Supplements: Needed or Not?

Last Editorial Review: 10/1/2004

WebMD Live Events Transcript

A trip down the vitamin and supplement aisle can confuse even the smartest health consumer. How do you narrow down the choices? Which ones have been proven to work, and how do you know if you need them? We sorted through the supplements with WebMD nutrition expert Kelly Dorfman.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

MEMBER QUESTION:
I am considering purchasing some dietary supplements for daily use. The vitamins and minerals, in many cases, are listed as having up to 225% of the RDA (although in most cases it is about 100% or a little more). Is there a danger in taking more than the RDA (such as kidney or liver damage), or is this actually a recommended thing to do? Also, if there is documented medical evidence or other studies to back this up, I would love to see it.

DORFMAN:
It depends if you're talking about vitamins or minerals. Minerals are a separate case because you can excrete them easily. So for minerals, you want to stick to approximately the recommended dietary allowances.

For the vitamins, except for vitamin A, that's not as important. If you are a man, you want to make sure your multivitamin does not contain iron at all, because men cannot excrete it and it can tend to cause medical problems. B vitamins, if you take more than the recommended allowance, you urinate out the extra and this is generally not a problem, except with certain medical conditions.

There was a book written a number of years ago called The Right Dose , by Patricia Hausman, and this took several thousand medical studies and distilled them down to determine the safe dosing for supplements. This might be a good resource for you.

MODERATOR:
This reminds me of the trend of 'mega-doses' of vitamin C that was touted for a while. Are people still doing that? Or was it shown to be unhelpful, dangerous or both?

DORFMAN:
Some people are still doing it, and vitamin C has a unique situation, in that it will be actively absorbed until you don't need it anymore. At that point, it becomes passively absorbed and causes loose stool. Therefore, it is very difficult to become toxic in vitamin C, because you just get diarrhea and cannot absorb any more.

In an old study they found that up to about 3 grams of vitamin C in the blood improved immune parameters. So I think there still is some evidence that higher doses of vitamin C can be useful.

Many people, including myself, feel the recommended allowances for vitamin C are way too low. Humans are one of the few mammals that don't make vitamin C. (Guinea pigs are another!) So we need a lot more vitamin C. If you actually took as much vitamin C as you would make if you were a mammal of your weight that made it, it would be several thousand milligrams, which is one of the reasons higher levels are recommended.

MEMBER QUESTION:
Does green tea really have any effect on weight loss? It's added to my multivitamin and claims to speed the process.

DORFMAN:
I am not aware of any components of green tea, other than caffeine, that could shift metabolism. As a weight loss device, I'm dubious. There is, however, an antioxidant in green tea that has been found to help prevent cancer.

"Many people, including myself, feel the recommended allowances for vitamin C are way too low. Humans are one of the few mammals that don't make vitamin C. (Guinea pigs are another!) So we need a lot more vitamin C."

MEMBER QUESTION:
I've been living with chronic pain conditions for many years now and can't take the usual prescribed antidepressants (I've tried too many). I've heard about St. John's Wort and the use of magnesium and some others, but I find it quite confusing when told about dosages and brands that are not chelated. Any recommendations about where I could find info on the subject?

DORFMAN:
You need to see a healthcare practitioner for a condition that's this complicated, but you could certainly do more reading by checking out Burton Goldberg's Alternative Medicine Guides.

Concerning St. John's Wort, it looks like a mild MAO inhibitor, which stands for monoamine oxidase. MAO inhibitors are an old class of antidepressants that had a lot of side effects. So I would be concerned that if you have problems with many medications that this might cause problems also. There are other alternatives that don't work on these pathways that may be useful, but you will need professional help.

Another resource is a company called Neuroscience. They train doctors and practitioners to use nutritional supplements for neurological and pain conditions.

MEMBER QUESTION:
I have tried many brands of multivitamins with minerals and they all upset my stomach. I have now selected certain vitamins (B-Complex, C, E, folic acid, zinc, calcium). I wanted to know if my body was getting enough of the essential vitamins taking certain ones than a complete multivitamin?

DORFMAN:
It sounds to be like you are getting almost everything but iron, and iron is the component of multivitamins that most often causes stomach trouble. So it sounds to me like you've done a pretty good job of working out the problem. You may want to look for ferrous sulfate in multivitamins if you have stomach problems. It often causes constipation or stomach distress.

MEMBER QUESTION:
Since becoming menopausal, I have experienced dry eyes, nose, dry mouth, and my skin is dry. My doctor said to drink more water. I now drink eight 12-ounce glasses of water a day with no improvement. Would taking essential fatty acids help?

DORFMAN:
You may want to consider either ground flax seeds (which should be kept in the freezer) or flax seed oil.

Dry skin after menopause is often a result of diminishing hormones. Estrogen and progesterone are both steroid hormones. That means they come from fat. Secondary production of these hormones can sometimes improve by providing the raw materials needed to make them. So many women report that essential fats help ameliorate some of this dryness.

MEMBER QUESTION:
Does taking psyllium for part of one's daily fiber consumption affect vitamins or medications that one is currently taking?

DORFMAN:
In studies with fiber they found that people adjusted to a higher fiber intake, so I would say over time there should not be any appreciable problem. However, you should ask your doctor to double check about any medication that may have special interactions.

"A number of studies...found garlic could be useful in part of a balanced program for controlling hypertension and lowering cholesterol."

