Isadore Rosenfeld, M.D.
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 The difference is that the latter contain much higher doses than do run-of-the-mill multivitamins. For example, the usual dose of vitamin C in a multivitamin ranges from 50 milligrams to 500; someone who feels a cold coming on may take 2,000 milligrams or more. Once symptoms start, they may increase the dosage to as much as 5,000 milligrams. Those are megadoses! Megavitamin preparations are also apt to contain additional substances and more trace elements in greater amounts than the usual multivitamin. Megadoses can have mega-side effects. |
Gale Maleskey
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 These may be labeled as B-50 or B-100 complex multivitamins, depending on whether they contain 50 or 100 milligrams of the B vitamins that are listed on the label. Many brands are available.
Mind the Minerals
Chromium and magnesium can help eliminate cravings and stabilize levels of blood sugar (glucose), which fluctuate wildly when a person binges on large amounts of food, says Dr. Kowalsky.
Take 200 micrograms of chromium and 500 to 700 milligrams of magnesium daily, says Dr. Kowalsky, but be sure to check with your doctor first if you have heart or kidney problems. |
Isadore Rosenfeld, M.D.
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| If you're not eating as well as you once did for whatever reason—because you're older, poorer, or can't chew well—supplement your diet with multivitamins.
CANCER OF THE PANCREAS: ONE OF THE WORST
Here's yet another relationship between cancer and cigarettes. Smokers (this time it's only cigarettes, not pipes or cigars) have twice the incidence of pancreatic cancer of nonsmokers. This suggests that the carcinogen involved is present in inhaled smoke, since most pipe or cigar smokers either do not inhale or do so less deeply than cigarette smokers. |
| The reaction of many physicians to this theory is very much like what it is to multivitamins. Ask most M.D.s in their professional capacity whether such supplements have been proven to be effective, and you'll get either an "I'm not sure" or a frank "no" for an answer. But if you were a fly on your doctor's bathroom wall, you might very well see him or her taking a multivitamin every morning. Here is one doctor's reaction to the aluminum theory. Recently I was in a stuffy and overheated conference room sitting next to a physician who was a perfect stranger. |
| In addition to these general dos and don'ts, I advise persons with kidney disease to take supplemental multivitamins containing at least 250 milligrams of vitamin C, 400 IU of vitamin E, 1 milligram of folic acid, and the B-complex group containing the RDA of its various constituents.
Before the availability of dialysis and organ transplants, the diet for patients with end-stage kidney disease was mainly palliative—it made them feel a little better in their dying days. |
Gale Maleskey
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| Studies have shown that women who take a multivitamin that contains folic acid while pregnant also have lower risks of delivering babies with cleft lip and palate—a split in the lip or in the roof of the mouth that occurs during fetal development. multivitamins with folic acid also lower risk for a variety of heart defects, limb deficiencies, and urinary tract defects.
The catch is that folic acid is most important from the time of conception through the first six weeks—a time when many women don't yet realize that they're pregnant. |
Neal Barnard, M.D.
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 Most people who take multivitamins already have plenty of iron in their diets and loads of stored iron in their bodies.
In addition, some doctors and pharmacists have been overzealous in prescribing iron pills or iron-rich foods to patients complaining of fatigue. Fatigue is much more likely to be caused by stress, depression, or illness than by iron deficiency.
So much for the bad news. The good news is that it is easy to find out how much iron you have in your body and to get rid of any excess. |
| Standard multivitamins can also correct these deficiencies. Meats and dairy products are very low in folate, and although they do contain B6 and B12, their load of fat and cholesterol causes them to do much more harm than good.
Lipoprotein (a). One newly discovered cholesterol-containing particle in the blood is named lipoprotein (a). It is very similar to LDL (the "bad cholesterol") and some research suggests that people with extra lipoprotein(a) in their blood have a higher heart disease risk. |
| All common multivitamins, including vegetarian brands, also contain B12. These are all good sources.
Meats and other animal products contain vitamin B12 because bacteria produce it in the animals' intestines and it is then absorbed into their tissues. These foods are obviously not recommended due to their inherent fat and cholesterol and other problems.
There is no reason to include animal products in your diet to get B]2. But do include a source of B12 in your regular diet. |
Gale Maleskey
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| That said, most people take multivitamins with meals, and that's just fine, Dr. Saltman says. Digestive juices that flow when you eat help you digest the ingredients in the pill, too. Even if there are some elements in foods, such as fiber, that interfere somewhat with nutrient absorption, unless you have serious gastrointestinal problems, you'll still absorb plenty.
Here are some additional ways to optimize vitamin and mineral absorption.
?Take fat-soluble vitamins—E, D, A, and K—with a meal that contains a teaspoon or so of fat to aid absorption, says Dr. Saltman.
? |
| Lots of other trace minerals, even those found in multivitamins or sold singly, haven't been proven essential. There's some evidence that nickel, silicon, boron, and vanadium might be, but scientists still don't know for sure. And the jury's still out on minerals like germanium.
