Healthwise: Navigating the Vitamin Maze

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Healthwise: Navigating the Vitamin Maze

http://www.hcvadvocate.org/200006/page4.cfm

By Lucinda K. Porter, RN

Are you curious about vitamins and supplements? Do you

wonder which to take and which to avoid? Do you have

questions about which brands to buy? If so, you are in

good company. I am frequently asked questions about

vitamins and supplements by patients with chronic

hepatitis C virus (HCV) infection. This article

discusses some aspects of supplementation. One

caveat-the perspective I offer is exactly that-a

perspective. My views are not a substitute for medical

care. You are strongly advised to speak to your

physician or other health care provider about any

vitamins, minerals, or herbal supplementation you are

taking. If your physician is disinterested about this

topic, consider exercising your right to a second

opinion or asking for a referral to a nutritionist.

What, if any supplements should you consider? In a

recent article published in Health magazine (March

2000), there were a few sensible suggestions. I have

modified these recommendations for patients with liver

disease. Keep in mind that supplements are not a

substitute for good nutrition.

Multivitamins

This is the one supplement that most experts

recommend. Unless your doctor advises you otherwise,

look for a multivitamin without iron. These can be

found in the " over 50 " versions of most major brands.

As for which brands, there are many to choose from.

High price does not correlate with high quality. Most

manufacturers buy the ingredients from the same

sources. If you are paying more money for your

multivitamin, it is probably for advertising or

unnecessary fillers. These fillers are often herbs in

doses too low to offer any benefit. Here are a few

suggestions for multivitamins without iron:

o Safeway Select OmniSource Senior

o Rite Aid Whole Source Mature Adult

o Dr. Art Ulene Nutrition Boost Formula (Senior

version)

Vitamin C

This vitamin is best obtained from food. A minimum of

5 servings of most fruits and vegetables will cover

most of your vitamin C requirements. If you do

supplement, look for small dose pills, such as 100 or

250 milligrams (mg). You can also break a 500 mg pill

in half. A government advisory panel has recently

recommended that women consume 75 mg daily. The

recommendation for men is 95 mg. Smokers need an

additional 35 mg daily. Do not exceed 2000 mg per day.

If you eat a high iron meal, postpone taking your

vitamin C supplement. Vitamin C can bind with iron,

putting extra load on the liver. As for specific

brand, your body cannot tell the difference between an

inexpensive or expensive version.

Vitamin E

This vitamin is constantly making news. It has been

the subject of research in liver disease as well as a

host of other conditions. The optimum levels appear to

be between 400 and 800 International Units (IU) daily.

Vitamin E is available in natural and synthetic forms.

Natural E is absorbed by the body better than the

synthetic form. It is also more expensive. However,

most of the clinical trials that show the benefits of

vitamin E use the synthetic form. All in all, this may

be the better choice. If you use the natural form, the

dosage may be closer to 200 - 400 IU daily. Do not

exceed 800 IU per day. At high doses, vitamin E can

act as an anticoagulant, or anticlotting agent.

Consult your doctor if you have low platelets, are

taking Coumadin or have a clotting disorder.

Selenium

This mineral is found in most multivitamins, but it

may be worth it to add this in as a supplement. The

recommended daily doses for men is 70 micrograms (mcg)

and 55 mcg for women. In a recent article in the

Nutrition Action Newsletter, the Center for Science in

the Public Interest (CSPI) suggested a daily dose of

200 mcg. Do not exceed 400 mcg daily. Selenium can be

toxic at higher levels. Selenium can be purchased in

its most inexpensive form.

Calcium

The daily doses for this are 1000 mg (ages 19-50),

1200 mg (51-70), and 1500mg if you are over 70 years

old. Each serving of low fat milk, yogurt, or cheese

has roughly 300 mg of calcium. Add in a supplement for

each one you miss. Talk to your doctor about calcium

supplementation if you have kidney or gall stones. Any

brand that can dissolve in a glass of warm water in 30

minutes should be the guiding factor, rather than

price. Most brands of calcium are acceptable although

lately there has been some evidence that the most

expensive form, calcium citrate, has the most

bioavailability. Avoid calcium from oyster shell or

dolomite sources.

Milk Thistle

The jury is still debating the milk thistle (or

silymarin or thisilyn) issue. Milk thistle has been

used for hundreds of years as a folk remedy for liver

disease. The European medical community has done some

promising research using milk thistle for liver

diseases, but as for HCV, the evidence is just not

solid. The good news is that milk thistle does not

appear to do any harm and may provide some benefit.

The recommended dose is 200 mg three times daily. Only

buy brands that use standardized amounts of at least

80% silymarin. Try to find a brand that states it

complies with standards of the American Herbal

Pharmacopoeia, the German Commission E, or any of the

organizations that are striving to maintain standards

in a market that is completely unregulated. This is

the one supplement in which I spare no expense. I use

Nature's Way Thisilyn or Eclectic Institute's Milk

Thistle, but there are other fine brands.

What supplements should you avoid?

The Information Packet published by the Hepatitis C

Support Project has a list of herbs that should be

avoided, especially for those with liver disease. This

list can be obtained either by contacting the Project

(see address and phone number on this newsletter) or

through their web site at www.hcvadvocate.org. In

addition to the herbs listed, avoid supplementation

with vitamin A, D and iron. One can usually get

sufficient vitamin D in a multivitamin, diet, and sun.

Unless these are not available to you, supplementing

with extra D is not recommended. Large doses of any

supplements are strongly discouraged. Vitamin A in

doses above those recommended can cause liver injury.

Certain foods and medications interfere with vitamin

and mineral absorbency. Consult with a nutritionist if

you want individual counseling about your particular

situation. For more general information, the following

magazines are good sources of up to date information:

o Health (800) 274-2522

o Nutrition Action Newsletter, published by the Center

for Science in the Public Interest CSPI, 1875

Connecticut Ave., NW, Suite 300, Washington, D.C.

20009

www.cspinet.org o Prevention (800) 813-8070

Copyright Lucinda K. Porter 2000

Lucinda K. Porter, RN is a research nurse and patient

educator at Stanford in the area of hepatology. She

co-facilitates a support group and is active in many

aspects of hepatitis C education. In addition to being

HCV+, she has a life which include her husband and

teenaged daughter.

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