Revisiting Supplementation

23 09 2013

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Earlier this year I started up a short series on vitamin supplementation. Since this time I’ve read numerous additional articles and studies and thought it would be a good idea to post my latest thoughts on vitamin supplementation.

As I said in my first post, vitamin supplementation is not absolutely necessary for everyone and most vitamins and minerals should be achieved through eating a well-balanced diet of whole foods. Take the term supplementation literally; you should really only supplement with something if you cannot get adequate amounts from your diet. With this in mind, let’s start with the most commonly used supplement out there: multivitamins.

Multivitamins

Earlier this year, my general stance on multivitamins was that they were a good way to ensure intake of all vitamins and the benefits surely outweighed the risks. Even the Harvard School of Public Health agreed: “Looking at all the evidence, the potential health benefits of taking a standard daily multivitamin seem to outweigh the potential risks for most people.” However, the more I read, the more I become skeptical of effectiveness of multivitamin products. The major issues?:

  • Most multivitamins provide levels around the recommended daily allowance (RDA), which accounts for a minimum level of health, not an optimal level.
  • Most multivitamins contain a majority of micronutrients that are readily met through even the poorest of diets. You end up getting very little of what you actually need, and too much of what is unnecessary.
  • Multivitamins lack the other compounds of real food which are necessary for absorption and that contribute to optimal health.
  • Too much focus on including a plethora of vitamins and minerals, not enough focus on the necessary vitamins and minerals, nor optimal dosing.

I have multivitamins in the house, but I stopped taking them earlier this summer. When I stopped, there was no noticeable change in my energy levels, general well-being, or overall health. Instead, I began to concentrate on individual vitamins and minerals that are difficult to get through a balanced diet, which is now the recommendation that I would make for others. Multivitamins are great in concept, but their effectiveness has not been proven. Due to this, most people will be much better off spending their money on only the vitamins and minerals that are the most difficult to get, which include…

Vitamin D

The RDA for vitamin D is roughly 400-800 IU, but the optimal level is, at minimum, 2000 IU; as I mentioned in my post on Vitamin D earlier in the year, daily intake of closer to 4000 IU is recommended. The only people who do not need to concern themselves with vitamin D are those that live within the tropics and have frequent sun exposure with bare skin (wearing a t-shirt and shorts is not enough). For the majority of my readers, those of us in the northern hemisphere, vitamin D supplementation is absolutely necessary for optimal health, especially in the winter. Don’t overlook this important vitamin!!!

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Vitamin K

The RDA for vitamin K is roughly 60-120 mcg, and the optimal level is roughly 1000 mcg. The problem with getting enough vitamin K is that most foods containing the vitamin have very poor bioavailability, or in other words, the human body is simply unable to extract the full amount from the food. Due to this, supplementing with vitamin K might be necessary.However, if you eat a diet that contains a lot of leafy greens (kale, spinach, collards, broccoli, brussels sprouts, etc.) and lean animal protein (especially whole eggs), you likely needn’t worry about additional supplementation.

Iron

A friend of mine recently told me that she was thinking about getting an iron supplement. My reaction: Why? Her answer: Because a friend of mine said it helped with her premenstrual cramps. Okie dokie. Here’s the thing about iron: yes, it is a common deficiency (especially among women) in our society, but you shouldn’t start taking an iron supplement on a whim. I suffered from an iron deficiency for years, supplemented with over-the-counter pills and liquids for a few years, and since my levels returned to normal I have been able to maintain healthy levels of iron through my diet. The cause of my deficiency remains a mystery, but those typically at risk include children and pre-menopausal women, most notably those with diets restrictive of animal sources (vegans and vegetarians). If you suffer from the symptoms below, please consult your physician to see if iron supplementation is right for you:

  • fatigue
  • dizziness
  • pallor
  • hair loss
  • twitches
  • weakness

Calcium

Deficiency is common in older people and those with low dairy intake. If you do not consume dairy and do not eat a lot of kale, collard greens, broccoli, or other greens, you will almost surely be calcium-deficient. These whole foods contain far more bioavailable calcium than their supplemental counterparts, so increasing these foods in the diet should be option #1, but supplementing with a high quality calcium supplement could be a secondary option. My first suggestion would be to start with a whey protein supplement, as whey contains 20% of the RDA for calcium and also provides additional protein- something that will only benefit the body. If you are considering a calcium supplement, please first consult your physician; multiple studies have linked calcium supplementation with an increased risk of cardiovascular disease and several forms of cancer, so proceed with caution. Again, whole foods are the best choice.

Magnesium

I covered this in-depth in its own piece a few months ago, but long story short:magnesium supplementation can be quite beneficial for athletes. For the general population, if you don’t consume a diet that contains ample amounts of nuts, seeds, beans and/or leafy greens, you may very well be magnesium-deficient.

Fish oil/Omega-3

Yep, fish oil is important. Do it.

Yep, fish oil is important. Do it.

