Should I take vitamins and supplements?

Transcript

Prakash Chandran: We’ve all heard about them, the vitamins and supplements that will boost your health, ease your pain, and protect your immune system. But with so many different options out there, how do consumers make the healthiest choice? We’re gonna talk about it today with Dr. Elise LeBel, an internal medicine physician for Prisma Health.

This is Flourish, a podcast brought to you by Prisma Health. My name is Prakash Chandran. So Dr. LeBel, thank you so much for joining us today. I really appreciate your time. I wanted to get started with a high level question just around vitamin deficiency. I’ve also heard of vitamin insufficiency. Can you talk about these concepts and how they differ from one another?

Dr. Elise LeBel: A vitamin deficiency would be more a measured deficit in a vitamin, which can sometimes be profound. An insufficiency is more, a slight lack in the diet. Like a lot of our micronutrients, like zinc and selenium and copper have been depleted out of our soil, so our fruits and vegetables don’t have as much of those in them, and that’s more likely to give you an insufficiency.

Prakash Chandran: Got it. And so when we talk about like our society today, do you feel like there’s more deficiency or insufficiency?

Dr. Elise LeBel: It’s actually a pretty broad combination of both. A lot of the ways we eat, a lot of the diseases that I read about in school are now things that we see, like for example, scurvy or vitamin C deficiency had pretty much been taken care of by adding citrus fruit into the diet. But now that people are sometimes having fast food type diets, imbalanced diets, picky eaters, and in particular the bariatric surgery patients who have lack of absorption due to a procedure, a lot of these diseases we didn’t see in America are coming back.

Prakash Chandran: Okay, so that leads me to my next question. What are some of the most common vitamin deficiencies that you see?

Dr. Elise LeBel: We have about 70% of Americans are vitamin D deficient, you know, which is a lot of people. You also see a lot of deficiency in calcium. And then another thing we’re seeing deficiency of our fluoride because fluoride’s not a naturally occurring mineral, but our water is fortified with it, so you only have to worry about it like if you drink well water all the time. But now that we’re drinking bottled water, lack of fluoride has become a problem.

Prakash Chandran: So let’s talk about how people can increase their vitamin levels naturally. If there’s a deficiency in vitamin D as you mentioned, and in calcium, what are some things people can start doing to start increasing these levels?

Dr. Elise LeBel: Well for vitamin D you can expose your forearms to sunshine 10 minutes a day, most days of the week. Because that’s the main way that we get vitamin D is through sunshine. You can also eat more vitamin D fortified products such as milk products. And it’s actually the fact that fewer people are having milk products that has led to people getting less oral vitamin D in their diet. And then calcium. You can eat more calcium containing products, which are not just milk and milk type products. You can also get calcium out of leafy green vegetables and one of the things I tell my patients is if what commonly has vitamins or minerals in it, you don’t like to eat it, then just Google calcium rich foods or vitamin D rich foods and find other things that suit your fancy on the list.

Prakash Chandran: So another thing that comes into play are vitamins and supplements. Can you talk about what supplements and vitamins the average person should take and why?

Dr. Elise LeBel: There are really not that many supplements that the average person needs to take. If you eat a balanced diet, then you don’t need a multivitamin. In fact, intake of multivitamins, some studies that show they’ve been a slight benefit, but some studies have also shown that, multivitamins can increase negative components and it’s much better to get your multivitamins through the well rounded diet than to take a multivitamin itself.

Definitely anybody who wants to get pregnant or could get pregnant should be taking folic acid. Vegetarians need to take B12 because most B12 is from meat sources. Those who have age-related macular degeneration need to be taking vitamins known as AREDS, which contain C, E, zinc, copper, lutein, and zeaxanthin. And the multivitamins really are for very picky eaters, people actively dieting or the bariatric surgery patients.

Prakash Chandran: So, when I go to the store, like a Walgreens or even a Whole Foods, there’s a lot of vitamins on the shelf. So how do I know how to pick the one that is safe? Or how do I know which vitamins or supplements are safe and how do I also make sure that the dose that I’m taking is appropriate?

Dr. Elise LeBel: Well, there are actually a number of really good sources out there. There’s a company called Natural Medicines that actually looks at all the data as it comes out in studies and will give people a clear cut idea of, does the supplement actually help anything? And is it harmful to you? And definitely anything that’s harmful or could be harmful, I would encourage people to avoid. Also, the NIH, the National Institute of Health, has an office of dietary supplements, which has a very expansive list of more supplements than I had thought of even, and what they do, what problems they can cause, whether they’re sufficient or insufficient evidence or whether there are dangers to taking this.

Then also you want to make sure that the product you’re going to take has been tested by a third party. And three of the common third parties that test supplements and vitamins are consumerlab.com, US Pharmacopia and NSF International, and they make sure that the products are safe, that you have the same amount in different capsules or tablets. Because one of the things a lot of people don’t know is the FDA does not regulate these things.

Prakash Chandran: I did not know that. So in terms of vitamins or dosage or anything like that, this is something that people need to kind of be well informed of. And you were saying that Natural Medicines is a good resource to understand what they should be taking and how much of it, right?

Dr. Elise LeBel: Correct. It’s a starting place, but you then also need to talk to your physician about the pharmaceutical medicines you’re taking, because some of these supplements can interact with your pharmaceutical medicines and sometimes it’s as simple as, let’s take calcium. Calcium is pretty dense so it can prevent absorption of other pills you take at the same time, so you may not want to take it together. Vitamins C and E are antioxidants and they can decrease the effectiveness of your chemotherapy potentially.

