Vitamin Information Center

Q. For foods that act as natural blood thinners (such as broccoli, cabbage, etc.), does it make a difference whether the foods are eaten raw or cooked? My mom, who takes prescription blood thinners, has been told that she should avoid all these foods. But these foods are also good for you and I would like to be able to find a balance. It seems to me that you would need to consume a great deal of vitamin K in order for it to produce a negative effect together with the Coumadin.

A. First, a clarification on why people taking blood-thinners are sometimes advised to avoid foods that are high in vitamin K. Vitamin K does not act as a natural blood-thinner; quite the opposite. Vitamin K regulates clotting action and can interfere with blood-thinning medication.

But you are quite right to note that these foods are also very good for you and, in fact, it is not necessary to eliminate them from the diet when taking blood-thinning medication.  It is important, however, to keep your intake of vitamin K relatively steady from day to day so that your doctor can calibrate your dosage appropriately. Please refer to this post for a more complete discussion of this issue.

To your question about how cooking affects vitamin K levels: The amount of vitamin K is not greatly affected by cooking.  Nonetheless, most vegetables are listed in our database in both their raw and cooked forms so you can check the vitamin K content of a food according to how its prepared.

Editor’s note:  A recent study found that use of vitamin E supplements was not associated with reduced risk of lung cancer among the general population. Among current smokers, taking vitamin E supplements may even dramatically increase the risk of the cancer up to 28%.  The following is compiled by a foodconsumer.org editor for those who want to know more about this vitamin. The key point is that vitamin E by definition is essential to your health and you should not avoid it.  The best source is of course food. But when you take a supplement, make sure you are taking the natural form of vitamin E.  Read on for detail.

Vitamin E: What you need to know

What is vitamin E?

Vitamin E is a group of eight nutrients including four tocopherols, (alpha-, beta-, gamma- and delta-) and four tocotrienols (alpha-, beta-, gamma- and delta-). Alpha-tocopherol is the only form of vitamin E that is active in the body.

What does vitamin E do in the body?

The form of vitamin E most known today is alpha-tocopherol, which is believed to be used in the body mainly as an antioxidant. Antioxidants are expected to neutralize free radials endogenously and oxidative environmental pollutants.

Alpha-tocopherol is fat-soluble and helps protect against oxidation of fatty components in the cell membrane and also protect fats in low density liporpoteins (LDLs), which transport cholesterol from the liver to the tissue of the body. Oxidation of LDLs could lead to development of cardiovascular diseases.

Alpha-tocopherol also affects some enzymes and the production of immune and inflammatory cells among other things.

The functions of other forms of vitamin E are not as well understood.

What are the consequences of vitamin E deficiency?

Vitamin E deficiency could be caused either by low intake of the vitamin or by some conditions that disable the alpha-tocopherol transfer protein or by some problem with fat absorption.  Those who can’t absorb fat such as patients with cystic fibrosis or cholesterol liver disease would have a problem with absorbing this vitamin from the diet, potentially leading to vitamin E deficiency.

The main consequences of severe vitamin E deficiency are neurological symptoms such as ataxia (impaired balance and coordination), peripheral neuropathy (injury to sensory nerves, myopathy (muscle weakness) and pigmented retinopathy (damage to the eye retina). People who experience these symptoms should be checked for their vitamin E status.  Children are more sensitive and thus more vulnerable to vitamin E deficiency and they can quickly show neurological symptoms while adults may not develop symptoms due to the deficiency for 10 to 20 years.

Vitamin E deficiency due to low intake of this nutrient rarely results in any reported symptoms.  In effect, vitamin E deficiency due to low dietary intake is rare although suboptimal intake of this nutrient is found common in the U.S. population. A study known as the U.S. National Health and Nutrition Examination Survey III (NHANES III) showed 27 % of whites, 41% of blacks, 28% Mexican Americans and 32% of others have less than 20 micromoles/liter, a level of vitamin E that is believed to pose a risk for cardiovascular disease.

What is the recommended dietary allowance for vitamin E?

The RDA set by the Food and Nutrition Board of the Institute of Medicine in 2000 varies with age.  The RDA for both adult males and females is 15 mg or 22.5 IU per day.  Pregnancy does not require extra vitamin E, but breastfeeding mother need 19 mg or 28.5 IU per day.

What are the conditions or diseases on which vitamin E may have an effect?

