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.

Low Vitamin D: A Global Concern

Recent studies suggest that vitamin D is much more important in fighting off disease than previously thought. Being deficient in this vitamin puts one at risk of diseases such as cancer, osteoporosis, and multiple sclerosis. Chances are that if you live in a northerly geographic region you do not get enough vitamin D. Persons who live a rather sedentary lifestyle and do not get outside for at least a 15-minute daily walk in the sun are in the same position. Latinos, African-Americans and others with dark skin tend to have much lower levels of vitamin D, as do people who are overweight or obese. All around the world millions of persons suffer from vitamin D deficiency. This phenomenon is so common that it affects persons on every continent, of all ethnic groups, and across all ages. Some surveys suggest that perhaps half of the world’s population has inadequate blood levels of vitamin D. Sadly, physicians, even in industrialized countries, are seeing the resurgence of rickets, the bone-weakening disease that had been largely eradicated through vitamin D fortification.

As with most research findings, there is plenty of debate. Indeed, as opposed to what many people think, there are few certainties in science; its nature is to be open to criticism, discussion, and revision. The Institute of Medicine (IOM) released a report in November 2010 which recommends a daily vitamin D intake of 600 IU per day, for people ages 1 to 70, and 800 IU, for people over age 70—the report referred to persons living in the U.S. and Canada. The report also recognized the safety of vitamin D by increasing the upper limit from 2,000 to 4,000 IU per day, and acknowledged that even at 4,000 IU per day, there was no good evidence of harm.

Some in the scientific community believe the new guidelines are too conservative about the intake, and that they do not give due consideration to the latest findings about vitamin D and health. They contend that the new guidelines are not enough to prevent chronic disease, and they are not sufficient to help those who have problems with their bones. This is an important debate, and in order to understand it better it is necessary to know the origins of vitamin D and how it functions in the human body.

Vitamin D Sources and Function

Our body makes vitamin D and it is also a nutrient we eat. The body produces vitamin D from cholesterol, which itself is triggered by sun lighting on the skin. Yet many persons do not make enough vitamin D from the sun, persons with darker skin, those who are overweight, and persons who use products that block sunlight being among them. Correctly applied sunscreen reduces our ability to absorb vitamin D by more than 90 percent.

To be sure, not all sunlight is of the same quality and intensity: The sun’s ultraviolet B (UVB) rays—the so-called “tanning” rays, and the rays that trigger the skin to produce vitamin D—are stronger near the equator and weaker at higher latitudes. Indeed, persons who live in places prone to considerable cloudiness and rain can suffer from vitamin D deficiency. The other way we get vitamin D is to eat food that contains a lot of it. However, few foods are naturally rich in vitamin D, so the biggest dietary sources of vitamin D are fortified foods and vitamins supplements.

Vitamin D helps the body absorb and retains calcium and phosphorus, which are critical elements for building bone. Laboratory studies show that vitamin D can reduce cancer cell growth, can increase muscle strength, and can help control infections. There may yet be other functions for vitamin D, and scientists continue to explore the many other uses for this important substance.

New Vitamin D Research: Beyond Building Bones

Vitamin D research has proved to be of considerable fecundity. Although there have been many reports issued over the years, there are only a few that offer enough evidence to constitute a clear medical breakthrough. Here we provide the more promising areas of vitamin D research, highlighting the complex role of vitamin D in disease prevention—and the many unanswered questions that remain.

Vitamin D and Bone and Muscle Strength

A number of random trials have shown that high doses of vitamin D supplements help reduce bone fractures. A summary of the evidence comes from a combined analysis of 12 fracture prevention trials that included more than 40,000 elderly people, most of them women. Researchers found that high intakes of vitamin D supplements—of about 800 IU per day—reduced hip and non-spine fractures by over 20 percent, while lower intakes (400 IU or less) failed to offer any fracture prevention benefit.

