Vitamins, your opinions please

[Hepth]

I know a lot of people that take vitamins, and I myself have been thinking about it. I know I need more Iron, as for the past year I have REALLY cut back on my red meat, and although I eat a lot of dark green vegetables I don't think its enough. I eventually start to get more and more tired until I change my diet back or start taking iron pills.

I am wondering about everyone's opinions, not only in effectiveness but also in edibility. I can't seem to regularly take large vitamins, as about 50% of the time it turns in my throat (Centrum) and gets stuck.

I'm wondering if anyone has any experience with vitamin chewables or powders. There is so much binder and filler in the pills.

I'm looking for really maybe Calcium, Iron and Vitamin-D to increase their absorption rate. That's about it, with as little filler as possible. I'd rather it taste horrible and be chewable than some of these peanut sized pills that have no reason to be that large. I don't think I'm deficient in anything else. My wife's doctor recommended her to take something similar as her body has a resistance to iron absorption which causes hair loss if she's not taking it.

 

[Astronuc]

One could take multivitamins occasionally, and one could take the tablet with food and/or drink to avoid getting it stuck in one's throat.

One can get most vitamins and sufficient amounts from certain foods.

Quinoa has relatively high Fe, or otherwise beans, lentils, prunes and raisins, instead of meat.

http://www.webmd.com/diet/features/top-10-iron-rich-foods


Some folks overdo vitamins. Excessive vitamins are excreted and not beneficial. They should be consumed in moderation.

 

[Evo]

Before you assume you need iron, please have your doctor do a blood test to check for iron. I thought I needed iron due to being so lethargic, turns out I have too much iron and it was killing me, I now have to give blood to reduce iron levels since the body hardly excretes any iron. I have also stopped eating foods high in iron.

As long as you don't have health issues, a multi-vitamin with the RDA of vitamins and minerals should be ok, just stay away from those mega doses, those are something that should only be given by a doctor if there is a very specific reason.

 

[SteamKing]

If you find your vitamin pills hard to swallow due to their size, you might cut them in two. A lot of people have this problem.

There is a device known as a pill cutter which can be used to cut oblong pills into two parts along the scoring in the middle of the pill.

My neighbor had the same problem and she had one, but I'm not sure where she got hers.

Wait... Here, you might try some of these from the pharmacy, pill cutters and pill crushers:

http://www.walgreens.com/store/c/pill-cutters-and-splitters/ID=361561-tier3

 

[Student100]

It always amazes me at the number of people who take supplements or vitamins without first consulting a doctor for a vitamin deficiency profile. Before taking any supplement or multi-vitamin you should see a doctor. Every year while taking your supplements you should go in for a follow up, or every 3-5 years when you aren't.

There have been epidemiological studies that show vitamins are completely safe and the best thing since sliced bread. There are also epidemiological studies that show vitamins can kill you or otherwise shorten your life. Also, if you're a post-menopausal women you should never take iron supplements unless you're anemic and seen a doctor.

See a doctor, you might even save some money if he tells you that you don't need to take a multi-vitamin.

 

[Pythagorean]

Hi student. Could you provide sources for all the claims in your second paragraph?

 

[Evo]

I know he's right about post menopausal women.

But what about women who have gone through menopause? Should they take iron supplements?

Mayo Clinic's Dr. Richa Sood says, if they’re healthy, the answer is no. She says the majority of postmenopausal women who are healthy and eat an iron-rich diet don't need iron supplements and shouldn't take them. The reason is, with excessive ingestion there's a risk of iron buildup in the body. Although most women will simply pass the extra iron if they ingest too much, a small percentage can’t do that. Extra iron can buildup in the tissues such as the liver and joints and that can cause damage. So it’s best not to take iron supplements if you don’t need them.

http://newsnetwork.mayoclinic.org/discussion/should-postmenopausal-women-take-extra-iron/

And his suggestion that you see a doctor first is correct. But Pyth is right, we need to see the studies, that way people can understand the issues.

