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May 25, 2016

Infrequently Asked Questions: How do I know what vitamins to take?

The world is full of questions we all want answers to but are either too embarrassed, time-crunched or intimidated to actually ask. In the spirit of that shared experience, we've embarked on a journey to answer all of the questions that burn in the minds of Philadelphians — everything from universal curiosities (Why do disposable coffee cups still leak?) to Philly-specific musings (How does one clean the Liberty Bell?). 

Basically every bottle in your grocery store's vitamin aisle claims to be "essential," but who has the time — or the money — for all that? 

In an effort to make the mysterious world of vitamins a little less overwhelming, we reached out to Dr. Rashna Staid, a physician with the Brind-Marcus Center of Integrative Medicine at Jefferson University Hospital in Villanova.

It's overwhelming, the sprawl of vitamins you see at the grocery store. What's the best way to sort through that and figure out what's a good idea to take?

I've been giving a talk on which vitamins are essential and what you need for years. I actually have a picture of someone staring at a vitamin aisle, scratching their head — so totally mystified over not only what to take, but how much to take, what form to take it in, and wondering 'Will it cause any further problems?' And it's interesting in that we test almost everything, but when it comes to basic lifestyle and diet, we don't pay attention to it, nor do we kind of look at people and say 'What nutrients are they missing that may be causing the need?' What nutrients are we depleting by giving them medication?' It's actually much more complicated and there's a good reason people scratch their heads.

The approach I take over the years, if it's an average patient doing fairly well, I look at them and say 'What are they? Woman? Man? A certain age? What are things they most likely benefit from?' So if I had to meet someone on an elevator, and had a suggestion, and they're in their 40s to 60s — the people who are popping these things these days, quite honestly — then I think most people would do well on an omega-3 fatty acid; most people would benefit from a probiotic; people would do well taking possibly a B-complex vitamin; and most people will benefit from Vitamin D. So that's on average. But I don't like average because I'm not talking to general populations when I'm talking to patients; I'm talking to individuals with specific medical concerns, medications, etc.

So, what I do in my office is — most people don't know this is available — but it's a micro-nutrient test. I actually draw blood in the office and there are two tests I use: One is what I call a functional test that looks at how your white blood cells are utilizing the nutrients. And your white blood cells are your entire immune system. It's not 'How much are you taking,' but 'How much your body is actually seeing.' Some people are taking supplements and they're just urinating them down the drain. And if you're not getting them where they need to [go], for other medical conditions or problems, they're not being very helpful to you. It may be the form you're taking or the amount you're taking that might cause that. 

I like doing a functional micro-nutrient test on patients who have concerns or worries about a medical problem or how healthy they are or people who want to do sports enhancement — those people I love drawing the test because then I give them specific recommendations. We're not guessing. Your body is telling us 'You need this much.' And then I can point you in the right direction of what brands and vitamins are considered good quality, what form to take and when to recheck. Just because I start you on something doesn't mean you need it forever. The way I practice is to supplement to get rid of the deficiency, then teach you how to eat those foods to prevent them from reoccurring. The last thing we want to do is eat vitamins all day. We need to eat food to get our vitamins.

The downside to that is the American diet is getting more and more depleted of vitamins in general. The magnesium of our food from 45 years ago is not what we're seeing today. So we're actually seeing more and more deficiencies, things people should be getting in their diet. Another problem is people aren't eating real food. They're eating chemicals we call food that doesn't have any real nutrients in them. ...

What's really important is to teach people you need to eat whole, nutritious food in the form — not to get religious — that God gave us. Not in this reproduced, manufactured, artificially colored form that people eat today.

Rather than take all these individual vitamins, why doesn't everyone opt for a multivitamin?

I don't want to name names, but there are a lot of once-daily vitamins that's one pill that has A to Z, it's kind of junky. They're full of fillers; there's no possible way to get all the nutrients you need in one pill. They're not what most people who are into vitamins say are good quality, or will suffice to kind of build someone back up who is depleted. So these one-a-day kind of formulas usually can't have everything. And to top that off, a lot of supplements, you shouldn't take together. Iron shouldn't go with some other types of electrolytes because they bind each other. So how can you have them all in one pill? The time of day you take them, how you take them, some need to be with food. Fat-soluble vitamins are better absorbed with fat in your diet, with a meal. Other vitamins, B vitamins for instance, kind of make you buzz and give you energy. You shouldn't take them at night. So you really want to kind of be smart about how you're taking your supplements, and sometimes one size, one pill, does not fit the need.

Any kind of vitamin good for the typical city-dweller?

I wouldn't say city-dwellers — I look at the personal makeup of the patient. But the reason I said Vitamin D is important — I think anyone indoors, let's put it that way. If you're working outside, let's say most of the year, you're probably getting enough Vitamin D half of the year in Philadelphia. And that's because Vitamin D comes from the sun; however, [it depends] on the color of your skin, age, own ability to manufacture it, as well as — also, it's half the year, I say, because we only get the UV spectrum our skin needs to absorb for half the year because we're north of Atlanta, and north of Atlanta we don't even get the UV we need to make the Vitamin D we need adequately for half the year. 

Dr. Staid: I tell my patients all the time 'No one has a Lipitor deficiency.'

... Here, where we're such an indoor society, the only light we see is our computer screen most of the day. We need our Vitamin D. And Vitamin D is not just a vitamin as a vital nutrient, but it also acts as if it's a hormone in our body. It has more than 300 receptor sites that it interacts with, and those protect us from bone loss to cancer, autoimmune diseases to cardiovascular diseases — it's unbelievable how important and essential it is to so many facets of health and well-being. It kind of miffs me a little that the United States comes up with people who sit at a table and say 'We don't need this,' because the data clearly shows.

... I tell my patients all the time 'No one has a Lipitor deficiency.' You do have vitamin deficiencies, yet doctors aren't looking at them and it drives me crazy. And a lot of medications we use deplete us further. Common everyday birth control, blood pressure medications, cholesterol medications, deplete us of some important nutrients, and in those individuals, supplementation is even more important.

How about fish oil? It almost seems trendy to take fish oil.

So fish oil is a great anti-inflammatory, but fish oil is not all the same. In my opinion, what seems to work best, you want to get one that's high in specifically DHA and EPA. Those are the important fatty acids. So a good fish oil capsule will have close to a combination of 1000 mg, you want it in the triglyceride form; it's better absorbed and seems to work better for patients. 

And not everyone needs it. So if someone has no arthritis, inflammation, has great triglyceride levels, I'd rather get them a nutrient they need. This 'everyone needs everything' notion is not true. And I'd rather tell someone to have some wild cod fish twice a week instead of popping fish oil every day if they don't need it.

Are gummies too good to be true?

I don't like gummy vitamins. I kind of think you're getting sugar, and artificial colors and sweeteners in them. I'm a proponent of eating whole foods, so I'm not a fan of eating gummies.

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