It has been shown that vitamin D may also help increase muscle strength, which can help prevent elderly persons from falling, a common problem that leads to increased rates of disability and death among them. A combined meta-analysis found that taking 700 to 1,000 IU of vitamin D per day lowered the risk of falls by 19 percent; the combined studies also show that taking 200 to 600 IU per day offered no such protection. Based on this data, the International Osteoporosis Foundation recommends that adults over age 60 maintain vitamin D blood levels of 30ng/ml. This means that most people will need vitamin D supplements of at least 800 to 1,000 IU per day, and possibly higher, to reach these levels.

Vitamin D and Heart Disease

The heart, as a skeletal muscle, is a receptor of vitamin D. A number of studies have found that lack of vitamin D is linked to heart disease. The Health Professional Follow-Up Study observed the vitamin D blood levels in nearly 50,000 men who were healthy. They followed the same group for 10 years and found that men who were low in vitamin D were twice as likely to have a heart attack as men who had adequate levels of vitamin D. Other studies have linked low vitamin D levels to an increased of heart failure, sudden cardiac death, stroke, overall cardiovascular disease, and cardiovascular death. There is some evidence that vitamin D plays a vital role in controlling blood pressure and preventing artery damage. This goes some ways in explaining the findings above. However, more research is needed before a sounder conclusion can be made.

Vitamin D and Cancer

Nearly 30 years ago, researchers discovered an interesting correlation between colon cancer deaths and geographic location. They found that people who lived at higher latitudes, such as in the northern U.S. or Canada, had higher rates of death from colon cancer than people who lived closer to the equator. The sun’s UVB rays are weaker at higher latitudes, and in turn, people’s vitamin D levels in these high latitude locales tend to be lower. Researchers formed the hypothesis that vitamin D deficiency can lead to an increased risk for getting colon cancer

Some time has passed, but dozens of studies suggest a relationship does exist between low vitamin D levels and increased risks of colon and other cancers. The evidence is strongest for colorectal cancer, with observational studies have found that persons with lower vitamin D levels are at higher risk of getting such diseases. Vitamin D levels may also predict cancer survival, but there is as yet little evidence to support this. However, it is not yet certain that taking vitamin D supplements necessarily lowers the risk of contracting cancer. This latter idea will be tested in the VITAL trial. The VITAL trial will look specifically at whether vitamin D supplements lower cancer risk. However, it is likely to be years before the trial produces any results. Additionally, the VITAL trial could fail to detect a real benefit of vitamin D. There are several reasons for this. First, if people in the placebo group decide to take their own vitamin D supplements, the differences between the placebo group and the supplement group could be minimized. Second, the study may not follow participants for a long enough time to show a cancer prevention benefit; or study participants may be starting supplements too late in life to lower their cancer risk.

In any case, given the evidence now on hand, 16 scientists have circulated a “call for action” on vitamin D and cancer prevention. Given the high rates of vitamin D inadequacy in North America, the strong evidence for reduction of osteoporosis and fractures, the potential cancer-fighting benefits of vitamin D, and the low risk of vitamin D supplementation, these scientists recommend vitamin D supplementation of 2,000 IU per day. The Canadian Cancer Society has also recommended that Canadian adults consider taking vitamin D supplements of 1,000 IU per day during the fall and winter. They also recommend that people who are at high risk of having low vitamin D levels because of old age, dark skin, or geographic location take vitamin D supplements year round.

Folate and Cancer

Focus on Folate

One of the biggest breakthroughs in vitamin research was when researchers discovered that a woman with a deficiency in folate, a B vitamin, was at an increased risk of having a child with a neural tube defect such as spina bifida or anencephaly. In the past, it was unknown what caused these birth defects. Now it is understood that these neural tube defects occur in the very early stages of pregnancy, often before a woman even knows she is pregnant. This is because spinal cord development is one of the very early stages of fetal development.

Over 30 years ago, researchers in the UK discovered that women who had borne children with spina bifida had lower-than-normal levels of certain vitamins, including folate. During the course of two large trial studies in which women were given either folate or a placebo it was discovered that those who had been given the placebo had a higher incidence of having a child with a neural tube defect. Inversely, the studies showed that the women who had been given adequate levels of folate were less likely to have a baby with a neural tube defect.

