Healthwise: Navigating the Vitamin Maze
- Healthwise: Navigating the Vitamin Maze
By Lucinda K. Porter, RN
Are you curious about vitamins and supplements? Do you
wonder which to take and which to avoid? Do you have
questions about which brands to buy? If so, you are in
good company. I am frequently asked questions about
vitamins and supplements by patients with chronic
hepatitis C virus (HCV) infection. This article
discusses some aspects of supplementation. One
caveat-the perspective I offer is exactly that-a
perspective. My views are not a substitute for medical
care. You are strongly advised to speak to your
physician or other health care provider about any
vitamins, minerals, or herbal supplementation you are
taking. If your physician is disinterested about this
topic, consider exercising your right to a second
opinion or asking for a referral to a nutritionist.
What, if any supplements should you consider? In a
recent article published in Health magazine (March
2000), there were a few sensible suggestions. I have
modified these recommendations for patients with liver
disease. Keep in mind that supplements are not a
substitute for good nutrition.
This is the one supplement that most experts
recommend. Unless your doctor advises you otherwise,
look for a multivitamin without iron. These can be
found in the "over 50" versions of most major brands.
As for which brands, there are many to choose from.
High price does not correlate with high quality. Most
manufacturers buy the ingredients from the same
sources. If you are paying more money for your
multivitamin, it is probably for advertising or
unnecessary fillers. These fillers are often herbs in
doses too low to offer any benefit. Here are a few
suggestions for multivitamins without iron:
o Safeway Select OmniSource Senior
o Rite Aid Whole Source Mature Adult
o Dr. Art Ulene Nutrition Boost Formula (Senior
This vitamin is best obtained from food. A minimum of
5 servings of most fruits and vegetables will cover
most of your vitamin C requirements. If you do
supplement, look for small dose pills, such as 100 or
250 milligrams (mg). You can also break a 500 mg pill
in half. A government advisory panel has recently
recommended that women consume 75 mg daily. The
recommendation for men is 95 mg. Smokers need an
additional 35 mg daily. Do not exceed 2000 mg per day.
If you eat a high iron meal, postpone taking your
vitamin C supplement. Vitamin C can bind with iron,
putting extra load on the liver. As for specific
brand, your body cannot tell the difference between an
inexpensive or expensive version.
This vitamin is constantly making news. It has been
the subject of research in liver disease as well as a
host of other conditions. The optimum levels appear to
be between 400 and 800 International Units (IU) daily.
Vitamin E is available in natural and synthetic forms.
Natural E is absorbed by the body better than the
synthetic form. It is also more expensive. However,
most of the clinical trials that show the benefits of
vitamin E use the synthetic form. All in all, this may
be the better choice. If you use the natural form, the
dosage may be closer to 200 - 400 IU daily. Do not
exceed 800 IU per day. At high doses, vitamin E can
act as an anticoagulant, or anticlotting agent.
Consult your doctor if you have low platelets, are
taking Coumadin or have a clotting disorder.
This mineral is found in most multivitamins, but it
may be worth it to add this in as a supplement. The
recommended daily doses for men is 70 micrograms (mcg)
and 55 mcg for women. In a recent article in the
Nutrition Action Newsletter, the Center for Science in
the Public Interest (CSPI) suggested a daily dose of
200 mcg. Do not exceed 400 mcg daily. Selenium can be
toxic at higher levels. Selenium can be purchased in
its most inexpensive form.
The daily doses for this are 1000 mg (ages 19-50),
1200 mg (51-70), and 1500mg if you are over 70 years
old. Each serving of low fat milk, yogurt, or cheese
has roughly 300 mg of calcium. Add in a supplement for
each one you miss. Talk to your doctor about calcium
supplementation if you have kidney or gall stones. Any
brand that can dissolve in a glass of warm water in 30
minutes should be the guiding factor, rather than
price. Most brands of calcium are acceptable although
lately there has been some evidence that the most
expensive form, calcium citrate, has the most
bioavailability. Avoid calcium from oyster shell or
The jury is still debating the milk thistle (or
silymarin or thisilyn) issue. Milk thistle has been
used for hundreds of years as a folk remedy for liver
disease. The European medical community has done some
promising research using milk thistle for liver
diseases, but as for HCV, the evidence is just not
solid. The good news is that milk thistle does not
appear to do any harm and may provide some benefit.
The recommended dose is 200 mg three times daily. Only
buy brands that use standardized amounts of at least
80% silymarin. Try to find a brand that states it
complies with standards of the American Herbal
Pharmacopoeia, the German Commission E, or any of the
organizations that are striving to maintain standards
in a market that is completely unregulated. This is
the one supplement in which I spare no expense. I use
Nature's Way Thisilyn or Eclectic Institute's Milk
Thistle, but there are other fine brands.
What supplements should you avoid?
The Information Packet published by the Hepatitis C
Support Project has a list of herbs that should be
avoided, especially for those with liver disease. This
list can be obtained either by contacting the Project
(see address and phone number on this newsletter) or
through their web site at www.hcvadvocate.org. In
addition to the herbs listed, avoid supplementation
with vitamin A, D and iron. One can usually get
sufficient vitamin D in a multivitamin, diet, and sun.
Unless these are not available to you, supplementing
with extra D is not recommended. Large doses of any
supplements are strongly discouraged. Vitamin A in
doses above those recommended can cause liver injury.
Certain foods and medications interfere with vitamin
and mineral absorbency. Consult with a nutritionist if
you want individual counseling about your particular
situation. For more general information, the following
magazines are good sources of up to date information:
o Health (800) 274-2522
o Nutrition Action Newsletter, published by the Center
for Science in the Public Interest CSPI, 1875
Connecticut Ave., NW, Suite 300, Washington, D.C.
www.cspinet.org o Prevention (800) 813-8070
Copyright Lucinda K. Porter 2000
All Rights Reserved
Lucinda K. Porter, RN is a research nurse and patient
educator at Stanford in the area of hepatology. She
co-facilitates a support group and is active in many
aspects of hepatitis C education. In addition to being
HCV+, she has a life which include her husband and
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