What Vitamins Should I Take Doctor?

Published April 6, 2002 in the North Island Weekender

We can answer this question with a much more informed answer now than we could ten years ago. Considerable new research both clinical and experimental has given us this information.
Folic acid we all know now, if at low levels before and during pregnancy and during significantly increases the risk of various types of birth defects including the most common, neural tube defect.  There is also an association of low levels of folic acid and an increased risk of heart disease, stroke, diabetes, arthritis and bone mineral metabolism. 20% of the population has a deficiency of an enzyme MTHFR that makes them less responsive to folate in their diet. Some people are also poor absorbers of folate in the gut so there is a decrease of folic acid absorption across the gastrointestinal membrane. This nutrient is certainly on the list and the evidence exists that supplemental folate appears to be preferable to a food form, in increasing the levels of plasma folate and improving physiologic function. If someone says food sources of a nutrient is always preferable to supplements, this is a case where the evidence suggests that supplemental folic acid and its various forms are preferable to food sources. High serum folic acid levels are associated with lower risk of colon and breast cancer. Dosages may vary depending on the individuality of the person, 400mcg may be enough to keep the homocysteine (see my Dec 29, 2001 article on heart disease) levels within normal limits, but dosages much higher than that may be required to reduce the risk of cancer, especially in someone who has a decreased MTHFR enzyme.
Vitamin B6 has an RDA of 2mg! If dietary intake falls below this there is an increase in coronary heart disease. Meats and legumes are the major sources of B6 and as people decrease their intake of meat they need to increase their intake of legumes to make sure they are getting enough B6. A multivitamin will typically give you up to 50- 100 mg per pill, which is very adequate for prevention of heart disease.
Vitamin B12 is decreased in the elderly who have reduced absorption due to decreased stomach acid and elevated homocysteine is found in this population. Similarly those who are taking acid suppressing drugs also have lowered serum B12 levels. 12% of the elderly may have inadequate B12 stores and this marginal B12 status may have neurological implications causing depression and cognitive dysfunction. So in this population B12 supplementation may be desirable. The form of B12 in a multivitamin does not require gastric acid for absorption so a multivitamin can ensure adequate intake and is preferable to the food form.
Vitamin A is the number one of the fat soluble vitamins. It is often thought to be the same as beta-carotene and carotenoids, but these are precursors to Vitamin A that need to be cleaved by certain enzymes to form retinal, or Vitamin A. We used to say that as long as you ate enough dark red and orange vegetables that you were getting enough Vitamin A, or in other words “Eat your carrots, it is good for your eyes”. However now it is recognized that Vitamin A doesn’t always get delivered due to the uniqueness of a person’s metabolism and it is more than a vision related nutrient. It is found in its metabolic form as all-trans-retinoic acid and is a very important in binding retinoid receptors and Vitamin D metabolites to regulate gene expression. This metabolite is important in messaging between cells and preventing some forms of cancer and for proper cell differentiation of cells for healthy aging. Vitamin A is a problem nutrient in many individuals and supplementation of both vitamin A and carotenes may be important.
This discussion about the article “What vitamins should I take doctor” found in the December 20th 2001 issue of the New England Journal of Medicine will continue to include vitamin D, vitamin C and vitamin E.

Dr. Pincott has been practicing naturopathic medicine since 1985 and is currently practicing in Campbell River. She can be reached at (250) 286-3655 or www.DrPincott.com