Vitamin Information Center

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

UroToday - the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice.

To access the latest urology news releases from UroToday, go to: www.urotoday.com

Do you take a multivitamin? Or a single vitamin, mineral, or combination supplement? If so, you are in the company of tens of millions of U.S. adults.

Why do you take them? Most people say it makes them feel healthier or they believe it will prevent chronic diseases, or colds and flu. But you may be surprised to know that what is in your bottle and on the label is not strictly regulated. And there is no system in place to collect reports of adverse affects.

Over the past few years there has been increasing evidence that multivitamins and single or combination type vitamin/mineral supplements may not provide the health benefit sought by you, the consumer. In some cases the opposite or no beneficial effects have been reported.

Alarming to think that vitamin or mineral supplements could actually cause more harm than good. An example of this is the use of beta carotene by smokers actually increased the incidence of lung cancer. This is echoed by a recent study out of the University of Washington that reports the use of multivitamins, vitamin C, vitamin E and folate did not reduce the risk of lung cancer.

It is not all bad news though; there are studies to support the use of folate (folic acid) prior to and during pregnancy in the prevention of neural tube defects in the developing fetus. And history has proven that vitamins and minerals play a critical role in our health — the reason we know about the benefits of vitamins and minerals in food is because of the major discoveries in disease prevention such as vitamin C and scurvy and thiamine, a B vitamin, and beri beri (a wasting type disease).

This may leave you wondering if those vitamin mineral supplements in your medicine cabinet are doing what they should or even worth your money.

Let’s look at this way — do you eat a well balanced diet? If so, you may not need a multivitamin and if you take one as a “safety net” know that you may exceed what your body needs or can use.

Are you concerned about a chronic disease? If so, making changes in your diet and exercise habits, not smoking and following through with recommended screenings by your physician are more likely to benefit your overall health picture.

Consider your current state of health, talk to your doctor and/or dietitian, and weigh the possible benefits and risks of a multivitamin and mineral supplement for you.

To your health,

Katherine

The use of some vitamin supplements can be controversial, with scientists and manufacturers arguing over their usefulness. But they don’t spend much time arguing about the lowly and somewhat boring multivitamin.No one has ever argued that multivitamins might not be good for you. Until now.

The Harvard Men’s Health Watch, which once endorsed these popular supplements, now says that a reappraisal of that advice is in order.

The publication, in its March 2008 issue, notes that some recent studies have linked multivitamin use to prostate cancer. More convincingly, it says studies have linked high intakes of folic acid to colon polyps, the precursors of colorectal cancer.

Researchers speculate that high intakes of folic acid, which was first added to grain products in the 1990s, may have contributed to an increase in colorectal cancers in the mid-1990s.

What does all of this have to do with multivitamins?

Now that folic acid is added to so many grain products, it’s easy to see how a healthy diet, combined with a multivitamin, could boost a person’s daily intake to 1,000 mcg or more, potentially increasing the risk of colorectal and possibly prostate and breast cancers.

In light of this research, Harvard Men’s Health Watch editors suggest that the average man give up the multivitamin, at least until scientists solve the puzzle of folic acid and cancer.

However, if you stop taking a multivitamin, the authors suggest you consider taking a vitamin D supplement. The typical diet for most men and women doesn’t supply enough of this crucial vitamin, and while sun exposure boosts vitamin D production, it has health risks of its own.

Last month, a study suggested some multivitamins might increase cancer risk.

“Our study of supplemental multivitamins, vitamin C, vitamin E and folate did not show any evidence for a decreased risk of lung cancer,” wrote the study’s author, Christopher G. Slatore, M.D., of the University of Washington, in Seattle. “Indeed, increasing intake of supplemental vitamin E was associated with a slightly increased risk of lung cancer.”

Findings of the study of 77,000 vitamin users were published in the first issue for March of the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine.

You’ve been told for years that popping a multivitamin every day might help you live longer. But the daily-multi habit has been getting a bit of bad press lately.

