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Healthwise: Navigating the Vitamin Maze

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    Healthwise: Navigating the Vitamin Maze http://www.hcvadvocate.org/200006/page4.cfm By Lucinda K. Porter, RN Are you curious about vitamins and supplements? Do
    Message 1 of 1 , Dec 29, 2001
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      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

      Vitamin C

      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.

      Vitamin E

      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
      dolomite sources.

      Milk Thistle

      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
      teenaged daughter.

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