Vitamin Information Center

Vitamin B12 (Cobalamin)
•Required for nerve function, synthesis of DNA and RNA, metabolism of energy,
enzyme reactions, and production of red blood cells.
•Used therapeutically for heart health (lowers homocysteine), male infertility, pre-
vention of neural tube defects, asthma, and cancer prevention.
•Defi ciency is common among the elderly and those with poor diets, pernicious ane-
mia, depression, Alzheimer’s, or malabsorption conditions (celiac disease).
•Defi ciency symptoms: anemia, appetite loss, constipation, numbness and tingling
in the extremities, and confusion. Pregnant women with defi ciency have increased
risk of giving birth to a child with neural tube defects.
•Drugs that deplete B12: acid-lowering drugs (omeprazole, lansoprazole, ranitidine),
oral contraceptives, antibiotics, cholestyramine, and metformin.
•Supplements are recommended for those over age 50, vegetarians, women planning
to become pregnant, those with poor diets, and those at risk of heart disease.

“Doctor, should I take vitamin C during the cold and flu season?” If you were to ask 10 doctors this question, you might get 12 different answers.

There is substantial medical research demonstrating that vitamin C is beneficial for viral infections and in preventing pneumonia. At the same time, there is a lot of research suggesting no benefit. These differences may be explained by how much vitamin C per day was used.

Vitamin C is a dietary nutrient that prevents a disease called scurvy. In the 1940s and 1950s, medical research showed high-dose vitamin C to be effective against influenza, leprosy, tuberculosis and even polio. But with the advent of antibiotics, vitamin C therapy was used infrequently and the clinical expertise was gradually lost with each new generation of physicians.

Vitamin C is necessary for a variety of metabolic functions. Besides its role as an antioxidant, it also used in tissue repair, brain chemical production, adrenal function, wound healing, immune function, heart disease, diabetes, lung function, detoxification and cancer prevention.

All animals - except for humans, primates and guinea pigs - make vitamin C. The daily-recommended dose of vitamin C is 500 mg, the minimal amount needed to prevent scurvy. The optimal dose is not known.

However, the average, 40-pound barnyard goat makes 10,000 mg on a daily basis and more than 100,000 mg when stressed. One could postulate that we are under-dosed and that a 170-pound person certainly needs more than 500 mg per day.

So, do we need more than 500 mg of vitamin C during the cold and flu season? The answer is yes. In studies based on 1,000 mg of vitamin C per day, the majority of research indicates fewer and less severe colds. In the research using less than 1,000 mg per day, there doesn’t seem to be any benefit.

What is really interesting is what happens when vitamin C is given intravenously. Vitamin C given intravenously can easily achieve the high blood levels of the goat. In those studies, vitamin C was curative for infectious diseases such as polio.

Intravenous vitamin C also seems to improve healing and stress-related conditions, and some professional and amateur athletes use intravenous vitamin C to minimize fatigue and improve recovery time.

For many of my patients, intravenous vitamin C has proven benefits. High doses of vitamin C orally can cause diarrhea and should not be done in children. Intravenous vitamin C is contraindicated for people with certain enzyme deficiencies and kidney stones and should only be done under the direction of a physician.

• Patrick B. Massey M.D., Ph.D., is medical director for complementary and alternative medicine for Alexian Brothers Hospital Network.

Next time you visit your local chemist, pause in the aisle containing vitamin supplements, and take in the quantities and varieties of pills and potions on offer. Tiny boxes and bottles stretch as far as the eye can see, affirming that even in these cash-strapped times, the gorging of such “miracle cures” continues to be big business.

But as the UK population continues to shell out millions annually on vitamin supplements, the scientific evidence supporting their efficacy is waning. Earlier this month, US scientists discovered that taking vitamins A and E does not lower your risk of cancer, one of the supposed major benefits of taking them.

“There have been a number of previous studies that have suggested that vitamin E and vitamin C might be important in the prevention of cancer,” says Dr Howard Sesso, one of those involved in the recent research. “The lack of an effect that we observe for vitamin E or C on cancer does convince us that these particular doses that we tested really have no role for recommendation for cancer prevention,” continues the academic. The clinical trials he oversaw involved nearly 15,000 American men.

Another recent study, part-funded by German chemicals firm BASF, whose products include vitamins, working in association with Brigham and Women’s Hospital, Boston, discovered that there were no significant effects on rates of heart disease after taking vitamins E and C. Two months ago, a major trial studying whether vitamin E and selenium (which, among other things, helps regulate hormone metabolism in the thyroid) could lower a man’s risk of prostate cancer ended amid worries that such treatments may do more harm than good. As if that were not enough, doctors at New York’s Memorial Sloan-Kettering Cancer Centre have warned that vitamin C seems to protect not only healthy cells, but cancer cells, too.

