Vitamin Supplements

General
1

Vitamin supplements have been mentioned quite a lot recently. I have a bit of a mental block about them - basically I can't see the point.

Since my PsA diagnosis I've tried to maximise my intake of vitamins & minerals by eating as wide a variety of foods as possible. I like cooking and if I see something that I don't eat regularly, I grab it ... figs and asparagus, for example, at this time of year. I'm considering sea urchins which the local fishmonger has on offer, though when he said they were more of a 'taste experience' than a 'yum yum' experience I put them on hold. I also grow a lot of vegetables which I think produces particularly nutritious stuff. My rheumy is of a mind with me on food & drink: "why would you need vitamin D supplements? Just get out in the sun!" And he also thinks the occasional glass of wine is pretty damn essential. I love that man. (Hope he doesn't check this site!)

Despite my prejudices I'm open to persuasion. Has anyone's rheumy recommended vitamin supplements? Or are there any you swear by? I'm interested in contraindications with drugs too.

2

Hi,
My Rheumy has me on quite a few supplements.
vitamin D3 5000iu a day. It would be nice to get D3 from the sun, but I cannot go in the sun…
Anti inflammatory supplements: ginger root and Curcuminoids from Tumeric.
Glucosamine & Chondroitin for joint support
A good multi vitamin "PhytoMulti"
Boswellia- another supplement that helps reduce inflammation.

I eat a very healthful diet also, I have been a vegetarian for 38 years, but eat eggs and cheese.
Hope this helps!
Jon

3

I’m with you on the vitamin supplement thing, Sybil, except for one: Vitamin D. Both my GP and my rheumatologist encourage me to take that one. For the rest I depend on my very varied and balanced diet. I see no point in taking large quantities of water-soluble vitamins, only to flush them down the toilet. As for the fat-soluble ones, well, I’d really rather the excess of those didn’t start loading my fat cells, because there is a potential for toxicity. I’m pretty sure I’m not short of Vitamin A. During my hip replacement, the following conversation took place:

Dr: Seenie, do you eat a lot of vegetables?

Me: Yes, Dr. Sawbones, why do you ask?

Dr: I’ll tell you later.

Don’t remember much after that, until I felt them hauling on my leg and popping the joint together. Sorry, TMI. Anyway, later I asked and he said that my fat was a very buttery golden colour from my very adequate VitA intake. So no, I won’t take a supplement of that!

I also take an Omega3 fish oil supplement, also suggested by GP and rheumy. But nothing else.

4

Thank you for your reply Jon.

I can see that vitamin D supplements are vital if you can't take the sun. I live in a very rural area and some of the farmers look almost like a race apart ... people in their 60s & 70s so tanned & toned - they glow! But I guess they're a good advert for physical activity as much as anything.

I've thought about glucosamine, I believe the scientific jury is out as to whether or not it helps with OA-type damage. Boswellia sounds exotic .... is it okay alongside PsA meds?



Jon_sparky said:

Hi,
My Rheumy has me on quite a few supplements.
vitamin D3 5000iu a day. It would be nice to get D3 from the sun, but I cannot go in the sun...
Anti inflammatory supplements: ginger root and Curcuminoids from Tumeric.
Glucosamine & Chondroitin for joint support
A good multi vitamin "PhytoMulti"
Boswellia- another supplement that helps reduce inflammation.

I eat a very healthful diet also, I have been a vegetarian for 38 years, but eat eggs and cheese.
Hope this helps!
Jon
5

Oh heavens, I spent a small fortune on Krill capsules, then left them to rot. I don't know why I did that. I will check if they have gone off yet actually, when they go, you surely know it! The fish oils do seem like an obvious choice after vitamin D for those who can't get enough sun.

Congrats on your lovely buttery fat! I eat a whole load of carrots so I hope mine is just as pretty!

It's interesting that at least one person has similar views about supplements. But then we both love to cook so have a lot of confidence in what food alone can deliver.



