Tuesday, August 18, 2009

Neutriceutical Supplements Can Kill or Help You or Just Waste Your Money!

When was the last time your doctor asked you if you are taking any supplements? Most of you probably never. I have had patients die or loss a limb from over the counter supplement use.

A recent article from Mayo Clinic Health letter they clarified that over the counter supplements are not always safe. They pointed out that,
"St. John's wort: This supplement can greatly increase or decrease the potency of many medications and cause serious side effects. Patients who take antidepressants, anti-blood-clotting drugs, certain asthma drugs, immune-suppressing medications or steroids should probably avoid St. John's wort.
S-adenosylmethionine (SAM-e): This can cause serious side effects when taken with antidepressant medications that affect serotonin.
Garlic, ginseng, ginger and feverfew: Patients who take anti-clotting medications such as aspirin,
warfarin (Coumadin) and clopidogrel (Plavix) should avoid these supplements. They may increase the risk of bleeding. Supplements chondroitin and glucosamine also may interfere with warfarin.
Ginkgo: Ginkgo may increase the risk of bleeding in patients taking anti-clotting medications. Ginkgo can counteract the blood pressure-lowering benefits of thiazide diuretic drugs. It also can interfere with anti-seizure medications."

This is why every Doctor should ask you if you take any Vitamins, supplements or over the counter meds. Unfortunately very few do. You should tell them if they don't. You should also notify your doctor if you add one.

VITAMINS AND SUPPLEMENTS. There are multiple vitamins and supplements that are available on the market. Actually, there are over 3000 uniquely different vitamins and supplements. During a nine-month period of time, I actually reviewed all 3000 of these in order to determine which ones have actual evidence that is peer reviewed and are blinded studies to confirm that these work. I had a second level that they had studies that were not necessarily blinded. Out of the 3000 supplements, there were actually approximately 120 that had more than one study that showed some form of efficacy whether it was blinded or not blinded. 25 of these substances either had such dangerous side effects that I eliminated from my ultimate list or that were not available in the United States in a dosage that was comparable to the dosage used in the study. Either the dose available in the United States was multiple; one is a magnitude larger or multiple others with magnitude smaller. I have therefore distilled this down to a list of 95 substances that had a hint of some level of efficacy. I have to say that for all but a small few there still is not enough data to say they are efficacious or safe. I do not recommend, unless you are having a specific problem that you are taking the supplement for, that you do take the supplement just to prevent the problem. There is no evidence for any supplement whatsoever that they can prevent you from developing a problem except for the ones which I am going to be listing below. The following lists of supplements are ones which, if you fit into the category mentioned, you should be taking these.

1.MULTIVITAMINS – Many adults should be taking a multivitamin because of the highly processed foods that we eat. However, if you eat a balanced diet you most likely do not need one. Many people who do not eat this balanced diet (40% carbs, 30% calories from fat, 30% of calories from protein with 8-12 portions of fresh fruits and vegies per day) do not get the minimal requirements of the full range of multivitamins. I actually recommend taking the senior types of multivitamins and this is because you want to keep down on the total amount of the vitamin A that you have. Vitamin A at 5000 per day will accelerate osteoporosis and the regular multivitamins, usually at 5000, where the senior has 2500 of vitamin A. So if your multivitamin has more then 2500 of vitamin A take it every other day.

2.B-COMPLEX – B-complex has multiple advantages and multiple studies that show it has advantages. Among women who were of child bearing age, it obviously gives them the folic acid (folate) that they need to prevent birth defects. There have been many studies that have shown that Folate actually does prevent birth defects. I recommend taking a B-complex 100 which has 100 mg of each of the B vitamins and then also has folate appropriately dosed. There are many studies that show B-complex reduces Homocysteine and that leads to a decrease in cardiovascular risk.

3.OMEGA 3 FISH OILS – The recommended dose is 3 g per days which is usually three soft gel capsules. This is very important to prevent atherosclerosis and stroke. It has actually been shown in patients who take this versus controls who do not, that you decrease by between 10% and 25% the incidents of heart attacks and strokes in these patients.

4.LUTEIN 20-40 mg – This has been demonstrated to prevent development of macular degeneration, the most common cause of blindness in the entire population followed closely by diabetes-related blindness. It actually has also been shown to reverse the early blindness caused by macular degeneration (in the higher dose). This should be taken by everyone over the age of 45 and should essentially be taken for the rest of your life to prevent macular degenerative blindness.

5.BABY ASPIRIN – The use of aspirin to prevent heart attack and stroke has clearly been demonstrated. There is still some controversy as to whether everyone should be taking this or whether only people at high risk should be taking it. My read of the research studies and my read of the literature indicate that I feel all adults should be taking a baby aspirin. Now, the actual dose is if you take a chewable form of baby aspirin, you take one everyday. If you take an enteric-coated form of the baby aspirin, you take two every day and you try not to take any aspirin for any other cause. Obviously, if you do have an allergy to aspirin or have intolerance to aspirin, you should not use this and you should check with your physician.

6.CALCIUM – Most people and particularly women, postmenopausal, and patients who are obese with a BMI over 35 need to be taking calcium supplementation. Fat and the change in hormonal balance in old women both seem to be contributory factors to loss of calcium. I recommend between 1500 and 3000 mg of calcium per day. The calcium should definitely have vitamin D in it. Note here about vitamin D, 70% to 80% of all adults not living in the Sun Belt are vitamin D deficient. If you have any problem with calcium metabolism, have osteopenia or your have osteoporosis, I strongly recommend that your doctor obtain a vitamin D level on you because that is probably the biggest cause of osteoporosis (pathologically decreased calcium levels in bone) and osteopenia (mildly depleted calcium levels in the bone). Some people might need mega supplementation with vitamin D to get them back to a therapeutic level.

7.GLUCOSAMINE – There has been a lot of discussion about glucosamine and chondroitin and as individuals or as combinations. I have looked at multiple different studies and the bottom line is that these do work. They do decrease joint complications. Every orthopedic surgeon who does total hip or total knee replacement says that every adult should be on glucosamine on a daily basis, although there is no research evidence that supports this position. However, if you do have any jont problems at all, then this is definitely supported by the medical literature to be one of either medication or the combination. Now, let me talk about which of the three forms you should take. I personally recommend glucosamine for multiple reasons. The typical dosage would be 1500 mg per day. There has not been any study that shows that chondroitin has better or worse response than glucosamine and there is no study that shows that the combination of chondroitin and glucosamine increases the efficacy of either one.
8.VITAMIN D – 70% of all children in the USA are vitamin D deficit and 15% serriously. The rate for adults is even higher especially if you live north of the Mason-Dixon Line. This is a vitamin you cannot take too much of. I recommend 2000 per day in summer months and 3000 per day in winter months.


  1. Wondering if you think D3 is more effective than D2? It is, according to my readings. I take 4,000 per day.

  2. Nice,and very informative article about VITAMINS AND SUPPLEMENTS