So should we be taking vitamin supplements at all? “We say that people don’t need to take vitamin supplements to have a healthy balanced diet. The only situation in which you should have to take vitamin supplements is if you are elderly or suffering from a long-term illness. People should address whether they have a healthy diet rather than seeing vitamins as a complete solution,” says Heather Caswell, nutrition scientist at the British Nutrition Foundation.

“People get a lot of vitamins from food,” adds health expert and author Oliver Gillie. “The exception is, of course, if you have too many things in your diet that are vitamin-depleted because they are totally refined. This includes cake and biscuits, which have large amounts of refined starches in them. On the other hand, if you are eating brown bread and you are consuming lots of vegetables, and a certain amount of meat and eggs, you will be OK.”

If the evidence against supplements is rapidly becoming insurmountable, why do people keep taking them? Well, some supplements still have proven advantages for people’s health. Vitamins such as B12 – that are good for facilitating normal functioning of the brain and nervous system – are still believed by some to have benefits for women of child-bearing age and the elderly. Furthermore, calcium and vitamin D in women over 65 appear to protect the health of the bones of those taking them.

People seem to experience the placebo effect more than ever with vitamins – thinking that the more they spend, the more they are able to stave off the worst effects of disease and age. The general belief is that they boost the body’s ability to mop up cancer-and-heart-disease-causing free radicals.

In some cases, in the UK at least, there is increasing evidence that some vitamins do have benefits. “Vitamin D is different,” adds Gillie. “A healthy person normally gets 90 per cent of the vitamin D they need from the sun. Unless you are an Eskimo or a Scottish fisherman living 100 years ago where you ate fish every day, then you can’t get enough from your diet.” A lack of vitamin D has been linked to increased rates of cancer, high blood pressure, osteoporosis, depression and schizophrenia.

Today, top Scottish doctors are meeting to discuss how to deal with the fact that, due to the country’s northerly location and consequent lack of sunlight, large swathes of its population are not getting enough of the vitamin, which is believed to support the healthy operation of organs.

“I am going to a conference in Edinburgh called by Scotland’s chief medical officer, Dr Harry Burns, who is concerned with the low levels of vitamin D in the Scottish population. It is an extreme case in the industrial world. In places like Glasgow there is so little ultraviolet light that people are in drastic need of vitamins. They are in an extreme situation because of their maritime climate. Scotland has got more cases of multiple sclerosis [which is believed to be naturally inhibited by vitamin D] than any other country in the world.”

But there’s now increasing evidence that taking too much of some vitamins can cause harm to people’s health. Recent studies – one by the Johns Hopkins School of Medicine – have shown that taking large amounts of vitamin E with other vitamins results in a 6 per cent higher risk of premature death. Another study, reported in the Journal of Clinical Oncology, of 540 patients showed that cancer recurrence rates were higher among vitamin users than among non-users. There seems to be increasing evidence that the death knell for certain vitamin supplements has now well and truly been sounded. Could it be time to step out of the chemist’s and back into the kitchen?

Complete meals: How to get your daily dose

Vitamin A

Liver, full-fat dairy products, spinach, broccoli, tomato juice, peppers and watercress. Orange things, such as mango, dried apricots, butternut squash, carrots, sweet potatoes and pumpkin tend to be good sources of this vitamin.

Vitamin D

Oily fish (salmon, sardines, pilchards, tuna, mackerel, trout or herring), dairy products and eggs. Also exposure to sunlight.

Vitamin E

Broccoli, nuts, soya beans, brussels sprouts, spinach and eggs. Some believe vitamin E is destroyed by heat, so try to eat your vegetables raw or lightly cooked.

Vitamin C

Citrus fruits and juices, kiwi fruit, strawberries, blueberries, tomatoes and peppers.

Vitamin B

Vitamin B1 is found in whole grains, flour and bread and green leafy vegetables; Vitamin B2 is found in eggs, liver, milk, and cheese; B3 is in protein-rich foods like meat, liver and peanuts; B5 is in chicken, eggs, beef and broccoli;

B6 is in fish, chicken and wholegrain cereals; B9 is in raw fruit as well as yeast and liver and B12 is in fish, dairy produce, meat and yeast extract.

Despite great advances in medicine, cancer is still a very common disease. At current rates, more than a third of us will suffer from cancer during our lifetime and about one in four of us will die from it. According to the American Cancer Society, 7.6 million people worldwide died from cancer in 2007.

Research statistics report that 30 to 40% of cancers are directly linked to nutrition, which shows the importance of a healthy diet in cancer prevention. Meanwhile, scientists continue to investigate foods known to be anti-carcinogenic in order to develop strategies for both cancer prevention (chemoprevention) and treatment (chemotherapy). As Hippocrates said over 2000 years ago, “Let food be thy medicine.”

