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Vitamins and Supplements

Vitamins and Supplements. How much is too much? Cecily Kelly, M.D. Topics to be covered. Recommended vitamins/supplements Pregnancy Osteoporosis High cholesterol Cold Prevention/Treatment Weight Loss Supplements Miscellaneous. Overview. How much do we use?.

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Vitamins and Supplements

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  1. Vitamins and Supplements How much is too much? Cecily Kelly, M.D.

  2. Topics to be covered • Recommended vitamins/supplements • Pregnancy • Osteoporosis • High cholesterol • Cold Prevention/Treatment • Weight Loss Supplements • Miscellaneous

  3. Overview

  4. How much do we use? • Survey done by the National Center for Complementary and Alternative Medicine found that 4 in 10 adults had used “integrative therapy” in the past year

  5. Vitamins

  6. Vitamins A,D,E,K • Fat soluble • Stored in fat globules • It is possible to get too much-hypervitaminosis

  7. Vitamins B and C • Water soluble • Too much Vitamin B • Worsen diabetic neuropathy • Too much Vitamin C • Loose money

  8. Vitamin Deficiencies

  9. Beriberi-thiamine • Occurs in alcoholics due to malnourishment • Heart failure • Muscle wasting • Peripheral nervous system problems • Problems with thinking

  10. Pellagra-niacin

  11. Scurvy-Vitamin C • Tiredness, muscle weakness, joint and muscle aches, bleeding gums, rash on skin, loss of teeth

  12. Vitamin D-rickets

  13. Deficiencies • Not seen in developed world because of • Adequate supply of food • Many fortified foods

  14. Too much? • Fat soluble • Vitamin A-nausea, vomiting, headache, dizziness, blurred vision • Vitamin D-excess may cause cardiovascular problems • Vitamin E-increase bleeding problems • Water Soluble • Vitamin C-laxative effect • Vitamin B6-skin problems and peripheral neuropathy

  15. United States Preventative Services Task Force • Has found poor evidence to recommend routine use of Vitamin A, D, or E, multivitamins with folic acid, or antioxidant combinations to reduce the risk of cardiovascular disease or cancer

  16. Pregnancy

  17. Vitamins in Pregnancy • Calcium • Keeps bones of mom and baby healthy • 1,300 mg/day age 14-18 • 1,000 mg/day age 19-50 • Folic acid • Brain and spinal cord development • 600 mcg/day • Iron • Prevents anemia in mom and baby • 27 mg/day

  18. Folic Acid • US preventive services task force recommends supplementation of 400mcg to 800mcg daily for all women capable of pregnancy

  19. Calcium • Most pre-natal vitamins do not contain enough calcium and expectant mothers must get additional calcium through diet or supplements

  20. Osteoporosis

  21. Calcium • Women 51-70 (Men over 70) recommended 1,200mg/day • Two divided doses-body only able to absorb approx 500mg at a time • Do not take with medication for reflux like prilosec, nexium, omeprazole • Calcium citrate or calcium carbonate • Take with vitamin D which helps absorption

  22. Food Sources of Calcium • Eight ounces of yogurt-300mg • One cup of milk-300mg • 1.5 oz of cheese-300mg • 8 oz of fortified OJ-300mg

  23. Vitamin D • Adults < 70 • 600 IU/day • Adults > 70 • 800 IU/day • Helps us absorb calcium • Also can get from the sun

  24. Food Sources of Vitamin D • Sockeye Salmon-800 IU • 3 oz can of tuna- 150 IU • Vit D fortified milk- 80IU • OJ fortified- 80 IU • Fortified yogurt-80 IU

  25. Do I get enough? • People typically get 300mg of calcium from their diet daily • With the use of sunscreen, long hours spent indoors, or people who live in the northern latitude, overall decreased sun exposure causes pts to not get enough Vitamin D

  26. What happens if I don’t get enough? • Colon cancer • Kidney stones • Obesity • Hypertension • Osteoporosis • Bone fracture

  27. How much is too much? • >2500mg/day may increase the risk of hypercalcemia and kidney problems • Kidney stones- >2150 mg/day in postmenopausal women • Avoid coral or dolomite (a kind of limestone) because they can contain heavy metals like lead

  28. Omega-3

  29. What is it? • Essential fatty acid that we must get from our diet • Fish • Salmon • Tuna • Halibut • Nut oils

  30. Why do I need it? • Crucial for brain development • Involved in growth and development • Shown to decrease risk of heart disease • Decrease inflammation

  31. How do I get it? • The American Heart Association recommends two servings a week of fatty fish, such as: • Mackerel • Sardines • Albacore Tuna • Large Trout • Salmon

