Why should I care about nutritional supplements

"Coronary artery disease, cancer, strokes, arthritis, multiple sclerosis, Alzheimer's dementia, and macular degeneration... every chronic degenerative disease I have mentioned is the direct result of the "dark-side" of oxygen-oxidative stress. In fact, oxidative stress is the leading theory behind the aging process itself. This generation is under greater attack from the pollutants in our air, food, and water than any other previous generation. Our stress-filled lifestyle also takes its toll on our health. It is critical that we understand the best defense against developing any of these degenerative diseases and premature aging is the body's natural defense system, not the drugs I can prescribe. This is why the truths revealed in this book are so critical to our health."

-Ray Strand, M.D.

When Dr. Strand's wife, Liz, began to feel tired, it was easy enough to chalk it up to the demands of being a wife and a mother of three children under age four. By the couple's tenth anniversary, however, Liz was experiencing constant total body pain, overwhelming fatigue, debilitating allergies, and recurrent sinus and lung infections. Even with drugs to treat every symptom, Liz was unable to keep up with basic household chores or care for the horses she had once so enjoyed riding. When a friend told Liz and Ray about a course of nutritional supplements that had dramatically improved her husband's health, a desperate Ray could only surrender: "Honey, you can try anything you want. We doctors certainly are not doing you any good."

Within months, the sparkle returned to Liz's eyes. She was out riding horses again and seemed to have completely renewed strength and joy. How just a few nutritional supplements could cause such a dramatic improvement was a mystery to Dr. Strand. He had always dismissed vitamin supplementation as simply the ingredients for "expensive urine." This experience with his wife proved to be the launching pad for a seven-year quest to research for himself the facts behind nutritional medicine.

What Dr. Strand discovered made a revolutionary impact on his practice. And based on his extraordinary findings, whether your desire is to protect your good health or reclaim it, you can now learn what to do to improve your own health.

Discover how you can:

Start now using the practical nutrient guidelines contained in this book to equip your body to fight the war within.

RAY D. STRAND, M.D., graduated from the University of Colorado Medical School and finished his postgraduate training at Mercy Hospital in San Diego, California. He has been involved in an active private family practice for the past thirty years. He has focused his practice on nutritional medicine over the past seven years while lecturing internationally on the subject across the United States, Canada. Australia, England, the Netherlands, and New Zealand. Dr. Strand lives on a horse ranch in South Dakota with his lovely wife, Elizabeth. They have three grown children.

Introduction

Physicians are disease-oriented. We study disease. We look for disease. We are pharmaceutically trained to treat disease. And in order to do so, we know our drugs. In medical school we study pharmacology and learn how the body absorbs each drug, and when and how the body excretes it. We know which drugs disrupt certain chemical pathways to create a therapeutic effect. We learn the side-effect profiles of drugs, and we work carefully to balance the benefits against any potential danger.

Physicians know their drugs and don’t hesitate to prescribe them. Consider for a moment the number of drugs that our patients are taking for high blood pressure, elevated cholesterol, diabetes mellitus, arthritis, heart disease, and depression, to name just a few. As a result of the discovery and use of antibiotics in the war against infectious disease, our philosophy in medicine has become: attack disease.

The medical community has carried this aggressive attitude and approach into the twenty-first century in the attempt to treat all the various chronic degenerative diseases. A study estimates that in 1997, pharmacies filled more than 2.5 billion retail prescriptions in the United States alone. The sale of prescription drugs has more than doubled in just the past eight years! [1]

In 1990 Americans spent $37.7 billion on prescriptions. In 1997 that spending increased to $78.9 billion. Prescription drugs haw been the fastest-growing portion of health-care costs over the past decade, rising at the rate of about 17 percent per year (well above the average rate of inflation) [2]. Physicians and insurance companies have placed all their hopes in drugs as the way to approach and hopefully slow down this epidemic of chronic degenerative disease - much to the delight of the pharmaceutical industry. Yes - We love our drugs.

I have not met a person yet who does not want to have excellent health. Most of us assume that we always will. But the truth is that many of us (doctors included!) are losing our health each day. I know, because health care is my job. Every day of my career involves informing patients that they have lost their health in one aspect or another. One patient may have developed diabetes or maybe degenerative arthritis. Another patient may have just suffered a heart attack or stroke. Still another may have to be told that he has metastatic cancer and has only a few months to live. Everyone desires to maintain or regain his health, but he does not always know what he needs to do to achieve that goal.