So, part of it is looking at these sites and at least figuring out if things are dangerous and what the dosing is, but also talking with your physician about your individual position where you’re at. The NIH Office of Dietary Supplements actually has a great form titled My Dietary Supplements and Medicine Record that you can print out at home and then share it with your doctor.

Prakash Chandran: So I wanted to circle back to vitamin D specifically because you mentioned that 70% of the population has a deficiency there, is this something that everyone should be taking?

Dr. Elise LeBel: Well, vitamin D is actually not a vitamin, but we probably won’t change its name in our lifetimes. Vitamin D is a steroid hormones. It has more in common with estrogen, testosterone, and thyroid than it does with the other vitamins. And the main thing it does is it helps get calcium into bones, but because it’s a steroid hormone, it also acts as a key in cells to turning on different processes, including our immune systems.

And vitamin D, especially if you talk to the dermatologist, may be one of the things where a supplement is a better idea than sunshine because all that extra sunshine could lead to skin cancer. And vitamin D is also something that’s easy to measure so that you can make sure that you’re taking the right amount and not getting too much. Some of my patients feel less focused, have dental pain, have fatigue or just have you know bad bone densities if they become vitamin D defficient.

But at the same time, vitamin D toxicity can cause fogginess of your memory and how your brain is working and can cause aches and pains. And vitamin D does not wash out of your system quickly. So getting too much in, you’re just stuck waiting for it to come out, which can be weeks.

Prakash Chandran: Okay. Understood. And I had no idea that it wasn’t an actual vitamin. This is the first time I’m hearing that. I think you’re gonna blow a lot of people’s minds here. As a physician, what do you think about essential oils or CBD oils? Are they helpful and why or why not?

Dr. Elise LeBel: Well, I think you have to be careful with essential oils because some of them are meant for oral intake and some are not. And so depending on whether you are using them for sort of ambience and mood from a sort of smell perspective, and there’s a lot of data that can calm you, help you sleep better and things like that, versus people who are ingesting them, you definitely want to make sure that you got the type you can swallow before you swallow it.

And there’s a lot of data in the naturopathic literature that things like lavender can be soothing and citrus can decrease pain after surgery and other things of that sort. So there’s definitely validity, though most of the data I’ve seen on it has been more from smells, not with ingesting them.

With the CBD, I think the difficulty is that a lot of our national organizations have come out saying that we really can’t advocate for CBD because there are essentially minimal to no studies.

You know, at the same time, just by stories my patients have told me, a lot of them have decrease in their anxiety, decrease in their pain, better sleep with CBD. But what we really need are studies to look at the safety and also how much of what people are experiencing is the placebo effect. And there are well over a hundred different chemicals in the plant. And so when you talk about CBD oil, and here in South Carolina marijuana is illegal, but CBD oil in the state can have one to 6% marijuana in it or THC because there’s no process anywhere in the world that I’m aware of that can actually separate these things out completely.

Prakash Chandran: Another thing I wanted to ask about is the efficacy or the safety of natural medicines. I think that a lot of people believe that when there’s a natural vitamin or a natural supplement, that it’s automatically safe to take. What are your thoughts on that?

Dr. Elise LeBel: I think that we need to keep in mind that, for example, there’s estrogen that comes from a factory and there’s estrogen in soy and yams and things of that sort. But to the best of our knowledge, an estrogen is an estrogen, whether it comes directly from the factory or it comes from soy as a soy isolate. So if there’s a risk of breast cancer, it will be with both formats. To the best of our knowledge, the natural products are not safer. The good news for the patients though is, is that eating some tofu here and there, or eating a yam here and there is not enough estrogen. The concern would be more folks who are getting into soy isolates, which are concentrated doses of soy.

Prakash Chandran: Got it. That’s very helpful. So, as we start to wrap, one of the things we’re trying to figure out is, is it helpful to take vitamins or supplements? And I know that what I’m getting from this episode is, it kind of depends, but if there’s a rule of thumb that people should follow, what might you recommend?

Dr. Elise LeBel: Well, I would recommend trying to eat a balanced diet, and if you feel your diet is not balanced, make an appointment with a dietitian or nutritionist to find out how you can get around what you’re not getting in your diet by eating alternative things that you might be willing to eat. And you know also to talk to your physician about what’s going on and to be careful in particular about taking levels of vitamins above the recommended daily allowance. Because it’s in that area that people are going to get into trouble.

And then you need to look into your own medical issues because like if you’re a man and you smoke, you want to avoid vitamin A because for some reason there’s a correlation between vitamin A male smokers and increase in lung cancer. And then there are also a lot of foods that you can add to your diet, like fermented foods that seem to be good for the system versus taking a probiotic.

Prakash Chandran: Last question. In all of your experience as an internal medicine physician, in all of the patients that you’ve seen and helped, what’s one thing that you know to be true that you wish more people knew about vitamins and supplements?

Dr. Elise LeBel: Well, one of the most important vitamins is calcium and one of the ones that’s hard to get completely within food for a lot of people and so many of us are taking stomach acid pills, that if you’re going to take calcium and you’re going to take an over-the-counter prescription stomach acid pill, then you need to find a calcium citrate because most of the calcium supplements are carbonates or bicarbonates and won’t get absorbed if you take them along with stomach acid pills.

Prakash Chandran: Well, that is wonderful advice, Dr. LeBel. Thank you so much for your time today.

Dr. Elise LeBel: Thank you.

Prakash Chandran: That was Dr. Elise LeBel, an internal medicine physician for Prisma Health. For more information, you can visit our website at PrismaHealth.org and to listen to other podcasts just like this one. You can head on over to blog.prismahealth.org/podcast. This has been Flourish, a podcast brought to you by Prisma Health. My name’s Prakash Chandran. Thank you so much, and we’ll talk next time.