  32. And what if I don’t eat fish… • American Heart Association • Adults with no history of heart disease • Fish two times a week • Adults with coronary heart disease • 1 gram daily of EPA and DHA • Adults with high cholesterol levels • 2-4 grams daily of EPA and DHA

  33. How much is too much? • Do not take more than 3 grams without a physician supervision • Side effects include fish breath, gas, bloating, belching, diarrhea • Use with caution if you take a medication to thin your blood or have a bleeding disorder- omega-3 supplements can increase your risk of bleeding • Get supplement from an established company that certifies that their products are free of contaminants like lead, heavy metals, mercury

  34. Cold Prevention

  35. Vitamin C • Prevention • Might help immune function • Most evidence (8 studies) suggests that even in doses of 1 gram a day does not prevent colds • Treatment • “Some evidence” that taking high doses may decrease sx duration by 1-1.5 days

  36. Zinc • Prevention • Only in vitro evidence (in the lab) that it stops the growth of the common cold • No reliable evidence that it can prevent the cold in vivo (in humans) • Treatment • 9-24 mg elemental zinc started within 24-48 hrs of symptoms to reduce severity and duration of colds (6 studies)-take every 2-3 hrs while awake • Other studies show no effect (5 studies)

  37. Echinacea • Prevention • In vitro (in the lab) research suggests it stimulates immune system • In vivo (in people) studies for prevention against the common cold has “consistently been shown to be ineffective” (9 studies) • Treatment • “Some preparations” may reduce symptom severity and duration possibly by about 10%-30% • Different species • Best evidence with Echinacea purpurea

  38. Garlic • Prevention • May have immunostimulant activity and antiviral • If taken between November and February may have one fewer cold episode than patients taking placebo

  39. How much is too much? • Patients who have autoimmune disease such as RA (rheumatoid arthritis or lupus) may do worse with the supplements that “stimulate” the immune system • Echinacea-Ragweed allergies should not use-cross allergy • Vitamin C-high doses may increase risk of side effects • Zinc-nasal spray withdrawn from market due to permanent anosmia (loss of sense of smell) • Garlic-adverse effects like bad breath and body odor, interaction with warfarin (coumadin) causing increase in risk of bleeding

  40. What about Airborne? • Promotional material “developed by a teacher who was sick of catching colds in class” • Contains vit C, vit E, vit A, zinc, echinacea • No proof it can prevent or treat a cold • Not recommended

  41. Others • American ginseng- maybe beneficial • Probiotics-maybe beneficial for respiratory infection prevention-more in children • Panaxginseng-might have immunostimulant effects and protect against colds and improve response to flu vaccine • Vitamin E-some evidence that it might help the body build immune response with vaccination • Andrographis • Astragalus • Elderberry- possibly use in treating the flu-antiviral and immune system changing effects • Goldenseal • Pau d’arco, bee propolis, wild indigo, boneset, Siberian ginseng, larch arabinogalactan • Teas-elderflower, rose hips, goldenseal, chamomile, peppermint, slippery else, ginger, Mormon tea, linden flowers, meadowsweet

  42. So what can I do? • Flu shot every year-Usually starts August-March • Hand washing or alcohol based hand gels • Hand washing-2 min with soap and water • “Some evidence that alcohol based hand gels, which have 62% ethyl alcohol, lower the amount of cold-causing viruses on fingers better than water.”2,3

  43. Weight Loss Supplements

  44. “Increase Energy Expenditure” • Ephedra (aka Ma huang) • May also be bitter orange or country mallow • Weight loss of 2lb/month • Caffeine • Adverse events shown in 50 trials-psychiatric, autonomic, cardiovascular, GI symptoms • Another review showed 87 reports of hypertension, abnormal heart rhythm, heart attack, stroke, seizures • Ten events led to death, 13 permanent disability-9 of those were at the recommended dosage.

  45. Sale was ban by FDA in April 2004

  46. “Modulate Carbohydrate Metabolism” • Chromium picolinate • Studies of chromium and obesity show no difference between study group and placebo • Kidney failure is sometimes related to doses of more than 1,000 mcg a day • Uncertain safety profile

  47. “Increase Satiety” • Forms of soluble fiber • Guar gum • Relatively safe, also 11 trials with this vs placebo showed no difference • Glucomannan • Trials show moderate weight loss, but only 20-50 pts in each trial • Psyllium • Improved glucose and cholesterol, no differences in weight loss

  48. Others • Hydroxycitric acid • Linoleic acid • Green tea • Licorice • Pyruvate • Vitamin B5 • Andl-Carnitine • Chitosan • Dandelion • Spirulina • Guggul

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