Because physicians are disease- and drug-oriented, we spend most of our time and effort trying to identify a disease process so we can prescribe a drug or treatment plan for our patient. Even Jesus made the statement, "It is not those who are healthy who need a physician, but those who are sick." [3]

Yet it just makes common sense that it is much easier to maintain our health than to try to regain it after it has been lost. Prevention of disease should be the first order of business for any physician. But to whom do you actually turn when you want to learn about the best way to protect your health? Is your doctor providing you with this information? The medical community gives plenty of lip service to "preventive medicine" and even names its leading medical insurance plans HMOs (Health Maintenance Organizations). By all appearances preventive medicine seems to be a top priority.

Yet less than 1 percent of our health care dollars are spent on so-called preventive medicine. In reality the majority of our preventive medicine programs simply attempt to detect disease earlier. For example, mammograms, chemistry profiles, and PSA tests (for prostate cancer) are all designed to detect a problem or cancer as early as possible. Doctors want to know if you have elevated cholesterol, whether you have become diabetic or developed hypertension. But they spend very little rime trying to help the patient understand the lifestyle changes that are necessary to actually protect his or her health. Physicians are too busy treating all the disease they face each day.

Are you aware that less than 6 percent of graduating physicians receive any formal training in nutrition [4]? And I would boldly state that few physicians receive training in medical school in regard to nutritional supplementation.

This was certainly true in my case.

Nothing curls a physician's toes more readily than the moment his patient asks if he should be taking nutritional supplements. I’ve used all the patented answers in the past: "They're just snake oil." "Vitamins just make expensive urine." "You can get all the required nutrients by eating the right foods." If my patients persisted, I told them nutritional supplements probably would not hurt them, but they should take the cheapest ones they could find because vitamins most likely wouldn't help much either.

Maybe you have heard some of these same comments from your physician. For the first twenty-three years of my clinical practice, I simply did nor believe in nutritional supplements. During the past seven years, however, I have reconsidered my position based on recent studies published in the medical literature. What I've found is so astonishing, I have changed the course of my medical practice. I have converted.

Why aren't more doctors responding to nutrition as I have? First, physicians must be skeptical in order to protect their patients against any scheme or product that could be harmful to their health. Believe me, I have seen plenty of gimmicks and quackery peddled to my patients. Physicians must rely on scientific research studies conducted through double-blind, placebo-controlled clinical trials (the standard in clinical medicine).

Because I know it's the most effective evidence available, I present only clinical trial study results in this book. Most of the medical studies I offer here are not from abstract or alternative journals. Instead, I have painstakingly researched mainstream, credible medical journals that the medical community greatly respects, such as the New England Journal of Medicine, Journal of the American Meal Association, British Lancet, and many others.

Another reason doctors haven't accepted the nutritional supplement idea as good preventive medicine is that most practicing physicians don't fully understand the cause of degenerative diseases. Those who do often feel this is an interesting subject for the biochemist and scientific researchers, but it has little in the way of practical use in clinical medicine. An apparent chasm exists between the research scientist and the practicing physician. Even though research scientists are making tremendous discoveries into the root causes of these diseases, very few physicians are applying this science to their patients. Doctors simply wait until patients develop one of these diseases and then begin to treat it.

Physicians seem content to allow the pharmaceutical companies to determine new therapies as they develop new drugs. But as you will learn throughout this book, it is our own bodies that are the best defense against developing a chronic degenerative disease -not the drugs doctors can prescribe.

Though most physicians do not yet well understand the concepts presented here, the facts remain. As I have applied these principles in treating my patients, the results have been nothing short of amazing. I have been involved with numerous patients with multiple sclerosis who have gone from being wheelchair-bound to walking again. I have helped patients with cardiomyopathy get off the heart-transplant list. Some cancer patients have gone into remission; patients with macular degeneration have had significant visual improvement; and fibromyalgia patients have gotten their lives back, Nutritional medicine is common-sense, mainstream, preventive medicine.

In this age of biochemical research, we are now able to determine what is happening in every part of each cell, and the very essence of degenerative diseases is now coming to light. As such, I recommend this, book to physicians who are willing to look objectively at medical evidence.