MEMBER QUESTION:
What about female libido enhancers like the ones from GNC?

DORFMAN:
You might want to ask your doctor about the use of small amounts of testosterone, because emerging studies have found this hormone to be important for women. It may also help bone density.

MEMBER QUESTION:
Kelly, my son is one of your patients. He recently had a bout with hives that lasted about a week. The only thing that I gave him out of the norm was a sip or two of Miracle 2000 dissolved in orange juice. Could the sea algae be the reason for the hives (by the way, they would come back at night in force, fading by morning and through the day)?

DORFMAN:
Hives occur shortly after exposure to something, within two hours, so it would have to be something he was exposed to very recently. The only way to test it is to stop the suspect items, both the orange juice and the vitamin, wait a week and re-introduce one, then the other.

MEMBER QUESTION:
Can lack of magnesium be linked to anxiety?

DORFMAN:
Possibly. Magnesium is the mineral that regulates the sodium potassium pump. If you remember your biology, the sodium potassium pump moves electrolytes so that you can send nerve transmissions. In magnesium deficiency the nervous system gets jumpy and you can have symptoms, like heart arrhythmia or eye twitching. Because of magnesium's calming effect on the nervous system, and because the average American diet tends to be low in magnesium, it is possible that supplemental magnesium could help some types of anxiety.

MEMBER QUESTION:
When taking calcium supplements you hear that it should be taken with vitamin D or magnesium to be absorbed properly by the body. Is this true for other types of vitamins that need to be taken conjunctly with another vitamin for better absorption?

DORFMAN:
There are many nutrient interactions, but in general nutrients are best taken with food because that's where they're found. Without going into a long lecture of all the nutrient interactions, my philosophy is that consistency is 9/10 of the law and taking your calcium with magnesium and vitamin D on a consistent basis is the most important thing.

MEMBER QUESTION:
Is the supplement 5-HTP safe?

DORFMAN:
5-HTP stands for 5-hydroxy tryptophan. Tryptophan is an amino acid. The body uses tryptophan to make the neurotransmitter serotonin. Normally you start with tryptophan that converts to 5-HTP, and then it is converted in the next step to serotonin. So you use 5-HTP to enhance serotonin for this reaction.

Years ago there was a contamination problem with tryptophan supplements and they were withdrawn from the market. They are now back as 5-HTP, and there have not been any contamination issues. The company that caused the tryptophan problem is now out of business, and there's no reason to think that 5-HTP will have the same problem.

The only problems associated with taking 5-HTP would be, in theory, those that would result from improperly increasing serotonin. So you must be sure that your doctor knows you're taking it, especially if you're taking serotonin-altering drugs, such as Paxil or the other SSRIs.

MEMBER QUESTION:
What is the difference between SAM-e and 5-HTP? Which is more effective for depression?

DORFMAN:
It depends on what the chemical basis of the depression is. Unfortunately, our technology for unraveling that is somewhat primitive, so mostly we use trial and terror. So 5-HTP works better for some, and SAM-e will work better for others.

MEMBER QUESTION:
Could you explain further your comments about taking raw materials to improve production of estrogen, etc.?

DORFMAN:
Estrogen is made from cholesterol, and most people are trying not to eat too many cholesterol-laden foods these days, but they are built on fats. So balancing fats may be useful in optimizing estrogen production later in life.

The adrenal glands are responsible for secondary estrogen production after menopause and they produce steroid hormones also, but many women in our culture stress their adrenal glands with busy, stressful lives. Sometimes this becomes more noticeable as we age and these glands aren't as flexible any more.

MEMBER QUESTION:
Do you recommend a person have a blood test that would specifically measure vitamin and mineral levels and check for deficiencies? It seems it is only when one has symptoms that one looks to supplement one's diet. I would like to know where I stand in order to minimize any nutritional deficiencies.

DORFMAN:
If only there were a test that could do that easily we'd all be ordering it, but there isn't a simple test. Part of the reason is because of the wide range of bio-individuality. So a level that would be normal for one person might be too low for the next.

The best vitamin tests are expensive, so to find an inexpensive broad test to look at a number of factors is pretty tough. Besides, those tests tend to only find severe deficiencies, and the question is whether you're trying to treat severe deficiency or optimize health. The "optimize health" situation is much trickier, but hopefully that's where most of us are operating. Most of us, at worst, have marginal deficiencies and they're hard to find with even the best tests. So that's why general nutritional supplements can be so useful.

MEMBER QUESTION:
I read where a taking garlic supplement is good for high blood pressure and lowering your cholesterol. Does it really work?

DORFMAN:
There were actually a number of studies that found garlic could be useful in part of a balanced program for controlling hypertension and lowering cholesterol. It's certainly safe enough.

MODERATOR:
Do you have any final words on choosing and using supplements for us, Kelly

DORFMAN:
I think that supplements can be used safely by most people without undue concern. You can make yourself toxic with nutritional supplements, but generally you have to work at it. The most important concern is the potential interaction with the more obscure supplements such as 5-HTP and medication.

One other important piece of information: If you are taking fish oils to lower heart disease risk you need to stop them one week to 10 days before any surgery, because they tend to increase bleeding time, which is good for lowering heart attack risk, but bad when you're recovering from surgery. They can be resumed 10 days after surgery if it's OK with your doctor.

MODERATOR:
Thanks to Kelly Dorfman MS, LN, LD, for sharing her expertise with us.



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