Vitamins

[Susan]

This is COMPLETELY off topic but the other day I saw a commercial that they now have these vitamins that are like sour patch kids. When I grew up it was Flintstones, and today there is some controversy about making vitamins for children taste like candy because kids could take too many thinking it IS candy (the ones under 7 anyhow)

But why the hell don't they have sour patch Centrum for adults? I go through phases of taking vitamins but I never stick with it. Why? Because I hate taking those horse pills, sure the calcium tablets taste like orange (more like tang packed into candy form) but I don't think we'll have much trouble with adults OD'ing on a bottle of vitamins. At least the companies wouldn't be held accountable because adults know better, we can also read warning labels and all that. They could have a sugar-free form for diabetics. I once heard about chocolate vitamins but i don't want to gum on some fake chocolate, end up breaking out and probably eating all of it because with chocolate there IS no self control.

What is wrong with companies? Who sits in these board rooms? For the most part the advertising and marketing for adult vitamins has not changed. Even toilet paper has changed.

Was this a necessary topic? Probably not 

[Ash]

Speaking of vitamins...
I just received a shipment of vitamins from Puritan's Pride the other day.
They have a special...buy 1...get 1 free or buy 2...get 4 free.

I ordered about $50 worth.

I must get this vitamin thing from my dad.
As a boy, I always remember him taking about 8 different vitamins with his breakfast.  He even had this neat dispenser that was made just for vitamins.
In it, he had vitamins of all sizes.  Big one's, small one's, squishy oval shaped gel one's with liquid inside of them.  It had this turnable top with labels.
Kind of like this one only it was bigger:


Matter of fact, I think I might buy one for myself.   
For me to not take my vitamins every day feels weird & almost unthinkable.
Taking them has been part of my daily routine for years.

I ordered Ultra Vita-Man:


Green Tea Extract:


And Lycopene:


You should see some of the ingredients in the time-release Ultra Vita-man vitamins.
Some of the main vitamins in it are 1000% to 5000% over the US RDA!
They also contain a slew of plant extracts...most of which I've never heard of.
You've got to take them with food...if you don't, you'll be hanging over the toilet within 30 minutes puking your guts out.
They really wreak havoc on your stomach without food.
And yes, they're big horse pills but I've never had any trouble swallowing them and they go down easy.

I also grew up with Flintstones chewables.
They tasted great!  

[Susan]

That's a lot of vitamins Ash. Are you trying to glow in the dark? 

[Ash]

That's a lot of vitamins Ash. Are you trying to glow in the dark? 

Nope....just trying to live forever.   

[Menard]

The reason for taking your vitamins with food, Ash, is so that they will more readily be absorbed into your system. It is usually best to take them shortly after you have eaten; this will both dissolve the vitamin better than taking it on its own and allow it to pass through your system more slowly allowing your digestive system to more fully absorb the nutrients. If, however, the vitamins are making you sick when taking them on an empty stomach, well, I would not take those vitamins; they should not have that kind of an affect on you.

The vitamins which are rated at multiples of the US RDA/RDI are the B vitamins and other water soluble vitamins (vitamins are either water or fat soluble). Water soluble vitamins pass through the system quickly, unlike fat soluble vitamins which take longer and can actually be stored in your body. The idea behing the large dosing is to increase the amount of vitamins you are taking, thus increasing the chances of your body more effectively absorbing the nutrients it needs as water soluble vitamins are not that readily absorbed by the body (again, the importance of taking the vitamins shortly after eating). This is often referred to as megavitamin therapy or simply megadosing.

The problem I have with megavitamin therapy, and as such have never been a proponent of it, is that anything your body does not absorb and metabolize, has to be flushed out. Since these megadoses are of water soluble vitamins, this means that all of the unused vitamins have to be flushed through your kidneys. Albeit, we all put things into our bodies that are worse on our kidneys than megadoses of vitamins, but, when something is unneccessary in the first place, it is that little bit less of a strain we can put on our kidneys. This is just a niggling bias of mine and probably has little significance.

For my own vitamins (I will not go into all the supplements I take) I prefer a senior formula (I am not at that age yet  ). The senior formulas have increased amounts of some of the B vitamins (200% and 400% respectively, not thousands), extra E, and reduced iron*. The idea behind the senior formulas is to increase some of the vitamins which become harder to absorb as a person becomes older. These same vitamin increases, however, can benefit someone who is younger, as these vitamins are not that well absorbed by the body at any age.

