Medicine For People!
- Nutritional Supplements - a Good Strategy for Health
- Vitamin B12
- Essential Fatty Acids
- Individual Genetics
- Treatment Can Reduce Symptoms
- Alternatives to Aspirin
- Learn More
- What You Can Do
Nutritional Supplements - a Good Strategy for Health
How often have I heard respectable physicians say that healthy people don't need to take vitamins? It always strikes me as tragic that physicians are still giving this bad advice! This attitude can make people vulnerable to unnecessary illness. On the other hand, informing yourself of your needs and taking the appropriate nutritional supplements can be a very good strategy for a healthy, long life. Over and over again, research has shown the connection between adequate nutrients and good health. In this month's Medicine for People I want to make two concepts abundantly clear.
- Micronutrient deficiency is rampant in the so-called "healthy" populations.
- Individual needs for nutrients vary greatly.
Here are some examples of key vitamin and mineral deficiencies in the United States today.
Iron deficiency affects about one-third of women of child-bearing years. Often physicians will screen for this deficiency by looking for anemia, which fails to identify most women with iron deficiency. The best test is to check the level of ferritin. This protein in the blood is involved with iron metabolism. Although we can measure iron directly in the blood, the ferritin level is a much more sensitive indicator of the amount of iron available for the body's use. Iron is important to the immune system and to the energy systems as well as in the manufacture of hemoglobin.
A second reason iron deficiency is underdiagnosed is that the normal values on the lab report form are incorrect. The laboratory computer states that values above ten are normal, but that is because their computer includes so many iron-deficient women in their "normal" population. Most physicians believe that the low normal value for men, 22 nanograms/milliliter, should also apply to women. However, some women will not grow hair normally with a ferritin level under 50.
Vitamin B12 can help prevent heart attacks and strokes and yet deficiency is common, often due to malabsorption. According to NutritionReview, "At least 40 percent of individuals had deficient or marginal plasma vitamin B12 concentrations in almost all locations and across all age groups." (NutrRev 2004 Jun;62;62 6 Pt 2):S29-33) Translation: 40 percent of all people don't have enough vitamin B12 in their blood.
Vitamin B12 deficiency leads to elevated levels of homocysteine, an amino acid in the blood. Elevated homocysteine accelerates the progression of fatty plaque deposits formation in the arteries, leading to heart disease and cancer. Elevated plasmahomocysteine levels are found in 5 to 10 percent of the general population and in up to 40 percent of patients with heart attacks or strokes. Some researchers state that if we could reduce this elevated plasmahomocysteine, we could prevent up to 25 percent of cardiovascular disease.
The connection between homocysteine levels and heart disease is well known, but most doctors still do not check for elevations in homocysteine. As aresult, people go on having preventable heart attacks. The prevalence of heart disease is high. The prevalence of marginal B12 status is high. If everyone over the age of fifty years (and younger for those with a strong family history of heart disease) took a daily B-complex vitamin, we'd save lives and money.
Researchers generally agree that about one-third of Americans are deficient in magnesium. Low levels of magnesium lead to headaches, high bloodpressure, muscle cramps, irregular heartbeat, menstrual cramps, fatigue,and many other problems. Yet this magnesium deficiency is generally ignored in clinics around the country. One reason for oversight is that blood levels of magnesium are misleading. Most of the magnesium in our bodies is inside the cells. A test may show normal levels in the blood, while intracellular levels can still be poor. There is no commonly available test for magnesium deficiency. Instead, the physician must do the difficult diagnostic work to uncover this deficiency. In our clinic,we see many people who respond positively to a therapeutic trial of magnesium. Often, a series of magnesium injections will dramatically reduce a patient's headaches, muscle cramps, or irregular heartbeat.
Essential Fatty Acids
A quick primer on fats: humans are good at making fat out of potatoes and bread but there are special kinds of fat we can't make. These are called the essential fats or fatty acids. Essential fats are present in salmon and flaxseed. We require these for a healthy brain, skin, joints, and indeed our overall health. One function of these essential fats is to make our blood platelets less sticky, and reduce the likelihood of the blood clots that can lead to heart disease and stroke.
