Dave R February 2020
“To all my little Hulkamaniacs, say your
prayers, take your vitamins and you will never go wrong.” Hulk Hogan
As a
confirmed supplement taker, it struck me some time ago that I should really
make more effort to understand what I'm
taking and why and whether I'm doing it in such a way that my body gains
maximum benefit. I always suspected that swallowing a handful of vitamins and
minerals with the orange juice every morning was possibly swallowing a whole
lot of advertising propaganda at the same time. Yet still I did it (and forgot
the orange juice too) because as someone with both HIV and neuropathy, I felt
that my immune system was continually under attack and therefore needed
boosting with supplements to enable it to fight off the unknown and unexpected.
It was almost a cliché in the
early eighties that desperate people trying to survive with HIV were taking
twenty to thirty supplements a day and that seemed shocking then. However, that
feeling that you're somehow letting your system down unless you use
supplements, hasn't gone away and is actively fed by the supplement industry, the
media and by the internet. Perhaps more worryingly, it is stronger than the
underlying and unsettling feeling that you may actually be overdoing it! Hmm!
Hints of addictive behaviour maybe! In my case I've just always felt that I
needed someone to tell me how to supplement sensibly instead of leaving me to
my own devices. Am I the only one? I somehow don't think so.
The problem
is, despite that nagging feeling that I should really be more responsible both
with my wallet and with what I throw down my throat, I still do it every day! I
have a few medical problems for which there are no cures and I suspect it's a
slightly panicked response to that. Eventually, my conscience pricked me enough
to do some research to try to find out what really is necessary and what the
best means of taking vitamins actually is. What I discovered was a maze of
differing opinions concerning which vitamins are useful for what; when they
should be taken and most importantly, what dosage strengths are recommended.
The industry behind supplements has mushroomed and that has led to conflicting
opinions as to what is truth and what is plainly lies, ad-speak and hot air.
What follows
is a summary of what most experts have found (you will always discover doctors
and nutritionists who disagree with various points). However, the only way an
ordinary person, without a nutritional science degree but with significant
health problems, can plot his or her way through the vitamin obstacle course,
is to take the consensus opinion and trust that it's not going to do you any
harm. Before you take any action however, you do need to talk to as many
medical experts as possible and do your own research. Your home doctor and/or
specialist should probably be the primary advice giver -- you don't want to be
taking anything that will compromise your current medication (we all know about
St. John's Wort and grapefruit for instance!)
The Harvard
nutritionist Victor Herbert's famous Time magazine quote in 1992, that vitamins
just give you "expensive urine",
has stuck in many people's minds. However, sales figures since then would beg
to differ, as would the American Food and Drug Administration, which to cite
just one example, began requiring Folic acid (a form of vitamin B) to be added
to grain products only four years later. That single smart move quickly
prevented a worrying rise in cases of spina bifida in babies, caused by mothers
not receiving enough folate in their diet and undoubtedly saved lives. Cases
like this convinced more and more people that boosting their vitamin levels was
a good idea.
According to
the American Journal of Preventative Medicine, more than half of all Americans
use vitamins or supplements and according to the Hartman Group, (a natural
products marketing firm) they spend more than five billion dollars each year in
the process! Whilst these astounding statistics are probably reasonably
accurate for most developed countries, the rest of the world may regard the
idea with some cynicism -- the cost and availability alone will make it
prohibitive for many populations. I wonder if the statistics are even higher
for people living with conditions such as HIV or cancer for instance; though
again, it may depend on their demographic. Whether it's somewhat of a western
luxury or not, the fact is that vitamin supplementation is here to stay and
shows no sign of slowing down. So what's the truth behind the hype?
Why Do People Living With Immune Diseases
Need Vitamin Supplements?
One of
today's buzz words is 'micronutrients'. These are basically vitamins, minerals
and anti-oxidants and although we don't require large amounts, they are
essential for good health. As the body goes through its normal daily functions,
the necessary chemical reactions in cells are 'fed' by micronutrients. However,
many people living with immune problems need more, or supplemented,
micronutrients to support cells damaged by their condition and to bolster the
immune system.
The most
common deficiencies include vitamins A, E, and B-complex (B1, B2, riboflavin,
niacin, B3, B6, B12, B9 and folic acid), leading to various immune system
related conditions and of course for readers of this blog, neuropathy. Some
studies have concluded that micronutrient deficiencies can even worsen certain
conditions but this is not universally accepted.
So What Are Vitamins and What Do They
Do?
There are
basically two sorts of vitamins and they are categorised according to how
they're transported through the body. The body cannot manufacture vitamins
itself (with the exceptions of vitamin D, which is manufactured by the body on
exposure to sunlight; and vitamin K, which is created by bacteria in the
intestine) and cannot survive without them.
Water-soluble
vitamins are carried around your system by water. They need to be replenished
daily because you lose them through fluids like sweat and urine.
