FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

[READER SHOULD TRY BRAND NAME MULTIVITAMIN PILL ]

Question: I know that vitamins are essential for good health, but how much of which types are necessary? Is a simple multivitamin enough, or should I take separate pills of C, E, B complex and others?

Answer: We humans are omnivorous. That is, most of us eat a diet with foods from both animal and plant sources. As a species this ability to flourish with a diverse diet has, in part, enabled us to live in almost every ecological niche of the planet. And judging by the planet's current population of 6 billion, we have survived quite well.

Our diets must provide a fairly large amount of food in three major categories - carbohydrates, proteins and fats. (Most Americans, as you know, consume too much fat.) Fortunately, appropriate amounts of carbohydrates, proteins, and fats can be obtained from a strict vegetarian diet or from an omnivorous one. We also need vitamins and minerals, but in much smaller quantities than we need these other types of nutrients.

All diets contain some of the essential vitamins and minerals. Therefore, the question you are actually posing is which ones are you not getting or not getting in sufficient amounts. Obviously, I have no way to answer this without much more information about the foods you eat. I can give you some general guidelines, however.

Vitamin E is obtained from vegetable and seed oils. Scientific studies are not overwhelmingly persuasive about the value of this vitamin, but the current evidence does suggest that taking 400 to 800 IU per day may reduce the risk of heart attack, and this amount is not reported to cause any health problems. The average American's diet only provides 15 IU of vitamin E, so either a dramatic change in diet is called for or one should take supplements.

Beta carotene and vitamin A are ingredients in most multivitamin products and are also sold separately. In a normal diet, beta carotene comes from dark colored vegetables while vitamin A comes from meats, fish, fish oil and dairy products. Studies have shown no benefit from taking large quantities of these vitamins, and one large study showed an increased risk of lung cancer in smokers who took 20 mg per day of beta carotene.

Our bodies normally make Vitamin D when we are exposed to sunlight. Because many people fail to get sufficient sun exposure, supplementation of this vitamin is a good idea. That is why it is added to milk.

Vitamin C is found in citrus fruit and tomatoes. A typical 8-ounce glass of orange juice contains 100 mg - with optimal levels being about 200 mg per day. Amounts over 1000 mg per day are associated with diarrhea and an increased risk of kidney stones. Depending upon your diet, supplements of vitamin C may be a good idea, but contrary to popular beliefs, taking large amounts will not prevent colds.

Vitamin B12, folate, B6, iron, zinc, copper, calcium and others are necessary for good health. Eating a balanced diet is the best way to get all of these. If you are unable or unwilling to eat in this way, then taking a supplement consisting of a multivitamin preparation with minerals is a good idea. In other words, both eat a good diet and take a multivitamin with minerals. One of the "brand name" multivitamin pills is just fine. Steer away from the exotic and "mega dose" approach advocated by the "vitamin peddlers." Remember that their advertising pitches are not based on scientific fact, and they play on your emotional desire for good health, not on your logic.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.