atherosclerosis (blocking of the arteries) and cancer. Some vitamins and supplements are more helpful to one person than another. Physician input on appropriate usage is beneficial for most patients. Finally, the reliability of vitamin supplements can be suspect.

The vitamin and supplement industry is not under government regulation. This means that what is on the label does not have to be in the pill. A recent study of supplements including garlic, ginseng, ginkgo and others showed most to have bacterial or fungal contamination. When the National Institute of Health (NIH) did a study on glucosamine, it surveyed every glucosamine available and found that all contained less glucosamine than their labels claimed. Most medical journals consider the purity of vitamins and supplements to be suspect. This is the reason many people feel little or no benefit from the vitamins and supplements they take. The process required by the FDA to manufacture prescription medications is called Good Manufacturing Process (GMP). Prevention First has found a company, Carlson Labs, that manufactures its vitamins and supplements using GMP. Now we can rest assured that what is on the label is actually in the product.

Water-soluble Vitamins
Water-soluble vitamins are found in fruits and vegetables. They include the B vitamins, vitamin C, biotin and folic acid. Many are associated with a disease state when deficient.

Vitamin B1 (Thiamine) - is essential for maintaining heart, brain and nerve health. Thiamine deficiency results in diseases called beriberi and Wernicke’s syndrome. These diseases can cause heart failure, confusion, numbness, weakness and difficulty walking. Cooking destroys thiamine in many foods. Multivitamins are the best way to assure adequate thiamine intake.

Vitamin B2 (Riboflavin) - is essential for mouth, skin and blood health. Riboflavin deficiency results in a sore throat, mouth and tongue. Anemia and dermatitis are also seen. Persons with a low dietary dairy intake, celiac disease, and those who take some seizure medications are at risk of deficiency. Multiple vitamins are a good way to avoid this problem.

Vitamin B3 (Niacin) - is essential for skin, bowel and brain health. Niacin deficiency results in dermatitis, diarrhea and dementia. Doses available in multivitamins can avoid these problems. Niacin is also an effective agent in lowering LDL (bad) and total cholesterol. It can also raise HDL cholesterol (good cholesterol). Cholesterol lowering requires doses higher than can be obtained in food or multivitamins. High doses can cause flushing. Slow release formulas are available to avoid this side effect.

Vitamin B6 (Pyridoxine) - is essential for oral and emotional health. Deficiency can cause irritability and depression. Low levels have also been associated with asthma, diabetes, heart disease and breast cancer. It is unclear if high levels help to prevent these problems. Too much pyridoxine can cause extremity numbness and pain. Multivitamins are a good source of pyridoxine.

Vitamin B12 (Cobalamin) - is essential for blood and neurologic health. Deficiency results in anemia as well as loss of memory and coordination. Contrary to widespread belief, B12 does not increase energy. Some experts support higher doses of B12 for helping to prevent heart disease and dementia. Many persons low in B12 require shots to correct the problem. High oral doses can sometimes overcome the need for shots. These doses are higher than contained in most multivitamins.

Folic acid (Folate) - is essential to prevent anemia. Folate supplementation has also been found to have substantial health benefits. These include prevention of birth defects, heart disease, colon cancer and breast cancer. Evidence suggests that folate may also help prevent osteoporosis and dementia. It is important to take at least 400 micrograms of folate a day to receive protection from heart disease and cancer. Women considering pregnancy should take from 800 micrograms to 4 milligrams. Some multivitamins do not contain these amounts of folate.

Vitamin C (Ascorbic acid) - is essential for all tissues. It helps to maintain collagen throughout the body. Inadequate amounts cause a disease called scurvy. Scurvy results in bleeding, arthritis, depression, numbness, weakness, low blood pressure and death. Vitamin C also helps promote wound healing and helps prevent heart disease. It does not prevent or treat the common cold. Vitamin C may be helpful in cancer prevention. Its role in building collagen has been shown to help prevent the changes of aging in the skin. Topical vitamin C can be used for this purpose. Most multivitamins contain adequate amounts of vitamin C.

Fat-Soluble Vitamins
Fat-soluble vitamins are found predominantly in vegetables. Since fats are harder to absorb, these vitamins do best when they are taken with meals. These vitamins prevent a number of health problems.

Vitamin A (Retinoic acid) - Vitamin A is essential for eye and skin health. It also supports the immune system. Vitamin A can help prevent vision loss. It can also help with acne and skin aging. Vitamin A may be helpful in preventing heart disease and some cancers but increases lung cancer risk in smokers. Vitamin A improves immunity to some illnesses. Excess vitamin A can cause nausea, vertigo, headaches, liver toxicity and, rarely, death. Doses greater than 30,000 units a day taken for several months are toxic. Proper supplementation is 5,000 units a day and is present in most multivitamins.

Vitamin D (Calciferol) - is essential for bone health and calcium metabolism. Recent studies suggest it may also help to prevent some cancers. Adequate supplementation can help prevent falls by improving muscle strength. Sun exposure allows human beings to generate their own vitamin D. Supplementation of 400 IU a day avoids the need for sunlight. Those with osteoporosis should take 800 IU a day. Most multivitamins contain 400 IU.

Vitamin E (Tocopherol) - is essential for muscle and brain health. Vitamin E also supports immune function. Several studies have failed to show benefits in preventing heart disease. However, studies have shown benefits in preventing prostate and lung cancer. Vitamin E may also be helpful in preventing and treating Alzheimer’s disease. Recommendations for vitamin E supplementation vary widely. Routine supplement recommendations are 30 IU per day. Immune and muscle function support may require 400 IU. Alzheimer’s treatment and prevention may be as high as 2,000 IU a day. Some multivitamins may contain as much as 400 IU. Higher doses require specific vitamin E supplements.

Vitamin K (Phylloquinone) - is essential for proper blood clotting. Deficiency in vitamin K results in easy bruising and spontaneous bleeding. Coumadin (warfarin) "blood thinner" works by inhibiting vitamin K metabolism. Therefore, patients taking Coumadin should avoid vitamin supplements containing vitamin K. Prevention First offers two multivitamins without vitamin K. Most of us do not require vitamin K supplementation. Those with liver disease may benefit from vitamin K. Prevention First is now offering Carlson Labs vitamins and supplements made using GMP. These are available at our office. We can also guide you in choosing the correct supplements and provide written instructions for their use.

Our next newsletter will cover vein problems. These include varicose veins, spider veins, swelling and other vein-related problems. Discussion will include treatment and prevention.

Bill J. Johnson, MD, MMM

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