 

[Student100]

In older women, several commonly used dietary vitamin and mineral supplements may be associated with increased total mortality risk; this association is strongest with supplemental iron. In contrast to the findings of many studies, calcium is associated with decreased risk.

http://archinte.jamanetwork.com/article.aspx?articleid=1105975

Heme Iron associated with increased risk of type two diabetes in women, of which several supplements are derived from.
http://care.diabetesjournals.org/content/29/6/1370.short

Iron stores and CHD
http://archinte.jamanetwork.com/article.aspx?articleid=485095

There are literally thousands of articles, for every vitamin supplement that you can think of which both show a risk or decrease in mortality.

Simultaneous use of vitamins E and C was associated with a lower risk of total mortality (RR = 0.58; 95% CI: 0.42, 0.79) and coronary mortality (RR = 0.47; 95% CI: 0.25, 0.87).

http://ajcn.nutrition.org/content/64/2/190.short

Multi-vitamins reduce the risk of cancer in men:
http://jama.jamanetwork.com/article.aspx?articleid=1380451

Excessive use of multi-vitamins lead to advanced and fatal forms of prostate cancer in men:
http://jnci.oxfordjournals.org/content/99/10/754.short

No increase or decrease in mortality associated with multi-vitamin use:
http://aje.oxfordjournals.org/content/early/2011/02/21/aje.kwq447.short

Vitamin C and risk of coronary heart disease in women
http://content.onlinejacc.org/article.aspx?articleid=1132452

You can Google scholar if you want to read the thousand of sometimes contradictory epidemiological studies on supplementation.


With that said, epidemiological studies shouldn't be used as a definite proof of causative links between vitamin/supplement use and increased or decreased mortality. RCT's are a bit better. The science is good enough however to recommend that before anyone begins taking a supplement that they see a doctor.

Further, why buy something that you might not need unless you're aware of a deficiency? Taking vitamins blindly when most adults get what they need from their normal diet is only an exercise in burning money. If you have dietary restrictions or a condition which prevents proper absorbent of certain vitamins or minerals, then supplementation may be needed. There's no way to really know without consulting a doctor.

FDA information regarding supplementation: http://www.fda.gov/Food/DietarySupplements/UsingDietarySupplements/ucm110567.htm

 

[Pythagorean]

Thanks for the studies. I'm curious if you have any thoughts on the nature of the conflicts between claims that vitamins are harmless to claims that they affect mortality.

 

[Student100]

Thanks for the studies. I'm curious if you have any thoughts on the nature of the conflicts between claims that vitamins are harmless to claims that they affect mortality.

It would all be pure speculation, human physiology is complex.

I actually looked into a long time ago when I was trying to see what supplements would be good for my workout routine. A lot of the information out there is confusing and/or misleading. That's why it best to discuss these things with a medical doctor that's up to date on all the latest research. It's also good so they can be aware of any potential drug interactions a multivitamin may have with prescribed medication.

 

[Evo]

It would all be pure speculation, human physiology is complex.

I actually looked into a long time ago when I was trying to see what supplements would be good for my workout routine. A lot of the information out there is confusing and/or misleading. That's why it best to discuss these things with a medical doctor that's up to date on all the latest research. It's also good so they can be aware of any potential drug interactions a multivitamin may have with prescribed medication.

Exactly. Do not guess or try to self diagnose. Only blood tests can tell.

Hereditary hemochromatosis (he-moe-kroe-muh-TOE-sis) causes your body to absorb too much iron from the food you eat. The excess iron is stored in your organs, especially your liver, heart and pancreas. The excess iron can poison these organs, leading to life-threatening conditions such as cancer, heart arrhythmias and cirrhosis.

http://www.mayoclinic.org/diseases-conditions/hemochromatosis/basics/definition/con-20023606

Go to a doctor, demand extensive blood tests, regular blood tests do not test for these fatal conditions.

