Can a Vitamin-a-Day Help Keep the Doctor Away?

ATHENS, Ohio (December 20, 2000) -- An apple a day will keep the doctor away -- as long as it's part of a well-balanced diet, of course. But how about a multivitamin a day?

More than a third of all Americans take daily vitamin supplements, and studies show that these persons tend to be well-educated and follow other healthful behaviors such as exercising, eating fruits and vegetables and avoiding tobacco and excessive use of alcohol. These individuals swear by vitamins, convinced that the supplements are necessary to ensure good health and nutrition.

The medical profession though has been slow to endorse the use of multivitamin supplements. That position may be changing though. According to Robert Gotfried, D.O., a family physician and assistant professor of family medicine at the Ohio University College of Osteopathic Medicine, "the most important factor in nutrition and health prevention is eating a diet that is well-balanced and diverse. We should all strive to eat at least five to eight servings a day of fruits and vegetables and multiple servings of whole grains. Unfortunately, eating the right foods is not easy for many people. Many of us have inadequate diets and consequently benefit from the use of supplements to prevent deficiencies."

New RDA's Announced

The recommended daily allowances for vitamins and minerals, established in 1941, has recently been revised by an expert panel. For the first time in many years the panel recommended raising the values for a number of supplements, including both vitamin C and vitamin E. According to Dr. Gotfried, "these nutrients have antioxidant effects. The changes in recommended doses are partially in response to new evidence about the possible role of antioxidant vitamins in preventing heart disease, cancer, Alzheimer's disease and other major illnesses. In addition, it appears that antioxidants may have a role in treating these conditions as well."

Dr. Gotfried goes on to explain that, in order to understand the importance of antioxidants it is first necessary to understand the process of oxidation. "As the body burns fuel for energy, destructive oxygen by-products develop called free-radicals. These substances are also generated by factors like cigarette smoke and polluted air. In nature the process of oxidation causes metal to rust, or fruit to turn brown. In our body free-radicals have a damaging effect on our cells that may increase the risk of certain cancers as well as promote the development of coronary artery disease. Antioxidants like vitamins C and E, carotenoids and the mineral selenium in particular seem to be able to limit the effects of free-radicals."

Vitamin C is readily available from citrus fruits and juices, bell peppers, broccoli, hot chili peppers, green leafy vegetables, tomatoes and potatoes. Deficiencies typically develop in the elderly, alcoholics, cancer patients, and some food faddists. Recognizing the oxidative stress on cells caused by cigarette smoke, the Institute of Medicine in 1989 recommended that smokers consume additional quantities of vitamin C. The daily recommended intake (DRI) of vitamin C is 75 mg for women and 90 mg for men. Supplementation doses may be as high as 500 -1500 mg/day but probably should not exceed this amount.

Vitamin E is a fat-soluble antioxidant vitamin that helps prevent cell membrane damage and may inhibit oxidation of LDL cholesterol (a process that increases its harmful effect on arteries). It is found mainly in vegetable oils, sweet potatoes, avocados, nuts, sunflower seeds, soybeans and the fatty portion of meats. The RDA for vitamin E was revised from 15 IU/day to 30 IU/day. Dr. Gotfried comments that "this dose is still quite conservative for many nutritionally-minded physicians who often typically recommend doses of 400 IU or more. He adds "part of the challenge with vitamin E is that it is difficult to get adequate intake from food without significantly increasing total calorie and fat consumption, hence the need for supplements."

It is important to note that not all vitamin E is the same. "Vitamin E is available in a natural form called d-alpha tocopherol, and a synthetic form call dl-alpha tocopherol" says Dr. Gotfried. "The body utilizes the natural form much more efficiently and is the preferred form for supplementation."

Carotenoids are nutrients found typically in bright yellow and orange vegetables and fruits. There are several hundred naturally occurring carotenoids available through dietary sources. Examples include lutein, lycopene, and xeaxanthin among others. Vitamin supplements often include a synthetic ingredient call beta-carotene. According to Dr. Gotfried, "the medical literature has surprisingly demonstrated that supplements with beta-carotene may actually increase cancer rates, particularly in smokers. I generally do not recommend taking high dose beta-carotene supplements because of these findings. This is definitely a vitamin class that we are much better off getting from nutritional sources."