Seenie said:

I'm with you on the vitamin supplement thing, Sybil, except for one: Vitamin D. Both my GP and my rheumatologist encourage me to take that one. For the rest I depend on my very varied and balanced diet. I see no point in taking large quantities of water-soluble vitamins, only to flush them down the toilet. As for the fat-soluble ones, well, I'd really rather the excess of those didn't start loading my fat cells, because there is a potential for toxicity. I'm pretty sure I'm not short of Vitamin A. During my hip replacement, the following conversation took place:
Dr: Seenie, do you eat a lot of vegetables?
Me: Yes, Dr. Sawbones, why do you ask?
Dr: I'll tell you later.
Don't remember much after that, until I felt them hauling on my leg and popping the joint together. Sorry, TMI. Anyway, later I asked and he said that my fat was a very buttery golden colour from my very adequate VitA intake. So no, I won't take a supplement of that!
I also take an Omega3 fish oil supplement, also suggested by GP and rheumy. But nothing else.
6

You got me wondering. Here’s some interesting info, even if it is for RA –

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3539179/
And here’s an interesting article which, despite being totally inconclusive, points to directions that are worth considering –
http://www.hindawi.com/journals/drp/2011/276079/

7

I have recently written a couple of posts on supplements and interactions for another Ben's Friends community that I help out on, so I'm happy to share these here:

Vitamins & Other Supplements

As a society we have been bombarded by advice and clever marketing surrounding supplements. It is an industry worth some £700 million in the UK and an incredible $30 billion in the USA. This alone is a flag to me except, of course, if I was a shareholder in the companies I'd be rubbing my hands together at the thought of all my dividend payments!

Have we all, though, come to see vitamins and nutrients as entities separate from their original food sources?

Our bodies have evolved over millions of years to be perfectly adapted to extracting nutrients and vitamins from a healthy varied diet (rich in fruit and vegetables and moderate intakes of other food groups), synthesizing metabolites as well as actually producing many vitamins in our intestines. We have the most incredible mechanisms for adjustment and regulation based on our requirements at any one time.

Scientists have told us what they believe are the important components in our food but do synthetic versions or extracts have the same effect as obtaining the nutrient or vitamin from food?

One study in 2012 looked at this question and found that in a clinical trial which compared natural broccoli to the equivalent broccoli extract; the natural product produced four times the amounts of the healthy polyphenols in the blood and urine compared to the artificial product. This suggests that the interplay between our food and the bio-availability of vitamins and nutrients is a complex one, more complex than science can currently explain. Our intestines are designed to gradually extract vitamins and nutrients from our food; but what of the sudden chemical surge that a handful or two of pills and capsules has on our stomach?

For some vitamins there is proven medical evidence of the benefit for supplementation, for example, folate for pre-conception and pregnancy. But outside of this group folate overdose is increasing, especially in countries that regularly add folate to manufactured food products such as bread. Many other vitamins and nutrients can be positively dangerous - in excess, in combination with each other or with over-the-counter and prescribed medicines. A degree in pharmacology is needed to navigate the potential rocks in this choppy sea!

I am not anti-supplementation, it has its purpose. Many people - many of us - have proven deficiency diseases or have poor diets because our diseases make it difficult to shop for and prepare meals from fresh ingredients or even stand in front of the heat of a cooker. My message here is one of safety; self-medication has the potential to endanger our already fragile health.

We all want to get better, feel better, reduce our symptoms BUT we need to exercise caution and common sense before trying something we have read about. The last thing any one of us needs is to (inadvertently) be making ourselves sicker.

So how do we do this? Here are my thoughts:

  • Investigate whether gold-standard randomised controlled trials have been done and what were the results. Be aware that observational studies are not reliable as they can be biased.
  • Remember one person's experience or outcome with a supplement may not be another's.
  • Discuss with your doctor(s) but be aware they may not know every detail of every drug or supplement or every possible reaction or contra-indication between them.
  • Read carefully all of the the Patient Information Leaflets for your medications and supplements to identify warnings relating to other medicines, supplements and herbs etc.
  • Use reputable web resources to research reactions between your medications and proposed supplements.
  • Ask your pharmacist. They do have degrees in pharmacology and are excellent information resources. Many (certainly in the UK) now offer full medication reviews.
  • Make a full list of all your medications and actual/proposed supplements. Be prepared to leave it with the doctor(s) or a pharmacist to be properly checked.

And in the meantime, think about whether you can boost any particular vitamin or nutrient intake with an extra portion of food just as nature intended us to have it.