The value of essential fatty acids is indisputable. According to one journal, "After 3.5 years, those taking the omega-3 fatty acids had experienced a 20 percent reduction in overall mortality and a 45 percent decrease in risk for sudden cardiac death." (Current AtherosclerosisReports 2001, 3:174-179). There is no government recommended daily allowance for omega-3 fatty acids. That is just one of many reasons many people don't get an adequate supply.
Just to complicate matters, some people have diminished ability to absorb fats. They won't benefit from an omega-3 supplement until they take a potent pancreatic enzyme along with it. Sad to say, most of the pancreatic supplements on the market, even some of the prescription ones, are not powerful enough for many of the people I see in my office. To read more about absorbing nutrients, see "Absorbing Facts" on our website.
So far we've talked about vitamin deficiencies that are common in the general population due to our national diet. There are other deficiencies that are particular to certain individuals. Each of us has a different genetic make-up. As a result, some of us have heightened needs for certain nutrients. You can't always tell by looking at the person, but these nutritional needs can make huge differences in the individual's life.
For example, on rare occasion babies are born with a condition called pyridoxine-dependent seizures. These babies have seizures shortly after birth and continue having them until the pediatric neurologist figures out the problem and administers an unusually large dose of vitamin B6. (Pyridoxine is a form of vitamin B6). The seizures then stop and the child, once his excessive needs for vitamin B6 are met, is entirely normal. Children with phenylketonuria, another genetic variant, need a diet low in phenylalanine. Phenylalanine, present in all high-protein foods, leads to permanent mental deficiency in such children.
Unfortunately, many nutritional researchers ignore these dramatic exceptions and assume that we are all biochemically similar. Take the example of the babies with pyridoxine-dependent seizures. Researchers may give vitamin B6 to a large number of infants and placebo to another large group, and see no difference in the percentage of each group that has seizures. The percentage of infants who require vitamin B6 is so low that they do not show up in a large statistical study. Therefore, learning about such infants is impossible if you restrict yourself to looking at large groups of infants and assuming they are all the same.
Phenylketonuria babies and those with pyridoxine-dependent seizures are extreme cases. Less well known, and less obvious, yet far more important are individual genetically determined needs for folic acid. I'll tell you more about that in our next issue. You'll learn about general and individual needs for folic acid. Folic acid deficiency has been linked to a variety of ills, including heart disease and cancer. Learn what folic acid supplements can do for your health.
Treatment Can Reduce Symptoms
There are far too many micronutrients to cover in this newsletter; these are some that I see most frequently in people with various complaints that have not responded to the usual medical measures. Treating these deficiencies frequently results in improved health.
What You Can Do
What can you do to make sure you set the odds in your favor nutritionally?
- Eat a diet that is largely composed of wholesome and fresh food. Nutritional supplements cannot and do not substitute for a good diet and plenty of exercise.
- Be sure to drink plenty of water. I won't tell you how much, because it varies with temperature, activity, and other factors. Just be aware of how you feel, and drink. If you feel hungry, you may find that water is what you need. Don't hesitate to drink from the tap. Far better to have adequate water in your system than to avoid the slight impurities in drinking water. Think of Mr Clean's motto- "Stronger than Dirt!" - as you drink.
- Take a quality multi-vitamin mineral supplement. Your physician should be able to guide you.
- If and when you have a health problem, be it elevated cholesterol levels, headaches, or a bad pap smear, inform yourself about how these may be symptoms of greater nutrient needs.
In future issues of Medicine for People, we will develop this idea morefully. There is unequivocal evidence that attention to our individual differences can help us tailor our nutritional needs to our unique genetic requirements. Laboratory tests that can inform this process are dropping in price. You can learn about these in our office or in future newsletters.
Medicine for People! is published by Douwe Rienstra, MD at Port Townsend, Washington. Edited by Carolyn Latteier.