Observational studies have showed an association between increased vitamin E intake and decreased risk of myocardial infarction or heart attack or death from heart disease in both men and women.  Studies also found plasma levels of alpha-tocopherol were inversely linked to the severity of carotid atherosclerosis. But trials often failed to see any protective effect of this vitamin on heart attacks and death.

Observational studies also showed vitamin E may protect against cataracts, but interventional trials did not find any protective effect when 400 IU of vitamin E was used for 7 years.

Alpha-tocopherol was also found to boost the immune response. One study showed 200 mg of synthetic-tocopherol daily for a few months increased production of antibodies in response to hepatitis B vaccine and tetanus vaccine in elderly people.

Because free radials are believed to cause damage to DNA, neutralization of these compounds by antioxidant vitamins such as vitamin E is believed to have a preventative effect against cancer.  But many studies showed that vitamin E supplements were not linked to reduced risk of cancer.  In a recent study, vitamin E supplementation for ten years was found even to increase the risk of lung cancer in current smokers.

What are the foods that contain high levels of vitamin E?

The major dietary sources of alpha-tocopherol include vegetable oils such as olive, sunflower and safflower oils; nuts such as almonds, hazelnuts and peanuts; whole grains products; and green leafy vegetables such as spinach.  All eight forms of vitamin E occur naturally in foods.

Those who would use vitamin E supplements should check and see if the form they buy is natural or synthetic.  They may better off buying and using only the natural form.  The synthetic form of vitamin is biochemically not usable by the body and potentially cause a physiologic problem in the body.  The natural form in food (not the fortified) is the form of the isomer, RRR-alpha-tocopherol.  In supplemental vitamin E, dl-alpha-tocopherol or all-rac-alpha-tocopherol means the vitamin is synthetic.

There are some other forms of vitamin E or derivatives used in supplements.  Foodconsumer.org recommends use of the natural form d-alpha-tocopherol.

What are the possible side effects of vitamin E?

Vitamin E is fat-soluble and too much of its intake through supplements may cause some side effects. But the Food and Nutrition Board of the Institute of Medicine believes 1000 mg or 1500 IU of alpha-tocopherol per day can be tolerated by adults aged 19 or older.  The dietary intake of this vitamin rarely poses any risk.

Heart Attack

Heart disease affects your heart’s muscle, blood vessels, and electrical system and is the leading cause of death among women. The most common form of heart disease is coronary artery disease in which plaque (a fat-like substance) deposits on artery walls. Plaque build-up is called atherosclerosis. This is a chronic condition that occurs in people with risk factors such as diabetes, obesity, smoking, abnormal levels of blood fats, high blood pressure, a family history of heart disease and older age. When a plaque ruptures, it causes a blood clot to form and suddenly block an artery. If this happens in a heart artery, it results in a heart attack.

Treatment

Don’t smoke Control your blood pressure Control your cholesterol level. Maintain a healthy weight. Exercise regularly. Eat a low-fat diet. Take care of diabetes. Be aware of chest pain.

High Blood Pressure

High blood pressure (also called hypertension) occurs when your blood moves through your arteries at a higher pressure than normal. The heart is a pump designed to force blood through our body. Blood is pumped from the heart through the arteries out to our muscles and organs.

Pumps work by generating pressure. Put simply, too much pressure puts a strain on the arteries and on the heart itself. This can cause an artery to rupture or the heart to fail under the strain - in the worst case stopping altogether.

Treatment

Blood pressure is measured with a monitor called a sphygmomanometer. This is a digital box attached to a tube with a cuff on the end. The cuff is placed around the upper arm and inflated to a certain level, then deflated slowly. A sensor in the cuff provides information about the blood pressure or a doctor or nurse will listen to the blood flow using a stethoscope.

Hypertensive Heart disease

Hypertensive heart disease is any of a number of complications of arterial hypertension that affect the heart. It is one of the most common causes of death in western societies. Hypertensive heart disease is the No. 1 cause of death associated with hypertension and is actually a group of disorders that include heart failure, ischemic heart disease, and left ventricular hypertrophy

Treatment

Common medications include diuretics, beta blockers, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor antagonists, and direct vasodilators. intravenous diazoxide or nitroprusside may be prescribed if hypertension is extremely severe and intensive care is necessary. Preventive measures against hypertensive heart disease emphasize control over weight, healthy diet (rich in fiber and vitamins), and abstinence from drugs and alcohol.

