Are multivitamins Worth the Price?

Some individuals may be wondering if multivitamins are worth the cost and the effort. Not surprising when one considers all the bad press multivitamins are getting lately. For instance, in the Harvard Men’s Health Watch, published March of 2008, readers may have gotten the impression that most of the ingredients in multivitamins were not worth buying or ingesting. In the Nutrition Action Health Letter of June 2008, it was suggested that individuals only take multivitamins every two days and not everyday. What brought about this concerned buzz? Folic acid. Or to be more precise, the concern that people were getting too much folic acid because of the use of multivitamins.

So, what to do? Here is a good suggestion. Take a multivitamin on a daily basis, but cut down, or eliminate, consumption of fortified foods that can deliver a lot of folic acid to the body.

The Difference Between Folic Acid and Folate

Folic acid and folate are both in the family of B vitamins. The names they carry come from the Latin word for leaf—folium. Folate can be found naturally in vegetables, fruits, many types of grains, and several other foods. It is in a natural form at this phase. On the other hand, folic acid is the synthetic form. It is only available when it is added to different types of foods or when added to vitamin supplements. The important thing to remember is that folic acid will absorb more quickly but the body will still need to convert it to folate before it actually does any work.

Folate is essential in healthy cell function. It has the job of moving carbon atoms (along with the attached hydrogen and oxygen atoms) from one chemical compound to the next. This transfer is crucial to cell functions and that is why folate is so important. Folate is also crucial for making and repairing DNA. It also assists in the conversion process of amino acids, which are the foundation for proteins. Some of the best ways to get folate is to eat beans, sunflower seeds, various types of greens, fruits, and vegetables.

Starting the late 1990’s, folic acid was added to just about all enriched breads sold in the US. It was also added to rice, pasta, flour, grain products and cornmeal. It was added to these food products as a means of preventing spina bifida as well as anencephaly. These are birth defects caused (in part) when there is not enough folate in the mother at the time of conception. By adding folic acid to food products, folic acid was increased, on average, by 100 micrograms per day. This helped to reduce the number of US children who were born with a neural tube defect by an estimated 25 to 50 percent. Controlled studies also showed that folic acid helps to protect people from strokes. Some studies have also suggested folic acid may reduce the risk of heart disease as well.

The IMO (Institute of Medicine) has recommended that adults receive 400 micrograms of folate or folic acid per day. They recommend that pregnant women get 600 micrograms per day. The IMO often sets guidelines for both vitamins and other nutrients. It should be noted that the IMO also suggested that individuals NOT take more than 1,000 micrograms of folic acid a day if it comes from vitamin supplements or if it comes from fortified food. This limit does not apply to folate that is eaten via food intake.

While it may sound contrary, it has been shown that taking too much folic acid can actually hide B12 vitamin deficiency signs. Older individuals often suffer from this at the rate of about one in six. This is often because the elderly do not get the level of B12 that they need or it is not absorbed efficiently. It has also been shown that excessive folic acid levels can mask the signs of anemia. This is another of the early warning signals of vitamin B12 deficiency. If not treated in a timely manner, it could lead to health issues such as dementia, confusion, and severe damage to the person’s nervous system; some of which may be irreversible.

The above are just a few of the health issues associated with excessive folic acid levels. It is also known that normal levels will often help prevent early tumors, but too much folic acid can actually help tumors grow faster. Some other studies have reported that too much folic acid may be linked to an increased risk for various types of cancer such as breast, colorectal, and prostate cancer. It should be noted, however, that these reports and studies are somewhat limited and many other studies have not found a link between excessive folic acid and cancer.

It is not surprising that many consumers are confused over folic acid. In one major study, it was reported that fortifying with folic acid may cause a minor increase in colon cancer. Another equally major study, suggested that other causes may be at the root of colon cancer. And others debate that more effective detection methods for finding colon cancer are the reasons more cases were noted. It could be argued that since doctors are now more effective in locating colon cancer earlier, it is their work that has brought about the increase in colon cancer reporting and that folic acid has nothing to do with it. In fact, studies have shown that there is a lowered chance of colon cancer, as well as breast cancer, when folic acid or folate levels are increased.

It is known that with higher intakes of folic acid the body cannot convert it all into folate. How this may or may not affect the person’s overall health is not clear at this time.

When is Enough?

