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Supplements
Amino Acids | Minerals | Vitamins
Nutritional supplements such as vitamins, minerals, amino acids, antioxidants, natural food-derived products, and herbs can help prevent disease, decrease side effects of conventional therapies, and improve the quality of life.
AMINO ACIDS
Amino acids are the building blocks of proteins. During the digestive process, dietary protein is broken down into individual amino acids. These amino acids are absorbed from the gastrointestinal tract, and then recombined to make new proteins. Next to water, proteins make up the greatest proportion of our body weight.
Nutritional Requirements
Despite advertising hype to the contrary, it’s not necessary to supplement your diet with a mixed amino acid supplement. Just the same, single amino acid supplements can be quite useful. For instance, the amino acid L-glutamine can prevent radiation-induced diarrhea. (Radiation therapy is commonly used to treat prostate cancer.) Used selectively by the intestinal cells as fuel, L-glutamine prevents diarrhea by protecting the intestinal lining.
Types Of Amino Acids
Supplemental amino acids are available in capsules, tablets, liquids, and powders. Amino acids are generally derived from animal, yeast, or vegetable protein. Choose products that contain USP (U.S. Pharmacopoeia) pharmaceutical-grade L-crystalline amino acids. Free-form amino acids, the purest forms of amino acids, are rapidly absorbed into the blood stream. In order to not compete with other proteins for absorption, amino acids should be taken on an empty stomach. Amino acids are safe when taken as directed. [Top]
MINERALS
Like vitamins, minerals are micronutrients that are essential for proper health. Eighteen different minerals play a role in human physiology. Vitamins and minerals form a buddy system - as coenzymes, they help each other initiate or facilitate biochemical reactions. Minerals are also needed for proper bone growth, muscle contractions, and nerve function.
Types Of Minerals
Minerals are divided into two groups: major minerals and minor (trace) minerals. The body needs at least one hundred milligrams per day of the major minerals (calcium, magnesium, sodium, potassium, and phosphorus) daily. In contrast, the body only needs microgram amounts of micronutrients (such as zinc and selenium).
Absorption Of Minerals
The best way to ensure that you get a sufficient amount of minerals is to eat plenty of fresh vegetables. Just the same, the mineral intake varies with an individual’s dietary habits, mineral content of the soil, degree of intestinal absorption, and influence of other minerals. You should also be aware that ingested minerals are only partially absorbed. Among other things, absorption depends on the body’s need for a particular mineral.
Factors That Affect Absorption
Substances that bind trace minerals to other compounds affect their absorption. For instance, metal minerals, such as zinc, cannot be used in the free or elemental state. Instead, they must be combined with other organic and inorganic substances to form ionic (charged) chemical compounds.
Organic Salts And Acids.
Organic acids such as succinates, gluconates, citrates, picolinates, and fumerates combine with trace metals to form organic salts (such as zinc picolinate). Organic salts are better absorbed than inorganic acids that combine with trace metals to form inorganic salts (such as zinc sulfate).
Chelation.
Minerals that are chelated (bonded to a protein in the middle of a larger molecule) are also more easily absorbed.
Colloidal Minerals.
Avoid colloidal minerals - nutritional supplements that are concocted from a mixture of clay and water. Despite exaggerated and unfounded claims, colloidal minerals are neither better absorbed that other minerals, nor are they required for optimal health. As a matter of fact, colloidal minerals may contain dangerous concentrations of aluminum and arsenic.
Safety Issues
Minerals are primarily stored in bone and muscle tissue. To be most effective, minerals and vitamins must maintain a proper balance in the body. Although minerals have a wide safety range, when taken in excessive amounts, minerals can be harmful, even toxic. For instance, too much zinc can cause a copper deficiency, and too much calcium can affect magnesium absorption. Furthermore, selenium can be toxic in amounts greater than nine hundred micrograms daily.
Minerals can also interfere with the absorption of certain antibiotics and other medications. Therefore, if you are taking prescription medication, check with your pharmacist before taking a mineral supplement.