 

[verty]

Excessive use of multi-vitamins lead to advanced and fatal forms of prostate cancer in men:
http://jnci.oxfordjournals.org/content/99/10/754.short

Reading the results paragraph, the association is in men taking multivitamins more than seven times per week, that is, more than recommended. Of these men, the risk of prostate cancer was highest for those with a family history of prostate cancer and those who were taking individual supplements as well, for example, beta carotene and zinc. So men who are taking multivitamins more than seven times a week along with individual probably high-dose supplements are most at risk of these cancerous complications. And as usual there could be contributory causes: high-dose users are more likely to be poor and uneducated, more likely to smoke, will eat differently, there could even be a race connection if these mega users tend to fall into one racial group.

For example, cancer is more likely to progress further in poor populations, so the increased incidence of advanced and fatal cancers in these mega users may mean they were from poorer households and were thus less likely to seek medical help early. We also know this group is predisposed to self-medicate, so we might expect them only to seek help when it was truly at an advanced stage.

 

[Student100]

Reading the results paragraph, the association is in men taking multivitamins more than seven times per week, that is, more than recommended. Of these men, the risk of prostate cancer was highest for those with a family history of prostate cancer and those who were taking individual supplements as well, for example, beta carotene and zinc. So men who are taking multivitamins more than seven times a week along with individual probably high-dose supplements are most at risk of these cancerous complications. And as usual there could be contributory causes: high-dose users are more likely to be poor and uneducated, more likely to smoke, will eat differently, there could even be a race connection if these mega users tend to fall into one racial group.

For example, cancer is more likely to progress further in poor populations, so the increased incidence of advanced and fatal cancers in these mega users may mean they were from poorer households and were thus less likely to seek medical help early. We also know this group is predisposed to self-medicate, so we might expect them only to seek help when it was truly at an advanced stage.

Yeah that particular study only showed a negative correlation in taking more than recommend doses of multivitamins.

I've also read studies that suggest men who take multivitamins are more educated, wealthier and more likely to exercise though. I think most of these studies do post numerical fiddling to try to account for these factors. These studies aren't that great anyway, diets, vitamin adherence and other factors could all skew these results in statistically significant ways.

There were some meta analysis I read yesterday that suggested a review of studies showed predominately positive effects, with something like 4% of the studies correlating to an increase in mortality and 40% have no effect on patient heath after adjustments were made. Still, talking to a physician would be the best course of action.

 

[DrDu]

Thanks for the studies. I'm curious if you have any thoughts on the nature of the conflicts between claims that vitamins are harmless to claims that they affect mortality.

After having worked 5 years in epidemiology, I can say some words on this:
You have to read every study very carefully, not only the abstract, but especially the discussion. What kind of study is it? A fully randomized clinical study or epidemiology.

E.g., I had at random a quick look at this study:
Vitamin E and vitamin C supplement use and risk of all-cause and coronary heart disease mortality in older persons: the Established Populations for Epidemiologic Studies of the Elderly. K G Losonczy, T B Harris, and R J Havlik, Am J Clin Nutr August 1996 vol. 64 no. 2 190-196
which had been cited by Student100.
http://ajcn.nutrition.org/content/64/2/190.short

It is an epidemiological cohort study with a cohort size of 11 178. Sounds impressive. But if you read beyond the abstract and look at table 1, only 320 persons have reported use of vitamin E and only 76 of them have died in the study period. So in fact the study is quite small for the risk factor of interest.
Typically, a cohort study is planned so that there is some decent power to discover detrimental effects of not more than a hand full of mayor risk factors, but information on many more factors is collected. After data collection, all kinds of analyses are run on the data, after the main risk factors have been analyzed (and hopefully been published). I would suspect that the effect of vitamin E is such a secondary factor.

Now look at the medical history reported in the group "all E" and compare with group "none". Only 2.5% of vitamin E users self reported (sic) a previous stroke as compared to 6.1% in the group of non-users. With diabetes the comparison is similar (10.3 vs. 17.1 %). Although they tried to adjust for these factors, it is to be expected that the group of vitamin E users was generally more healthy (and perhaps avoiding other risk factors) than the group of non-users, which is what they say in the discussion:
"It is plausible that our results are due to confounding by other factors associated with vitamin supplement use, such as practice of better health habits and access to better health care by users compared with nonusers."