8

Drug & Medication Interactions Checkers

WebMD produce a useful patient information resource on supplements, over the counter medicines and prescription medicines, including interactions between them:

This link takes you to their Vitamins & Supplements Centre

This link takes you to their Drugs & Medications Centre

You can view information on interactions from the page of each individual supplement or drug but there is also a dedicated tool WebMDinteractionchecker

Other online drug interactions checkers can be found at:

Drugs.com - Drug Interactions Checker

Medscape - Drug Interaction Checker

RXList.com - Drug Interaction Checker

PLEASE TAKE NOTE OF THE DISCLAIMERS ON ALL THESE SITES AND ALWAYS ENSURE YOU TAKE THE ADVICE OF A SUITABLY QUALIFIED MEDICAL PROFESSIONAL

Other useful resources include:

U S Food and Drug Administration

Gov UK Medicines and Healthcare products Regulations Agency

PainEDU Improving Pain Treatment Through Education have a number of helpful Interactive Tools relating to pain medications and pain therapies.

9

I am already completely convinced that vitamin D is very important. RA & PsA are far more prevalent in the Northern Hemisphere than anywhere else. I believe that PsA is found amongst native americans descended from the most northerly tribes, but hardly at all in others.

This is familiar territory for me as my Mum had multiple sclerosis and similar findings apply re vitamin D. One of the two most northerly islands of the UK, Orkney, has more MS per head of population than anywhere else in the world, and as it happens my PsA symptoms hit me during a summer spend on its sister island(s), Shetland. Gorgeous places in many ways but I found myself wondering how people could thrive with so little sunlight even though I was still thinking "I've just got a bad knee & I'm very lazy" at the time.

I do realise that there may be other explanations for disease distribution, such as genetics, but there would seem to be a buzz about Vitamin D in medical circles in recent years.

10

I agree that supplements aren't necessary. I suppose if you had a really crappy diet like some people I know, supplements could help a little, but it's still a better idea to just eat a healthy diet. I do tend to think sugar is very bad for us (I imagine small amounts can't do much harm, but some of us eat too much of it. High fructose corn syrup, which is found in so many processed foods nowadays, is really bad for us.) So, eliminating most of that sort of garbage from our diets could only help our health.

To keep my cholesterol in check, I take 2000 mg of Ultimate Omega fish oil--super triglyceride formula. I know for a fact it keeps my cholesterol and triglyceride levels healthy (I won't take statins). I also take 100 mg of coq10, which I'm pretty sure helps keep my bp normal and it seemed to help relieve inflammation before I went on Enbrel. My rheumy told me a long time ago studies were showing good results with it. He also had told me glucosamine hasn't been shown to improve joint health, and to be honest, I took it for quite a long time and never noticed any relief of my joint pains from it. My internist told me to take calcium + D because my bones are thinning. I've been a little lazy about, but instead try to eat more calcium-rich foods.

Sybil, that's really interesting about people in the n. Hemisphere having more of these diseases! Do we just need more sun and we'll get well??!!! And, same here--the older people don't worry as much about sun exposure. I, for one, have only used sunscreen about 3 times in my life--when I went to Florida! My dad was a fair-skinned German, but in the summers his old skinny arms would get nearly black from being in the sun working in his garden. It looks so healthy. And, watch out about using too much sunscreen. My coworker used it all the time and stayed white as a ghost all year. She ended up being diagnosed with extremely low vitamin D and had to take D supplements and her doctor told her to stop using sunscreen! So there you go!

11

For anyone in the UK who wants to get their Vitamin D level checked you can try your GP (good luck with that!) or order a sample kit from the Department of Clinical Biochemistry, City Hospital Birmingham .... last one I ordered was £25. Here is the link to their website http://www.cityassays.org.uk/vitamins.html

12

I am getting another BCC removed from my neck, this is the fourth one, I have also had SCC removed from my nose, they had to graft a piece of my ear to fill up the hole. I take 2 medications that make me photosensitive, along with possible SLE Lupus, I am a strong believer in sunscreen now…




Grandma J said:

I agree that supplements aren’t necessary. I suppose if you had a really crappy diet like some people I know, supplements could help a little, but it’s still a better idea to just eat a healthy diet. I do tend to think sugar is very bad for us (I imagine small amounts can’t do much harm, but some of us eat too much of it. High fructose corn syrup, which is found in so many processed foods nowadays, is really bad for us.) So, eliminating most of that sort of garbage from our diets could only help our health.