They're
mainly the B-vitamins: folic acid, biotin, pantothenic acid, thiamine (B1),
niacin (B3), pyridoxine (B6) and cyanocobalamin (B12) and vitamin C.
Fat-soluble
vitamins are carried by fats found in the blood stream. Since fat stores
vitamins better than water, it's not so important if the daily dose is
interrupted. These vitamins include, A (retinol), D (calciferol), E and K.
However, overdosing with these vitamins can lead to a build-up of toxic levels.
They're much harder for the body to dispose of through urination and that's why
many doctors and nutritionists give out warnings.
Water-soluble
vitamins (B, C, folic acid), are found in meat, fish, fruit, vegetables and
whole grains and you should eat foods containing these every day. Over-cooking
also destroys them, so it's always better to grill or steam rather than
boiling. As I've already mentioned, many people with HIV have trouble eating
normally and that's where supplementation comes in.
Fat-soluble
vitamins (A, D, E, and K), are generally found in meat and meat products,
animal fat and vegetable oils, dairy products and fish.
n.b.: This
article is not going into the subject of minerals but it is important to
remember that vitamins and minerals are two completely different things. In
general, minerals help vitamins to work properly. Just for reference, the most
important minerals are: calcium, iron, magnesium, iodine, copper, phosphorus,
manganese, chromium, selenium and zinc. The last two are frequently recommended
for people with autoimmune problems but they are not vitamins.
But What Do Vitamins Actually Do?
Vitamins are
essential for good health and people whose immune systems are compromised do
need to maintain a normal level of vitamins daily in their system.
Vitamin A is
the body tissue vitamin; helping to maintain and develop skin and bone. It also
helps with vision, the functioning of the nervous system, reproduction and
growth.
The B
vitamins increase fat production along with proteins and carbohydrates and assist
with metabolism, building red blood cells and maintaining the protective
sheathes of the nerves (especially relevant for neuropathy patients).
Vitamin C is
definitely an aid for immune system performance, helping to heal wounds as well
as forming tissues, cells, bones and teeth.
Vitamin E
protects the membranes on the outside of cells and therefore assists the immune
system in fighting off illness.
Vitamin K is
necessary for blood clotting at wound sites.
The following
two sections, are probably the ones of most interest to most people and for
that I apologise for the amount of information you had to wade through to get
to this point. Although we want to know when to take these supplements and
which daily dose is the right one; I always want to know what it is I take and
what it's supposed to do. This is not so easy when researching neuropathic
medications but is much easier with vitamins.
When Should We Take Them for the Best
Effect?
For many
people living with HIV specifically, their daily routine revolves around the
time of day they take their HIV medications. It may be necessary to adjust your
supplement intake accordingly but never the other way round -- your ARV intake
is of prime importance.
Instructions
on vitamin bottles can sometimes be so small; you need a magnifying glass to be
able to read them. This is generally because of the amount of legally required
information but that doesn't make it any easier for the user. Many people look
at the recommended daily dose and take everything at the same time and when it's
most convenient. However, this can lead to mal-absorption and thus a waste of
your money.
Studies seem
to show that concentrated man-made vitamins (the most commonly found on the
supermarket shelves) need to actually bond with real food vitamins in order to
be properly absorbed by the body. Just drinking water and popping vitamins may
be a diet option but won't be maintaining your health the way you hope it will.
Another
problem is the sheer variety of opinions amongst the medical and nutritional
professions. I've tried to bring together the most often recommended times for
taking vitamins but you will always find contradictions. The human body
metabolizes food at different rates and times for different people. Some people
metabolize slowly in the mornings and faster at the end of the day and for
others it's the opposite. Hard and fast rules are difficult to prove then.
Single
vitamin supplements have their own "best times" and again, opinions
differ according to what you read.
Most
nutritionists state that vitamin Bs, vitamin B-complexes, vitamin C and vitamin
E should be taken in the morning, with some food, so that you can best benefit
from their energy giving properties.
If you then
take your vitamin D (and necessary calcium) with the next meal, you won't have
problems with the absorption of the calcium. Most multivitamins contain iron
and iron can clash with the calcium, leading to poor absorption of both.
Minerals such as calcium and magnesium (plus vitamin D) are natural muscle
relaxants and can also be taken before going to bed.
Vitamins A,
D, E and K should preferably be taken with foods containing fat or oil, so that
they can form "micelles" to allow absorption (a handful of nuts is
one option).
Although
rare, some doctors advise taking vitamin supplements on an empty stomach
because they feel the body will absorb the nutrients better. Vitamin C is not
one of them because it is so quickly flushed out of the body. Vitamin C
actually only lasts a few hours in the bloodstream, so should really be
repeated two or three times a day but it's not a good idea to take it last
thing in the evening because of its stimulant properties.
Taking vitamins on an
empty stomach can also cause heartburn and indigestion problems. If that's the
case, it may be better to open up the capsules or grind the tablets and blend
them into a smoothy.
