Central  South  Dakota Medical News
The Clinical View
by P.E. Hoffsten, M.D.
4 July 2002

VITAMINS, STILL IMPORTANT

     One of the most common questions I hear is, “Do I need to take vitamins?”.  Most often the question is asked in the context of somebody who is feeling tired and not as strong as they would like to feel.  As the discussion goes on, the question of what is a vitamin invariably comes up.

        A vitamin can be thought of as an essential chemical for body machinery that the body cannot make for itself.  A good example is Vitamin C.  In the 1700’s, sailors who went to sea for many months would develop a disease called scurvy.  The English learned that providing citrus fruit for their sailors would prevent the problem and they reasoned that there must be an essential something in citrus fruit that the body needed.  The English then provided limes on their ships and required sailors to eat limes to avoid scurvy.  Limes were chosen because they would last for months without rotting on the long voyages without refrigeration.  Thus was born the slang term for the English sailor who used to be called “limeys”.

       By the mid 1930’s, the structure of ascorbic acid (Vitamin C) was discovered.  Vitamin C is unusual in that it is essential only for monkeys, humans, and guinea pigs.  Horses, cows, chickens, dogs and cats can all make Vitamin C by themselves, where as for some reason, the human primates and guinea pigs lost the ability to synthesize Vitamin C for themselves and have to obtain it externally from their diet.

       I have been in practice more than 40 years and have never seen a case of Vitamin C deficiency.  It might seem that perhaps vitamins aren’t important.    Nothing could be further from the truth.  Like everything else, some problems get solved and new ones seem to crop up. This last week in the Journal of the American Medical Association almost 15 pages were devoted to review of vitamin function and appropriate supplementations. Emphasized was the point that at least 30% of our population has suboptimal vitamin intake and this leads to slowly developing degenerative problems.   The most prominent recent discovery was the importance of folic acid.  It turns out that there is a amino acid in our blood called homocystine.  When this amino acid builds up to slightly abnormal levels, it leads to early artery disease causing heart attacks and strokes.  If a person takes a milligram of folic acid a day, homocystine levels drop down into safe levels and heart attacks and strokes are prevented.  In the past, folic acid was added to our cereal with the thought that this supplement would solve the problem for the whole population.  In fact if one uses breakfast cereal, this yields only 10% of the folic acid that is needed for the day.  If a person doesn’t use breakfast cereal or eat enough green leafy vegetables and fruit, folic acid intake will be suboptimal and the development of artery disease leading to heart attacks and strokes can progress.  The recommended daily requirement for folic acid for adults is now one mg per day.

     The second major vitamin deficiency in today’s society has to do with Vitamin D. Inadequate Vitamin D leads to osteoporosis and early fractures of the spine, hips, and wrists. Disability and death after a hip fracture is very common.  It is especially sad thinking that it is simply due to a vitamin deficiency and inadequate calcium intake. Vitamin B-12 is the third vitamin that in today’s world is a relatively common cause of both anemia and lose of mental function often called Alzheimer’s (dementia).  It turns out that in order to absorb Vitamin B-12 normally, a factor in the stomach is necessary to recognize Vitamin B-12 and bring it into the body.  Disease processes and the degenerative changes of aging often lead to a deficiency of this factor and therefore a deficiency of Vitamin B-12 in the body.  Unfortunately, if a person has a Vitamin B-12 deficiency, it most often requires injectable Vitamin B-12 monthly.  This is one of the most common injections given in the clinic.

     Coming to the question that was originally asked at the start of this column, the article in the Journal of the American Medical Association states that adults should be on a multivitamin tablet and probably 2 tablets per day.  They remark that many of the adult minimal daily requirements recommended by our Food and Nutrition Board of the National Academy of Science are probably set too low.  Instead of 400 units of Vitamin D per day, we need at least 800 units per day.  Instead of .2 of a milligram of folic acid per day, adults probably need a milligram per day.  Without going further down the individual vitamins, the answer is that the two standard vitamin tablets per day will lead to optimum health.

     If one goes to the vitamin shelf at the pharmacy, the variation in prices is amazing.  Your local pharmacist can be a help in selecting a vitamin preparation reasonably priced and comprehensive enough to cover the adult needs.  Don’t be fooled by “natural” vitamins.  All the vitamins are natural.    Sticking that word in front of the label, simply jacks up the price with no benefit to the user.

     As a last word of caution, “too much of a good thing is not better”.  There is such a thing as Vitamin D and Vitamin A intoxication.  The fat soluble vitamins are completely absorbed from the bowel but there is no mechanism for their excretion and more than 800 units of Vitamin D per day can cause problems.  Individuals using blood thinners such as Coumadin can make their medication very difficult to regulate if they vary the amount of Vitamin K in their diet. Coumadin is a direct antagonist of Vitamin K and thus a consistency of intake helps with regulating blood thinners such as Coumadin.

    The healthcare professionals at your local clinics can help in selecting vitamin preparations and supplements necessary.  In this time when many people do not drink milk, many people do not use fresh fruits and vegetables, considerations for vitamin preparations are important and as the Journal of American Medical Association article mentions, all adults should use a supplemental vitamin daily.