For folate to effectively lessen the risk of having a child with a neural tube defect, proper timing is essential. For optimal effectiveness, the vitamin must be taken regularly during the first few weeks following conception, with neural tube development occurs. The problem with this is that many women do not even know they are pregnant until after this stage passes by, making it difficult to time taking the requisite amount of folate. To ensure that enough folate is taken, women of childbearing age who could become pregnant should take folate regularly, either on its own or as part of a multivitamin.

Women of childbearing age who themselves were born with a neural tube defect need to take particular caution. These women are at a higher risk of having a child with a neural tube defect and they will need to take a much higher dose of folate prior to and during the early stages of pregnancy. Although most women can take an over-the-counter folic acid supplement, women who have spina bifida or another neural tube defect will need a prescription-strength supplement that can only be obtained by way of a doctor’s prescription.

It may be tempting to assume that adequate levels of folate can be achieved through a healthy diet, but this isn’t always an easy task. Women should take at least 400 micrograms daily, which can be extremely difficult to get from the average diet. Fortunately, the United States Food and Drug Administration has mandated that folic acid (a form of folate) be added to products such as breads, pasta, rice and other enriched products. Since the government has mandated the fortification of products with folate, there has been a dramatic decrease in the incidence of babies born with neural tube defects, somewhere in the neighborhood of 25 percent.

Folate and cancer

Folate plays an important role in the building of DNA. These complex substances are what form the basis of our genetic blueprint, or one-of-a-kind (excepting identical twins) genetic makeup. Studies have shown that those who receive adequate amounts of folic acid from their diets and/or supplements for more than 15 years exhibit a lesser chance of getting colon cancer or breast cancer. Those who drink alcohol must be particularly careful, as alcohol in the system interferes with the proper metabolism of folate by the body. The protection offered by folate against breast cancer seems to be mitigated by those who have more than one alcoholic drink daily, moreover. A Swedish study supports these findings: That study indicates that the protection offered against breast cancer by folate is only applicable to those women who consume one alcoholic drink or less daily.

It is difficult to ascertain the true relationship between folate and certain kinds of cancer, however. It is a complicated relationship, particularly for those who are already at a higher risk for colon cancer. This is because those people who already have colorectal adenomas (polyps) are not further helped by the taking of folate. In fact, one study’s finding suggests that taking folate may actually increase the risk of those with polyps developing further growths that may be cancerous. However, it is very important to note that the participants in this study were taking a much higher than normal amount of folate than what is typically found in a standard multivitamin – about twice as much, in fact. This could be another instance wherein the timing of taking folate is the key. It may be that folate may prevent the development of polyps in those who don’t already have them, but that it also may speed up the development of polyp growth in those who already do have them.

The key in ascertaining any potential causal relationship between a vitamin supplement and cancer is understanding what cancer cells actually are. They are our own cells gone awry, not a foreign invader like a virus or bacteria. Cancer results from our own cells growing and dividing too rapidly. Because they are on “overdrive,” cancer cells require more nutrients than the rest of our cells do, which is why it seems that certain levels of various nutrients in the body can actually accelerate the growth of already-present cancer cells. This is why chemotherapy often contains nutrient antagonists (including folate antagonists) which are designed to combat the “feeding” of cancer cells by these nutrients.

As always, before taking any vitamin supplements for any reason, it is wise to consult your doctor. They will advise you what to take and how, and what to possibly avoid given your particular situation. Depending on your health needs and current situation, you may be instructed to bump up your intake of certain things or to avoid taking other things. The important thing is to get educated, to be open and honest with your health care professional and to be proactive about your health.

Use of Alternative Medicine

Alternative or complementary medicine, often referred to as integrative medicine, includes a broad range of healing philosophies, approaches, and therapies. A therapy is generally called complementary when it is used in addition to conventional treatments and alternative when it is used instead of them.

Use of alternative or complementary medicine has grown tremendously in the United States over the past decade. Some studies report that the percentage of Americans using alternative therapies rose from 34 percent in 1990 to 69 percent in 1998. Alternative therapies have become increasingly popular among patients with chronic illnesses, including cancer. Early pioneers, such as renowned oncologist O. Carl Simonton, introduced the idea that one’s state of mind could influence the ability to survive cancer.

