Vitamin Information Center

Vitamin B3 (Niacin) •Required for energy metabolism, enzyme reactions, skin and nerve health, and digestion. •High doses of nicotinic acid (3 g daily) can lower cholesterol (reduce LDL and tri- glycerides and increase HDL) and reduce the risk of heart attack and stroke; high dosages should be supervised by a physician. •Defi ciency causes pellagra, the symptoms of which are skin rash, diarrhea, demen- tia, and death. •Defi ciency may be caused by poor diet, malabsorption diseases, dialysis, and HIV. •Drugs that deplete vitamin B3: antibiotics, isoniazid, and 5-Fluorouracil (chemo- therapy). •High-dose niacin, taken along with statin drugs (i.e., lovastatin), may increase the risk of rhabdomyolysis (muscle degeneration and kidney disease). •Most people get adequate niacin from diet and/or a multivitamin; supplements may be recommended for those with high cholesterol.

Vitamin B2 (Riboflavin)
•Required for energy metabolism, enzyme reactions, vision, and skin/hair/nail
health; functions as an antioxidant; activates vitamin B6, niacin, and folate.
•May play a role in preventing migraine headaches and cataracts.
•Defi ciency occurs in alcoholics, the elderly, and those with poor diets.
•Symptoms of defi ciency include sore throat; redness/swelling of the mouth, throat,
tongue, lips, and skin; decreased red blood cell count; and blood vessel growth over
the eyes. Defi ciency may impair iron absorption and increase risk of pre-eclampsia
in pregnant women.
•Drugs that deplete vitamin B2: antibiotics, chlorpromazine, amitriptyline, adriamy-
cin, and phenobarbitol.
•Most people get adequate ribofl avin from diet and/or a multivitamin.

Vitamin A
•Found in animal foods and converted from beta-carotene in plant foods.
•Required for vision, gene expression, reproduction, embryonic development, red
blood cell production, and immune function.
•Prescription vitamin A derivatives are used to treat skin conditions (acne) and reti-
nitis pigmentosa (genetic eye disease).
•Defi ciency is rare in Canada, but common in developing countries due to malnutri-
tion. It causes night blindness, dry eyes and skin, and impaired growth.
•Drugs that deplete vitamin A: cholestyramine, colestipol, mineral oil, and neomycin.
•Supplements should be avoided by those at risk of lung cancer (smokers) or liver
toxicity (alcoholics, liver disease).
•Doses greater than 10,000 IU daily should be avoided by pregnant women due to the
risk of birth defects. Most prenatal vitamins provide 5,000 IU.
•Doses greater than 5,000 IU may increase risk of osteoporosis.
•Supplements of vitamin A beyond what is provided in a multivitamin are not rec-
ommended due to risk of toxicity. To avoid this risk, choose a multivitamin that
contains beta-carotene, which is converted to vitamin A in the liver, but is not as-
sociated with health risks.

A flurry of recent reports trumpeting the health benefits of vitamin D have vaulted the supplement to a starring role on the merchandise shelves at Burns Drugs in La Jolla.

Pharmacist Wayne Woods, who owns the store, said he’s seeing a growing number of customers asking for bottles of high-dosage vitamin D.

“We barely carried it before, but physicians are recommending it as a normal supplement on a daily basis in addition to taking your multivitamin,” Woods said.

Vitamin D’s role in bone health has long been known – think rickets in malnourished children and osteoporosis in older people. But research tying vitamin D deficiency to cancers, heart disease, diabetes and other illnesses has transformed the nutrient into a potential miracle cure. A global network of influential scientists said daily intake should be up to 10 times higher than the U.S. government’s current recommendations.

Yesterday, more than 100 physicians, nutritionists, acupuncturists, massage therapists and others gathered at the University of California San Diego for a daylong conference extolling vitamin D.

But not everyone is as enthusiastic, especially after a succession of reports dimmed the spotlight on vitamin supplements. Last month, two major clinical trials debunked vitamin B as a treatment for Alzheimer’s disease and vitamins E and C as protectors against cancer.

The scientific uncertainty has generated debate over the virtues and dangers of vitamin D. One big reason for the researchers’ disagreements: The most promising studies suggest a relationship between low vitamin D intake and many diseases, but they have failed to show a direct cause and effect.

Skeptics of dramatically boosting vitamin D supplements point to the lack of large-scale, random and “double blind” clinical studies comparing the nutrient to placebos. Dermatologists also have bristled at suggestions that people spend more time in the sun to increase the natural production of vitamin D.

