| Supplements
 The Supplement Department at Patients Medical
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WHY TAKE VITAMIN SUPPLEMENTS?
One of the commonest "health maintenance" questions we hear at our Center is
"should I be taking a vitamin supplement?" This seemingly "simple question" can be answered differently, depending on one's point of view. In the past, the "orthodox" medical science answer was "no," because a "well balanced" diet should provide all the essential nutrients an average person requires according to the RDA's (Recommended Dietary Allowances).
The problems with this answer are several.
First, most (all?) medical doctors have never actually read the RDA manifesto.
Second, RDA's are statistical averages, developed from some science, but mostly committee "thought experiments" and discussions, with no real scientific data to back up the actual recommendations being made.
Third, the entire concept of "RDA" was developed for reasons of "national defense" (pg v) and has absolutely nothing to do with health.
Fourth, the RDA's were never intended to be applied to any specific individual patient (pg 1).
Fifth, RDA's were designed to apply to "healthy" groups and not to individuals, and specifically not to individuals at the extremes of age (young or old), those using medications, with infections, chronic diseases or metabolic disorders (pg 1). Since approximately 30 to 40% of the U.S. adult population are obese (a metabolic disorder) or have one of more "chronic degenerative disorders", then exactly who do RDA's realistically apply to? In addition, the modern practice of "scientific" agriculture (aka "agri-business") has resulted in micronutrient depletion of the soil to the point that chemicals must be added to make produce look good, but its nutritional- functional attributes are being seriously questioned.
Finally, excessive use of toxic pesticides, herbicides, etc. are causing long term risks to health and wholesale genetic modification of foods to increase profits is being accomplished without any data as to safety, effectiveness and future health impact. Thus, the food we eat can no longer be relied upon to supply adequate essential vitamins, minerals and other trace nutrients.
Another way to view the question of whether supplements should be taken can be based on more "modern clinical science." For example, good scientific evidence has now been published showing that micronutrient (vitamin and/or mineral) deficiency is a major cause of cancer and the use of micronutrients well beyond the limits set by the committees that "designed" the RDA's, such as the B vitamins, folic acid, B6, B12and multi-vitamins, prevents cancer.2-9 Modern scientific studies also support the use of B vitamins well in excess of RDA's to prevent the occurrence of neural tube defects (brain and spinal chord deformities) in unborn babies,10,11 atherosclerosis including heart attacks, strokes and peripheral circulation disease in adults,12-21 osteoporosis (bone softening) in adults,22-24 Alzheimer's disease 25-27and age related immune deficiency and infections in adults.25-27 It is now known scientifically that poor nutrition is the leading cause of immune deficiency syndrome in the elderly. 28-30 In fact, so much modern research has shown that vitamin and/or mineral supplements have been found to be clinically effective that even the most rigid scientific investigators now admit that everyone should be taking a "multi-vitamin" and mineral preparation for wellness protection or health "insurance."
So the correct answer to the question "should I be taking a vitamin supplement" is "yes," and probably more....
WHICH SUPPLEMENTS TO CONSIDER?
Again, there are several ways this question can be answered, depending on the point of view being taken. For example, with regard to taking a "multi-vitamin" preparation, there are a number of choices one can make. Simply go to the vitamin section of any grocery store to see the large number of choices available to consumers. Although there may seem to be a large number of products to select from, the fact of the matter is that the choice of preparations will fall or segregate into one of three categories:
1) "replacement multi-vitamin,"
2) "therapeutic multi-vitamin" and/or
3) individual or single vitamin products.
The difference between the first two is critical. Almost all "national" replacement multi-vitamin preparations (Centrum TM, Centrum SilverTM, Theragram MTM, etc.) are based on the RDA recommendations. As discussed above, RDA levels are now being scientifically demonstrated to be ineffective in preventing many chronic degenerative diseases. Good examples of this are the inadequate levels of vitamin D, folic acid and vitamin C in many well known, nationally advertised replacement multi-vitamin formulas. A common explanation given in defense of these lower amounts is that the user will get additional vitamins from eating a "well balanced diet." Of course, the depleted soil and agri-business approach to putting back only those nutrients into the soil that increase "yield" and "marketable appearance" of the crop, but do not reflect what Nature actually intended to be in the produce clearly negates this argument.
On the other hand, a therapeutic multi-vitamin contains therapeutically optimal amounts of all ingredients, usually multiple times the minimalist RDA values. The basis of "optimal" amounts versus "minimalist" amounts is the fundamental difference between a "replacement" and a "therapeutic" multi-vitamin and mineral.
