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Vitamins-Do You Need Them?  Why?

By Stan M. Gardner, M.D., CNS [1]

Twenty-five years ago I set up practice and told my patients what I had been taught in medical school-that if they ate a well-balanced diet, there was no need for vitamin and mineral supplementation.  There are many reasons why this philosophy is no longer tenable:

1. “Experts” have trouble deciding what constitutes a balanced diet, and their decisions change through the years. 
2. Genetic makeup demands different levels of nutrients for different individuals (called biochemical individuality), up to 40 times difference. [2]
3. Pollutions and toxins in the environment today stress our ‘detoxification’ systems, hence requiring greater need for nutrients.  Air (fuel exhaust, industrial waste, cigarette smoke exposure), water (toxic heavy metals [lead, arsenic and fluoride], chlorine, pesticides, chemical wastes), and food toxins create an added burden for our bodies to overcome. 
4. Present day agricultural practices are methods that are designed more to increase quantity or facilitate transportation and storage than for nutritional value.  Soil quality does not carry the full complement of nutrients.  Fertilizers do not replace the broad range of known needed minerals.  Pesticides and herbicides are used (including food imports from other countries that use products which are banned in the United States), along with other risky chemicals in the processing of foods. [3]   Fruits and vegetables are often picked before they are fully ripened, before the full complement of minerals and vitamins are present. 
5. Present Recommended Daily Allowances (RDA) are levels designed to prevent nutritional deficiency diseases in most healthy people, but the levels are not useful in establishing optimal health.  They have been influenced as much by economic and political consideration as by science.  Health needs today fall more often within the degenerative diseases category than the deficiency diseases category.

The first principle of medical ethics is “Do no harm.”  More than 100,000 people die each year from adverse reaction to prescription drugs, making it the fourth leading cause of death (after heart disease, cancer and stroke). [4]   History has shown us the connections between nutrients and diseases such as scurvy, beri-beri, kwashiorkor, and pellagra.  When disease symptoms which resemble minor versions of nutritional deficiency or allergy to foods are manifest, doesn’t it make sense to explore nutrition options to help the body heal itself as our first line of defense?  Many vitamins, minerals, amino acids, essential fatty acids, accessory food factors and herbs have been shown to be very useful in both prevention and treatment of many disease states.

It is difficult to know how to approach the topic of supplements without this article looking like a list, a textbook or a research paper.  I’ll first deal with vitamins, although I will mention only the most common or important uses.  Let’s look at the water-soluble vitamins (considered safe at almost any dose because they are readily excreted in the urine).

Although individual vitamins may help specific disease states, it is important to recognize that a good broad base of all vitamins is often necessary to get the most benefit of that one vitamin for that one condition.  For instance, an individual recently asked me if there were nutrients specific for vision and the eyes (for which there are several).  However, I reinforced the premise that until she was on an adequate total vitamin and mineral program, those eye nutrients would not provide maximum benefit for her eyes. 

Vitamin C

Vitamin C is made by all but five animals on earth, and man is one of those who do not manufacture it.  Goats and rats make the human equivalent of four grams (4000 mg) per day.  When traumatized or stressed, their level goes up to about 20 gm per day.  Scurvy is the deficiency disease which results when intake is less than the RDA of 60 mg per day.

Vitamin C’s most important uses are as an antioxidant, for the production of collagen (connective tissue that holds us together), and for the immune system.  Cardiovascular and cerebrovascular mortality reduced by about 30% in the high vitamin C intake group compared to normal intake.  Interestingly, during infection, vitamin C levels in the white blood cells drop, and cannot be maintained at normal levels with under 6 grams per day.  My recommended dosage for adults is 4 grams per day, although 1-4 grams per day may be adequate.  When a viral illness is present, an increase to 6-10 grams per day is appropriate.  Its immune system effects are not limited to infection, but also include autoimmune disorders, allergies and cancer.  Because it has the potential to cause loose bowels at high enough doses (which are different for each individual) in everyone, it is highly effective and safe for constipation.