If you are a patient, don't expect your physician to jump onto the bandwagon immediately. Vitamins are a hot issue within the medical field. What Your Doctor Doesn't Know is, as I said, the outcome of more than seven years of personal research into the medical literature as it pertains to nutritional medicine. I wasn't immediately convinced either.

Nutritional medicine is foreign to most physicians as well as the public; this is true. But the verdict is in: what your doctor doesn't brow about nutritional medicine may be killing you. The good news is that you do not have to be a physician to start practicing nutritional medicine; you, the patient, can become proactive about preserving the health you have.


A Converted Doctor

I know that you probably have never heard of me. Why should you take the word of some doctor who practices medicine in a small city in the Midwest? Good question! That's why I want you to read every page in this book. I want you to undertake a journey similar to mine. Let me show you the same medical evidence that made me believe that vitamin supplements can protect and improve health.

Pleasem do read or at least scan the entire book. I know the temptation is to jump ahead to the specific chapter that discusses your health problem. But it is important that you become aware of the foundational information on how your body functions and what it needs to protect itself and become or stay healthy.

One final request: Since it's you health and life that are at stake, I encourage you to hear me out and withhold judgment. All I ask is that you be an open-minded skeptic - the kind of seeker I was when I first discovered this wondrous form of preventive medicines. I had to humble myself a bit to learn that even though I was a good doctor I had much to learn about health. Are you willing to do the same?

Physicians' Bias Against Nutritional Supplements

As I reflect back on my first years of medical practice, I clearly remember my own bias against nutritional supplements. So I don't have to look any farther than myself when it comes to understanding the basic prejudice doctors have. I am sure that my past feelings are not too different from those of the majority of physicians practicing medicine today.

I remember telling joy patients that they could get everything that they needed from their food, if they would just eat a healthy diet. “You just go down to your local grocery store and buy the right kind of foods, and you don't have to take any of those supplements,” I would insist. "Taking vitamins is a waste of money."

If that didn't convince them, I would share a study or two that showed a vitamin to be harmful. I remember that the negative studies were really the only ones on vitamins of which I was really aware. After all, when negative studies were publicized in the lay media or medical journals, I would tell myself, "See, you were right all along about those vitamins. It's a shame that these charlatans have played such scams ort my patients."

Part of the reason have changed my mind about vitamins is the quality of our diet.


The Typical American Diet

I have a confession to make right here, right now: I have actually eaten out in a fast-food restaurant. All right, if you must know the gritty details, I had a Big Mac, French fries, a large Coke - super-sized, even - and a hot apple pie. But you must also know that that was years ago. I have learned a little something about eating since then.

Did you find yourself chuckling at the thought of a person confessing to something we all have done more often than we want to admit? In spite of the knowledge that fast food is about the worst excuse for fuel we can ingest into our bodies, we line up by the fryer vat, waiting to pay our hard-earned cash for the detriment of our future health. Friends, knowing and doing are two different realities. As much lip service as we give to losing weight and eating healthy, in reality, it's just not happening.

Approximately 40 percent of our calories in the typical American diet cone from fat, and most of this is saturated fat (the bad stuff). The September 1997 issue of the medical journal Pediatrics reported that only 1 percent of children in the United States get the proper RDA levels of the essential nutrients from their diet [1]. Not only are children not getting proper nutrition for their growing bodies, they are establishing poor eating habits in childhood that usually persist into their adult years. It has amazed me how many of these young teenagers already have full-blown insulin resistance.

The Second National Health and Nutritional Survey evaluated twelve thousand Americans adults and their eating habits. Here are some of their findings:

· Seventeen percent of the population did not eat any vegetables
· Excluding potatoes and salads, 50 percent of the population did not eat any vegetables. In other words only half of the population ate garden vegetables.
· Only 41 percent consumed any fruit or fruit juices.
· Only 10 percent of the population met the USDA guideline of eating a minimum of five servings of fruits and vegetables a day. Among African Americans, only 5 percent ate the recommended amounts [2].

Ever though physicians and registered dietician recommend that we consume multiple servings of fruits and vegetables daily, our society is falling woefully short. This study shows us that if we exclude French fries and baked potatoes, more than half of the population is not eating any vegetables.

Worse yet, almost 60 percent of the population is not eating any fruits. In truth Americans are not eating a healthy diet even though they know better.