They write that their result is consistent with other studies. OK. Does it add much additional evidence? Probably not.

 

[lisab]

Hepth, gummi-bear style multi-vitamins are available now (at least in the US). If traditional pills get stuck in your throat, but your doc advises that you take them anyway, perhaps that could be an alternative.

 

[DrDu]

To me, taking vitamin mega doses seems to be some kind of pseudo-scientific superstition, which is quite widespread in the US but not so much in the rest of the world. This may be due to the strong influence of Nobel prize winner Linus Pauling, who propagated it.
In fact, hardly anyone in developed countries suffers from vitamin or mineral deficits. If you really think you have low levels of iron, get an analysis of your blood first.
I would also consider first other possible causes of fatigue, like e.g. thyroid hormone status.

If you really should have low levels of iron, and don't want to take big pills, there are also many juices and syrups which contain ferrous gluconate.

 

[Pythagorean]

My wife was prescribed iron during pregnancy, and in Alaska we were casually presribed vitamin D as there have been studues showing that D deficiency is common in the north due to limited sun exposure during the winter.

But none of this is based on blood testing, it was meant more as a preventative measure, I assume.

 

[Student100]

To me, taking vitamin mega doses seems to be some kind of pseudo-scientific superstition, which is quite widespread in the US but not so much in the rest of the world. This may be due to the strong influence of Nobel prize winner Linus Pauling, who propagated it.
In fact, hardly anyone in developed countries suffers from vitamin or mineral deficits. If you really think you have low levels of iron, get an analysis of your blood first.
I would also consider first other possible causes of fatigue, like e.g. thyroid hormone status.

If you really should have low levels of iron, and don't want to take big pills, there are also many juices and syrups which contain ferrous gluconate.

I think most people prescribe to the idea that "vitamins are good for you, so more is better", however, this isn't always the case. Supplements are a billion dollar industry in the US, and over 40% of the population take some kind of supplement; which is mind blowing when you consider most don’t actually need to be taking them.

 

[Ygggdrasil]

Nature just published a news feature on this topic that discusses this issue, and it echoes advice in this thread that vitamins are probably beneficial if you are deficient in a particular nutrient but are not beneficial (and can in some cases be harmful) if you are not already deficient in that nutrient:

Researchers at the Harvard School of Public Health recruited 672 health professionals with histories of benign colorectal tumours, a risk factor for colorectal cancer, to see if folic acid helped to reduce tumour recurrence. Half of the participants took 1 milligram of folic acid a day for between 3 and 6.5 years, and the other half took a placebo. The supplements had no effect when everyone was analysed together, but among the people with the lowest folic acid intake at the start of the trial, those who took supplements had a reduced risk of recurrence.

On the other side of the coin, several large trials suggest that over-consuming nutrients could be dangerous. The Alpha-Tocopherol Beta-Carotene Cancer Prevention Trial set out to see whether smokers would benefit from certain supplements. It turned out that those who took 20 mg of the vitamin A precursor β-carotene a day — 3 times the US recommended daily allowance for vitamin A — for 5–8 years were, in fact, 18% more likely to develop lung cancer than those taking a placebo. A potential explanation is that the breakdown products of β-carotene can, at high doses, cause cell proliferation.

These results illustrate one of the many complexities of nutrient metabolism. Nutrition scientists now recognize that risk curves are J- or U-shaped: nutrients have beneficial effects at low doses and toxic effects at high doses. The magnitude of the response differs, too, depending on where individuals start on the curve — their baseline status.

The article also discusses how it can be difficult to draw conclusions from the published literature because of many confounding variables in the studies (e.g. problems with self-reporting of diets, compliance with the treatments, and differing baseline intakes of the nutrients among study participants).