Some
nutritionists also advise taking vitamins on an empty stomach but with specific
instructions that they should be chewed. Some think that a chewed tablet is far
better than one swallowed whole. Again, the grinding into a drink option may be
more appealing.
In general,
most sources advise taking vitamins with, or just after food and the science
seems to bear that out but as already mentioned, other experts think
differently. Some people may be finding eating solid food difficult enough but
still need the vitamin intake. It's best to take advice and then see what works
for you.
What Is the Recommended Daily Dosage?
Another
controversial topic is how much of each vitamin you need to supplement. Many
people take their multi-vitamin and then take other vitamins at recommended
daily dosages separately, forgetting that they've already ingested a
substantial amount of their daily intake in the multi-vitamin. This can lead to
health problems as well as being a waste of money.
Recommended
daily intakes (RDI) are not an exact science. Your particular health problem
may require larger doses of particular vitamins to help with your deficiency
and you will possibly see different RDIs on every different brand.
Multi-vitamins can be bewildering when you try to work out exactly how much
they contain. It's a bit of a minefield and isn't helped by the various
acronyms which almost nobody understands. Here's a short list of some of the
nutritional values to help you make your decisions.
RDI:
recommended daily intake (it is illegal in Canada for instance to print RDIs on
a vitamin bottle, maybe for a good reason.)
RDA: Recommended Dietary Allowances
DV: daily value
RE: retinol equivalents
G: Gram
Mg: milligram (nutrients are expressed in a variety of units)
Ug (or mcg): microgram (for instance 0.5 mg is the same as 500 ug)
IU: international units
RDA: Recommended Dietary Allowances
DV: daily value
RE: retinol equivalents
G: Gram
Mg: milligram (nutrients are expressed in a variety of units)
Ug (or mcg): microgram (for instance 0.5 mg is the same as 500 ug)
IU: international units
comparable
with others, or an international standard. Besides that, the difference between
synthetic and "natural" vitamins is very significant. If any industry
required urgent regulation, it's this one!
However, as
vitamin users we have to make a judgement somewhere, or just not use them at
all. After searching through many nutritional websites, the following
recommendations from the European Union are at the bottom end of the scale in
comparison with most others but again, every individual is different and your
health status and age may require different daily intakes.
The link that
follows refers to the United States FDA and Canadian recommendations, which are
slightly different in some cases. It is also not my job to recommend any sort
of vitamin dosage to other people; that would be irresponsible. Apart from
this, these are recommended daily intakes for normal, healthy people and we are
not. It's very difficult knowing what's best but your doctor should be able to
advise you.
Vitamin A:
800 mcg
Vitamin B1: 1.4 mg
Vitamin B2: 1.6 mg
Vitamin B12: 2 mcg
Vitamin C: 60 mg
Vitamin D: 5 mcg
Vitamin E: 10 mg
Folic Acid: 200 mcg
Vitamin B1: 1.4 mg
Vitamin B2: 1.6 mg
Vitamin B12: 2 mcg
Vitamin C: 60 mg
Vitamin D: 5 mcg
Vitamin E: 10 mg
Folic Acid: 200 mcg
Conclusion
What follows
are a few general tips that most reputable sites offer regarding vitamins and
although they may go without saying, they're worth bearing in mind.
Cost is
always an issue and generally, synthetic supplements are cheaper than organic
and subject to aggressive marketing because they have a substantial market
share to fight over. However, as mentioned earlier, you need to be more careful
with how you take them in order to get optimum benefit.
Try to buy
the best quality for the price you can afford.
Check expiry
dates on boxes or bottles and store your vitamins in a cool place.
Buy
cold-pressed capsules rather than tablets as they tend to be more easily
absorbed than pills or tablets.
Vitamin
supplements are rarely strictly regulated and it can be difficult to tell
whether you're getting what the label claims, so it may be wise to confine your
purchases to reputable brands.
Never buy
vitamins online unless you can clearly verify their street address, phone
number, e-mail address and refund policy.
Be wary of
"extras" like gingko, ginseng or green tea in multi-vitamins. There
is little evidence that the amounts provided have any meaningful effect.
Watch out of
claims like, "high potency, super, complete or all natural" which may
just be advertising jargon with no intrinsic meaning. Studies have shown that
there is little difference between basic brands and those with extravagant
claims. "Let the buyer beware" very much applies to this branch of
the health industry.
We are a
vulnerable group of people. We have health problems which can't be cured and
sometimes the side effects of the illness, or the medication used to treat it
can leave us looking for any relief, anywhere. It's human nature but we have to
use our common sense and try to make decisions supported by expert advice and
careful research. An unregulated industry can persuade you to swallow anything
but people living with HIV and other diseases like neuropathy have learned to
be sceptical of exaggerated promises and claims. It's only logical that we should
be cautious with what we put into our bodies.
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