ASK THE DOCTOR: MULTIPLE CHOICE - End vitamin confusion - less is better
By DR. JIM MITTERANDO
The Patriot Ledger

Q. I do not know which vitamins I should take. I hear antioxidants are good but now read that vitamin E is not safe. What do you recommend?

A. Don't overdo vitamin consumption. Recent reports on benefits and harms of vitamins have created some confusion. Many people think if they load up on vitamins they'll be healthier. Aggressive and false marketing of vitamins attributing increased energy, strength or longevity led to people consuming handfuls of vitamins without any supporting long-term studies.

Studies show people whose diets are richer in antioxidants - vitamin C, vitamin E and beta carotene - have lower risk of heart disease and cancer. This led to the idea that ‘‘more must be better,'' which fueled the popularity of mega-dose, antioxidant supplements in the 1990s. In fact, recent studies have shown high doses of the antioxidant vitamins may increase the risk of some cancers and heart disease and should be avoided. Furthermore, vitamin C does not help prevent or fight a cold as commonly believed.

— Take home message: Avoid vitamin C, E, and A supplements. The amounts in a multivitamin are much smaller and considered safe.

Vitamins do not substitute for a healthy diet but rather complement it. The benefits of a well-balanced diet exceed what you can get from a vitamin alone. Eating at least five servings of fruits and vegetables provides thousands of natural, beneficial nutrients that ensure good health. Unfortunately, most Americans do not meet this goal.

Multivitamins will not make up for the sins of an unhealthy diet. But they can fill in the nutritional holes for adults and children who do not meet their nutritional needs.

Multivitamins also are useful in pregnant women to help prevent birth defects, breastfeeding women to ensure adequate nutrients for mom and infant, and people over 50 who do not absorb vitamin B-12 as well and also may be vitamin D deficient.

With antioxidants losing their appeal, B vitamins (especially folate, B-6 and B-12) are getting a lot more attention. They have never generated the hype like vitamin E and other antioxidants, but they may reduce clogging of arteries by reducing homocysteine levels. Long-term studies are still needed to prove this claim.

Multivitamins supplement up to 100 percent of the daily recommended vitamins providing safe quantities and avoiding mega-dose levels. I recommend the generic, store brands of multivitamins. The high-cost brand names have no added benefit. Special vitamin formulations for different age groups or genders are based more on marketing rather than science. Vitamin manufacturers may tinker with an individual vitamin level such as B-12, change the label and claim unique benefits for seniors or women.

Avoid vitamins with iron unless directed by a doctor. Excessive iron can be harmful and some people harbor a predisposition to accumulate iron in their liver and organs that causes damage. People wrongly blame fatigue on anemia. Most fatigue has no relation to anemia and is not cured by iron supplementation.

Vitamin B-12 is only found in animal derived foods. Vegetarians can get adequate B-12 if they consume dairy products, eggs or B-12 fortified cereals or soymilk.

Alcohol interferes with the metabolism of folate. People who drink daily should consider a multivitamin because it provides extra folate.

Multivitamins can contain vitamin K that will interact with the blood thinner warfarin (Coumadin). People who take Coumadin may consider finding a multivitamin without vitamin K or one with small amounts that is taken regularly to avoid fluctuations in the INR blood test.

Regular use of medications that reduce stomach acid such as antacids (Tums, Maalox and Mylanta), Zantac or Prilosec can decrease absorption of vitamin B-12. The diabetes pill, metformin (Glucophage), also can decrease vitamin B-12 absorption. If you take these medications, you should consider taking a multivitamin.

Dr. Jim Mitterando is a family doctor at Cohasset Family Practice and a staff member at South Shore Hospital in Weymouth.

Readers should send questions to: Ask the Doctor, The Patriot Ledger, P.O. Box 699159, Quincy, MA 02269-9159, or by E-mail to his attention at features@ledger.com.Questions of general interest will be answered in this column. The information in this column is not intended to diagnose individual conditions, and individual replies are not possible. Readers should see their own doctors about specific problems.

Copyright 2005 The Patriot Ledger
Transmitted Tuesday, April 12, 2005