Is it any wonder that mote than 50 percent of our nation is now considered to be significantly overweight? When you combine these poor eating habits with the high-glycemic foods discussed in Chapter 14, it is no wonder that we have an epidemic of insulin resistance and diabetes in the U.S. If I were to challenge you to go out and not eat any white bread, white flour, pasta, rice, and potatoes for two weeks, you would quickly realize why so many people (more than 8 million Americans) have developed insulin resistance known as Syndrome X.


Quality of Food in the U.S.

No other nation on the face of the earth has produced the abundance of food that America has over the past half century. But when you look at the quality of our food from a health perspective, there are definite concerns. The processes used to produce and preserve our foods today have had a serious effect on the quality of this tremendous food supply. Rex Beach wrote in his report to the U.S. Senate:

Do you know that most of us today are suffering from certain dangerous diet deficiencies, which cannot be remedied until the depleted soils from which our foods come are brought unto proper mineral balance? The alarming fact is that foods - fruits and vegetables and grains - now being raised on millions of acres of land that no longer contain enough of certain minerals, are starving us no matter how much we eat [3].

Beach made this statement in 1936, And in the almost seventy years since Beach's plea to the Senate, little has been done to improve our nation's depleted soil; in fact, the situation is much, worse today than ever before in history [4]. Five major minerals (calcium, magnesium, chloride, phosphorous, and potassium) and at least sixteen trace minerals are essential for optimal health. Plants cannot create minerals. They must absorb them from the soil. And if our soils do not have these minerals, our plants will not have them either.

And they don't. Why? Organic fertilizers that contain these minerals are expensive and difficult to obtain. U.S. farmers manage their costs by using fertilizers that replenish the soil with only nitrogen, phosphorous, and potassium (called NPK). With these NPK fertilizers, farmers are able to grow good-looking grains and produce, though the crops remain depleted in all the other necessary minerals. Unfortunately economics is the driving force behind American agriculture, causing farmers to be more concerned about bushels per acre than the nutrient content of the food they harvest.

Few would argue about the quality of our foods and its decline compared to foods of a generation or two ago. Hybrid grains, vegetables, and fruits have increased in popularity. These hybrid seeds boast big, luscious products that are more resistant to diseases. The nutrient content of hybrids, however, is significantly less than that of their natural counterparts. The fanner is paid according to bushels per acre - not for the quality of his produce. Agriculture too has become a demanding and politically charged industry. In spite of our need for nutrition, the bottom line for farmers is making a living, and hybrid produce makes it possible.

Our food industry, due to special transportation and storage techniques, has been able to make a wide variety of fruits and vegetables available nationwide throughout the year. The variety is good. But these are made available at a sacrifice. Green harvesting means picking fruits and vegetables before they are mature. Shipping food over long distances requires cold storage and other preservation methods, which allow for depletion of vital nutrients. Our food is also highly processed. For example, the refinement process of our flour to create white bread removes more than twenty-three essential nutrients, magnesium being one of the most important. Our food industry then puts about eight of these nutrients back into our bread and calls it "enriched".

Did you know?
· In the process of making white flour, out removing the germ from the outer portion of the grain costs us more than 80 percent of flour's magnesium.
· The processing of our meats removes 50 to 70 percent of vitamin B6.
· Cold storage removes up to 50 percent of tangerines' vitamin C.
· Asparagus stored for just one week can lose 90 percent of its vitamin C [5].

It is a fact that our food is significantly deficient in vital nutrients, even at the time we purchase them; however, the way we prepare our foods is perhaps even more critical. Overcooking, delay in preparing fresh foods, and freezing foods are some of the reasons our foods lose nutritional value. For example:

· Fresh salads and cut vegetables and fruits lose more than 40 to 50 percent of their value if they sit for more than three hours.
· Vitamin C is vulnerable to both heat and cold, and prolonged storage depletes it.
· The preparation of food significantly decreases folic acid.
· Freezing meats can destroy more than 50 percent of the B vitamins [6].

We began with depleted nutrients in our soils, which NPK fertilizers made worse. Then came the hybrid grains that produced nutrient-depleted food. Modern processing and food storage caused further depletion of the quality of our foods. We then take these foods home and continue to create further depletion because of storage and preparation. These all make good, solid arguments as to why we should be supplementing our diets with high quality nutritional supplements.

You must understand, however, that these are not the primary reasons I recommend the use of nutritional supplementation. Though these conditions have proven to be detrimental to our American health, our understanding of nutrition has been equally if not more harmful. We must rethink the meaning of RDAs - recommended daily allowances.