Dosage
As a rule, minerals are better absorbed when they are taken with food. There are exceptions to the rule, though. For instance, fiber supplements decrease mineral absorption; hence, they should not be taken together. In addition to fiber, calcium absorption is impaired by excess dietary fat, caffeine, and alcohol. Therefore, supplemental calcium supplements (in addition to those in your multivitamin) are better absorbed if they are taken at other times. Calcium should also be balanced with magnesium, ranging between a one-to-one to a two-to-one ratio. Taken at bedtime, calcium and magnesium are not only better absorbed; they promote sleep.
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Vitamins
Vitamins are essential organic compounds that our bodies use for normal metabolic function. (The Latin word ‘vita’ means life.) Vitamins are called essential because bodies can’t manufacture most of them. They’re also called micronutrients because they’re only needed in small amounts. Before vitamins can be utilized, though, the body must first convert them into another substance called a co-enzyme. Coenzymes make enzymes work better. Enzymes are substances that catalyze chemical reactions in the body.
Types Of Vitamins
In the early part of the twentieth century, the vitamin era was spawned when researchers discovered how to extract vitamins from natural foods. They classified vitamins as being either water-soluble or fat-soluble. Scientists also discovered that vitamins and minerals (to be discussed later) work best in combination; therefore, commercial multivitamins usually contain a mixture of both.
Water-soluble Vitamins
As their name implies, water-soluble vitamins dissolve in water. The B-vitamins and vitamin C make up the family of water-soluble vitamins. Water-soluble vitamins can’t be stored. They’re excreted in the urine over a period of one to four days. Therefore, water-soluble vitamins must be taken daily. As a rule, since water-soluble vitamins can’t be stored, they have a wide safety range and are rarely toxic.
Fat-soluble Vitamins On the other hand, fat-soluble vitamins (which include vitamins D, E, A, and K) are stored in adipose tissue (body fat) and the liver. Therefore, it’s possible to get an overdose of fat-soluble vitamins. Although caution is in order, if taken as directed, fat-soluble vitamins rarely cause serious side effects. Furthermore, most side effects, if they occur, are reversible once the vitamins are stopped.
Answers To Commonly Asked Questions
Patients often tell me that they become glassy eyed the moment they try to make sense of the baffling array of vitamin products. Patients are confused about which brand to buy, when to take them, common side effects, etc. Product labels are not helpful – abbreviations and ingredients are unfamiliar, and each product claims to be the best. As a result, patients often give up in despair. To help you sort things out, we’ll explore the answers to these and other frequently asked questions.
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Why Should I Take Vitamins?
As mentioned above, eating a standard American diet is not enough to promote optimal health and well-being. Therefore, I recommend taking a multiple vitamin as part of an overall wellness program.
What Kind Of Vitamins Should I Buy?
This is by far the most common question that patients ask me. Vitamins come in a variety of shapes, sizes, and formulations. For instance, vitamins are available as tablets, capsules, powder, sublingual wafers (items that are placed under the tongue), lozenges, liquid, micellized brands (vitamins that are bound to small particles), and injection (given by a shot or infused into a vein). It usually doesn’t matter what kind of vitamin you buy as long as you purchase vitamins from a reputable manufacturer (see below).
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Absorption.
Vitamins that are given by injection or taken sublingually are absorbed directly into the blood stream, whereas vitamin pills and tablets are first digested in the stomach, and then absorbed. Water-soluble vitamins are directly absorbed through the stomach or intestinal lining. On the other hand, fat-soluble vitamins must be acted upon by bile acids from the liver before they can be absorbed. Similar to dietary fats, fat-soluble vitamins are “micellized” to aid intestinal absorption and blood transport.
Utilization.
Regardless of their route of administration, before the body can utilize vitamins, they must be transformed into their respective coenzyme or cofactor form. Contrary to advertising hype, quality vitamins made by reputable manufacturers, regardless of their form are generally well absorbed and utilized. For best absorption, vitamins should be taken with meals.
Special Considerations.
People that have trouble swallowing tablets or pills may have better luck taking liquid vitamins. Also, large vitamin tablets can be broken into smaller pieces and swallowed separately. Finally, some vitamin brands are available in less potent, smaller capsules. If you wish to take a high potency vitamin, but the pill is too big, simply take more of the smaller version to make up the difference. Note: Chewable vitamin C lozenges may erode teeth enamel.
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When Should I Take My Vitamins?