First, ConsumerLab.com, a watchdog of the supplement industry, found that more than half of the 21 multis it tested had too much (or too little) of certain vitamins—or had been contaminated with dangerous substances like lead. Then a controversial paper from researchers in Denmark and other European countries, published in the Journal of the American Medical Association, made the claim that taking vitamins may actually shorten your life.

What’s the real story? Health talked to leading nutrition experts at Harvard and Tufts universities to find out and to get some answers on this and other confusing info about vitamins.

Are multivitamins safe?
Vitamins have been recommended for years because they help you get key nutrients if your diet’s low on fruits and veggies—and may even help prevent cancer and heart disease. And it’s unlikely that one critical paper (speculating that vitamin supplements might upset your body’s natural healing process and boost your risk of death) will change that.

Longtime vitamin experts at Tufts University and the Linus Pauling Institute at Oregon State University continue to say multis aren’t dangerous and the paper’s findings are wrong. The paper analyzed previous studies, including many with people who were sick before taking vitamins, so there’s a good chance vitamins weren’t responsible for shortening their lives. Experts say the paper also ignored two major studies that found vitamins reduced the risk of death.

At the same time, the study from ConsumerLab.com shows that you can’t assume just any vitamin is safe. Because there are no uniform manufacturing rules for supplements, a multi may not contain what the bottle claims, could be contaminated with something from the manufacturing plant, or might have tainted ingredients.

Your best bet: Avoid the vitamins singled out by ConsumerLab.com (see “11 Multis to Avoid”), and stick with mainstream names like Centrum Silver and One-A-Day Women’s, which were found to be free of impurities and accurately labeled. Also, check vitamin bottles for the United States Pharmacopoeia (USP), NSF International (NSF), or ConsumerLab.com (CL) seals. The USP and NSF are nonprofit groups that verify whether companies offer contamination-free products and use good manufacturing practices. Not every brand has the seals—some don’t want to submit to testing—but those that do (Kirkland and Nature Made carry the USP seal, for instance) are reliable.

How much should I spend to get the biggest benefits?
Price isn’t a sign of quality. In fact, some of the priciest vitamins—like The Greatest Vitamin in the World and Eniva Vibe, which cost more than $39.95 per bottle—failed the Consumer Lab.com tests. A mainstream brand like One-A-Day Women’s is $8.99 for a bottle of 100 tablets at about 9 cents per day.

How do I find the right multi for me?
In your childbearing years, make sure your multi has 400 micrograms (mcg) of folic acid, which helps make and maintain new cells. And pregnant women should take a vitamin with 600 mcg of folic acid daily; this nutrient also reduces the incidence of neural tube birth defects like spina bifida.

A premenopausal woman should look for a multivitamin with iron to replace the iron lost during menstruation. Menopausal women should go without the iron. “Too much iron may raise the risk of heart disease,” says Meir Stampfer, PhD, professor of nutrition and epidemiology at Harvard School of Public Health.

If you’re taking a prescription, check with your doctor about risky interactions. (Vitamin E, for instance, may be a problem if you’re taking a blood thinner.) If you’re a cancer patient, you should ask your doctor about risks before taking vitamins. “Cancer cells need vitamins to grow, too,” Stampfer says. Plus, some vitamins can interfere with chemotherapy.

What’s the best way to avoid that queasy feeling after taking a multi?
“Consider switching brands,” Stampfer suggests. Trial and error is the best way to determine which brands won’t break down poorly in your stomach and lead to irritation. Also, take your multi with food because your body needs some fat (or lipids) to absorb some of the individual vitamins. The delivery method (pill, liquid, gummy bear) makes no difference. But vitamins in liquid form may degrade more quickly on the shelf.

How much of each vitamin should my multi have?
The amount per serving numbers on the label should match the government’s Dietary Reference Intakes (DRI). It’s OK if they’re higher as long as they don’t exceed the tolerable upper limit (UL). (To find the DRIs and ULs, While most vitamins are listed in milligrams (mg) or micrograms (mcg), the label may use IUs (international units) for vitamins A, D, and E. The DRIs are 2,300 IUs for vitamin A, 200 for D, and 22 for E. What about the label’s % Daily Value column? Look at it with a skeptical eye: Those numbers haven’t been updated since 1968.