*The main distinction between men's and women's formulas of vitamins is the iron content. Women, until a certain time in their lives, have a regular (usually) menstration cycle which causes them to lose iron; hence, they have a greater need to replenish iron than do men. Senior formulas come in both reduced iron and iron free formulas (as the distinction between the iron needs of men and women decreases after a certain age and it can actually become harmful to a woman to get too much iron after a certain age). I prefer the reduced iron formula for the simple reason that iron is still an essential mineral for the body; being a vegetarian, my iron intake from the foods I eat is reduced anyway. If you eat red meat, eat prunes (one of the best sources of iron that there is), eat dark fruits and vegetables (beets, figs, etc.; tomatoes don't count), or eat dark green leafy vegetables (spinach, greens, broccoli, etc.), on a regular basis, then you probably don't need iron supplementation.

Seeing that you have a men's formula of vitamin, I will provide a warning about some formulas of vitamins specifically aimed at men, especially those for the purpose of increasing performance (uh, virility). Unless you seriously know what you are doing (and even at that, one should not do it anyway) avoid any formulas which specifically contain a nutrient called Yohimbe. Yes, yohimbe is the best natural treatment for increasing a man's virility long before viagra ever came along (and it is the only natural treatment of its kind). Yohimbe, however, chemically contains a MAO (monoamine oxidase) Inhibitor.

A MAO Inhibitor was originally used as a treatment for depression. Though it has been synthesized in the lab, MAO Inhibitors do exist naturally in certain substances. As its name suggests, it inhibits a certain function. Our bodies have a natural regulator, often associated with metabolism, which determines how much a certain amount of any substance can affect us. An MAO Inhibitor inhibits this regulation and can cause unforseen effects, and potential mortality, when combined with certain drugs and foods. A common substance, known as tyramine, that can be found in certain cheeses, beer, some soy products, and other foods, can have dangerous effects when combined with MAO Inhibitors.

Yohimbe can have unpleasant, and even dangerous, side effects when combined with certain foods, and especially with prescription drugs. Unfortunately many of the supplements which contain yohimbe do not contain a warning, or give an insufficient warning, about such interactions.

For anybody who takes a supplement which contains yohimbe, there are alternatives. Yes, yohimbe works the best out of natural treatments, but the risk, IMO, is not worth it. Alternative natural supplements which have been used for male virility include ginger (and ginger root), ginkgo biloba, bilberry, and l-arginine (an amino acid); you will notice a common theme of circulatory stimulation with these supplements.


Oh well, I have spent enough time boring everybody.

I just want to say that I love Flintstones chewables as a kid. My least favorite, though, was the grape. I wonder though, were the different colors actually flavored differently, or did we just perceive them to be different flavors because of their colors?

[Ash]

I wouldn't consider what I take everyday to be megavitamin therapy.
I only take those three supplements once a day and that's it.
The scary thing is that Ultra Vita Man recommends that a person take 2 per day!
I don't do that...no way.  I only take one per day.
What I take is nothing compared to a few guys I know.  They'll take up to 7-10 different vitamins with a meal like my dad used to.
I called my dad last night and asked him if he still takes that many.  He told me that he takes 4 different supplements per day now.

And no, none of the vitamins I take contain Yohimbe.
I know all about that after reading a horror story about it in Maxim Magazine.

They had a story about this guy who took some and when his erection didn't go away after something like 3-4 days, he had to undergo major surgery and now his you-know-what doesen't work properly anymore.
He said that the pain of having an erection for that long was absolutely excruciating.
Yikes!

The local tobacco shop sells yohimbe capsules for like $3 a pack.
After reading that story, you couldn't pay me to take it.

[Zapranoth]

There's some reasonable evidence for:

1.  Folic acid supplementation if you're a woman of childbearing years,
2.  Calcium and vitamin D (for bone strength, osteoporosis prevention)

The rest of it is all unsubstantiated, evidence-less woo woo.

You're paying rent on them, basically.  Unless of course you are taking toxic overdoses of any of them, which some people do...

[Menard]

There's some reasonable evidence for:

1.  Folic acid supplementation if you're a woman of childbearing years,
2.  Calcium and vitamin D (for bone strength, osteoporosis prevention)

The rest of it is all unsubstantiated, evidence-less woo woo.

You're paying rent on them, basically.  Unless of course you are taking toxic overdoses of any of them, which some people do...