We get more than enough of certain trace minerals such as molybdenum and silicon in our diets, Dr. Nielsen says. Others, such as manform the food we eat into energy that our bodies can use. In a series of chemical reactions, the food is broken down and transported to cells. |
Larry Trivieri, Jr.
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 Ross uses an individualized program that includes a strict diet and the addition of nutritional supplementation with multivitamins, chromium (100-200 mg daily), and glutamine (1,000 mg, three times a day, 30 minutes before meals). He recommends a high-protein, low-carbohydrate diet and, instead of three meals daily, the patient eats smaller meals five times a day, with frequent high-protein snacks. After the first four months, patients are introduced to a maintenance diet that includes no more than three servings of fruit a day. |
Isadore Rosenfeld, M.D.
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| However, if you think your vitamin D intake is too low, there are many multivitamins and calcium supplements themselves that contain it. Like vitamin A, however, too much vitamin D, say more than 400 milligrams per day, can be harmful.
Replacing the estrogen lost after menopause will also combat osteoporosis. I have discussed in more detail the pros and cons of estrogen replacement therapy (ERT) in the section on menopause. I feel strongly that women who may safely take ERT should do so at menopause (see page 317). In my opinion, the benefits greatly outweigh the risks. |
Dr. Mary Dan Eades
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 I am not able to say, from the research available to me at this point, whether your taking iron in multivitamins would lead to worse diabetic symptoms or, on the other hand whether your reducing iron intake would make a difference in control of your diabetes. Still, the response of this particular group of people with high ferritin levels is quite impressive. Recommendation: I would certainly recommend that you ask your personal physician to check your ferritin level, and if it is elevated to consider this treatment for you. |
The Complete Book of Alternative NutritionSelene Y. Craig, Jennifer Haigh, Sari Harrar and the Editors of PREVENTION Magazine Health Books
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| Those ranges are the total amount for the day, so you don't want to take 400 international units of vitamin E if you're also taking a multivitamin that has vitamin E," says Roe. Most multivitamins have 30 to 100 international units of vitamin E, but some have as much as 400 international units.
A calcium supplement may also be important, especially for women, who are more likely than men to have bone loss or osteoporosis in later years. "We don't recommend calcium for everybody," says Roe. "It really depends on what your diet is like and a number of other factors, including your sodium intake. |
Mark Stengler, N.D.
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 Most multivitamins contain potassium and help increase the daily intake. Potassium is also available as a supplement. Supplements are not allowed to contain more than 99 milligrams per dose. A dose of 500 to 3,000 milligrams is used by doctors for the therapeutic treatment of hypertension.
Remember, a diet rich in potassium and low in sodium will require a much lower dosage of potassium supplements. Consult a nutrition-oriented doctor to find the dosage of potassium that is correct for you.
WHAT ARE THE SIDE EFFECTS? |
Nicola Reavley
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 While multivitamins do contain some calcium, the amount is not usually sufficient to meet daily requirements and separate calcium supplements are more useful.
Bonemeal, dolomite and oyster shells are common sources of calcium, but they should be avoided as they may be contaminated with lead and cadmium, which can be toxic. Antacids are also good sources of calcium, but those containing aluminum or sodium should be avoided as aluminum inhibits calcium absorption and sodium can raise blood pressure. |
| The most popular supplements are multivitamins, vitamin C, vitamin E, B complex, calcium and magnesium. Recent media coverage of the benefits of herbs such as Echinacea, St John's wort and Ginkgo means that these are also very popular. Women are more likely to use supplements than men, and most people who take them tend to do so because they feel that their food is of poor quality and contains toxic chemicals. Some people see supplements as health insurance and some take them for what they see as their specific benefits; for example, vitamin C for colds.
Who might need supplements? |
| According to a 1996 study of prescription multivitamins reported in the Journal of The American Pharmaceutical Association, US researchers found that several brands did not deliver the expected amount of folic acid because the tablets did not dissolve quickly enough. The researchers examined nine multivitamin products to see if they released 75 per cent of the folic acid within one hour, as required by the United States Pharmacopoeia Convention's dissolution standard. Only three of the products did so and most of the products missed the standard by a wide margin. |
| If the multivitamins do not dissolve within about an hour, the folic acid may pass this area and the amount available for optimal absorption is not adequate.19
Toxic effects of excess intake
Toxicity is considered rare. Symptoms are gastrointestinal disturbances, sleep problems and possible allergic skin reactions. These effects can occur at doses above 15mg. |
Mark Stengler, N.D.
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| Prenatal Infant Growth
Selenium appears to be important for proper fetal growth and is included in prenatal multivitamins.
°^ Rheumatoid Arthritis
Selenium helps to reduce the production of inflammatory chemicals and supports the function of vitamin E in preventing joint inflammation and destruction.
°*->Skin
Selenium helps to prevent oxidative damage to the skin. It appears to help prevent skin cancer, but does not help once the cancer has already developed.