To obtain the best results and prevent side effects such as heartburn, indigestion, and nausea, vitamins should be taken just prior to or at the beginning of a meal. If vitamins are taken after a meal, they often cause an aftertaste.
What Is The Difference Between Natural And Synthetic Vitamins?
In natural foods, vitamins are bound to proteins, lipids (fat), carbohydrates, and bioflavonoids (compounds that are found in green plants). The difference between natural and synthetic vitamins is often fuzzy unless you know how to read the fine print.
Natural Vitamins.
Vitamins that are derived from natural foods are called natural vitamins. Some experts maintain that natural vitamins that are bound to proteins (such as those that are contained in whole food supplements) are better absorbed than synthetic vitamins.
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Synthetic vitamins.
As opposed to natural vitamins, synthetic vitamins are made in the laboratory from isolated chemicals that mirror natural vitamins. The difference between the two types of vitamins is only relevant if the natural form is better absorbed or utilized differently than the synthetic form (see the discussion on vitamin E below). Normally, natural and synthetic vitamins are absorbed equally well.
What To Look For In The Fine Print.
Despite the hype, so-called natural vitamins are usually a mixture of both natural and synthetic vitamins. The word ‘natural’ usually merely implies that a synthetic vitamin is not tainted with unnatural substances such as coal tars, artificial coloring, preservatives, sugar, starch, corn, starch, or other additives.
Natural Versus Synthetic Vitamin E.
Certain vitamins have different molecular forms or isomers, that have different biologic activity. For instance, vitamin E has eight different isomers – alpha, beta, gamma, and delta ‘tocopherols’ and ‘tocotrienols’. Of these isomers, the diet contains mainly alpha and gamma tocopherol.
Natural Vitamin E. The natural form of vitamin E is the dextro or d-isomer. (The prefix ‘dextro’, which is Latin for right, refers to the way the molecule is turned.) ‘Hence, vitamins that contain ‘natural vitamin E’ usually contain d-alpha tocopherol, d-alpha tocopherol acetate, or d-alpha tocopheryl succinate (acetate and succinate are organic salts that bind to vitamin E and aid absorption).
Synthetic Vitamin E. The synthetic form of vitamin E is designated as levo or ‘l-’ (‘levo’ is Latin for left). Most synthetic vitamins contain dl-alpha tocopherol - a mixture of natural (‘d’) and synthetic (‘l’) forms.
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Mixed tocopherols.
According to many experts, the body utilizes natural vitamin E, the kind derived from the diet, more efficiently than synthetic vitamin E. Therefore, for optimal effectiveness, purchase a brand that contains a blend of natural isomers called ‘mixed tocopherols’.
How Long Do Vitamins Maintain Their Potency?
According to one expert, unopened vitamins retain their potency for two years after the date of purchase, and for one year after they’ve been opened. Just the same, I recommend buying a fresh supply of vitamins every month or so. Also, be sure to avoid buying out-of-date vitamins by checking the expiration date that’s listed on the bottle.
Storage.
Vitamins that are exposed to heat, moisture, or sunlight lose their potency. Therefore, store vitamins in an opaque, sealed container in a dry, dark, and cool place such as a kitchen cabinet (but not in the refrigerator).
Travel.
If you travel, stash your vitamins in an opaque container, and keep them away from extreme temperatures. Inserting a small sealed packet of desiccant, a moisture absorbent that is found inside most supplement bottles, will keep moisture from spoiling the vitamins.
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How Do I Know That The Vitamins Are Working?
There isn’t a simple answer to this question.
Changes Noticed By Healthy Patients.
I advise my healthy patients that they may not notice any difference once they start taking vitamins, or if they do, the change will be subtle. Nevertheless, I explain that taking vitamins (in addition to other healthy habits) will protect their ‘organ reserve’ and allow them to enjoy vitality into their golden years. Organ reserve is the spare capacity that is inherent within every organ system in the body. Unbelievably, an organ can lose eighty percent of its reserve function before diagnostic tests start to register an underlying abnormality. Though sufficient in most cases to last a lifetime, this reserve is not endless. Destructive lifestyle choices deplete this reserve and lead to the emergence of disease and premature aging.
Changes Noticed By Unwell Patients.