I always love how calcium is recommended, but everyone forgets that magnesium is an essential mineral to have in order for calcium to be absorded by the body. Without the presence of magnesium, calcium cannot be absorbed.

Vitamin D can easily be overdosed; basically because people are getting enough of it in enriched foods, and especially if they drink milk. Even though Vitamin D helps the body to absorb calcium, too much of it causes the body to lose calcium.

Vitamin K is a essential nutrient our bodies use for blood clotting.

Vitamin B 12 is an essential nutrient in the formation of blood cells, as are many other nutrients. Vitamin B 12 deficiency is known as pernicious anemia.

Iron is a neccessary mineral needed for the formation of red blood cells and muscle tissue, especially the cardiac muscles. Deficiency of iron in the system causes a reduction in the rate of red cell production, atrophy of muscle tissue, and the inefficient utilization of oxygen by the body.

I could go on and on as I speak woo woo very well.

[Zapranoth]

I've taken care of patients in the ICU who were magnesium deficient, and a couple with renal magnesium wasting...  otherwise it's not something I see commonly.  Magnesium supplementation is a non-issue for most people.   Vitamin D overdose is also essentially a non-issue, except in the people who insist that if 400 IU of vitamin D is good, then 4 million IU must be better.

Deficiencies of K and B12 are in the main unusual, too... well, do see B12 deficiency in alcoholics, but that's about it, in this country.  Most of the time, I see B-12 deficiency when I'm admitting someone to the hospital for alcohol withdrawal.

Most people who don't have genetic problems with bleeding but do have a problem with vitamin K are people taking prescriptions to thin their blood (warfarin).  Otherwise, vitamin K deficiency is generally a non-issue, clinically.

In rich countries, iron deficiency generally happens in people who bleed too much or who chew up their blood cells (women with menstrual disorders, people with GI bleeds, and also people with hypoproliferative bone marrow disorders, spleen disease etc).  Americans generally don't become iron deficient by dietary insuffiency -- we either eat lots of red meat, or if we're strict vegetarians we get plenty of iron that way too.  But try to get people to take supplemental iron!   Good luck.  I've never gotten someone to take three tablets a day.  I don't even ask anymore.  I ask for two, and hope they'll at least take one.   But realistically iron deficiency for most people is a non-issue, too.

The only vitamin deficiency states I see in the office on any regular basis at all are B-12 states in alcoholics (and the rare person with atrophic gastritis, H pylori infection, etc).  But that isn't a burning problem in my everyday practice, either.

I wish people would spend less energy and waste less money on vitamins, and more on just reducing caloric intake, and moving more.  That'd solve many more important health issues.  And save a helluva lot of money.

[Menard]

Vitamin D overdose is also essentially a non-issue, except in the people who insist that if 400 IU of vitamin D is good, then 4 million IU must be better.

Now you and I both know that is an overexaggeration. Yes, vitamin D oversupplementation is uncommon, but it does not require 4 million IU to achieve it. That is just misleading as it suggests there is no danger in taking megadoses of vitamin D. We all get plenty of vitamin D in our diets (due to the natural content of the foods we eat and the enrichment of the foods we eat) and not to mention from just spending a little time out in the sun*. The effects of over supplementation of vitamin D are not immediately noticeable. Someone who gets more than enough vitamin D from their diet, spends time out in the sun, and supplements themselves heavily (say 1600 IU a day) can have negative effects form this if they maintain this over a period of time.

Of course, the question comes about, well who would be in that group?

This is an example of poor advice given to someone on many levels.

A pharmasist recommended to a young woman that she needs vitamin D with her calcium supplement (he said that was all she needed to absorb the calcium). She had wanted supplements for her hair and skin (she was quite vain) and someone at a health food store recommended two supplements; both of which contained vitamin D. She, of course, took a daily vitamin, which also contained vitamin D. Several of the foods she ate also were supplemented with vitamin D (calcium enriched orange juice, protein drinks, etc.). She also sunbathed on a fairly regular basis.

Now the end results were not disastrous by any means; but she began to suffer from general fatigue, occasional nausea, and occasional aches and pains. Of course it was suggested to her that she may be suffering from fibromyalgia, when in fact she was simply suffering from poor advice and misdiagnosis (amazingly rampant).