It is important that readers understand that getting too much of the folate form is not a problem. This form is found in foods and it is naturally balanced within that food. The body can easily take care of its absorption. Now, folic acid, on the other hand, can become a problem. Here is how that problem occurs:

Many of the foods that we eat everyday such as nutrition bars, breakfast cereals, and forms of fortified foods, can contain as much as 800 micrograms of folic acid. This is more than double what most people need on a day-to-day basis. Consider this: if a person consumes an average size bowl of the breakfast cereal Special K, they will get about 390 micrograms of folic acid. If that same person ingests a Nitro-Tech nutrition bar later in the day, they have addd another 800 micrograms of folic acid. And if they eat just one half cup of pasta later on, they can add another 85 micrograms to the total. As you can see, it doesn’t take much to get to and exceed the daily recommended upper limit of 1000 micrograms. And this is the upper limit as set by the IMO.

It is important to know when enough is enough when it comes to vitamin intake. And this applies to all vitamins and minerals. For instance, too much vitamin A can lead to a weakening of bones which can lead to bone fractures. Likewise, too much folic acid can lead to health issues as well.

On the other hand, it is also important to remember that we often do not get the needed amount of vitamins and folic acid that we require through food alone. Eating foods that are fortified with folic acid is one way to increase intake, but it must be done with common sense. Nothing is better than healthy food, but multivitamins and supplements can play an important role as well. This can be especially true for certain groups of people such as pregnant women, elderly individuals, those who do not have access to healthy food on a regular basis and others.

A sensible idea is to take a multivitamin every day and make it a habit to limit or eliminate foods that have been fortified above 100 to 200 micrograms of folic acid. This is one of the best ways to get the vitamins you need without going overboard.

B Vitamins and Heart Disease

Can B vitamins keep your heart healthy?

Sadly, the death of two young children who had died of massive strokes were the catalyst for a 1968 investigation. The Boston pathologist who investigated the death of the children found that they had extraordinarily high levels of a protein breakdown product in their blood. Both children’s arteries were blocked by cholesterol as well, resembling more closely the arteries of a middle-aged unhealthy person than those of a young child. These discoveries led to the hypothesis that elevated levels of this breakdown product (know as homocysteine) had contributed to the process of hardening of the arteries. This condition is called atherosclerosis. So, what is the connection between B vitamins and heart health?

Folate, vitamin B6 and vitamin B12 are instrumental in the body’s ability to convert homocysteine into methionine. Methionine is one of the 20 substances that help the body to build new proteins. Insufficient levels of any or all of these B vitamins can hamper the conversion process, driving homocysteine levels up. Sufficient levels of these vitamisn, on the other hand, can help to keep homocysteine at a safe level.

Many studies over the last few decades have shown that high levels of homocysteine can be associated with an increase in the risk of heart disease and stroke. Some studies have also shown that there is a causal relationship between high intakes of folate and the lower incidence of cardiovascular disease, hypertension and strokes. There cannot be a direct link made, however, between higher homocysteine levels and lower folate levels to an increased risk of heart disease. In other words, it cannot be definitely stated that lower homocysteine levels by taking more folic acid and other B vitamins will lower one’s risk of having a heart attack, stroke or other heart-related condition.

There have been several randomized trials involving B vitamins and heart health, but they have not conclusively shown any relationship between the two. In the studies adutl participants who had a history of heart conditions or who were in the upper risk categories for heart disease were given either a placebo or a pill that contained high doses of vitamins B6, B12 and folic acid. The result of the study was that taking the high doses of the three B vitamins did lower the levels of homocysteine present in the body, but that that reduction did not lead to a reduction in the number of cardiac events in the participants. There is some suggestion that the participants in this study were already too far gone in terms of heart health for the B vitamins to have an effect.

Recently, analysis of several studies seems to suggest that taking folic acid supplements can reduce the likelihood of a stroke in a person who had never before suffered a stroke. The risk reduction does not occur, however, in people who have already had a stroke. Further, folic acid was most effective in promoting heart health when combined with vitamins B6 and B12 as opposed to when it is consumed in isolation.

In the United States and in Canada, since the governments in those countries have mandated that certain products such as bread and pasta be fortified with folic acid, the rate of death from stroke has fallen dramatically. In the UK, where folic acid fortification is not yet mandated, there has been no significant change in the rate of death from strokes.

