B Vitamins and Omega 3 Fatty Acids vs. Heart Disease

We are always looking for ways to prevent heart disease, the number one killer in the United States. As we gain technology, we are able to look at more and more components in our blood that lead to clot formation and heart attacks. You'd have to be hiding under a rock to not have heard about cholesterol levels, right?

Well, the trick in medicine today is to make sure that we are focusing on PATIENT OUTCOMES more than LAB VALUES. This is the premise behind evidence-based medicine, where we try to look at specific outcomes (did he have a heart attack or stroke) versus did we lower his cholesterol numbers. My patients hear me whine that so many people are willing to spend money on vitamins, supplements and prescription medicines to "lower their numbers" but are NOT willing to change their behavior to eat more fruits and vegetables and to exercise daily. Why do I complain? Because we DO have evidence-based medical data that shows convincingly more exercise and healthier diets not only lower weight, blood sugars and cholesterol numbers, but they decrease the number of heart attacks, strokes and deaths- and isn't that what we're looking for?

Along those lines, a study was published last month in the British Medical Journal that looked at whether or not giving B Vitamins and Omega 3's to patients who had already had a cardiovascular event (heart attack, stroke, or unstable chest pains) would reduce their subsequent numbers of additional cardiovascular events. What they found was that although the supplements worked better than placebo to change some blood tests, there was no difference in actual heart attacks and strokes.

What is the take home message here? Am I saying B Vitamins and omega 3 fatty acids are useless? NO, I am not. It does appear that they don't have great benefit when started AFTER you've already had a heart attack or stroke. Might they help prevent disease in a healthy person? Maybe.

BOTTOM LINE: Let's focus on the common sense changes that we KNOW benefit our health (MORE fruits and vegetables and exercise) and spend less time, money and energy chasing down lab values.

Vitamin C for Colds?

Okay, since I talked again about vitamin D last week, why not talk about a few more vitamins? What about Vitamin C for colds? Should it be taken as prevention, or as a cure? Can you get too much?


Honestly, the medical literature has gone back and forth on vitamin C and colds. Large studies have shown little benefit in prevention, unless you are an extreme athlete or living in very cold temperatures. For people in those categories, it appears Vitamin C in doses greater than 200mg per day can indeed decrease the frequency of upper respiratory infections. Skiers, perhaps you should start your morning with a big glass of juice instead of hot chocolate or coffee!

Where there does seem to be benefit across the board is when Vitamin C (again in doses greater than 200mg per day) is taken once you develop cold symptoms. At that point, Vitamin C seems to decrease the duration of symptoms.

How much is too much? The RDA is 75mg for women and 90mg for men. Supplements come in 100, 200 and 500mg tablets, plus I'm sure you've seen and maybe taken the mega-dose vitamin C packets that come in powder packets. These typically have 1000mg of Vitamin C (along with a handful of other vitamins). While C is water-soluble, which means that "extra" vitamin C not used by your body will simply exit in your urine, it is possible for megadoses (often exceding 2000mg per day) to cause kidney damage by precipitating a special type of stone formation in the kidneys.

What type of Vitamin C is best? As always, you are better off getting your vitamin C from whole foods-fruits like berries, red peppers, guavas, kiwis, and yes, oranges. You will NOT overdose from these natural sources!

BOTTOM LINE: Vitamin C may help shorten the duration of a cold, and could help with prevention for those in cold climates or if you will be doing "extreme" physical activity.

Supplements for Alzheimer's Disease

Bummer- another study that shows a specific supplement does NOT, in fact, delay or halt progression of Alzheimer's Disease. This study is titled Docosahexaenoic Acid Supplementation and Cognitive Decline in Alzheimer Disease, better known as DHA. We believe that DHA, a fatty acid used in the brain, has beneficial effects when taken as a supplement in humans. The question was whether or not taking this supplement would help to delay the progressive memory loss and other dysfunctions in Alzheimer's.