To keep my cholesterol in check, I take 2000 mg of Ultimate Omega fish oil–super triglyceride formula. I know for a fact it keeps my cholesterol and triglyceride levels healthy (I won’t take statins). I also take 100 mg of coq10, which I’m pretty sure helps keep my bp normal and it seemed to help relieve inflammation before I went on Enbrel. My rheumy told me a long time ago studies were showing good results with it. He also had told me glucosamine hasn’t been shown to improve joint health, and to be honest, I took it for quite a long time and never noticed any relief of my joint pains from it. My internist told me to take calcium + D because my bones are thinning. I’ve been a little lazy about, but instead try to eat more calcium-rich foods.

Sybil, that’s really interesting about people in the n. Hemisphere having more of these diseases! Do we just need more sun and we’ll get well!!! And, same here–the older people don’t worry as much about sun exposure. I, for one, have only used sunscreen about 3 times in my life–when I went to Florida! My dad was a fair-skinned German, but in the summers his old skinny arms would get nearly black from being in the sun working in his garden. It looks so healthy. And, watch out about using too much sunscreen. My coworker used it all the time and stayed white as a ghost all year. She ended up being diagnosed with extremely low vitamin D and had to take D supplements and her doctor told her to stop using sunscreen! So there you go!

13

Quite understand Jon. If the sun doesn't agree with you or the meds then you have to avoid over-exposure.

Jon_sparky said:

I am getting another BCC removed from my neck, this is the fourth one, I have also had SCC removed from my nose, they had to graft a piece of my ear to fill up the hole. I take 2 medications that make me photosensitive, along with possible SLE Lupus, I am a strong believer in sunscreen now...


14

Hey Grandma J, if only it was that easy! I reckon that if we can safely take the sun, then it's a quick & easy way of upping the Vitamin D levels, which is a good thing. I don't use sunscreen, but I don't burn. Well, once in a while I do but I know that is not desirable. I've given up thinking that any one healthy thing will make me better though! It really does seem that this disease doesn't get up & go. But healthy lifestyle one way or another plus the right meds give us more get up & go!

I am going to think about fish oils.

Grandma J said:

I agree that supplements aren't necessary. I suppose if you had a really crappy diet like some people I know, supplements could help a little, but it's still a better idea to just eat a healthy diet. I do tend to think sugar is very bad for us (I imagine small amounts can't do much harm, but some of us eat too much of it. High fructose corn syrup, which is found in so many processed foods nowadays, is really bad for us.) So, eliminating most of that sort of garbage from our diets could only help our health.

To keep my cholesterol in check, I take 2000 mg of Ultimate Omega fish oil--super triglyceride formula. I know for a fact it keeps my cholesterol and triglyceride levels healthy (I won't take statins). I also take 100 mg of coq10, which I'm pretty sure helps keep my bp normal and it seemed to help relieve inflammation before I went on Enbrel. My rheumy told me a long time ago studies were showing good results with it. He also had told me glucosamine hasn't been shown to improve joint health, and to be honest, I took it for quite a long time and never noticed any relief of my joint pains from it. My internist told me to take calcium + D because my bones are thinning. I've been a little lazy about, but instead try to eat more calcium-rich foods.

Sybil, that's really interesting about people in the n. Hemisphere having more of these diseases! Do we just need more sun and we'll get well??!!! And, same here--the older people don't worry as much about sun exposure. I, for one, have only used sunscreen about 3 times in my life--when I went to Florida! My dad was a fair-skinned German, but in the summers his old skinny arms would get nearly black from being in the sun working in his garden. It looks so healthy. And, watch out about using too much sunscreen. My coworker used it all the time and stayed white as a ghost all year. She ended up being diagnosed with extremely low vitamin D and had to take D supplements and her doctor told her to stop using sunscreen! So there you go!

15

Good luck with that indeed! I asked several times for a Vitamin D test in the past but no joy. I might order a test just for fun, sort of! My idea of fun is a bit different than it used to be.

Jules G said:

For anyone in the UK who wants to get their Vitamin D level checked you can try your GP (good luck with that!) or order a sample kit from the Department of Clinical Biochemistry, City Hospital Birmingham .... last one I ordered was £25. Here is the link to their website http://www.cityassays.org.uk/vitamins.html

16

Awesome info Jules, thank you! I too get the impression that the interaction between vitamins and the body is complex and that good food contains the right combinations of vitamins & minerals & allow them to be more easily absorbed than pills and capsules do.