Essential fatty acids (EFAs) omega-6 and omega-3 are essential to human health and must be consumed in the diet. The North American diet contains a plethora of omega-6 foods, but very few omega-3s. An optimal ratio of the two EFAs is 1:1, so everyone should make an effort to eat fatty fish a few times a week or to supplement with a fish oil supplement. I covered this supplement here.

Creatine

Often thought of as a supplement for bodybuilders and gym junkies, creatine has gotten a weird reputation. Creatine is naturally produced in the human body and is a major component in supplying energy to cells, namely muscle. Yes, creatine has demonstrated reliability when it comes to things like overall power output and strength, but it is also very beneficial for people who do not frequent the gym. Non-meat eaters are a population that should surely be supplementing with creatine. As roughly half the creatine stored in the human body comes from the diet (which can only be derived from animal sources), vegetarians and vegans have significantly lower levels in their bodies. This can result in poor energy levels and decreased cognition. Creatine supplementation studies have shown a significant increase in cognition/intelligence, as well as the ability to ward off the symptoms of depression, most notably in vegetarian/female populations. If you are a meat-eater, you may not need creatine supplementation (unless you have personal strength goals at the gym, in which case you should definitely be supplementing), but for non-meat eaters, creatine supplementation should be seriously considered.

Aside from these supplements listed above, there really aren’t many other that I would advise looking into. One of my favourite online images will serve to give you a very good idea of which supplements can be trusted for what:

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The graphic isn’t perfect- for example there have been reliable studies conducted on magnesium demonstrating an increase in serum magnesium in the body, a decrease in blood pressure and an increase in aerobic capacity and muscle oxygenation- but it’s a nice overview with fairly accurate indication of what you should and should not spend your money on. In the end there are tons of supplements on the market claiming to do many things, but the reality of the matter is that most are good in theory, but poor in practice. Eat whole foods, do your homework, and if you are taking a supplement, be honest with yourself and listen to your body- are you actually getting any benefit from the supplement? If not, save your money and improve your diet!

For more information on nutritional supplementation, or for questions related to specific supplements, please feel free to post a comment below!

Happy Monday!

DW

 





Supplements 101: Vitamin D

23 02 2013
Of course I used this picture.

Of course I used this picture.

What is Vitamin D?

Vitamin D is a fat soluble vitamin that exists in various forms. There is an animal form (vitamin D3 aka cholecalciferol) and a plant form (vitamin D2 aka ergocalciferol). Vitamin D2 and D3 are not biologically active; they must be modified in the body to have any effect. Once in the body, the active form of vitamin D is a hormone is known as 1,25-dihydroxyvitamin D3 aka calcitriol.

Foods that contain vitamin D are extremely rare. It is found in only fish, cod liver oil, mushrooms, liver and eggs, as well as fortified-foods like milk and cereal, but never in substantial amounts (except in cod liver oil). Due to this, getting enough vitamin D from whole foods is virtually impossible.

Natural sunlight is our fuel for creating vitamin D. Spending 20 minutes riding your bike outside in the summer sun produces 100 times more vitamin D than you need to survive. Activated vitamin D has a serum half-life of 2-3 weeks and its production in the skin is limited to 10,000-20,000 IU each day; once serum levels reach 150 nmol/L, any excess is inactivated, so the human body generates what it can use and destroys the rest to prevent us from overdose.

What are the benefits of taking a Vitamin D supplement?

Almost every tissue and cell in our body has a vitamin D receptor. Without enough activated vitamin D in the body, dietary calcium cannot be absorbed. Calcium is essential for the signaling between brain cells and the development of bone and teeth; it is very important.

Studies also reveal that low vitamin D levels in the body are associated with:

  • Increased loss of muscle strength and mass as we age
  • Lower levels of immunity
  • Higher blood pressure
  • The development of neurological disorders
  • The development of diabetes

An even more recent study also suggested that vitamin D can help prevent cancer. The researchers write: “Raising the minimum year-around serum 25(OH)D level to 40 to 60 ng/mL (100–150 nmol/L) would prevent approximately 58,000 new cases of breast cancer and 49,000 new cases of colorectal cancer each year, and three-fourths of deaths from these diseases in the United States and Canada… Such intakes also are expected to reduce case-fatality rates of patients who have breast, colorectal, or prostate cancer by half. There are no unreasonable risks from intake of 2000 IU per day of vitamin D3 , or from a population serum 25(OH)D level of 40 to 60 ng/mL.”

In summary, we need vitamin D for our brains to work properly, for our bodies to properly maintain themselves and it also acts as a powerful defender to chronic disease.

Vitamin-D3-Weight-LossWhen should we take a Vitamin D supplement?

A vitamin D supplement should be taken once daily, at any time.

How much Vitamin D should we consume?