The long and the short of it is this: Folic acid supplementation may reduce the risk of heart disease in people who have lower levels of folate in their systems. This will typically include those people living in countries where folic acid fortification of food is not yet the rule. In countries where people already get adequate levels of folic acid from their food, further supplementation, even levels that are much higher than can be found in a standard multivitamin, has not been sufficiently shown to be of any significant benefit and, actually, may cause harm.

Currently, what constitutes a sufficient daily intake of B vitamins isn’t clearly defined. The definition would likely change over time anyway, as more data are collected from randomized trials. Currently in the United States, folic acid fortification of food has led to an increase in the percentage of adults who have adequate levels of folate in their systems. Still, only a small percentage of American adults currently get the recommended daily intake of all B vitamins derived just from their diets alone.

For Your Health – What is anemia

IT’S A COLD, dreary winter’s morning after the holidays, and it takes all your strength just to get out of bed, but it’s not just today— you’ve been feeling tired and run-down for more than a month. Unfortunately, fatigue is a nonspecific symptom that can occur for any number of reasons. One common cause is anemia. Here are a few things you should know about it.

What is anemia exactly, and how does it affect the body?

Anemia is a general term that refers to various conditions that affect red blood cells in a way that prevents the body from getting all the oxygen it needs, resulting in fatigue. This occurs any time there aren’t enough red blood cells with enough hemoglobin, a protein-based component of red blood cells that can properly hold on to oxygen. Symptoms of the common forms of anemia include tiredness, pale skin, trouble sleeping, dizziness, shortness of breath and fast heartbeat.

What are some common causes of the different types of anemia?

Red blood cells can be lost when a person has bleeding due to an undetected stomach ulcer, hemorrhoids, childbirth, heavy menstruation or some surgical procedures. One type of anemia is iron-deficiency anemia, where the body doesn’t have enough iron to make hemoglobin. The body also needs folic acid and vitamin B12 to make hemoglobin. Those who do not get enough meat or vegetables in their diet can sometimes be low in one or more of these three things.

If my doctor advises me to take iron supplements, what should I know about them?

The first thing to know is that iron is a metal and can be toxic at doses higher than recommended. Iron supplements come in different salt forms that each contain a different amount of elemental (actual) iron and are most easily taken orally as tablets. It is important that your doctor tell you how much elemental iron is being recommended so that when you go to the pharmacy counter your pharmacist can help you choose the right one for you.

Often, a doctor may recommend taking iron at a higher dose for three to six months to get the total body levels corrected, and then at a much lower regular dose or discontinued altogether based on blood-test results.

Iron supplements are absorbed into the body best on an empty stomach accompanied by some acidic juice, such as orange juice. Most stomach upset can be reduced by increasing the dose slowly to the prescribed dose and constipation can be managed by drinking plenty of water.

Where can I learn more?

In addition to whatever information your doctor, primary physican or pharmacist can provide, there are a number of valuable sources on the Internet. Two good ones are:
• National Anemia Action Council, www.anemia.org
• Keep Kids Healthy, www.keepkidshealthy.com

Research on A Risk Factor for Stroke

British researchers attempted to shed some light on an amino acid in the blood long suspected as a risk factor for stroke.

The study results suggest people who carry a gene that produces a higher level of the amino acid homocysteine have a small increased risk for stroke. If confirmed by other studies, the finding could lead to treatment with folic acid and vitamin B, which are known to reduce homocysteine levels in the blood.

The research involved a review of the medical literature on homocysteine levels and stroke. Most of the work so far, report the authors, has been observational in nature. Therefore, investigators question whether the link between stroke and homocysteine levels might be influenced by other factors also known to cause an increase in stroke risk, such as smoking and lower socioeconomic status.

The authors of this study used a standard scientific approach to weed out the confounding factors by looking at data on the link between homocysteine and gene variations that cause people to have higher or lower levels of the amino acid in their blood. They compared risks from observational studies with those from the gene-based studies to arrive at their findings.

Other researchers writing in a commentary in the same issue, however, say it’s too soon to say the gene variation causing higher homocysteine levels is really to blame for an increased risk of stroke in that population, noting the gene variation itself may also affect behavioral or socioeconomic factors that could be increasing the stroke risk.