The problem with current chemotherapeutic treatments is that most are not completely selective for carcinogenic cells—they harm normal cells too—and decrease the quality of life for cancer patients. Scientists are hoping that by developing chemopreventive or chemotherapeutic agents based on natural micronutrients, they will be able to develop drugs that target cancer cells with less or no harm to normal cells.

Vitamin E is an important antioxidant micronutrient. Research shows that vitamin E not only improves skin health, boosts the immune system, protects against heart disease, aging and Alzheimer’s, but also has a role in protection against some types of cancer. Unlike some vitamins, which consist of a single compound, vitamin E consists of eight different compounds, four tocopherols and four tocotrienols. Our food contains all eight compounds. Tocopherols are most commonly found in nuts and vegetable oils, whereas tocotrienols are primarily derived from palm oil, oat, rye, wheat germ, barley and rice bran.

Even though the vitamin E family consists of 8 members, most research has traditionally focused on alpha-tocopherol. Alpha-tocopherol is the most abundant form of vitamin E in the plasma and tissue of humans as well as in vitamin supplements, while the seven other types of vitamin E were greatly ignored for many years. Recent research over the last few years has led to the conclusion that the eight vitamin E compounds have different anti-carcinogenic potencies which need to be considered.

The cancer preventive properties of vitamin E were first suspected when studies showed that people in the Mediterranean area who consume diets rich in vitamin E have a lower risk of colon cancer than people in Northern Europe and the U.S. (Eur J Clin Nutr. 1989; 43:49-55, Cancer Causes Control. 1995; 6:525-31.) More recently, the Melbourne Colorectal Cancer Study showed that dietary vitamins E and C were protective for both colon and rectal cancer, and that for both vitamins there was a dose-response effect of increasing protection. (Nutr Cancer. 2006; 56:11-21.)

Another clinical study supported a preventive effect of vitamin E in the development of prostate cancer. This study included over 29,000 elderly male smokers and showed that those taking vitamin E for six years had 32% fewer diagnoses of prostate cancer and 41% fewer prostate cancer deaths than men who did not take vitamin E. (J Natl Cancer Inst. 1998; 90:440-446.) The ongoing NIH sponsored Selenium and Vitamin E Cancer Prevention Trial (SELECT) is investigating selenium and vitamin E for prostate cancer prevention based on the encouraging results of earlier studies.

In the past few years most of the research has focused on structural variations of the natural forms of vitamin E with the aim of developing the anti-carcinogenic potency of these agents. The scientific community is hoping to take some of the synthetic derivatives to clinical trials, so it will be interesting to see if any of these compounds will be eventually developed into chemopreventive or chemotherapeutic agents.

But you should be aware that all vitamin E supplements are NOT created equal. Many contain synthetic vitamin E, and many do not contain all of the various types of natural vitamin E that the body requires. Make certain that your supplement contains both natural tocopherols and tocotrienols in their natural forms if you want to get the most out of what vitamin E has to offer. Only products that contain the complete vitamin E family—tocopherols plus tocotrienols—provide the full spectrum of benefits of vitamim E.

The Anti-Aging Bottom Line: A careful examination of the research performed so far on vitamin E and cancer leads me to conclude that vitamin E possesses strong anti-carcinogenic properties. While food is by far the preferred source of vitamin E, it is practically impossible to get protective amounts of vitamin E from food alone. Therefore, I feel that taking supplemental vitamin E is absolutely essential to achieving vibrant health and longevity.

Everywhere you look this month, someone seems to be talking about Vitamin D. Good Morning America, Parenting Magazine, and numerous news organizations have focused on the possible benefits of the vitamin your body produces itself, yet most people seem to lack.

All this attention has led to some confusion. South Jersey Healthcare outpatient dietitian Deborah Stump helped shine some light on vitamin D last week by answering more than a dozen questions submitted to The Daily Journal’s Healthline.

“It’s a big topic right now,” said Stump. She added that recent studies have linked vitamin D to everything from diabetes to cancer prevention.
What is it?

Vitamin D helps the body absorb calcium and form bone. It also strengthens the immune system.
How do I get it?

Getting vitamin D is as easy as going outside. Your skin turns UVB rays from sunlight into vitamin D. It also is found in most multi-vitamin supplements, stand-alone supplements, and in “fortified” foods such as milk and some fruit juices and cereals.

So, if it’s so easy to get, why are more than half of children and some 65 percent of adults not getting enough?

Turns out, according to Stump, some generally-accepted, healthy habits have had the unintended consequence of restricting vitamin D. The first: sunscreen.