Those concerns didn’t deter several longtime advocates of vitamin D supplements at yesterday’s meeting, including Dr. Robert Heaney, a professor at Creighton University in Omaha, Neb.

Heaney said studies conducted in North America and Europe found low vitamin D levels in as many as 95 percent of participants. “I think we can take it as a given that the vast majority of patients in the U.S. are vitamin D deficient,” he said.

People get most of their vitamin D from exposure to sunlight, according to the National Institutes of Health. Spending 10 to 15 minutes outdoors two to three times each week is typically enough.

The best food sources of the nutrient are oil-rich fish such as salmon, tuna and mackerel. Milk and some cereals also are fortified with the vitamin.

Another speaker at the conference, Dr. Cedric Garland, said vitamin D might prevent certain cancers partly because it helps to form the glue that binds cells to each other. Without that glue, cells can become malignant and spread to other parts of the body.

Despite the academic nature of the presentations, the gathering at times felt more like a pep rally for campaign partisans.

Carole Baggerly of Encinitas opened the conference by leading the crowd in singing “You Are My Sunshine.”

She is a former computer sales and marketing executive who founded the conference’s sponsor organization, GrassrootsHealth, after surviving breast cancer.

Baggerly called on conference attendees to become part of her organization’s D*action campaign, a “grand mission” to promote testing for vitamin D deficiency.

“There is no need for a vitamin deficiency epidemic to go on and on and on,” she said.

GrassrootsHealth and some of the conference speakers want federal health officials to increase the daily recommended intake of vitamin D to as much as 2,000 international units.

Current U.S. nutritional guidelines call for 200 international units per day for children and adults up to age 50, 400 international units for people up to 70, and 600 international units for those 71 and older.

The American Medical Association and the American Academy of Pediatrics also have called on the government to raise its vitamin D benchmarks.

But the effort is opposed by the American Academy of Dermatology, which last month advised against too much sun exposure because of the heightened risk of developing skin cancer.

While there is a growing body of “exciting” discoveries pointing to the benefits of vitamin D, more research is needed before health officials adjust supplement standards, said Patsy Brannon, a professor of nutritional science at Cornell University in Ithaca, N.Y.

“The evidence on safety and efficacy is not as strong as what we would like it to be,” she said.

At least two studies meeting the rigorous criteria of large-scale clinical trials have offered reasons for caution.

The federal Women’s Health Initiative found that women taking 400 international units of vitamin D plus 1,000 milligrams of calcium daily had a 17 percent higher risk of developing kidney stones over seven years. Their risk of developing colorectal cancers was no different than that of women who took a placebo.

In Finland, male smokers who took high doses of vitamin D supplements had a significantly greater risk of developing pancreatic cancer.

Last week, an international group of cancer researchers warned that changes to vitamin D recommendations could end up harming people if higher doses are eventually found to elevate the risk for some diseases.

“There is insufficient evidence (to prove) a lack of harm due to long-term, higher levels of vitamin D,” the scientists wrote in a report prepared for the World Health Organization’s International Agency for Research on Cancer.

The bottom line is “controversy and conflicting evidence,” Brannon said, “so there is no consensus.”

For now, people concerned about their vitamin D levels should make sure they are following the government’s guidelines by tracking their daily intake through food and supplement labels, she said.

Elderly people at risk of developing brittle bones should consult their physicians before taking supplements.

Keith Darce: (619) 293-1020; keith.darce@uniontrib.com

WASHINGTON (Reuters) - Two U.S. lawmakers are investigating advertising claims by Wyeth that promote its Centrum Cardio vitamin as a cholesterol-lowering product, according to a letter to the company released on Friday.

Michigan Reps. John Dingell and Bart Stupak are seeking related company documents following television commercials that tout the vitamin as “the only complete multivitamin that can lower cholesterol,” according to the lawmakers’ letter.

“We are concerned that these statements may be misleading to the general public and that patients with high cholesterol may erroneously substitute Centrum Cardio for a treatment plan prescribed by their physician,” the lawmakers wrote.

As Democrats, the two men chair the U.S. House of Representatives Committee on Energy and Commerce and its Subcommittee on Oversight and Investigations, respectively.

Representatives for the company could not be immediately reached for comment.

Centrum Cardio, launched in October 2007, is part of Wyeth’s Centrum line of multivitamin products.

On Wyeth’s website, the company cites a 2000 U.S. Food and Drug Administration interim rule that allows dietary supplements or foods that provide of 800 milligrams of free phytosterols to claim a possible reduction in heart disease.