Our circulating 25-hydroxyvitamin D [25(OH)D] concentration lets us know how much vitamin D has been produced in our body from sun, food and supplements. Its half-life is 15 days. The most advantageous serum concentrations of 25(OH)D seem to begin at 75 nmol/L, with the optimal levels being between 90 and 100 nmol/L. Most people will be unable to reach these levels with an intake between 200 and 600 IU of vitamin D. An intake of greater than or equal to about 1000 IU may be needed for most of the population.

For infants at northern latitudes, studies suggest that 200 IU vitamin D per day may not be enough to prevent vitamin D deficiency.  A recent study on women in Maine found that 800 IU of vitamin D per day was enough to reach and maintain adequate blood levels during the winter (for most of the women).

Blood level classifications for 25(OH)D:

  • Vitamin D intoxication: >/= 375 nmol/L
  • Preferred range: 75-100 nmol/L
  • Insufficient range: 50-75 nmol/L
  • Mild deficiency: 25-50 nmol/L
  • Moderate deficiency: 12.5-25 nmol/L
  • Severe deficiency: <12.5 nmol/L

The total requirement for vitamin D (sun and food) is about 4000 IU/day to keep 25(OH)D levels above and/or around 100 nmol/L. Treating deficiency can require more. To normalize stores, adults require 3000-5000 IU per day for 6 to 12 weeks. For those of us in Canada, here are the guidelines to follow:

From March – October:  15-30 minutes of mid-day sun (15 for those with lighter skin, 30 for darker) OR  4,000 IU supplemental vitamin D2 daily

From November – February: 4,000 IU supplemental vitamin D2 daily

Who should be taking a Vitamin D supplement?

As the recommendations indicate, a Vitamin D supplement is recommended for everyone during the winter when we take in no sunlight, and should also be taken on days in the summer months when you don’t get more than 20 minutes of direct sunlight. I take a 4,000 IU every morning in the winter. I get enough sun in the summer time so I don’t worry about supplementing until late October/November. If you think that you are vitamin D deficient, please consult your physician before beginning to supplement, as the risk of toxicity is possible (albeit extremely hard to achieve).

Despite the importance of vitamin D, it’s estimated that anywhere from 30% to 80% of the U.S. population is vitamin D deficient. It’s likely worse among people with darker skin living in northern zones, as their skin pigmentation screens out the relatively limited sunlight more effectively. If your skin is darker, consider more time in the sun.

Vitamin D levels can also be affected by age and body fat levels. As we age, our ability to make vitamin D is reduced by 75%. For postmenopausal women and older men, 25(OH)D concentrations of less than 30 to 80 nmol/L are associated with negative health outcomes. Furthermore, vitamin D can get trapped in body fat, leading to a 55% reduction in blood levels for those who are overweight or obese.

As indicated by the Canadian guidelines above, Vitamin D production via the sun also changes throughout the year depending on where you live. If you live north of Atlanta, GA, you will make zero vitamin D from the sunlight between November and March (for those of you that are geographically-constipated, that’s us Canada!). If you live below Atlanta, GA, you’ll be all right. It is possible to build some reserves of vitamin D, but these reserves won’t last longer than a few weeks.

** Bonus facts: Glass blocks virtually all UVB, preventing vitamin D from being made. Applying sunscreen with an SPF of 15 will decrease the amount of vitamin D made in the body by about 99%. In conclusion, you have to be outside, during the summer/south of Atlanta and without sunscreen in order to produce any vitamin D!

How do I find a high-quality Vitamin D supplement?

27931275Here are some things to look for when shopping for vitamin D:

– You want to take the supplement most like the form you make in your skin: vitamin D3, or cholecalciferol. This supplement is formed by extracting 7-dehydrocholesterol from lanolin (yes, like sheep’s wool).

NOTE: Some strict vegetarians may prefer D2 since it’s not derived from animals, but because it’s less potent, higher doses are needed to get the same effect as D3.

– Liquid is the best form to take (most readily available and absorbed by the body), followed by capsules (like liquid with a coating), followed by less pure tablets (which may not dissolve properly).

– Taking a multivitamin for the purposes of getting vitamin D is a poor idea because by the time you take enough pills to reach your recommended dose, you will already have a toxic dose of other vitamins; particularly vitamin A.

– Try to pick a reputable brand that hasn’t had any of their products recalled; good companies also test all raw materials individually for carcinogens like arsenic, cadmium, lead, and mercury.

Other considerations

There are few adverse effects with vitamin D supplementation- it is very safe to supplement. Intakes of up to 10,000 IU per day have not been associated with adverse effects. If you take more than 10,000 IU per day of vitamin D orally for more than 6 months, you run the unnecessary risk of becoming vitamin D toxic. Taking 50 or more times the recommended daily allowance (RDA) per day for several months can cause toxicity and a high calcium level in the blood (hypercalcemia). This can lead to calcium deposits in the organs of the body. Like with most things, take only what you need and don’t be an idiot.

That’s it and that’s all! For additional questions on vitamin D supplementation, don’t hesitate to post a comment below or contact me personally!

DW