I had a blood transfusion following the birth of my second son and was meant to take iron tablets. Being young and stupid I did not take them. That sort of arrogance is not something I'd recommend as I was very possibly lucky to get away with it. But get away with it I did .... I stuffed my face with green vegetables and swilled it all down with guinness. And the iron levels went up so quick the doctors were very pleased with me for being such a compliant patient.

When I had my first son I was given guinness on prescription .... used to get it from the pharmacy! Boy, those were the days! If only doctors could prescribe broccoli etc. now ..... and guinness too perhaps.



Jules G said:

I have recently written a couple of posts on supplements and interactions for another Ben's Friends community that I help out on, so I'm happy to share these here:

Vitamins & Other Supplements

As a society we have been bombarded by advice and clever marketing surrounding supplements. It is an industry worth some £700 million in the UK and an incredible $30 billion in the USA. This alone is a flag to me except, of course, if I was a shareholder in the companies I'd be rubbing my hands together at the thought of all my dividend payments!

Have we all, though, come to see vitamins and nutrients as entities separate from their original food sources?

Our bodies have evolved over millions of years to be perfectly adapted to extracting nutrients and vitamins from a healthy varied diet (rich in fruit and vegetables and moderate intakes of other food groups), synthesizing metabolites as well as actually producing many vitamins in our intestines. We have the most incredible mechanisms for adjustment and regulation based on our requirements at any one time.

Scientists have told us what they believe are the important components in our food but do synthetic versions or extracts have the same effect as obtaining the nutrient or vitamin from food?

One study in 2012 looked at this question and found that in a clinical trial which compared natural broccoli to the equivalent broccoli extract; the natural product produced four times the amounts of the healthy polyphenols in the blood and urine compared to the artificial product. This suggests that the interplay between our food and the bio-availability of vitamins and nutrients is a complex one, more complex than science can currently explain. Our intestines are designed to gradually extract vitamins and nutrients from our food; but what of the sudden chemical surge that a handful or two of pills and capsules has on our stomach?

For some vitamins there is proven medical evidence of the benefit for supplementation, for example, folate for pre-conception and pregnancy. But outside of this group folate overdose is increasing, especially in countries that regularly add folate to manufactured food products such as bread. Many other vitamins and nutrients can be positively dangerous - in excess, in combination with each other or with over-the-counter and prescribed medicines. A degree in pharmacology is needed to navigate the potential rocks in this choppy sea!

I am not anti-supplementation, it has its purpose. Many people - many of us - have proven deficiency diseases or have poor diets because our diseases make it difficult to shop for and prepare meals from fresh ingredients or even stand in front of the heat of a cooker. My message here is one of safety; self-medication has the potential to endanger our already fragile health.

We all want to get better, feel better, reduce our symptoms BUT we need to exercise caution and common sense before trying something we have read about. The last thing any one of us needs is to (inadvertently) be making ourselves sicker.

So how do we do this? Here are my thoughts:

  • Investigate whether gold-standard randomised controlled trials have been done and what were the results. Be aware that observational studies are not reliable as they can be biased.
  • Remember one person's experience or outcome with a supplement may not be another's.
  • Discuss with your doctor(s) but be aware they may not know every detail of every drug or supplement or every possible reaction or contra-indication between them.
  • Read carefully all of the the Patient Information Leaflets for your medications and supplements to identify warnings relating to other medicines, supplements and herbs etc.
  • Use reputable web resources to research reactions between your medications and proposed supplements.
  • Ask your pharmacist. They do have degrees in pharmacology and are excellent information resources. Many (certainly in the UK) now offer full medication reviews.
  • Make a full list of all your medications and actual/proposed supplements. Be prepared to leave it with the doctor(s) or a pharmacist to be properly checked.

And in the meantime, think about whether you can boost any particular vitamin or nutrient intake with an extra portion of food just as nature intended us to have it.

17

I'm told that there is no way a person in our lattitude (North America) can possibly get enough sun so I take Vitamin D supplements and Folic Acid because of the Methotrexate. Other than that I take a chewy vitamin daily.

18

I've heard the same about anywhere north of Birmingham (Birmingham UK that is - about halfway up). But I'm not sure it's true.

jennyb said:

I'm told that there is no way a person in our lattitude (North America) can possibly get enough sun so I take Vitamin D supplements and Folic Acid because of the Methotrexate. Other than that I take a chewy vitamin daily.