A daily serving of Centrum Cardio, or 2 tablets, contains 800 milligrams of phytosterols, it said.

(Reporting by Susan Heavey; Editing by Andre Grenon)

Supplements of vitamin B are thought to increase the risk of bowel cancer, warns Jennifer Swift

Shirley Sepstrup’s busy job in a hospital lab in East Sussex left her with little time to cook, so she often relied on convenience foods, hoping that her daily multivitamin pill would make up for any dietary deficiencies. But when a colonoscopy showed that, at 52, she had developed bowel cancer - like her father, uncle and grandfather - she had to radically change her eating habits.
Out went the ready meals, and Shirley began to eat wholefoods, drink 1.5 litres of water a day, and avoid known risks for bowel cancer - red meat, preserved meats such as ham and bacon, sugar and processed foods. But recently she learnt of an unexpected risk: a vitamin.

Folic acid is the synthetic form of a naturally occurring B vitamin, folate. Women who have good levels of folate in their diet, or take folic acid supplements, are far less likely to have babies affected by the birth defect spina bifida. America and Canada started adding folic acid to flour in 1998 and the Food Standards Agency (FSA) in the UK has called for a similar fortification here. But recent research has linked high folic acid consumption with an increased risk of bowel cancer; the modest-sounding annual increase of one per cent could, in fact, amount to an extra 3,000 cases per year in the UK. Other evidence points to an increased risk of breast or prostate cancers.

Natural folate protects against cancer because it allows the body to copy DNA accurately.

“But many middle-aged and elderly people have tiny pre?malignant lesions,” says Prof Young-Im Kim of the University of Toronto. “Excess folate, especially in the form of folic acid, can fuel lesion growth, accelerating progression into life-threatening cancers, because high levels of the vitamin make it easier for tumour cells to copy themselves.”

He says that soon after fortification of flour began in North America, the rate of bowel cancer - then in decline - abruptly increased. The FSA’s advisers were sufficiently concerned to recommend holding off a similar initiative until the results of two further studies emerge later this year.

Overdosing on B vitamins was thought to be impossible because they are water-soluble and any excess is excreted in the urine. But evidence is mounting that folic acid circumvents the body’s natural mechanisms for limiting folate absorption in the gut. Folic acid goes directly to the liver, which is easily saturated, and the excess spills out into the body.

“People with a high intake end up with unmetabolised folic acid floating in their bloodstream,” says Dr Siân Astley of the Institute for Food Research in Norwich. “We don’t really know what its consequences might be.”

The recommended daily intake for folate is 200 micrograms (mcg), and most multivitamins contain this amount of folic acid. But it is also added to breakfast cereals, snack bars and some margarines. Official government advice puts the safe upper limit for folic acid at 1,000mcg per day, but the leading vitamin B expert, Prof David Smith of Oxford University, thinks there is now sufficient evidence to cut that down to 500mcg in general and 400mcg for cancer survivors.

“If you eat a lot of fortified cereals, you may want to rethink your daily multivitamin. Or you could stick with the vitamin pill and switch to wholegrains without added synthetic vitamins, such as porridge or muesli,” says Dr Astley. “Fortification is an overly broad approach that increases everyone’s folic acid intake, instead of targeting those who need it.”

DEAR DR. DONOHUE: I am a 76-year-old female. Until December 2005, I thought I was in fairly decent health. That’s when I suffered a fractured hip. I didn’t fall, just sort of slipped down. I have recovered and feel great, and I exercise. Last April, my doctor prescribed 50,000 IU vitamin D once a week. I have been taking it ever since. I get lots of sun. I also take 600 mg of calcium with 200 IU vitamin D twice a day. And I take one multivitamin a day, a Centrum Silver. My doctor wants me to consider taking Fosamax. What’s going on? I worry about getting too much vitamin D. How does a person know how much is too much?

— T.W.

Most adults get too little vitamin D. The official recommendation for daily vitamin D intake is 200 IU for those from 19 to 50, 400 IU for those between 51 and 70, and 600 IU for those 71 and older. Many experts believe these recommendations are insufficient and that the daily dose should be 800 IU to 1,000 IU. Vitamin D enhances calcium absorption and plays a critical role, therefore, in keeping bones strong and in preventing fractures. There are hints that vitamin D prevents osteoarthritis, lessens the risk of prostate cancer and helps prevent diabetes and heart disease. Time will tell if all this is true. The stuff about bones is true.