Selenium is a mineral that is widely available from meat and animal products. Plant sources may have variable levels due to inconsistencies in soils. "Selenium," explains Dr. Gotfried "is an antioxidant that may help protect us from a number of different cancer-causing chemicals and viruses." The recommended daily dose is 70 mcg/day, but supplementation can be as high as 200mcg/day.

Dr. Gotfried points out that two other nutrients deserve special mention, not because of their antioxidant benefit, but because of their documented benefit in preventing other conditions. Folic acid is a B vitamin that is actually the only vitamin that can claim an FDA indication for medical benefit. It is recommended for all women of childbearing age; its use in the early stages of pregnancy reduces the incidence of congenital spinal cord abnormalities. Scientists have noted that the average American gets only about 200 mcg/day from diet, however the recommended dose is 400 mcg/day. In addition to the noted pregnancy benefits, evidence is mounting that this B vitamin, along with B-6 and B-12, has the power to protect against heart disease by lowering homocysteine levels.

The other supplement that should be mentioned is the mineral calcium. As we age our bones can become depleted of calcium leading to the condition called osteoporosis. This is a condition that is much more common in women, but can also be present in men. The risk for osteoporosis can be diminished with the daily intake of supplemental calcium. The recommended dose is 1000-1500 mg/day of elemental calcium.

The Case for Supplements

"In an ideal world, everyone would get all the necessary nutrients from fruits, vegetables, whole grains and low-fat meat, poultry, fish and dairy products," says Dr. Gotfried, who advocates the integration of herbal, vitamin and nutritional supplements in the treatment plans for his patients. "In today's world of fast food and prepared foods," he said "the reality is that many Americans do not eat a varied, balanced diet, and do not get the nutrients they need."

Even those who cook and eat at home on a regular basis are likely to be working with highly processed ingredients like white bread or white pasta that have been stripped of many of their natural nutrients, and heat-treated oils high in trans-fatty acids that are irritating to our systems. The family farm has largely been replaced by the industrialized factory farm, generating high yields from soils that are becoming depleted of vital minerals. Our produce often spends several days in transport and storage, and as a result it becomes nutritionally depleted. "To make matters worse, we live in an environment filled with smog, tobacco smoke, pesticides and other pollutants that may be working to deplete our bodies of essential nutrients," Dr. Gotfried continued. "These factors all probably make supplementation a good idea." He goes on to note that, "relatively inexpensive and safe multivitamin formulations are available that include the full range of vitamins in combinations that ensure maximum absorption."

Dr. Gotfried said that while there are many options in multivitamins there are certain features that one should look for in a product. Slick packaging and fancy marketing terms like "chelated" or "stress-formula" do not guarantee a good product. Dr. Gotfried recommends choosing a product offering 100% of the RDA of vitamins and minerals. He also advises that it is important to find a "USP" stamp on the label. He explains that, " a USP label indicates that the product has been tested by the US Pharmacopoeia which is an independent organization that sets standards for vitamin and mineral products. Many vitamin products are manufactured in such dense tablets that they don't actually dissolve after being swallowed. Products are not required to submit for testing, but those products with the USP label can be relied upon to dissolve and be absorbed into our systems." He adds, " I have found that often the inexpensive store brands actually have USP stamps whereas the fancy brand names don't. It is not necessary to pay the higher price for special brand names."

Dr. Gotfried notes that the higher doses of vitamins C and E, and calcium he suggests require that they be taken as supplements in addition to a multivitamin. He reminds us to inform our physician of any supplements we may be taking. He notes, " patients may be afraid to tell their doctors about vitamin use. My advice is always to do so. Simply by informing your physician that you are taking vitamins will often initiate an open dialogue where you can comfortably discuss what you are using and whether there is any potential for interactions with prescription medications one may be using."

So What is The Bottom Line?

We should all strive to get as many nutrients as we can from dietary sources. A well-balanced multivitamin supplement though provides cheap, easy, low-risk health insurance, particularly for those of us with poor diets, high pollution exposures, and significant family history of medical conditions. We have to be prudent consumers and be willing to read labels of the supplements we consider. We also need to involve our physicians and keep them advised about any supplements we may be taking.