What to know before jumping on the vitamin bandwagon

Research has demonstrated that vitamins support general good health, recovery from illness and surgery and reduce the symptoms of chronic diseases such as hypertension and diabetes. But vitamins are not a replacement for healthy habits.

“Nothing replaces a good healthy diet, but we are finding that even folks who eat healthful, balanced diets are not getting the vitamins and minerals they need,” said Chris Kleronomos, a nurse practitioner and doctor of acupuncture and oriental medicine.

Kleronomos said that most healthcare professionals agree that there is solid evidence that many vitamins help with allergies, recovery from many diseases and support general health. The problem is choosing which vitamin, or combination of vitamins at what dosage, will be effective.

“There are literally thousands of choices and often conflicting information about vitamins, minerals and related supplements,” Kleronomos said. He cautions that many supplements contain active ingredients that can have strong effects in the body. Always be alert to the possibility of unexpected side effects, especially when taking a new product.

Kleronomos recommends the following guidelines.

Involve a pharmacist or healthcare provider in selecting vitamins and dosages. They should be aware of research that supports evidence of the vitamin’s effectiveness.

Select individual vitamins that support multiple mechanisms of the body, such as vitamin C.

Don’t buy vitamins or supplements from questionable sources; only use reputable brands or brands recommended by a trusted source.

Buy brands that are from reputable companies that specialize in vitamins and health supplements.

Look at the label, and make sure to buy supplements that have been tested for purity. The label will identify if fillers, artificial chemicals or serious impurities are present. Labels play a large role in the selection of in safe and effective vitamin supplements.

Buy at a trusted source, such as reputable established health-food stores.

Look for a reasonable price. Beware of vitamins and supplements that are either “bargains” or so outrageously overpriced that they break your budget. Asked a trusted source (your health provider or pharmacist about how much to spend on a recommended vitamin supplement).

Capsules versus tablets provide less of a chance of the vitamin passing directly through you. Powders such as for vitamin C work well, too, but don’t always taste as good.

How to take

Registered dietitian Leslie Belfanti said if remembering to take a vitamin is difficult, try taking it at the same time each day, keeping them where you consistently are at, such as at your desk at work. “Put your vitamins next to objects you will use everyday (toothbrush, on top of the dinner plates, etc.),” she said.

Most vitamins can be taken together without problem, Kleronomos said. Take vitamins with food, however, because they can cause nausea, particularly the B complex and magnesium, he said. “Several are better to take together, such as Vitamin C with iron, as it will help absorption of the iron. Calcium and vitamin D work together, as well. Probiotics ideally should be taken on an empty stomach, but the real key is consistency. The different strains of bacteria live in different locations in the body and for different lengths of time. It is a great supplement to take several times a day if traveling to avoid ‘travels diarrhea.’

Vitamins to consider

Women of childbearing age: folate, vitamin D, iron
Pregnant and lactating women: vitamin B6, folate, vitamin D, iron
People who consume less than 1,200 calories a day: multiple micronutrients
Obese individuals: multiple micronutrients
Infants, children and adolescents: vitamin D
People with dark-colored skin: vitamin D
Those who cover all exposed skin or using sunscreen whenever outside: vitamin D
Older adults: vitamin B12, vitamin D, zinc
Low socioeconomic status: multiple micronutrients
Patients who have had bariatric surgery: multiple micronutrients)
Patients with fat malabsorption syndromes: fat-soluble vitamins A, D, E, and K
Alcoholics: vitamin A, B vitamins
Smokers: vitamins C and E
Vegans and those with limited intake of animal products: vitamin B12, vitamin D, calcium
People whose diets are not adherent to the USDA’s food plate (the vast majority of Americans): multiple micronutrients

Source: Oregon State University Linus Pauling Institute Mirconutrient Information Center

The multivitamin debate

Kleronomos said to avoid multivitamins, that they are a “shot gun” approach to nutritional supplements, and it is hard to get that many nutrients into one tablet. However, Belfanti said while they won’t provide all the nutrients you need, they do give a boost to your nutrition without added calories. “It’s important to take a multivitamin when dieting,” she said. She added that lower-cost multivitamins are just as effective as higher-cost brand names. If multivitamins upset your stomach, she said, try taking the vitamin with food or before bed or take one without minerals.

Vitamins for different stages

Especially for women: Kleronomos recommends a calcium/magnesium combination for vascular contraction and vasodilatation, muscle function, nerve transmission, intracellular signaling and hormonal secretion. Calcium/magnesium also is recommended for Osseo Pena and bone-loss prevention. Kleromomos said to ask your healthcare professional about combining calcium/magnesium with vitamin D. Belfanti also recommended folic acid (a B vitamin) for all child-bearing females. “Everyone needs folic acid to help cells grow and divide. It protects against some birth defects and it may protect against heart disease,” she said. “Folic acid is needed during the first four weeks of pregnancy, when the baby’s brain and spine are forming. This is so early you may not even know you are pregnant.” She said all multivitamins contain enough folic acid to protect against birth defects of the spine and brain. For pregnant women, prenatal vitamins, particularly the folic acid and zinc, are important, Kleromomos said. Belfanti added that pregnant women need three to four servings of calcium-rich food sources a day. “If the woman is not willing or unable to consume this amount, a calcium supplement is crucial to protecting the mother from bone loss or tooth decay/loss; the baby will pull calcium from these areas in order to get enough calcium for growth.” She said calcium intake should not exceed 2,500 milligrams per day and that for best absorption, take no more than 500 mg of calcium at a time with meals, with the last dose at bedtime. Also, avoid taking calcium supplements with iron supplements, she cautioned. For women with heavy menses or those diagnosed with iron deficiency anemia, iron is important, Belfanti said. Because limited foods are high in iron, she recommended the following tips: When cooking acidic foods, such as spaghetti sauce, use a cast iron skillet to increase the iron in your food. Include a vitamin C rich food or juice with every meal to help absorb iron. Avoid drinking coffee, tea or milk with iron-containing meals or when taking iron supplements as they can decrease iron absorption. And avoid taking antacids or calcium supplements before eating an iron-containing meal or with an iron supplement.

During cold season: Vitamin D and zinc are both important during cold and flu season, Kleromomos said, as they help the immune system fight off invading bacteriaand viruses. Zinc also helps wounds heal and is important for a proper sense of taste and smell, he said.

Children: “Kids can benefit from fatty acids and D as well as C and zinc during cold/flu season,” Kleronomos said. “The body needs zinc to grow and develop properly.” He also said probiotics are key for children, and they have been shown to decrease allergies, asthma and skin disorders. Adolescents and teens have the highest need for calcium because this is the age where their bodies are forming the bone density (strength) that will carry them into adulthood, Belfanti said. “This age group needs to achieve the maximum bone density they can since adults continually lose bone density as they age.” Do not give adult iron supplements to children as they can be harmful, Belfanti warned.

Older adults: According to the Academy of Nutrition and Dietetics, as we get older, our bodies have different needs, so certain nutrients become especially important for good health. Older adults need more calcium and vitamin D to help maintain bone health. Many people older than 50 do not get enough vitamin B12, according to the academy. Fiber, which comes from fruits, vegetables, grains and beans, also can help lower your risk for heart disease, control your weight and prevent type 2 diabetes. “Our modern diets are really lacking in fiber, we all need more fiber to stay healthy,” Kleronomos said. Also, increasing potassium along with reducing sodium (salt) may lower your risk of high blood pressure.