We get vitamin D when sunlight strikes the skin. It turns a substance in the skin known as a “provitamin” into vitamin D. Ten minutes of sunlight on the face and arms, three times a week to daily, is all the sunlight needed for this conversion. Older people’s skin is not so efficient in making the vitamin, and those living in northern latitudes can’t depend on sunlight conversion in the winter months.

From your weekly 50,000 IU tablet, you get about 7,000 IU of the vitamin daily. Centrum Silver has 500 IU. You get another 400 IU with your daily calcium tablets. So your daily intake is around 8,000 IU. Too much vitamin D can be a problem. It can damage the kidneys and can actually draw calcium from the bones. The upper daily limit is set at 10,000 IU. You haven’t crossed the border, but you’re in its neighborhood. The 50,000 IU tablet can correct a vitamin D deficiency in six to eight weeks. I’d say you’ve made that correction. Ask your doctor about stopping this high-dose vitamin therapy. If there is a question about the adequacy of your body store of vitamin D, a blood test can determine if it is too low, too high or just right.

DEAR DR. DONOHUE: Our 21-year-old daughter has been diagnosed with peripheral neuropathy. Her finger turned a shade of blue. She went to the emergency room and got the diagnosis there. What kind of doctor should we consult to determine if this is her condition?

— V.C.

Your family doesn’t have a history of having peripheral neuropathy, right? So let’s remove all the genetic causes of it from consideration.

Twenty-one is young to come down with it. It’s more of an older person’s illness. People with diabetes and a few other diseases also are targets for it, but your daughter is in otherwise good health.

A blue finger isn’t a usual sign. Your daughter should see a neurologist or a vascular specialist to confirm this diagnosis, which appears a bit strange to me.

Readers may write to Dr. Donohue or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

DEATH BY VITAMINS!!! AS one of the fifth of the population using complementary medicine, I should surely be worried by the apparently sound scientific review purporting to show that vitamin supplements are a waste of time and could even shorten life. Somehow I can’t get my knickers in a twist about this latest revelation. Exposés of the dangers lurking in the healthfood shop and on the complementary medicine shelves at Boots come round more regularly than Christmas.

Oh, how the most narrow-minded conventional medics love to hammer anyone or anything that suggests that not every solution to every medical condition is to be found in pharmaceutical-based allopathic medicine. You’d think they’d be delighted that people like me take an active rather than a passive “Cure me doc, I’m sick” attitude towards their health.

Instead of clogging up their surgeries, we take to bed with a hot toddy and vitamin C, echinacea, and zinc. Surely to be encouraged? But while the more enlightened orthodox medics can see that some tried and tested complementary remedies can play a role in healing, many more are threatened by alternative approaches, even the humble vitamin, and relish any opportunity to bash them.

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Let’s get the risks in proportion here. It’s pretty hard, well-nigh impossible even, to commit suicide in a healthfood shop. Even supposing I went in there and binged on every multivitamin and herb I could lay my hands on - supposing I could actually swallow enough of these daunting, horse-sized capsules in the first place - the worst outcome would be projectile vomiting. Yet I never fail to be amazed how the knockers of complementary medicine seem inured to the not inconsiderable risks attached to pharmaceutical drugs.

The thinktank Compass recently quantified these. Latest annual figures showed 1,040,000 people in the UK admitted to hospital because of side- effects of prescription drugs, a staggering 6.5% of all admissions. Adverse reactions cost the the country £2 billion a year: that’s enough to eliminate MRSA from all our hospitals.

What sort of piffling reactions are we talking about? Certain conventional anti-depressants, for instance, leave some young people suicidal when they were only moderately depressed to start with. Whereas good old St John’s Wort, now a fairly mainstream herb dispensed in Germany, perks you up better, at no risk, unless you mix it with conventional drugs. And why should all those surprisingly supple senior citizens who find supplements such as MSM and glucosamine palpably effective in warding off creaky joints use conventional anti-arthitis medicine instead, after all the fuss over Vioxx, the arthritis painkiller now established to have caused heart attacks?

This week’s anti-vitamin headlines are based on a review by one particular group of researchers, effectively a rehash of their paper published last year in the Journal of the American Medical Association. Faced with a substantial number of studies reporting positive results for antioxidant vitamins, they first excluded more than 400 trials that had no deaths, then decided which trials they liked (those with a low risk bias) and did not like (those with a high risk bias).