Patients that are unwell, but not sick, often notice a significant improvement in their health status within several months after they start taking vitamins. They often report improvement in one or more of the following conditions: Sugar craving, sleep disorders, skin problems, headaches, recurrent infections, and chronic fatigue.
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Changes Noticed By Chronically Ill Patients.
Chronically ill patients have depleted organ reserves. As a result, they rarely notice an immediate improvement in their symptoms once they start taking supplemental vitamins. Nevertheless, since their bodies desperately need the added nutritional support, I encourage them to hang in there and keep taking their vitamins.
What’s The Difference Between A High Potency And A Regular Vitamin?
The term ‘high potency’ is an arbitrary term that implies a higher vitamin content than a ‘regular’ vitamin.
Regular Vitamin.
A regular vitamin contains slightly higher amounts than the recommended daily dietary allowance (RDA) of vitamins and minerals. A single pill taken once daily is usually all that is recommended.
High Potency Vitamin.
In contrast to a regular vitamin, a high potency vitamin contains significantly higher amounts than the RDA of vitamin and minerals in each pill. In addition, as many as six pills need to be taken daily in divided doses to deliver the desired amount of nutrients.
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What Does The Abbreviation ‘IU’ Stand For?
The abbreviation ‘IU’ stands for International Unit, a measure of potency (strength) that is based on an accepted international standard. For the most part, water-soluble vitamins are measured in milligrams, whereas most of the fat-soluble vitamins (except vitamin K) are expressed as international units. Since the assessment is measured on potency, not weight, the number of milligrams in an international unit varies, depending on the vitamin.
What Do The Terms RDA, RDI, and DV mean?
Most patients and many of their physicians are confused about the difference between these three terms. The RDA has been around for more than half a century, while the other two terms are relative new comers.
RDA. The term RDA stands for recommended daily dietary allowance. First established in the year 1941 by the National Academy of Sciences, the RDA is a guideline for the prevention of nutritional deficiencies such as scurvy (due to a lack of vitamin C), rickets (due to a lack of vitamin D), and pellagra (due to a lack of vitamin B3).
RDI. In the mid nineteen nineties, government planners devised a new guideline called the RDI, which stands for recommended daily intake. The RDI is based on a weighted average of age, gender, pregnancy, and lactation status.
DV. The term DV stands for daily value – the percentage of the RDI that is supplied by a recommended dose of a particular product. For instance, the recommended daily intake of vitamin E is 22 IU of natural-source vitamin E or 33 IU of synthetic vitamin E. Therefore, a vitamin or food that provides this amount of vitamin E provides one hundred percent of the DV. (The RDI and DV are based on uniform portion sizes.)
Limitations Of The RDA and RDI. The RDA and RDI relate to groups of healthy people, not individuals. In addition, neither guideline applies for patients with special needs such as patients that are sick, elderly, taking medications, combating chronic illness, or under stress. Furthermore, neither guideline takes into consideration individual biochemical differences among patients. For instance, although the RDA and RDI for vitamin E is standardized, individual vitamin E requirements show a five-fold difference for normal, healthy adults, and even more variability among those that eat a lot of junk food. Taken together, the RDA and RDI don’t apply for the majority of Americans, particularly for those that wish to achieve optimal health. Consequently, I tell all of my patients to take a high potency multivitamin daily.
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Aren’t Excess Vitamins Wasteful?
Doctors love to tell their patients that taking extra vitamins merely generates expensive urine. This simplistic explanation shows a complete lack of understanding or disregard of the individual nutritional requirements among patients. Although it’s true that vitamins are excreted in the urine after they’ve done their job, it doesn’t mean that the vitamins have been wasted, or that the body stores are over saturated with vitamins. Incidentally, it’s normal for urine to temporarily turn yellow after taking a high potency multivitamin. This harmless yellow coloration is caused by the excretion of riboflavin (vitamin B2).
How Long Is It Safe To Take Vitamins?
Vitamins can be taken indefinitely; they’re not addictive. Furthermore, multivitamins can be safely stopped without causing any unpleasant side effects.
How Safe Are Vitamins?
Contrary to popular belief, regular and high potency vitamins are safe when taken as directed. As a rule, I don’t recommend taking individual vitamins or minerals in addition to a high potency vitamin. There are exceptions to this rule, though. For instance, I often advise men with prostate cancer to supplement their multivitamins with selected vitamins and minerals that have been shown to prevent the progression (growth) of prostate cancer.
