Supplements Do You Really Need Them?
Have you ever stood in the vitamin and supplement aisle and felt totally overwhelmed by the rows upon rows of bottles claiming to help with every malady? These supplements are regulated by the Food and Drug Administration as food and therefore the labels may claim some health benefits. However, if you’re getting what your body requires from the food you eat, then these supplements may not be necessary. We spoke with Shore Physicians Group Hospitalist Dr. Sridevi Yangala to learn more about vitamins and supplements, when you should take them – and when to leave them on the shelf.
Vitamins in the diet
Dr. Yangala says that deciding which supplements are necessary should be determined on an individual basis with each patient.
“Vitamins are organic compounds essential for normal metabolism. They need to be ingested in the body since they cannot be synthesized in the body, with the exception of vitamin D, which comes into the body with the help of sunlight as it is made in the skin upon exposure to sunlight.”
In her opinion, Dr. Yangala says a healthy adult who consumes a well-balanced diet that includes a variety of fruits, vegetables, grains, nuts and dairy products does not need to take a multi-vitamin. But if a patient prefers to take one multivitamin tablet, it is not a bad thing.
Vitamins, as Dr. Yangala explained, are classified according to their solubility and are fat or water soluble. The fat soluble vitamins are vitamins A, D, E, and K. The water soluble vitamins are C and B complex. Water soluble vitamins are eliminated from the body through urine. Fat soluble vitamins are absorbed along with fat in the diet and stored in the liver and fatty tissue.
More is not always better
Vitamin A is generally not prescribed in developed countries like the United States since we get enough of it directly from the foods that we eat, like milk, butter and eggs. But is taking more of a vitamin a good thing? Not necessarily according to Dr. Yangala. “There is some evidence that higher Vitamin A intake is a risk factor in osteoporosis and fractures. So for patients who consume foods high in Vitamin A, there is no need for them to take a Vitamin A supplement.”
Vitamin D is a commonly prescribed fat soluble vitamin that helps in maintenance of skeletal health, preventing falls and osteoporosis. It also helps the body’s absorption of calcium. According to Dr. Yangala, calcium levels as well as vitamin D levels should be checked in high risk individuals that include post-menopausal women, elderly patients, those with limited exposure to sunlight and patients who have a known malabsorption problem, such as those patients who have had gastric bypass surgery, and supplement accordingly.
The recommended daily allowance of Vitamin D is 600-800 IU per day. The American Geriatrics Society and National Osteoporosis Foundation recommend 1000 IU per day for people 65 and above. “Several studies show that there is a reduction in the risk of falls in the elderly following Vitamin D supplementation. The World Health Organization identified an association between Vitamin D deficiency and an increased risk of colorectal cancer, and also cognitive impairment in Alzheimer’s dementia,” said Dr. Yangala. “Recommended blood levels of Vitamin D is about 30-40 ng/ml. There is a risk of Vitamin D toxicity if the levels exceed 60-80 mg.”
When it comes to calcium, the daily recommended intake for individuals under the age of 65 is 600-800 mg. That amount increases to 1000 mg daily over the age of 65. Dr. Yangala said for women 50 and over and men over 70 it is recommended they take up to 1200 mg/day, including any calcium derived from their daily dietary intake.
She suggested patients look at their diet and see how much calcium they are getting and added, “There is no need for additional calcium supplements if they are getting adequate calcium via diet.”
Vitamin C may not cure the common cold but it is touted as protection against immune system deficiencies, eye disease and skin wrinkling, but again, too much is not a good thing. Dr. Yangala said that excess vitamin C can lead to kidney stones.
Vitamin B 12 is naturally found in animal products only. The only source for people on a vegetarian diet is the milk and fortified cereals. Deficiency causes anemia, neuropathy and gait problems. Vitamin B 12 supplementation is necessary in people on vegan diets as well as those who had bariatric surgery.
“We come across the word antioxidant in the health and nutrition world but most people do not know what they are. The most common nutritional antioxidants are Vitamin C, Vitamin E, and Beta Carotene,” said Dr. Yangala. She pointed out that “free radicals” is another buzz term in the world of health and nutrition that most people are not quite sure what they are. “Free radicals are formed in the body and have been linked to cancer and premature aging. The antioxidants neutralize these free radicals and prevent cellular damage.”
Get what you need from food
“I would not recommend supplements to my patients,” said Dr. Yangala. “My advice: eat plenty of fruits and vegetables, yellow and orange fruits and veggies, green leafy vegetables, citrus fruits, tomatoes, nuts, oils, fish, seeds and all types of berries.” She suggested getting antioxidants from certain flavonoids like cocoa and dark chocolate.
The few supplements that Dr. Yangala did suggest would be glucosamine and chondroitin daily because it has been shown to have positive effects in delaying the progression of osteoarthritis of the knee. She added that there is limited evidence that turmeric may provide some relief of osteoarthritis. Dr. Yangala did say that patients who suffer with anemia or a low blood count will benefit from supplementing iron and that alcoholics will often need to take a Vitamin B and possibly folic acid because many tend to not eat a balanced diet.
Nutrient rich foods
Dr. Yangala suggested that before reaching for supplements, there are foods readily available that should provide what the body needs to remain healthy. Get the iron needed to fuel your body from oysters, white beans, soy beans, dark chocolate, liver, lentils, spinach and sardines. Vitamin B 12 is plentiful in beef, liver, chicken, fish, eggs, cheese and milk. Get the recommended dose from green leafy vegetables, salmon, liver, eggs, and legumes like lentils, beans, and chick peas.
Dr. Sridevi Yangala is a Hospitalist with Shore Physicians Group at Shore Medical Center in Somers Point.