According to one leading expert in this field, Dr Balz Frei, it is “a flawed analysis of flawed data, and it does little to help us understand the real health effects of antioxidants, whether beneficial or otherwise”. (For a detailed critique of the methodology of this study see www.patrickholford.com, “How antioxidant researchers cooked the books”.) Yes, yes, I know, the comforting wisdom doled out by government health gurus is that we don’t need supplements if we eat well. That might be persuasive, were it not that the concept of recommended daily amounts (RDAs) for vitamins and minerals was devised during the second world war to prevent deficiency diseases such as scurvy. RDAs are not to be confused with an optimum intake, which could be significantly higher. And can we lay to rest the stereotype, put about by mainstream health authorities, that consumers of supplements use them as a substitute for a healthy diet? In my experience, it’s precisely the dedicated healthy eaters who also take supplements.

Bear in mind that nitrogenous fertilisers and intensive food production methods have reduced vitamin and micronutrient levels in the food we eat. Our apples aren’t as nutritious as they were in the 1950s, say. It is undisputed, for example, that British soil has insufficient levels of selenium, the immune system booster, to promote health. Also, environmental pollution now exposes us to many more toxins than humans encountered even half a century ago, so it’s a thought worth considering that we might need higher levels of antioxidants to fight them than our diets can provide.

Rather than rubbishing supplements, medics with an enlightened, open attitude to promoting public health should accept that complementary medicine is here to stay, and encourage research that helps us understand better how it can work. Yet they experience a collective acute adverse reaction, even to users of vitamin C. That’s their hang-up and they need to get over it.

Dr. Robert Heaney, professor of internal medicine at St. Louis University School of Medicine, says 40 percent of his patients get too little vitamin D. He fears the condition could result in health problems as people age.

That corresponds with the 40 percent of Americans and more than 500 million worldwide who get too little vitamin D to stay healthy, according to the World Health Organization.

Vitamin D is known as the “sunshine vitamin” because people normally would get most of what they need from exposing their skin to the sun. UVB rays turn cholesterol in the skin into vitamin D.

And that’s the snag. As scientists find that vitamin D helps conditions from bones to heart health, physicians are rethinking the guidelines for sun exposure — to the chagrin of doctors who believe that’s an invitation to more skin cancer.

Fish oils, fish and fortified dairy products are the main vitamin D sources in food. “But you can eat fish every day of the week and be deficient in vitamin D,” Heaney says. “Vitamin D is difficult to get from food.”

Indeed, the American Vitamin D Council cites research that 10 to 15 minutes in the sun makes up to 12,000 IU (international units) of vitamin D. A sunburn can make up to 50,000. A multivitamin may have 400 IU, which is the recommended daily amount of vitamin D for adults, according to the National Institutes of Health.

Dr. John Cannell, founder of the American Vitamin D Council, says vitamin D is much more valuable than a tool to build bones and teeth. Researchers say vitamin D affects more than 1,000 genes, including ones that resist illness such as colds and even cancer.

“We never put together before that we get colds in the winter and not in the summer when we get more vitamin D in the summer,” Cannell said.

THE SNAG

Doctors who fight skin cancer fear that young people will start sunbathing — and sunburning — again, or use tanning beds to up their dose of vitamin D.

Dr. Susan Bayliss, professor of dermatology at the Washington University School of Medicine, recommends food supplements over increased sun

exposure. UVB and UVA sun rays remain culprits for skin cancer.

“The dilemma is that if you have really fair skin and red hair and freckles, it’s probably better to take your vitamin D in by mouth and put your sunscreen on,” says Bayliss, who also is director of pediatric dermatology and practices at St. Louis Children’s Hospital and the Center for Advanced Medicine.

People with more pigment (melanin) in the skin can tolerate more sun, she says.

AUSTRALIA’S DILEMMA

Heaney says that Australians, who have the highest rate of skin cancer in the world, years ago heeded the word about skin cancer and got out of the sun. But in only a few years, the rate of rickets — a disease of softened bones and bowed legs caused by vitamin D deficiency — increased.

Physicians who advocate more sun say vitamin D made with sunshine never reaches toxic levels. “Vitamin D gets to the useful level, then the sunshine destroys the surplus,” he says.

ELSEWHERE

As health experts wonder what to do with the new findings, they are examining vitamin D intake standards.

For example, the one-size-fits all approach is obsolete. Vitamin D intake recommendations change the closer you live to the equator. People who live in St. Louis don’t get the same amount of sun as southern neighbors, but we do get more sun that our northern states.

The Canadian Cancer Society, for example, last year raised its recommendation for daily vitamin D supplement intake to 1,000 IU per day, more than twice the 400 IU recommended daily for U.S. adults.