In addition to the mind/body connection, alternative medicine encompasses a wide variety of modalities, including diet, vitamin supplements, herbs, Traditional Chinese Medicine, ayurveda, homeopathy, massage therapy, chiropractic, etc.

There have been a number of alternative therapies developed specifically for cancer treatment. One such treatment involves using antineoplastins, a naturally occurring group of amino acids, and is a relatively non-toxic therapy developed by Stanislaw R. Burzynski, MD, Ph.D. He administers this therapy at his Texas clinic.

According to Mitchell Gaynor, M.D., director of Integrative Medicine at the Strang-Cornell Cancer Prevention Center in New York City, the most common therapies used by cancer patients are usually a combination of both nutritional and mind/body treatments. “That can involve anything from vitamins and herbs to meditation, yoga, or body work such as acupuncture,” says Dr. Gaynor.

“In my experience,” he adds, “Which may be due to the nature of our center, most patients are doing both — conventional and complementary. We call it integrative therapy.”

Anticoagulants (warfarin) and vitamin K

Many people are taking anti-coagulants to reduce the risk of clots forming in the arteries, veins or in the heart. Doctors monitor a blood clotting test called the INR. In patients taking anti-coagulants it is important that the INR is within the ideal range (usually 2-4). Lower figures may cause clotting; higher levels increase the risk of bleeding. Usually regular blood tests are done to check the level, and the doctor will increase or reduce the warfarin dose to keep the INR in the desirable range.

Vitamin K can neutralize the effect of warfarin, and so if a person eats a lot of food containing vitamin K, or takes a supplement containing vitamin K, the action of the warfarin will be reduced.

Some foods which contain a lot of vitamin K include: avocado, broccoli, Brussels sprouts, raw cabbage, chick peas, green beans, green tea, liver, lettuce and raw spinach. If you overindulge in these it can lower the INR. It is best to try and eat a similar amount of these foods most days, so that they have a consistent effect on the INR.

Most good vitamin supplements contain vitamin K which could also lower the INR. This is where the quality of the supplement is very important. If the supplement is made to pharmaceutical standards when each tablet contains exactly the same amount of vitamin K, and if you take the supplement regularly then it will make a consistent change to the INR, so that the doctor can then increase the dose of warfarin to maintain a stable INR level. The supplement must not be stopped or there may be an increased risk of bleeding.

If, however, the supplement is made to food standards, as most supplements are, the variable amount of vitamin K in each tablet will have a chaotic effect upon the INR. So supplements containing vitamin K and made to food standards should not be used by people taking anti-coagulants.

Some good supplement companies can also manufacture products that do not contain vitamin K and so are much safer to use.

People on warfarin can take vitamin supplements, but it is safer to use those which contain no vitamin K.

Some other supplements (e.g. co-enzyme Q10) can have a small effect upon the INR, thus it is much safer for people taking warfarin to always to use pharmaceutical grade supplements.

What supplements should NOT include

There are two ingredients frequently found in supplements which can build up in the body and have toxic effects and so should NOT be included in a routine vitamin/mineral supplement. These are vitamins A and iron.

• Vitamin A: this is a fat-soluble vitamin and its levels can build up in the tissues causing skin problems, bone pain and fractures, nausea, vomiting and weakness. A good vitamin supplement will have beta carotene instead of vitamin A. If the body needs more vitamin A it can create it from the beta carotene, but if not then the beta carotene can be harmlessly excreted.
• Iron: this is frequently found in supplement tablets, and for most people it causes no problem. BUT one person in 300 has a condition called haemochromatosis which means that the iron will continue to build up in the body tissues. This especially occurs in the liver, pancreas and heart, leading to cirrhosis, diabetes and heart failure, and can be fatal. Unfortunately only a special blood test can confirm the presence or absence of haemochromatosis, so to include iron in a routine supplement could potentially kill or maim one person in 300.

Some people do need iron (for anemia), but it should be taken as a separate tablet, only after a blood test has confirmed that there is a need.