Things that both Patients and Doctors need to know about Vitamins and Supplements
A recently published clinical guide on vitamin and mineral supplements strengthens all other evidence-based guidance, research review, and consensus on this issue. The bottom line is that a well-balanced diet, which is the ideal source of the vitamins and minerals we need, is not replaced.
The short article, jointly written by nutrition guru Dr. JoAnn Manson, quotes several large clinical trials that investigate the effects of multiple nutritional supplements on various endpoints. The nature of this is that our bodies prefer natural sources of vitamins and minerals. We better absorb these. Because vitamins, minerals, herbs, and others available on the market are combined as “supplements,” the FDA does not regulate them. When we ingest “supplements,” which have been processed, concentrated, and artificially packaged, we can harm ourselves. They may be harmful, ineffective, or polluted (all not unusual).
In other words, most people eating a healthy diet probably won’t benefit from nutritional supplements.
Take note of the essential qualifications. Most of us (not all) are talking about eating a healthy, well-balanced diet.
Does anyone need vitamin and mineral supplements? Well, yes
Medical conditions are present that place people at high risk of certain nutritional deficiencies, and specific dietary supplements may treat medical conditions. This is important, and the authors support this targeted addition. But who needs what and where to get these discussions are relevant.
Guidelines are available for different groups, such as pregnant women. Folic acid is particularly essential for healthy fetal development and spinal Bifida, a neurological condition, can be caused by deficiency. I advise my patients, ideally before they start conceiving, to start a prenatal vitamin with folic acid, or at least folic acid itself. As pregnancies progress, mom must provide everything to her growing fetus. Thus she will benefit from a prenatal vitamin (both prescribed or a well-vetted over-the-counter) that contains iron and calcium.
Older adults can have difficulty absorbing vitamin B12. When I check this level, I have a low threshold; it is very probable that if someone takes an acid reduction medication, they will become weak with B12 and iron, vitamin D, and calcium, among others. These people can benefit very well from a quality multivitamin.
There is, of course, a long list of medical problems that predispose people to vitamin deficiencies. For instance, weight loss operators require a variety of supplements, including vitamins A, D, E, K and B, iron, calcium, zinc, copper, and magnesium. People with inflammatory bowel disease (such as Crohn’s or colitis ulcerative) can have similar requirements. Vitamin D may significantly benefit people who are or are at risk of osteoporosis and can also benefit from calcium supplements depending on the nature of their diet and other factors.
Additional medical conditions can be treated with supplements. I think of inflammatory arthritis (or other inflammatory conditions) and turmeric immediately. There are several minor studies as well as history shows that turmeric has anti-inflammatory properties. However, quality scientific studies are missing, and I see that a few of our rheumatologists regularly prescribe this to patients for pain relief. Then there are prediabetes/diabetes and cinnamon that have lowering effects on blood sugar. With these compounds, I suggest that people use daily spices instead of processed/concentrated packaged supplements in their usual food quantities.
Not all vitamins are created equal
Here is another essential point that repeats: Manson recommends selecting vitamins tested by independent laboratories such as US Pharmacopeia, Consumer Lab, and NSF International, which have been verified as the appropriate ingredient in the labeled dose and which do not contain contaminants or polluting species. Many commercially available supplements from one of these laboratories in the USA will carry a label.
Gum vitamins are often not certified in this respect and often cause cavities. Yeah, everyone loves them, because necessarily they ‘re sweets. I recommend rubber vitamins for nobody, but not for pregnant women in particular.
I will also add a warning: I often hear about providers who directly sell their patients supplements or other products. That is a conflict of interest, and it is both immoral and full of all sorts of problems. Please be careful if you buy something directly from the prescribing provider.
The bottom line
In summary, enjoy a varied, colorful, and healthy diet, consider supplements if necessary, and carefully select your sources.