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Margin Of Safety.
Vitamins have a wide safety range. Scientific studies have shown that high doses of individual vitamins can be safely given to prevent or treat certain conditions without any associated serious side effects. For instance, consider the following two examples:
Vitamin B6. Although the RDA for vitamin B6 is only two milligrams daily, doses one hundred times this amount have been used to treat certain conditions (carpal tunnel syndrome, for example) without reports of adverse effects.
Vitamin E. While the RDA for natural vitamin E is 22 IU for adult males, doses as high as three thousand IU have been taken safely for a prolonged time without side effects. (Just the same, I advise patients not to take more than eight hundred IUs daily. In addition, patients that take blood thinners should not take supplemental vitamin E without first checking with their physician.)
Risk Of Toxic Reactions.
On the other hand, taking high doses of certain vitamins can create problems. This is particularly true for the following two fat-soluble vitamins:
Vitamin A. The RDA for vitamin A is nine hundred micrograms for men, and 700 micrograms for women. Doses ten times the RDA can cause side effects such as headache and nausea, and doses one hundred times the RDA can have acute, reversible side effects (such as liver damage).
Vitamin D. Vitamin D has an even narrower safety range. In fact, high doses of vitamin D can cause irreversible, even fatal side effects (acutely at one to three thousand IU per killigram [one kiligram equals two point two pounds], and chronically at ten to fifty thousand IU daily). Therefore, I advise patients to limit their daily intake of Vitamin D intake to one thousand IU or less.
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Controversy Regarding Vitamins And Cancer Therapies.
Although controversial, some experts warn that vitamins and other antioxidants can interfere with the cellular damage that is wrought by chemotherapy and radiation therapy (two common cancer therapies). On the plus side, vitamins and antioxidants prevent cellular damage to surrounding normal tissue, thereby preventing some of the nasty side effects of these cancer therapies. On the negative side, though, they may also protect targeted cancer cells, thereby making chemotherapy and radiation therapy less effective. While opinions are divided, until there are conclusive data, check with your oncologist before taking vitamins or supplements if you are about to undergo (or are undergoing) chemotherapy or radiation therapy.
What Are Vitamin Capsules Made Of?
Unless stated otherwise, gelatin vitamin capsules are derived from processed animal collagen (for instance, animal hoofs). “Vegicaps” on the other hand are made from vegetable protein and glycerine (a fat derivative).
Is It Safe To Take Vitamins Along With Other Medications?
In general, the answer to this question is yes. Just the same, I advise patients to check with their pharmacist beforehand to rule out any drug-vitamin interactions. For instance, if taken together, certain minerals (calcium, iron, magnesium, and zinc) can adversely affect the absorption of antibiotics (for example, tetracycline and the quinilone, two classes of antibiotics that are frequently used to treat prostate infection). Since multivitamins usually contain these four minerals, multivitamins should not be taken within two hours of taking tetracycline or quinolone antibiotics.
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Do Prescription Medications Deplete The Body Of Vitamins And Minerals?
Yes, prescription drugs can interfere with the absorption or utilization of certain vitamins. For instance, the following prescription drugs can deprive the body of precious vitamins and minerals:
Antibiotics. These medications deplete the body of B vitamins, folic acid, and vitamin K.
Heart Medications. Digitalis, a common heart medication, depletes magnesium.
Cholesterol-lowering Medications. ‘Statin’ drugs deplete Coenzyme Q10, a coenzyme that supplies the cell with energy.
Diuretics. Thiazide diuretics (water pills) deplete magnesium, sodium, potassium, and zinc.
Oral Diabetic Medication. Metformin (Glucophage®), a frequently prescribed diabetic medication, depletes vitamin B12 levels.
Anti-reflux Medications. Medications that are used to treat heartburn, including famotidine (Pepcid®), rantidine (Zantac®), and lansaprazalec (Prevacid®), deplete vitamin B12.
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What Are Hypoallergenic Vitamins?
Hypoallergenic vitamins have been formulated to minimize the chance of allergic reactions. Patients with known or suspected allergies may react to hidden ingredients that include any of the following: Flowing agents (such as ascorbyl palmitrate, an additive that makes it easier to press vitamins into tablets), lubricants, binders, allergenic fillers, artificial coloring agents, and corn protein (which is often camouflaged as natural vegetable coating).