Single or individual vitamin replacement is almost always used for "targeted" replacement and/or for therapeutic or treatment reasons. For example, the use of additional calcium supplements for optimal bone health, magnesium for optimal cardiovascular health and vitamins folic acid/B12/B6 for optimal gestational development, cardiovascular health and cancer protection. Amounts of folate/B12/B6 well above their respective RDA values have been scientifically demonstrated to play a very important part in protecting the nervous system of the developing fetus,6,10,11 preventing cancer, 3-9and preventing cardiovascular disease.12,13,16 Interestingly, it was the development of clinical and research scientific data regarding the scientific importance of vitamins B12, B6 and Folate well in excess of RDA values required for preventing "neural tube defects" in the fetus that began the scientific questioning of the validity of the RDA values. Given the current state of scientific research demonstrating current RDA's actually promote disease, they should be abandoned by any and all clinical practitioners as bench mark government values of little to no clinical value for individual patients.
BIO HEALTH SUPPLEMENT RECOMMENDATIONS
1. A good therapeutic multi-vitamin, without iron or copper (ie Metagenics), etc. (iron and copper are "pro-oxidants" and should only be supplemented when necessary.... based on specific lab testing for need). Although both are "essential" for normal function, they are also "toxic" free-radical generators at relatively low levels. They should be prescribed only when there is clear laboratory evidence of need.
2. Anti-Oxidants, either individually or in combination. The common "nutritional" anti-oxidants are Vitamin A, beta Carotene, Vitamin C, Vitamin E and Selenium ("ACES"). The doses may vary depending on circumstance and individual preference. Combination products are mixtures of moderate doses of all four "ACES" designed for simplicity and ease of use, usually requiring one capsule 2 or 3 times a day. Individual use of each anti-oxidant allows for more flexibility and individual choice, but at the expense of having to take many more pills, capsules or doses of powder daily.
I) Combination product recommended: Metagenics
OR
II) Individual Anti-Oxidant recommendations:
a) Vitamin A, no more than 5,000 daily.
b) Beta Carotene 15 to 60 milligrams daily (same as 25,000 to 100,000 units daily).
c) Vitamin C 500 to 2,000 milligrams daily in divided dose (corn free preferred).
d) Selenium (essential mineral that works with Vitamin E) 200 to 400 micrograms (mcg) daily.
e) Vitamin E (dry, not in oil) 400 to 2,000 IU daily (keep refrigerated) There are additional anti-oxidant preparations beyond the standard "nutritional" preparations (ACES) that can be taken, but these are more expensive and usually reserved for those with actual health problems, such as Diabetes, Cardio-Vascular Disease, etc. These include Coenzyme Q10, Lipoic Acid and Proanthocyanidins (PycnogenolTM). Due to the high cost of these additional anti-oxidants they are not routinely recommended for general use in otherwise healthy persons. In those with health problems, such as heart disease, diabetes, hypertension, arthritis, liver disease and/or chronic use of potentially toxic pharmaceutical drugs these additional and more powerful and expensive Anti-Oxidants are usually worth considering. For example, anyone taking a "statin" cholesterol lowering drug (MevacorTM, ZocorTM, LipitorTM, PravacholTM, LescolTM) will also experience a significant reduction in the amount of Co Enzyme Q10 produced by the body tissues. Co Enzyme Q 10 is made from cholesterol by the body and is essential to proper functioning of the heart, blood vessels and liver. Clinical congestive heart failure has been reported in scientific journals from this side effect of statin therapy for high cholesterol.
3. Therapeutic Folic Acid/B12/B6.
I) Combination product recommended: Metagenics
OR
II) Individual vitamin recommendations:
a) Folic Acid 5,000 micrograms (5 mg) daily.
b) Vitamin B12 2,000 micrograms (2 mg) daily.
c) Vitamin B6 50 mg daily.
Since these three particular vitamins are actually being recommended in "pharmacological" doses, they should be taken on a empty stomach (between meals or nothing to eat 1 hour before or 2 hours after meals) and away from any/all other supplements to maximize absorption. There have been no reported side effects to these vitamins in the recommended doses.
4. Bone Health. Calcium from ITI
OR
One thousand to 1,500 mg of highly absorbed calcium daily, divided into one third (333 to 500 mg) in the morning and two thirds (666 to 1,000 mg) at bedtime. In addition, Vitamin D3 600 to 1,500 units daily and Boron 2 to 4 mg daily.