°^ Sudden Infant Death Syndrome (SIDS)
Selenium deficiency may be a factor in sudden infant death syndrome. |
| On the shelves of your local pharmacies, supermarkets, and health food stores, you'll find the now-familiar, standard bottles of multivitamins alongside such newly compounded supplements as glucosamine sulfate (often helpful for arthritis), SAMe (a promising supplement for depression), or CoQIO (the valuable new heart-helping remedy), to name just a few.
A note about supplements: There's sometimes an L form of a supplement, which is used interchangeably with the non-L form. Whether I'm referring to an L form or non-L form, I'm talking about the same supplement. |
Earl Mindell
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 They ask a clerk for a multivitamin and take what they are given, not realizing that they might be getting shortchanged on the vitamin content. All multivitamins differ in amounts included, and the most expensive tablet is not necessarily the best. The only way to be sure you're getting the B6, folacin, or C that you need is to read the small print on the label. Also, if you have any allergies, it's wise to check what else you're getting with your supplement. (See section 23.)
If there are words on the label that you don't understand, ask the pharmacist or vitamin clerk to explain them. |
| Supplements are sold separately, but beta-carotene is included in mixed carotenoid formulas as well as most multivitamins and antioxidant formulas. Beta-carotene is available in two forms: all-trans-and 9-cw-beta-carotene. The 9-cis form may be better absorbed by the body.
CAUTION: If you have hypothyroidism, your body probably cannot convert alpha- or beta-carotene into vitamin A, so it's best to avoid these supplements. |
Mark Stengler, N.D.
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| Most high-potency multivitamins require 2 to 6 capsules or 2 to 4 tablets daily. Beyond obtaining a high-quality multivitamin, the most important consideration is consistency in taking it.
WHAT ARE THE SIDE EFFECTS?
Some people may experience digestive upset. This can be avoided by taking the supplement with meals and by using a high-quality product. Also, users can occasionally be sensitive to an ingredient in the multivitamin. This is more of a risk with cheap brands that use fillers, colorings, or other added chemicals. Choose a hypoallergenic multivitamin formula. |
Earl Mindell
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| B-complex capsules as well as high-quality multivitamins.
Available in 30-1,000 mg. strengths in regular and time-release form.
Doses most often used are 30-100 mg. three times a day.
Toxicity and Warning Signs of Excess:
No known toxic effects, but long-term programs of high dosages are not recommended.
Symptoms that might indicate an oversupply of PAB A are usually nausea and vomiting. (See section 334, "Cautions.")
Enemies:
Water, sulfa drugs, food-processing techniques, alcohol, estrogen. (See section 293. |
Schuyler W. Lininger, Jr. DC
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 Risks of orofacial clefts in children born to women using multivitamins containing folic acid periconceptionally. Lancet 1995; 345: 393-96.
5. Hayes C, Werler MM, Willett WC, Mitchell AA. Case-control study of periconceptional folic acid supplementation and oral clefts. Am J Epidemiol 1996; 143: 1229-34.
6. Russel RM. A minimum of 13,500 deaths annually from coronary artery disease could be prevented by increasing folate intake to reduce homocysteine levels. JAMA 1996; 275: 1828-29.
7. Houston DK, Johnson MA, Nozza RJ, et al. |
The Life Extension Editorial Staff
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 E, and calcium supplements was found to be associated with a lower incidence of recurrent adenomas in 448 patients with previous neoplasia who underwent follow-up colonoscopy. This study found a protective effect against the recurrence of precancerous adenomas when any vitamin supplement was used. On this same subject, a report in the American journal of Epidemiology (Tseng et al. 1996) showed that women with high folate intake were 40% less likely to develop adenomas of the colon than women with low folate intake.
But what if you already have cancer? |
James A. Howenstine, MD
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 What To Do Every Day To Stay Healthy
Take multivitamins daily. They must be free of iron and contain minerals. Vitamin C should be at least 300mg. daily. Also take Vitamin E 400mg to 800mg., Beta carotene 15,000 units, Vitamin D 400IU better 800 IU, B complex, Vitamin A 5,000 units and Biotin 300mcg.
Minerals that are needed include Calcium, Iodine, Magnesium, Zinc, Copper, Manganese, Chromium, Selenium 200 meg., Molybdenum, Vanadium and Boron.
Flaxseed Or Flax Oil
Everyone will benefit from taking 4 tablespoons of ground flaxseed or 2 tablespoons of flax oil daily. |
James A. Duke, Ph.D.
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 Most experts recommend taking 20 to 30 milligrams a day, more if you're pregnant (consult your prenatal-care provider). multivitamins with iron often provide enough of the mineral to prevent iron-deficiency anemia.
If you already have iron-deficiency anemia, your physician might prescribe an iron-only supplement. For best absorption, take your supplement with a vitamin C source. Orange juice and tomato juice are good choices. Also, don't take iron at the same time as calcium. Calcium interferes with iron absorption.
And remember: Keep iron supplements out of the reach of children. |
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