To say the vitamin D was absolutely the culprit would be premature as there were a number of other nutrients she was overusing. What the real culprit was is simply that nobody ever asked her about herself. They all gave advice on a generalized level without inquiring about the person asking for the advice.

This is not an example of oversupplentation, but just an example of someone being taken advantage of. A woman who was anemic was prescribed ferrous sulfate (I am not kidding). She lived in low income housing and could not afford her prescription at times (again, I am not kidding). Her doctor was aware of her financial situation. At no time was she aware that she could buy ferrous sulfate off the shelf without a prescription, and pay about 25% of what she was paying at the pharmacy.  The person who set her straight was a pharmacist who informed her that she could save money and buy it off the shelf.

*Zapranoth knows this, but for anybody following along and confused by that statement, vitamin D is produced naturally by the skin when exposed to sunlight.

I wish people would spend less energy and waste less money on vitamins, and more on just reducing caloric intake, and moving more.  That'd solve many more important health issues.  And save a helluva lot of money.

It would be nice if we were all round pegs which fit neatly into little round holes and marched to the beat of the same drummer....uh...wait a minute



no it wouldn't; that would be monotonous, boring, and any other description you would like to add.



We are all people who have our different desires, wants, goals, and yes, bad habits. Unfortunately our lives do not always, okay, rarely ever, lend themselves to the perfect lifestyle.

Factory workers have varying nutritional needs depending both on the materials with which they are working and the conditions under which they are working. In several factories around here, they do not have either an efficient AC system, or just simply none at all. When it is summer, the good factories are the ones where the inside temperatures are only 10 degrees higher than the outside temperature. In such a working environment, people lose important nutrients at an alarming rate (compared to someone working in an office). Of course, many of the factories do supply water and gatorade, but that does not do much if they don't use it regularly enough. It is not uncommon for a factory worker (actually it is quite common) to weigh 5 pounds less at end of their shifts due to the water loss alone.

That is just one example.

Are there massive deficiencies across the board in the United States? Of course not. As you pointed out, in an industrialized nation, nutrition is more readily accessible to the average citizen than in other countries; whether they want it or not. Despite that, we all have different needs. Though most of us nutritionally fall into a certain category of getting an adequate (notice that I did not say proper) and nutritionally supportive diet. However, we can always do better. There are different needs among each of us as well according to lifestyle differences and basic differences our bodies have.

Supplementation is not an all or none issue for most of us. We don't treat food (most of us anyway) as something we don't use until we absolutely need it; then we would have a problem. Supplementation is much the same way. We are not taking supplements to combat deficiencies (again, most of us anyway), just as a preventative to make certain we are getting our nutrients over the long haul rather than waiting to see what develops later then have to be treated for something which we could have possibly prevented. Of course, there are just as many of us taking supplements who do not have an adequate diet; and that is called wishful thinking.

Despite us living in an industrialized country, there are those who are not able to afford everything they need and cannot sustain a well balanced diet. Of course, there is not much concern about someone over supplementing themselves in this case either. There are, however, pockets of people in our country who live in depressed areas and nutritional deficiencies are greater in these areas (welcome to Appalachia).

I take supplementation myself for several reasons. Number one of which is that I am a vegetarian. This is why I take a senior formula which includes extra B12 and reduced iron (I want iron in the supplement, but not 100%). It has been recommended to to take additional folic acid due to high cholesterol. Of course, I could just treat it by cutting back on the meats and other high cholesterol foods I eat; uh...wait a minute....that's right...I'm a vegetarian and I do not have a high cholesterol diet; it is actually very low in cholesterol. I have a cholesterol in excess of 400 due to genetics and not the foods I eat.

There are various reasons why people have individual nutritional needs and require targeted supplementation. There are a lot more of us out here than your statement suggests. (I know you know that, as it was a generalized statement to make a point, but I just wanted to say it anyway  )

Of course, there is the standard bias of allopathy (Hahnemann was so much smarter than the physicians of his day that they didn't even realize the term was an insult; and still don't) which will always maintain that the proper way to health is through one's doctor and not one's self. We all want to be healthy and, to a certain degree, happy. If we believe we are doing ourselves some good (backed up by a little knowledge) then we will be doing ourselves some good. I don't believe there is any good that comes out of telling someone their lucky charm is not working or that god is not real when it is not doing any harm.



I didn't have a point; just felt like babbling for a little while.