SUNSHINE

For some, getting more sun is a back-to-basics measure.

Dr. John Morley, head of geriatrics at St. Louis University, says, “In our nursing homes, people are supposed to be on 800 IU a day,” he said. Still, “about 40-50 percent are vitamin D deficient by the criteria you have to measure the vitamin D. For people 25, that’s not so important and can be corrected. But at 60 or 65 you’re more likely to have falls and deterioration in your functional status, more injuries, hip fractures.”

Nursing homes where he consults now put residents in the sun about 30 minutes a day. The policy led to fewer falls and fractures as well as better health and mood.

“Even with lousy sunlight, if you get people out a half-hour a day, and they’re not covered up and they get some sun, they’ll do OK,” Morley says. “Since we’ve been doing that, we’ve noticed a marked decrease in fractures in the nursing homes, and we now have a rule in the nursing homes, you have to check the vitamin D and make sure the people get (the vitamin) and calcium at an appropriate level.

“But so many people don’t get any sunlight, and that’s particularly true with older people.”

SAFE STEPS

Physicians agree on some issues:

– Vitamin D is essential and needs to be maintained and monitored.

– Sunbathing for a long time in direct summer sun is still a bad thing. “You can get outside, even wearing a hat and expose the arms,” says Dr. Veronica McGregor, an endocrinologist with St. John’s Mercy Medical Center in West County. “About 10 to 15 minutes two or three times a week. It doesn’t take much sun to get adequate vitamin D.”

– Check food labels on supplements because not all vitamin D is the same, Heaney says. You’ll find two types. The best is “cholecalciferol,” the form that occurs naturally and exists mainly in fish oils. It can be synthesized. The second type, “ergocalciferol, is an inexpensively produced vitamin D but may be only 30 percent as effective as the other form. A label that doesn’t specify is probably the lesser form, Heaney says.

– Cod liver oil is the best single source of vitamin D besides sunshine. One tablespoon can deliver 340 percent of the daily recommended vitamin D.

– Don’t rely on fortified dairy products. “Those levels were established (decades ago) to address problems with rickets in children,” Heaney says. “They don’t supply enough for an adult.”

– Tanning beds aren’t the answer. They may not be balanced properly between UVB and UVA rays. Too much UVA is not beneficial.

– Talk to your doctor about a vitamin D test. People most likely to have deficiencies are people who get little sun and anyone who has a family history of bone-density problems.
Source: St. Louis Post-Dispatch

UroToday.com - Many of the 10 million cancer patients in the US are taking nutritional supplements, but an accurate assessment of the frequency is not well appreciated. In the February 1, 2008 issue of the Journal of Clinical Oncology, Christine Velicer and Cornelia Ulrich report a systematic review of supplement use among US cancer patients. Prostate cancer patients are among the lowest users of supplements.

A total of 32 studies published between 1999 and 2006 met the criteria for review of prevalence of vitamin and mineral supplement use among patients undergoing active cancer treatment. The review revealed that a range of 64% to 81% of survivors reported any vitamin or mineral supplement use and 26% to 77% reported using any vitamins. Nine studies reported use among breast cancer survivors, and use of any vitamins or minerals was 67%-87% and multivitamin use was 57%-62%. The increase in use after breast cancer diagnosis was up to 32%. Complimentary and alternative medicine (CAM) use was associated with younger age, higher education, greater physical activity and psychosocial factors. Use of any vitamins was 38%-43% for colorectal cancer patients and 60% for lung cancer patients.

In comparison, use of any vitamins among prostate cancer patients was 26%-35% and multivitamin use ranged from 13%-23%. Megavitamin use was 4%-24%. CAM use for prostate cancer patients was associated with higher education and higher income, but not cancer stage. Age and ethnicity were not clearly associated. In one study, 15% of patients undergoing radiotherapy used high-dose vitamins, but the treating physicians actually estimated that less than 5% were using them. After a diagnosis of prostate cancer, 15% of patients began using CAM (57% were already using CAM) but only 51% informed their physicians. In one study 20% of patients reported that their treating urologist or radiotherapist never raised the issue of CAM use with them.

The authors point out that while some therapies such as St. John’s wort may interfere with drug metabolism, a great understanding of the effects and utilization of CAM among cancer patients is needed. At the very least, physicians should gather intake about CAM use among their patients.

Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS Professor & Chairman Department of Urology University of California, Davis, School of Medicine Sacramento, CA

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