B Vitamins

Vitamin B1 (thiamine) is essential for energy formation (oxidative phosphorylation). Beri-beri is the deficiency disease manifested when there are indicators such as skin swelling (edema), neurologic symptoms (burning, tingling, numbness, cramping or weakness, dizziness) or heart/ circulatory system signs (enlarged heart, low diastolic pressure).  When the Western world introduced polished white rice (with the outer hull and bran removed) in Japan many of the Japanese people who consumed the processed rice developed symptoms of beri-beri. [5]   White rice is devoid of the B vitamins that are necessary for the proper breakdown of the rice carbohydrate into energy. 

Marginal deficiencies of thiamine are probably common in the U.S. diet.  In my practice I see response to thiamine supplements of 50-100 mg/ day for people who have numbness and tingling in their extremities, heart problems, neuropsychological complaints, low blood pressure and dizziness.  There is a fat soluble form called Allithiamine.  My colleague, Dr. Derrick Lonsdale, has placed this fat soluble TTFD (the activated form of thiamine) in a transdermal cream called Authia.  His recently patented TTFD form is being used successfully as part of a broader program for the autistic spectrum, which is very difficult to treat. [6]

Vitamin B2, riboflavin, helps maintain antioxidant levels and assists with muscle cramps and immune function.  Fifty milligrams per day is adequate.  The fluorescent yellow color of urine is the harmless excretion of this nutrient. 

Vitamin B3, niacin and niacinamide, was formerly called nicotinic acid.  The inositol hexaniacinate form does not cause the flushing that plain niacin does, nor is there concern with uric acid elevation (gout arthritis), gastric acid elevation (peptic ulcer disease) or liver problems that are occasional effects.  This vitamin lowers cholesterol and raises HDL (“good”) cholesterol, although the whole cholesterol “theory” will be addressed when we talk about cardiovascular diseases.  Because niacin can dilate blood vessels, it can lower blood pressure, improve circulation, reduce migraine headaches and Raynauds’ phenomenon and may even help the vertigo or dizziness with Meniere’s disease.  Niacin also minimizes hypoglycemia and usually reduces cravings for sweets. [7]   Most multiple vitamins have about 200 mg, although when administered therapeutically, doses of 500-3000 mg can be used.  Niacinamide has been useful in osteoarthritis at doses of 2-3 grams per day, but it does not lower cholesterol levels.

Vitamin B5, pantothenic acid, is essential (along with vitamin C) for proper adrenal function.  When the adrenals are exhausted, as in times of long-term stress, depression, fatigue and insomnia ensue.  High doses are often effective for recurrent illnesses, environmental (chemical) sensitivity or allergies.  A dose of five hundred milligrams per day is the typical amount in a multiple vitamin, whereas up to 2000 milligrams per day would be more appropriate in people with high stress levels.

Vitamin B6, pyridoxine, has many properties, and some of them are very unique.  Many people with peripheral neuropathy (including carpal tunnel syndrome) have responded to this vitamin.  High homocysteine levels (a toxin in the body that damages blood vessels and brain tissue) are reduced with vitamin B6, B12 and folic acid.  It is also unique in its ability to reduce the nausea and vomiting associated with early pregnancy.  Combined with magnesium it reduces symptoms of toxemia in pregnancy.  Many women have found this helps premenstrual syndrome (PMS).  Fifty to 100 milligrams are recommended daily, although doses up to 500 mg per day are safe.  Doses well above 500 mg per day have been associated with developing a neuropathy.

Folic acid is found in foliage, or green leafy vegetables.  For over 25 years scientists have known that folic acid would prevent 75% of the neural tube birth defects such as spina bifida and cleft palate. [8]   Only in the last 10 years has the information been made available to the general public.  Folic acid is beneficial in at least two cancers, lung and the cervical dysplasia which are precursor cells to cervical cancer.  Its role with reducing homocystine levels has already been mentioned.  Topical application to the gums prevents and treats gum disease.  High dose folic acid (5+ mg range) has been beneficial in osteoarthritis and gout.  The basic multiple vitamin has 400-800 micrograms (.4 to .8 mg).

Vitamin B12, cyanocobalomin, requires a healthy stomach to supply intrinsic factors for its absorption.  Absorption tends to diminish with age, often causing pernicious anemia and contributing to depression and fatigue.  I have already mentioned its usefulness with decreasing homocystine blood levels and the need to use it in many neurologic conditions in combination with B6 and folic acid.  Oral absorption tends to be poor, although many have benefited by sublingual (under the tongue) doses of 1000 micrograms.  Weekly or monthly B12 injections are the quickest way to increase blood levels.