5. Vitamin D3 is really not a vitamin (i.e. "vital amine") since, biochemically speaking, it does not contain an "amino group." In reality Vitamin D is an immune system modulating hormone. All class II restricted immune system cells in the human body have vitamin D receptors on the cell surface. This means that Vitamin D is vital to immune health. There are several biochemical types of Vitamin D. The most commonly encountered are Vitamin D2 (aka "ergo-calciferol," is made by treating yeast with ultraviolet light) and Vitamin D3 (aka "chole-calciferol," is made from sunlight [ultraviolet spectrum] interacting with cholesterol in human skin) have similar effects on calcium and bone metabolism they have very different effects on immune cells. Research done by Hoffman- La Roche pharmaceutical company demonstrated that Vitamin D2 (made from the yeast derived ergo-calciferol) actually decreases human immune cell function while Vitamin D3 enhances immune cell function. The RDA level of Vitamin D recommended for adults is 400 I.U. (international units). Current research has determined that this level has resulted in wide spread deficiency and/or sub-optimal blood levels in most people, independent of age (i.e. children and adults).31 Experts and researchers are currently recommending yearly blood testing of Vitamin D levels on all people and providing enough Vitamin D3 (1,000 to 4,000 IU daily) to keep their blood level in an "optimal" range of 40 to 60 ng/Dl not simply in a "statistically normal" range of 9 to 30 ng/Dl.32-33 For those who are not using Cal Mag day and Night formula listed in number 4 above it is that you take 1,000 to 4,000 units of Vitamin D3 (Cholecalciferol) daily as determined by vitamin D blood testing. If your are taking the Cal Mag listed in number 4 you may want to consider having your vitamin D level tested to see if it is in the optimal range or additional Vitamin D3 should be added.
6. Prostate Health. Recommended for men 45 years of age and older.
OR
Saw Palmetto 320 Mg daily + Pygeum Africanus 50 Mg daily + Stinging Nettle Root 500 Mg daily. In addition, one fresh tomato, 1 Tbls tomato paste, 1/4 cup of spagetti sauce or lycopene 15-20 mg daily and consideration of very low dose (0.5 to 1.0 mg daily) transdermal progesterone cream.
7. Hormone Health. Recommended for men or women 45 and older.
OR
Due to the increasingly common exposure to environmental estrogen-like compounds, such as by- products of chlorination of water, pesticides, plastics, etc., optimizing hormone health should be considered by anyone interested in maintaining health and disease prevention. The number of cancers that are now considered to be "estrogen-dependent" has grown to include not only the commonly recognized female cancers of breast, uterus and ovary, but also includes cancer of the pancreas, some prostate cancers, and others. For this reason, the use of natural compounds that increase human liver metabolism of estrogen bi-products, such as indole 3 carbinol and others should be considered for inclusion in the diet regularly or taken as concentrated nutritional supplements. Vegetables of the Brassica family, which contain high amounts of indole-3-carbinol, and include cabbage, broccoli, cauliflower, bok choy, kale, brussel sprouts and others should be eaten on a regular basis or the supplements recommended above should be used. SUPPLEMENT QUALITY
One of the most important issues involving supplemental nutritional products is the "Quality" of the ingredients. The fact of the matter is that almost all vitamin preparations are produced by only two or three large international pharmaceutical companies. BASF (Germany), Hoffmann-La Roche (Switzerland) and Takeda (Japan) are three of the largest producers of bulk vitamin and mineral raw materials. These materials are then purchased by wholesale producers and/or smaller nutrition specialty companies for formulation and/or repackaging and labeling. Thus, the primary determinant of "Quality" for most nutritional preparations is freshness... the time from manufacture to sale. In most cases, more expensive "pharmaceutical grade" vitamin and mineral products tend to have the highest quality (freshest, most pure) ingredients. In some cases pharmaceutical grade ingredients may be used. Cheaper vitamin brands are usually made from ware-housed older raw materials sold at a cheaper price. In almost all circumstances the most "cost effective" brands are made from auctioned raw materials that are near the expiration date of their shelf life.
Since the average consumer cannot determine the actual "Quality" of the product they are buying, they must rely on the seller and/or manufacturer.
For most products or brands we advise that the buyer try to stay with national companies of good reputation. It is unlikely that such a retailer would risk their good name and potential future business by using inferior raw materials. In the case of smaller companies and multi-level marketing type products one must use very good judgement and follow the legal theory of "caveat emptor"... let the buyer beware.
Vitamin/Mineral and Herbal Consultations: Learn to improve your immune function and help combat pain, allergies, sinusitis, fatigue, high cholesterol and other conditions with a customized program of nutritional supplements designed by our registered nutritionist and the professional staff.
For more information, or to schedule an appointment with our nutritionist,
call 212-679-9667.
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