Optimal Levels Versus RDA Levels

First, you must understand how recommended daily allowances were developed in the first place. The RDAs started in the early 1920s and 1930s as minimal requirements of ten essential nutrients that could help us avoid acute deficiency diseases. These are diseases like scurvy (deficiency of vitamin C), rickets (deficiency of vitamin D), and pellagra (deficiency of niacin). In other words if you consumed the RDAs for vitamin C, vitamin D, and niacin, you would not develop any of these illnesses.

Admittedly, the recommended daily allowances have done their job. In my three decades of clinical practice, I have never seen one of these diseases. They still occur, but they are rare. In fact the Center for Disease Control does not even track these diseases anymore.

The list of nutrients included in the RDAs grew over the next two decades, and in the early 1950s the definition of RDAs expanded to include the amounts of nutrients needed for normal growth and development.

Despite the fact that RDAs have proved useful, most physicians and laypeople tend to assign more meaning to RDA standards than they should. This is due in part to the U.S. government's requiring that all food and supplement labels give their percentages according to the RDAs. But after spending the past several years learning about nutritional supplementation and its effect on chronic degenerative diseases, I have become convinced of one overriding truth: RDAs have absolutely nothing to do with chronic degenerative diseases.

I believe this one simple truth is the cause of more confusion about the health benefits of nutritional supplementation than any other fact. Physicians are trained to believe that the RDAs are the level of nutrients that are needed by the body for optimal health. This false assumption is the main reason I believe physicians, registered dietitians, nutritionists, and the health-care community in general show such resistance to nutritional supplementation.

As you search the medical literature about oxidative stress and the amount of nutrients needed to prevent it, the level of nutritional supplementation is significantly greater than RDA levels. A good example of this is vitamin E. The recommended daily allowance of vitamin E is 10 IU, and in some schedules as high as 30 IU. The average American diet contains 8-10 IU. According to medical literature, you do not begin to see any health benefits until ingesting 100 IU of vitamin E in supplementation. This health benefit seems to improve all the way up to 400 IU and even higher. Most physicians who understand supplementation would agree that one must consume at least 400 IU of vitamin E daily.

The RDA for vitamin C is 60 mg, even though discussions over the past few years suggest this needs to be increased to 200 mg daily. The medical literature, on the other hand, indicates that our bodies need at least 1,000 mg of vitamin C before health benefits result. This benefit improves even more as we reach 2,000 mg.

I could go through all the major nutrients is and list the optimal levels shown to provide health benefit in the medical literature. In each case there is no relationship to the RDAs. Again, recommended daily allowances have nothing to do with chronic degenerative diseases. To get an idea of how much food we'd need to consume in order to achieve these optimal levels of nutrients, see below.

Amount of Food Needed to Achieve these Optimal Levels of Nutrients

Vitamin E (450 IU)
· 33 heads of spinach
· 27 pounds of butter
· 80 medium avocados
· 80 mangos
· 2 lbs. of sunflower seeds
· 23 cups of wheat germ
· 1.5 quarts of corn oil

Vitamin B6 (27 mg)
· 41 medium bananas
· 38 medium baked potatoes with skin
· 77 cups of lentils
· 15 lbs. of chicken breast
· 18 cups of wheat germ

Vitamin D (600 IU)
· 22 large egg yolks
· 6 cups of fortified milk
· 30 tablespoons of margarine
· 15 ounces of shrimp

Riboflavin (27 mg)
· 22 ounces of beef liver
· 16 cups of lowfat yogurt
· 9 dozen eggs
· 3.25 gallons of lowfat milk
· 64 cups of cooked spinach
I
Vitamin C (1300 mg)
· 17 medium kiwifruit
· 16 medium oranges
· 160 medium apples {including the skin)
· 10.5 cups of fresh orange juice
· 16 cups of raw chopped broccoli

Thiamin (27 mg)
· 135 cups of brown rice
· 2 lbs. of ham
· 3 lbs, of sunflower seeds
· 64 cups of green peas
· 12 cups of wheat germ

Folate (1 mg)
· 3.8 cups of cooked asparagus
· 4 cups of black beans
· 20 medium oranges
· 10 cups of brussel sprouts
· 3.8 cups of cooked spinach

There is simply no way to achieve these optimal levels of nutrients through food. If you desire to decrease your risk of developing a chronic degenerative disease, you must supplement your diet.

