Neal Shanblatt, MD

Vitamins and Supplements
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What should I be taking?

People often ask what vitamins and supplements they should be taking.  It would certainly be great if we could maintain our health with something quick and easy like a vitamin or supplement.  The reality is, however, that the best way to maintain good health is with a nutritious diet and regular exercise.  Rather than spend money on more pills, invest the time and effort to cultivate good health habits.  Some supplements have benefits, but many popular ones are not worth the cost.

Supplements are not tested or standardized, and they can have side effects, so let Dr. Shanblatt know which ones you are taking.

Information about common vitamins and supplements (listed alphabetically):

Calcium:  We need calcium to keep our bones strong, but how much to take and whether taking a supplement significantly reduces the risk of fracture is still debated.  You probably need about 1000mg of calcium daily. Some recent studies indicate that calcium supplements may promote plaque build-up in the heart, so it's better to try to get your calcium from food sources (non-fat dairy products, canned salmon and sardines, and vegetables like spinach, chard, and collard greens are good sources).   If you can't get enough from your diet,  a supplement may be helpful.  This is especially true for post-menopausal women who tend to have weaker bones.  Calcium carbonate needs stomach acid to be absorbed, so it's best to take it after a meal.  If you are taking an acid-suppressing medication, take calcium citrate instead, which is absorbed better even without food or stomach acid.  Smaller doses of calcium spread througout the day are preferable,  since higher amounts are not absorbed as well, and may cause more plaque in the heart.  Besides calcium, vitamin D and regular exercise are important to keep your bones healthy.  

Colon and Liver cleansers:  Growing in popularity, these supplements and spa treatments have little proven benefit.  If you want to cleanse your body and your colon, increase your fiber intake and drink more water.  If you suffer from chronic constipation, discuss it with Dr. Shanblatt.

Co-Q-10  Thought to have some heart benefits, especially for those taking statins, this supplement has not been shown to be helpful in some recent studies.  The evidence is still felt to be inconclusive.

Fish oil and omega 3:  These supplements improve heart health and lower cholesterol.  Adding fish (like salmon) to your diet twice a week is a good way to get the benefits of omega 3 oils.  Too much fish can espose you to mercury, so don't overdo it.   If you are at risk for heart disease, consider a fish oil supplement.  Take about 1g daily of fish oil that contains both  EPA and DHA oils.  Ground flaxseed or flaxseed oil is another good way to get more omega-3.

Folic acid: Women who might get pregnant should take 400mg daily of folic acid to reduce the risk of certain birth defects.  Pregnant and nursing women need more.

Glucosamine and chondroitin:  Some people find these helpful for arthritis. The evidence in inconclusive.

Grape seed extract: Contains anti-oxidants that may help fight heart disease, diabetes, and cancer.  More research is needed.  Most anti-oxidant supplements have been shown to not be helpful.  Eating more fruits and vegetables is a better bet.

Multivitamins:  If you are eating a well-balanced diet, you do not need a multivitamin.   If for medical reasons, you cannot eat a balanced diet, discuss with Dr. Shanblatt what supplements you might need.

Phytosterols (plant stanols and sterols):   These supplements are plant derivatives that help lower cholesterol.  They can be helpful for mildly elevated cholesterol, but it’s hard to ingest enough to make them really useful

Red yeast rice:  This supplement helps lower cholesterol because it contains a low-dose natural “statin” as its active ingredient.  If you take red yeast rice you should have your liver function tested and watch out for side effects like muscle aches.

Resveratrol:  Found in grape skins and wine, this substance is reported to possibly fight heart disease, prevent cancer, and extend life.  Some animal studies look promising, but it too soon to see if resveratrol is really helpful for humans.

Saw palmetto:  useful for men with early signs of enlarged prostate, like frequent urination or nighttime urination.

Selenium: Supplements of Selenium offered no benefit in large studies.

St. John’s Wort:  This supplement has mild anti-depressive properties but it does not seem as popular as in the past.

Vitamin B:  Studies of vitamin B6 and B12 showed that they did not help the heart.  B12 shots for fatigue, once very popular, are not likely to help, except possibly by placebo effect.

Vitamin C:  A large body of evidence shows that vitamin C supplements have little benefit.  When taken daily, Vitamin C may help slightly shorten the duration of colds.

Vitamin D:  Deficiency of this vitamin is more common than previously thought.  At least 400 units are recommended daily, and some people need more.  If you are not out in the sun much (10 minutes daily without sunscreen), and you are not eating vitamin D enriched foods, you should take a supplement.  Varying doses are recommended (400-1200 units daily).   We are now commonly checking vitamin D blood levels for people we suspect might not be getting enough.

Vitamin E:  Once thought to be a helpful anti-oxidant, Vitamin E did not offer any benefit in several large studies.  There was some evidence of increased cancer rates in some patients taking large doses of vitamin E, but this finding has been called into question.

Wine:  Drinking one glass of wine daily (especially red wine) is good for your heart.  Larger amounts of alcohol can be harmful, so caution is advised.

Zinc:  The most recent studies show that zinc does not help the common cold.