[Andrew]

In rich countries, iron deficiency generally happens in people who bleed too much or who chew up their blood cells (women with menstrual disorders, people with GI bleeds, and also people with hypoproliferative bone marrow disorders, spleen disease etc).  Americans generally don't become iron deficient by dietary insuffiency -- we either eat lots of red meat, or if we're strict vegetarians we get plenty of iron that way too.  But try to get people to take supplemental iron!   Good luck.  I've never gotten someone to take three tablets a day.  I don't even ask anymore.  I ask for two, and hope they'll at least take one.   But realistically iron deficiency for most people is a non-issue, too.

Had another SSgt that was our training chief at my unit in GA.  He was one of the serious runners like myself, in fact he trained for marathons.  He also started losing his head hair in patches.  Eventually, he just shaved it, but you could still tell where it was growing and where it was not.  It made him look like he had the mange.

A specialist finally diagnosed iron deficiency.  All the running meant he had much higher requirements than others.  So, he had to take the pills, eat certain foods, and bought a few cast iron skillets and such to cook on.  His hair started growing back in within a month.

[Zapranoth]

Menard, no offense I hope but that's way too much to read...

It's silly if we go back and forth about this.  I'm just giving my perspective as one of many family doctors here in America.  I see a lot, a lot, a lot of sedentary obese people who have heart attacks.  Who smoke.  Who "don't have time for exercise," etc.   Admittedly, this is a sore topic for me, because it touches on something that I spend a lot of effort on daily, with only limited success, and I'm worried about our future.

I'm not trying to say that the things you bring up are completely unimportant.   I'm just venturing what my experience has been -- that all this emphasis on alternative meds, "natural" meds, and lots of specifics about vitamins etc is an effort that could be better used for bigger problems.  You can take or leave that opinion; I'm fine with it either way.   Be careful, though.  I freely admit that of course I've got an allopath's bias because of course that's what I am, but I spend my whole workday addressing questions like these with people.  And although statistics and generalizations from them of course don't apply to each person, they do have their uses and they do at least offer one way to view what the trends are!

A few people have deficiencies of vitamins that cause them problems.  But of the large number of people who come in with fatigue, weight gain or loss, hair changes and other nonspecific symptoms -- most of the time it isn't a specific organic disease.  Most of the time it's related to lifestyle issues.   I do listen to people, examine them, and run tests on them, and I do think about it all critically.  Your implication that I try to pigeonhole everyone feels mean and misplaced to me.  You have no idea what a challenge it is to see the flood of people I do every day, and yet to manage to listen carefully to each story and to answer the real questions that lie beneath.  This is what I *do*, Menard.  People come in saying "I'm tired, I can't lose weight, and I'm sure it's a chemical problem... can we test my thryroid, can we do blood work?" and I'm just telling you that most of the time, they just want it to be some sort of imbalance, lack of vitamin, or something else that taking a pill can fix quickly, instead of making lifestyle changes that are hard to do, take real effort and time, and commitment to sustain.

So that's enough on that subject for me.  Please, if you reply, make it more concise? 

[Menard]

Your implication that I try to pigeonhole everyone feels mean and misplaced to me.

Part of what I said must have gotten lost in the length of my reply.

There are various reasons why people have individual nutritional needs and require targeted supplementation. There are a lot more of us out here than your statement suggests. (I know you know that, as it was a generalized statement to make a point, but I just wanted to say it anyway)

I apologize if it was too little to be noticed. I was replying to the generalization suggested in your previous statement and in no way was intending it as a reflection of you on any personal or professional level.




I replied to

I wish people would spend less energy and waste less money on vitamins, and more on just reducing caloric intake, and moving more.  That'd solve many more important health issues.  And save a helluva lot of money.

and did not intend that as a personal reflection on you or your practice; I took it as just a simple remark in casual conversation and not a statement of your philosophy toward people or patients and again apologize if I did not make that clear in my reply.

I agree to just leave it at that.

[RCMerchant]

Beer.Its full of vitamin P.

[djweevil]

FYI, The flinstones vitamins are sick does anyone here smoke or ever had bronchitis ? They taste like the crap when your sick that you cough up :( Anyways that was probaly un called for kinda like coffee tastes like puffed wheat to me. Damn I hate that stuff too. I remember the cough on the way to school having the puffed wheat flakes stuck in my throat. And no matter how much sugar you put on them it never made them any better. remember sugar smacks that was bs it was pre sugared puffed wheat and it was sick as hell too .....