The completed study involved around 300 people with mild to moderate Alzheimer's disease. They randomly received either a placebo or 2g of DHA daily for eighteen months (it was randomized and double-blinded- our gold standard in research.) Cognitive tests were given at the onset and a year and a half later. Unfortunately, the people in the trial who received the DHA supplements were no better off on cognitive tests nor on brain atrophy at the end of the study.

We have been through this same process with Vitamin E, estrogen, and a number of other over the counter supplements. I remain optimistic that there may be a dietary or behavioral modification that does make a difference, as well as new medications that will not only stop the progression but some day reverse the dreaded decline of dementia with Alzheimer's.

BOTTOM LINE: Let's continue to support Alzheimer research, as we now have yet another supplement (DHA) proven to NOT be successful.

B 12 Shots Revisited

It's time to talk about B12 replacement again, this time, because I'm reminded that people who take PPIs- Proton Pump Inhibitors- which are acid blockers such as Prilosec and Prevacid, decrease the acid in their stomach as intended, but often this causes LACK of absorption of the vitamin B !2. As a doctor, if I wait to see enlarged red blood cells and low total red blood cell count (macrocytosis and anemia, in medical language), I will be way behind the game. We should NOT wait till we see lab verification beyond an actual low B12 level to start replacement.

What are signs of B12 deficiency? Fatigue, memory loss, and funny sensations- paresthesias- often on the feet or hands. Does it hurt to get too much Vitamin B12? Not really- just your pocketbook. B 12 is a water-soluble vitamin, so if you get too much, the main danger is expensive urine. All the same, I don't advice OVER-replacing any vitamin.

If you DO need B12, you've got a variety of options. Many times you can simply take a daily oral supplement, and that will be enough. If absorption is impaired by change in stomach acid or by antibodies blocking receptors, then you will need a different form of replacement such as a shot, sublingual, or intranasal B12.

BOTTOM LINE: If you take acid blocking medications daily, and are feeling run down, ask your doctor to check a vitamin B12 level and see if you need to get tanked up!

Need a Vitamin B 12 Shot?

Why DO people get B 12 shots? As always, the answer is not exactly straight-forward. Many people get them because, well, they ask for one! There is a myth out there, quite popular with the entertainment industry, that getting a B 12 injection gives you a "shot" of energy. This idea has been around for many decades, and there are patients who absolutely swear it works. Additionally, many people believe if they are really stressed and run down- say at finals time in college- then a B 12 shot seems to keep them from getting sick. Is this true?
There are not any current evidence-based medical studies that support this theory. There is one recent study that showed high intake of Vitamin B12 (and of B6) is protective against depression in older adults living within the community. (Longitudinal association of vitamin B-6, folate, and vitamin B-12 with depressive symptoms among older adults over time.)
What we primarily use B 12 shots for, however, is the obvious- true B 12 deficiency. Why do people get this? A few get it as a side effect from bariatric surgery (a stomach bypass), but most get B 12 deficiency from making antibodies to B 12 receptors in your stomach. When this happens, you can no longer ABSORB B12 from your diet, so the only ways to get B 12 is from a shot or from a medicine that can be absorbed under your tongue, or more recently, a medicine you squirt in your nose (in the same manner as allergy nose sprays.) When you bypass the stomach receptors, the B12 can then enter your body effectively. Who is prone to getting B 12 deficiency? Anyone with other auto-immune diseases, where the body starts making antibodies to other organs or receptors. This includes adult onset diabetes, vitiligo, thyroid disease and other diseases in the rheumatic family such as lupus.
How about symptoms of B 12 deficiency? There may be none. In severe cases, the patient develops anemia. Often, we see nonspecific symptoms such as brittle fingernails, fatigue, and forgetfulness.
If you have a family history of true B 12 deficiency, that is also a risk factor.
The good news is that B12 is easily replaced, and though it will take a few months to get tanked back up, you should completely recover with time as long as you are consistent about your method of B 12 replacement. Additionally, extra B12 should not be harmful to anyone, as it is a water soluble vitamin (which means you may have lovely, expensive, bright yellow/green urine if you over-replace, but no other worries!)
BOTTOM LINE: B 12 replacement is only really necessary if your levels are low- check with your doctor if you are concerned!