How Do I Know If A Vitamin Manufacturer Is Reputable?
Consumers face this dilemma every time they shop for a nutritional supplement. A good place to start is learning how to recognize a health scam (see below). You can also protect yourself by purchasing vitamins from companies that conform to good manufacturing practices.
Good Manufacturing Practices. Reputable companies maintain high standards and protect their customers by adhering to the following criteria:
1. Listing all of the ingredients on the bottle label or package insert.
2. Assaying their products for purity and batch-to-batch consistency.
3. Not making false claims.
4. Listing an expiration date on their products.
5. Conforming to industry standards of excellence.
6. Providing a certificate of analysis upon request.
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How To Recognize Health Claims That Are Too Good To Be True
When it comes to selecting a nutritional supplement, I remind patients of the familiar Latin phrase ‘caveat emptor’, which means ‘let the buyer beware’. Unfortunately most junk mail, and much of the information on the Internet is nothing more than a glorified “infomercial” - impressive claims that are designed to sell a product. These claims are seldom based on solid scientific studies. Infomercials often list testimonials (personal statements based on belief, not fact), and quote scientific research without listing a source. Beware of these unsubstantiated claims. The following warning signs should also raise a red flag:
1. Product claims that boast a “revolutionary scientific breakthrough”, “miraculous cure”
2. Testimonials from experts for whom no credentials are given, and those that contain a “secret formula” or “ancient ingredient”.
3. Unbelievable results that are supported by undocumented case histories.
4. Products that supposedly cure a shopping list of complaints, usually within a matter of weeks.
5. Manufacturers or distributors that claim that the government is conspiring to suppress their product.
6. The ingredients are not listed or are called ‘proprietary’.
7. The product claims to cure cancer.
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How Do I Read A Vitamin Label?
Making sense of the ingredients on a vitamin label is not as complicated as it may appear. I have selected common features and displayed them below. Items in bold type are discussed in further detail.
Dietary Supplement
Serving Size: six capsules
Six capsules contain: %DV
Vitamin C . . . . . . . . . . . . 1200mg 1333%
Vitamin E . . . . . . . . . . . . 400IU 1818%
Selenium . . . . . . . . . . . . . 200mcg 363%
Vanadium . . . . . . . . . . . . 50mcg *
Bromelain . . . . . . . . . . . . 25mg *
L-Cysteine . . . . . . . . . . . . 200mg *
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*Daily Value not established
Other ingredients: cellulose, and magnesium stearate.
Best if used by: January 2002.
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1. Serving size is the unit of measure (number of capsules) that contains the specified ingredients.
2. DV stands for ‘Daily Value’ or the recommended daily amount.
3. 1333% indicates that the 1200mg of vitamin C contained in a serving (six tablets) is 13.33 times the recommended daily amount of vitamin C (ninety milligrams for non-smoking men). Although high potency multivitamins contain vitamins concentrations that are hundreds or even thousands of times greater than the DV, don’t be alarmed, they’re safe to take. The DV (and RDA) was established to prevent nutritional disease, not promote optimal health.
4. The abbreviation ‘mg’ stands for milligram (one-thousandth of a gram).
5. The abbreviation ‘mcg’ stands for microgram (one-millionth of a gram).
6. The statement ‘Daily Value not established’ is self-explanatory. Many vitamin supplements contain ingredients that don’t have an established daily requirement. These items include certain trace minerals (such as Vanadium), digestive enzymes, and amino acids. Digestive enzymes are identified by their word endings: Words that end in ‘ain’ (such as bromelain- a digestive enzyme made from pineapple), or ‘ase’ (such as lipase – a digestive pancreatic enzyme) are digestive enzymes. (The bottle should state whether the enzymes are derived from plant or animal sources.) Amino acids are identified by a ‘L’ or ‘DL’ before their name, for example L-cysteine.
7. Other ingredients: Read this section carefully. Supplements often contain other ingredients that are best avoided such as artificial coloring, preservatives, flavorings, corn, soy protein, wheat gluten, sugar, yeast, and dairy products.
8. Best if used by: Signifies the expiration date.
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