Fat Soluble Vitamins

Now let’s turn our attention to the fat soluble vitamins.  Fat soluble means the vitamins need fat to be absorbed, and the fat soluble vitamins are stored in the body, rather than excreted. This means they may build up over time in the fat storage tissue and become toxic, as opposed to the water soluble that will be excreted out in the urine when in excess.

Vitamin A is best known for its effect with vision, but it is also essential for bone growth, immune function, reproduction/fertility and white blood cell development.  It also helps to maintain the quality of your mucous membranes, making them resistant to infection and the harmful effects of air pollutants like cigarette smoke and car exhaust.  Acne has also been helped with massive doses of supplemental vitamin A. [9] [10]   Most multiple vitamins contain 5,000 to 10,000 IU, although a recent study would recommend no more than 5,000 IU generally.  No pregnant woman should take more than 10,000 IU in the first trimester without carefully weighing the risks.

Carotenes are a category of effective antioxidants, of which beta-carotene is the most known.  Beta-carotene is actually two vitamin A molecules that break down in the intestinal tract based on vitamin A need in the body.  The enzyme needed to make this happen may be sluggish.  A few of the 600 carotenes are alpha-carotene, lutein, lycopene, and zeaxanthin, which compose the color of green, yellow and orange fruits and vegetables.  Because these foods are exposed to both the good and damaging rays of the sun, the antioxidant protection in the skin protects the inside fruit.  Because of their antioxidant ability to quench free radicals, they are useful in cancer and heart disease.  Carotenemia is a yellowish-orange skin color, signifying extra protection from these vitamins (a totally harmless condition).

Vitamin E, d-alpha tocopherol plus a mixture of beta, gamma and delta tocophenols, is a strong antioxidant.  Included in a system with vitamin C and glutathione, it takes the unstable high energy toxic free radicals into a controlled energy (ATP) state.  This helps to explain vitamin E’s protective effects in heart and vascular disease, cancer and aging.  Expanding on its cardiovascular benefits includes reducing the amount of the free radical (or oxidized) cholesterol state called LDL cholesterol, protects essential fatty acids from oxidation (or becoming free radicals) and decreases platelet stickiness, which protects against excessive clotting and thrombosis (blockage of an artery).  One thing you can do to keep your natural peanut butter from going rancid is to break a 400-800 IU capsule of vitamin E, and add its contents to the oil on top of the peanut butter.  (Rancid oil is oil in the oxidized, free radical state).  Vitamin E has also been found to enhance the immune system, both by increasing the activity of white blood cells and by increasing antibody production.  Additional uses of vitamin E include treatment for leg cramps, premenstrual cramps, and fibrocystic heart disease.  The dl-alpha tocopherol is a synthetic form, with about 50% of the activity of the d-alpha form.  Four hundred to 800 IU per day is the normal range. 

Vitamin D3, cholecalciferol, should be classified more as a hormone than as a vitamin.  It is produced in the body by the ultraviolet light from the sun on the cholesterol in the skin.  This “vitamin” is required for all aspects of calcium absorption and utilization, making it essential for bone formation and maintenance, along with nerve and cell function and require calcium.  More vitamin D3 is necessary if there is less exposure to the sun or poor bowel absorption.  High levels of vitamin D3 will lead to excessive calcification in tissue, which is often irreversible.  One hundred to 400 IU is all that most people need in their supplements.

Vitamin K deficiency does not usually seem to be a problem.  It is made in the intestine by the bacterial flora.  It is essential for blood clotting and normal bone formation.  It is possible that with fat malabsorption, bowel disease with antibiotic induced suppression of intestinal bacterial flora that a deficiency of the vitamin could exist.  However, I have not used it.  

Although only indirectly related to vitamins, an excellent documentary film called “Supersize Me” reviews the rapid deterioration of the human body when consuming the high calorie, low nutrient density fast foods so popular today.  Once again, the Word of Wisdom truly is wise counsel to follow!

Healthful Hints

1. Vitamin supplementation is important to maintain optimal health in today’s world.
2.  Dr. Gardner recommends, as a minimum, a good multiple vitamin (4-6 tablets/capsules per day), vitamin C in the amount of 1-4 grams/day, and essential fatty acids taken daily.  Minerals will be discussed in the next article.

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