In cases of a severe heart problem, surgery may be required to restore the normal blood flow in the heart and/or blood vessels. In addition to medications, recommended lifestyle changes include weight loss, exercise, and dietary adjustments. Dietary recommendations include increasing fruits, vegetables, and low-fat dairy products. Whole grains, poultry, and fish are also generally recommended. Tran’s fats and saturated fats should be avoided. Patients may benefit from reducing salt intake. If you smoke, stop smoking — cigarettes are a major cause of hypertension and related heart disease. Reducing excessive alcohol consumption may also help.

Although vitamin C has long been touted as a preventive measure against the common cold, the available evidence from several large-scale randomized controlled trials does not support this claim. Continue Reading…

NORTH BERGEN, N.J., Feb. 6, 2008 (PRIME NEWSWIRE) — Americans are learning that there’s much more to chia seeds than sprouting terracotta pets. Chia seeds have been garnering quite a bit of media attention lately, and health-conscious consumers are wondering what all the hype is about. Continue Reading…

Availability of adequate fluoride confers significant resistance to dental caries. It is now considered that the topical action of fluoride on enamel and plaque is more important than the systemic effect. Where the natural fluoride content of the drinking water is significantly less than 1 mg per litre, artificial fluoridation is the most economical method of supplementing fluoride intake. Continue Reading…

Iodine is among the body’s essential trace elements. The recommended intake of iodine is 150 micrograms daily (200 micrograms daily in pregnant and breastfeeding women); in children the recommended intake of iodine is 50 micrograms daily for infants under 1 year, 90 micrograms daily for children aged 2–6 years, and 120 micrograms daily for children aged 7–12 years. Deficiency causes endemic goitre and results in endemic cretinism (characterized by deaf-mutism, intellectual deficit, spasticity and sometimes hypothyroidism), impaired mental function in children and adults and an increased incidence of still-births and perinatal and infant mortality. Iodine and iodides may suppress neonatal thyroid function and in general iodine compounds should be avoided in pregnancy. Where it is essential to prevent neonatal goitre and cretinism, iodine should not be witheld from pregnant women. Control of iodine deficiency largely depends upon salt iodization with potassium iodide or potassium iodate and through dietary diversification. In areas where iodine deficiency disorders are moderate to severe, iodized oil given either before or at any stage of pregnancy is found to be beneficial.

Oily injection (Solution for injection), iodine (as iodized oil) 480 mg/ml. 0.5-ml ampoule, 1-ml ampoule

Uses:

prevention and treatment of iodine deficiency

Contraindications:

breastfeeding (Appendix 3)

Precautions:

over 45 years old or with nodular goitre (especially susceptible to hyperthyroidism when given iodine supplements—iodized oil may not be appropriate); may interfere with thyroid-function tests; pregnancy (see notes above and Appendix 2)

Dosage:

Endemic moderate to severe iodine deficiency, by intramuscular injection , ADULT women of child-bearing age, including any stage of pregnancy, 480 mg once each year; by mouth , ADULT during pregnancy and one year postpartum, 300–480 mg once a year or 100–300 mg every 6 months; women of child-bearing age, 400–960 mg once a year or 200–480 mg every 6 months

Iodine deficiency, by intramuscular injection , INFANT up to 1 year, 190 mg; CHILD and ADULT 380 mg (aged over 45 years or with nodular goitre, 76 mg but see also Precautions) (provides up to 3 years protection)

Iodine deficiency, by mouth , ADULT (except during pregnancy) and CHILD above 6 years, 400 mg once a year; ADULT during pregnancy, single dose of 200 mg; INFANT under 1 year, single dose of 100 mg; CHILD 1–5 years, 200 mg once a year

Adverse effects:

hypersensitivity reactions; goitre and hypothyroidism; hyperthyroidism

Calcium supplements are usually only required where dietary calcium intake is deficient. This dietary requirement varies with age and is relatively greater in childhood, pregnancy and lactation due to an increased demand, and in old age, due to impaired absorption. Continue Reading…

Vitamin B₁

Tablets , thiamine hydrochloride 50 mg

Uses: Continue Reading…

Vitamin B₂

Tablets , riboflavin 5 mg

Uses:

vitamin B₂ deficiency

Dosage:

Treatment of vitamin B₂ deficiency, by mouth , ADULT and child up to 30 mg daily in divided doses

Prophylaxis of vitamin B₂ deficiency, by mouth , ADULT and child 1–2 mg daily