Vitamin + Supplement Tips
When buying vitamins and supplements that help autoimmune disorders (e.g., Vitamin D, omega-3 fatty acids, etc.), what factors are most important in choosing supplements that will absorb the best?
Unlike prescription drugs, the potency, purity, and content of dietary supplements cannot be guaranteed. Therefore, when purchasing supplements, you should first choose a manufacturer that adheres to the FDA’s Good Laboratory Practices. This, at least, assures some oversight of quality and safety. Second, whenever possible, make sure the ingredients in your supplement come from either domestic sources (preferably organic) or foreign sources that are certified organic and/or contaminant-free. Third, check with an independent reviewer, such as ConsumerLab.com, to see comparisons among similar supplements.
Next, do a bit of research to determine the most useful form of the supplement(s) you wish to take. (Be wary of websites sponsored by supplement manufacturers, for they’re often laced with hyperbole, “pumped-up” studies, or outright misrepresentations.) ConsumerLab.com is a good resource for this purpose too. If you don’t mind wading through scientific data and technical jargon, PubMed is a good place to initiate a search, too. Additional resources include the Office of Dietary Supplements and the National Center for Complementary and Alternative Medicine.
In general, liquid forms of vitamins and supplements are most readily assimilated, followed by soluble powders, capsules and tablets. However, some manufacturers will suspend cheaper, poorly absorbed compounds in liquids or pack them into capsules, because they know consumers prefer these vehicles. Again, do your homework.
Finally, it pays to read scientific studies that evaluate the efficacy of chemically similar nutrients. For example, while plant-based vitamin D2 is a fairly good source of vitamin D, most experts agree—and several well-designed studies support their contention—that vitamin D3 derived from animal sources is superior to D2 in humans. After all, D3 is what your body synthesizes when you step into the sun.
Similarly, studies demonstrate that eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), the omega-3 fatty acids found in fish oil, are more effective for reducing inflammation than plant-based alpha-linolenic acid (ALA). And, since ALA is inefficiently converted to EPA and DHA in humans, there simply isn’t a good substitute for EPA or DHA.
What is the right dosage of these two supplements? At what dosage would they be toxic?
Since scientists have been studying vitamin D for almost 100 years, you’d think they would have a pretty good notion about how it should be dosed in just about any situation. Surprisingly, though, there still isn’t even a consensus on how much vitamin D you need to meet your daily needs. Currently, the RDA for adults up to age 70 is 600 IU daily; for those over 70, 800 IU is the recommendation. The Institute of Medicine has set a tolerable upper limit for vitamin D at 4,000 IU daily. Some experts, such as Dr. Reinhold Vieth at the University of Toronto, believe the optimal daily dose is closer to 2,000 IU, and the tolerable upper limit should be adjusted upward to around 10,000 IU. (Physicians treating patients with autoimmune diseases routinely use daily doses in the 2,000 to 4,000 IU range.)
Likewise, there’s not widespread agreement about the optimal daily dosage of omega-3 fatty acids. The American Heart Association recommends an intake of 500 to 750 mg each of EPA and DHA for cardiovascular health, but larger doses—2 to 4 grams—are needed to treat specific disorders, such as hypertriglyceridemia or rheumatoid arthritis. (For vegetarians who won’t consume fish oil, a daily intake of ALA between 1.5 and 3 grams may be beneficial, but the conversion rate of ALA to EPA and DHA is less than one percent in humans.) While there’s probably no real upper limit for fish oil consumption, people taking much more than 4 grams daily experience unpleasant gastrointestinal side effects, such as diarrhea and belching.
Are supplement manufacturers regulated?
Aside from dealing with safety issues and false claims of efficacy surrounding supplements, the FDA doesn’t really constrain the supplement industry. The widely adapted Good Laboratory Practices represent a form of “self-regulation,” and the Dietary Supplement Health and Education Act of 1994 (DSHEA) provides the FDA with some clout regarding foreign supplement manufacturers. However, domestic firms don’t even need to register their products with FDA or get FDA approval before producing or selling dietary supplements.
Questions for your doctor:
- (For MS sufferers): I understand people with MS may benefit from taking high doses of vitamin D, so how much should I take each day?
- Are my supplements and vitamins safe to take with my prescription medications?
- Have you seen any recent studies that suggest a particular supplement or vitamin would be beneficial for my condition?
LA Houghton, R Vieth . “The case against ergocalciferol (vitamin D2) as a vitamin supplement.” Am J Clin Nutr. 2006;84(4):694-7
MB Covington. Omega-3 fatty acids. Am Fam Physician. 2004;70(1):133-140.
J Dörr, et al. Efficacy of vitamin D supplementation in multiple sclerosis (EVIDIMS Trial): study protocol for a randomized controlled trial. Trials. 2012;13:15
About the Author
Steve Christensen, MD – “Doom” to his close friends – was trained at the University of Utah School of Medicine. Since his premature retirement from medicine in 2003, Dr. Christensen has expanded his knowledge of alternative medicine: he is a certified herbalist; he has dabbled at the edges of Ayurvedism, shared ideas with Chinese physicians, rubbed shoulders with Native American healers and contemplated the healing powers of channeled energy.
This blog post was originally published by AutoimmuneMom.com, written by Steve Christensen, MD, and first published on Jun 9, 2012.
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