“You need 10-20 minutes of sun exposure three times a week,” she said, adding that the exposure should come between 11 a.m. and 3 p.m., when the sun is strongest. Sunscreen, of course, blocks those rays.

And yes, you have to go outside.

“One question asked if you can get sunlight through glass,” Stump said. “Glass lets about 78 percent of UVA rays through,” she said, “but it blocks all but about 5 percent of the important UVB rays. So, you have to get outside.”

Stump added that people should spend a little more time outside during the winter months, when the sun is not as strong.

Vitamin D took another hit as people moved away from eating saturated fats.

“As people started eating more poly and unsaturated fats, we saw a decrease in vitamin D,” she said.
How much do I need?

This was the most common Healthline question.

The Dietary Reference Intake for vitamin D is 200 International Units per day for kids and adults up to age 50, but that is being hotly debated. The American Academy of Pediatrics recommends 400 IU per day, and a quick check of a bottle of One-A-Day vitamins says that 400 IU covers 100 percent of my daily requirement.

Stump said even that may not be enough.

“There is a lot of research supporting 800-1,000 IU of Vitamin D per day,” she said.
What’s the use?

So why so much interest in vitamin D? Well, besides forming bone and helping the immune system, Stump said there is an association between vitamin D deficiency and Type 1 and 2 diabetes. Also, there is evidence that vitamin D can fight prostate, breast, and colon cancers as well as fight depression and improve cardio-vascular health.

Vitamin D kills prostate cancer cells in the laboratory. Now, specialists at the Hollings Cancer Center at the Medical University of South Carolina are studying whether vitamin D will halt the cancer’s progression in early-stage patients.

Drs. Sebastiano Gattoni-Celli and David Marshall hope to add a large dosage of vitamin D to “watchful waiting.”

Watchful waiting is an approach some men with slow-growing prostate cancer choose. Doctors monitor the disease for signs of growth. If and when that occurs, treatment may be sought.

“We offer something more than monitoring,” said Gattoni-Celli, principal investigator.

That “something more” is vitamin D — a nutrient mainly absorbed through sun exposure and long touted as a cancer-prevention agent.

The prostate is a walnut-sized gland below the bladder responsible for making and storing fluid that transports sperm. The gland is known to sequester vitamin D, which helps it function.

The recommended daily dose of vitamin D for men ages 51 to 70 is 400 International Units, or IUs. Study participants take 4,000 IUs of vitamin D daily.

The Food and Drug Administration approved the study-prescribed dosage as having minimal to no toxicity, said Gattoni-Celli, who has taken 4,000 IUs of vitamin D daily for three years.

“A good number of people may be deficient in vitamin D because we live and work indoors,” he said.

Participants in the watchful waiting and vitamin D study are monitored every eight weeks. If their levels of prostate-specific antigen — a protein found in blood that correlates with prostate cancer — rise twice consecutively, they will be counseled to reassess their treatment options.

Vitamin D is found in fortified milk, eggs and fatty fish, but people absorb most of what they need through ultraviolet rays. Fifteen minutes of sun exposure twice a week to the face, arms, hands or back without sunscreen is sufficient for most people to produce enough vitamin D, according to the National Institutes of Health.

People with dark skin might have difficulty getting enough vitamin D from the sun. Increased melanin, which gives dark skin its color, reduces the skin’s ability to synthesize the vitamin from sunlight.

Gattoni-Celli said he is not surprised by the fact that prostate cancer affects black men disproportionately. “The hunch is there,” he said about a link between vitamin D and prostate cancer, but the reality of collecting scientific evidence requires patience.

Patients can opt out of the study any time to pursue treatment, said Marshall, the study’s co- investigator. The only risk of watchful waiting is that treatment later might prove more complex than if used earlier, he said.

Watchful waiting is advisable because some forms of prostate cancer can proceed very slowly, Gattoni-Celli said.

Autopsies of older men who died of causes other than prostate cancer revealed that 50 percent of them had the disease, Gattoni-Celli said.

Some experts now worry that prostate cancer might be overdiagnosed and overtreated with the increased availability of prostate-specific antigen screening in the last 25 years. Men who otherwise might have lived the rest of their lives without suffering symptoms of the disease now could be receiving aggressive treatment.

Some prostate cancer patient advocates are critical of the watchful waiting approach, however.

Bob Strobel leads the Charleston chapter of Us TOO, a prostate cancer education and support group. “Anytime someone mentions watchful waiting to someone with prostate cancer, you’ll see them get irate,” he said.

Strobel pointed to advances in treatments. “The things that are happening now with medical treatment, it’s astounding,” he said.

Treatments include the surgical removal of the gland, radiation and hormone therapy. Doctors also can implant radioactive seeds into the gland or freeze the cancer. All treatment options can cause problems such as incontinence and erectile dysfunction.