Both the study authors and the commentators agree more study is needed before doctors should begin prescribing folic acid and/or vitamin B for people with higher homocysteine levels.

SOURCE: The Lancet, 2005;365:224-232,194-195

New Insight Into Cardiovascular Disease

A seldom-measured amino acid that is circulating in your blood may be an indication of cardiovascular disease. It is called homocysteine, and an increasing number of physicians and researchers are acknowledging that high levels of the chemical are associated with heart disease and stroke.

A summary of 15 studies revealed that elevated homocysteine levels produced a 70 percent increase in the risk of coronary artery disease and a greater risk for stroke. Previous studies have shown connections with schizophrenia, Alzheimer’s disease, hypothyroidism and anemia.

However, the evidence is not conclusive. “Five other studies found no link between homocysteine and cardiovascular disease,” says Oklahoma City internist Dr. E. Randy Eichner, a member of the Editorial Board of The Physician and Sportsmedicine, “but six studies did find a relationship. I think the balance of scientific evidence favors a homocysteine/CAD link.”

Atlanta cardiologist Dr. John Cantwell agrees with Eichner. “I recognize it as a possible risk factor, but the only time I measure it is when a person has a family history of heart disease without the more obvious risk factors.”

Dr. M. Rene Malinow, professor of medicine at the Oregon Health Sciences University and one of the nation’s leading homocysteine researchers, says we don’t yet know for sure that it is a cause of atherosclerosis. “We will have to wait for the results of clinical trials, and that could take several years.” Adds Malinow, “Although it is a relatively new risk factor by itself, it is possible that a high homocysteine level combined with traditional risks, such as hypertension or smoking, is even more significant.

Even those who think homocysteine is related to heart disease are not sure why it may have a harmful effect. One theory is that, in elevated amounts, it irritates the inner lining of the arteries and could cause blood clots to form. There is even a possibility that homocysteine levels increase after a stroke, not before.

Prevention

The good news is that a high homocysteine count can be prevented or treated by getting adequate amounts of folic acid (folate). Cantwell tells patients who have high levels to take 0.4 mg of folic acid per day, as well as a multivitamin supplement that includes B6 and B12. A high intake of folate by itself can mask other medical conditions, including a type of anemia.

The U.S. Food and Drug Administration has mandated that all enriched grain products be fortified with folate. Check the labels on cereal boxes. Most of them provide 25 percent of the daily folate requirement and many contain 25-35 percent of daily vitamin B6 and B12 needs. If you are eating a well-balanced diet, you probably don’t need the supplements.

Screening

Homocysteine screening is not very common. The American Heart Association is taking a very conservative position on the issue, saying that it’s too early to recommend general screening. Cantwell points out that the one-year cost of a folate and multivitamin supplement is approximately equal to the cost of a screening test.

Americans are well informed of the risk factors associated with heart disease. Sooner or later, a new one — elevated homocysteine levels — may be added to that list.

Folate is also good for unborn babies.

Folic Acid for Stroke

Cholesterol may not be the bad guy everyone thinks it is. Another substance in our blood seems to cause more harm to our arteries.

When real estate agent Liz Scotney suffered a mild stroke last year, it brought back frightening memories of her father’s final years. “He had, you know, lots of strokes where he was very disoriented and all that kind of thing,” said Liz.

Dr. William Feinberg is a neurologist who wants to protect people like Liz from future strokes. His weapon? A B-vitamin called folic acid.

William Feinburg, M.D., neurologist, University of Arizona, Tucson, Ariz., “Low intake of folic acid is associated with an increased risk of heart disease and stroke. We think that this is through an amino acid in the blood called homocysteine, which damages the blood vessels and makes atherosclerosis more likely.”

Dr. Feinberg gives stroke victims high doses of folic acid and vitamins B-6 and B-12. These vitamins are proven to prevent the buildup of homocysteine.

William Feinberg, M.D., “We hope that by giving more folic acid and lowering homocysteine, we can decrease the risk of heart attack and stroke.”

Liz says the vitamins give her hope that a second stroke will never happen. “If I can be helped not to have another stroke, that’s all I care about.”

Dr. Feinberg says screening for homocysteine may one day become as routine as having your cholesterol checked.

This study is a four-year trial involving 36 U.S. medical centers and 36-hundred patients who have suffered mild, non-debilitating strokes.