You may be heaving a sigh of relief thinking, Oh, good. I'm covered because I take a multivitamin. Don't relax just yet. Taking a daily multivitamin cannot protect you from degenerative disease either. Multivitamins are primarily based on RDAs. It is rare to see any reference in the medical literature to a health benefit in patients who are simply taking a multivitamin. You must take significant amounts of high-quality antioxidants and minerals if you have any desire to prevent or slowdown the chronic degenerative diseases described in this book.

The obvious next question should be. Is it safe to take these supplements at these optimal levels? As a physician who was not always convinced that taking supplements was a good idea, I would frequently discuss such dangers with my patients. I'm sure your physician can quote a few studies that showed a harm in taking supplements. Are there dangers? Sure there are. We need to discuss these in detail.


Dangers Versus Safety of Nutritional Supplements

Throughout this book I have related medical evidence that demonstrates the effectiveness of nutritional supplements in preventing and/or slowing the progression of degenerative diseases. For these supplements to be effective for this purpose, we must take them over a lifetime. We'll want to use them at much higher levels than the RDAs, and we're already an unhealthy population, so it is critical these nutrients be virtually free of any toxic effects and safe for use in strong doses.

Antioxidants are certainly safe when taken correctly. Nutritional supplements are simply nutrients we get from our foods, only at a higher level than is possible from regular eating. On the other hand pharmaceutical drugs may possess same clinical benefit in preventing some chronic diseases, but they inherently create a risk to the patient.

Every time a physician prescribes a medication, especially if it is for the treatment of a chronic illness, he must explain the potential danger for the use of that drug. "The medications we prescribe," said Dr. Bruce Pomeranz in the April 15, 1998 Journal of the American Medical Association, "cause over 100,000 deaths a year." He also states that another 2.1 million patients have serious complications because of medication [7]. Nutrients carry no such dangers.

In my next book titled Death by Prescription (to be released by Thomas Nelson Publishers in 2003), I explain the inherent dangers of all medication and the pitfalls in determining potential side effects of medication. There you will find a very practical and understandable guideline for avoiding suffering and possibly death from an adverse drug reaction.

Since properly prescribed and administered medication is the fourth leading cause of death in the U.S., it is time physicians and health-care providers begin to face this major health crisis [8]. Medical professionals speak out and fight to decrease the risk of heart disease, stroke, and cancer. But why don't we talk about helping our patients decrease their risk of suffering or dying from the medications we prescribe?

While our profession essentially ignores this significant cause of death, I find it terribly ironic that physicians continue to discourage their patients from taking supplements on the premise that supplements could be dangerous to their health!

Only a handful of deaths have been reported in the last several years related to supplements. And these have been cases in which individuals have taken many times the amounts recommended in this book of a particular nutrient such as niacin. Other reports involved accidental overdose of supplements in children.

Nonetheless, we still must be aware of the fact that nutritional supplements can be toxic if taken in very high amounts. Let's take a look at the main toxic effect of individual nutrients.

Vitamin A

Of all the nutritional supplements, straight vitamin A causes the most concern. Vitamin A toxicity can occur in adults who take in excess of 50,000 IU per day for a prolonged period of time. A lower dose may also create toxicity if the patient has liver disease. Signs of vitamin A toxicity include dry skin, brittle nails, hair loss, gingivitis, anorexia, nausea, fatigue, and irritability.

Accidental ingestion of a single large dose of vitamin A by children (100,000 - 300,000 IU) can cause acute toxicity. This may present as headache, vomiting, and stupor because of the increase in intracranial pressure [9]. A study reported in the January 2, 2002, issue of the Journal of the Medical Association indicates that vitamin A can be harmful for normal bone function, leading to an increase in hip fractures.

Women must avoid vitamin A supplementation during pregnancy. Dosages as low as 5,000 - 10,000 IU are believed to have caused birth defects [10].

I never recommend taking straight vitamin A in supplements. We can meet the need for vitamin A within the body by simply taking beta-carotene and the mixed carotenoids. These are very safe, and the body is able to turn beta-carotene into vitamin A as the need arises without any risk of toxicity.

Beta-Carotene

Beta-carotene has been used in high doses over several years without a single reported adverse effect. Some individuals develop a yellowing of the skin called carotenodermia, but this is totally benign and reverses completely once the beta-carotene is reduced or discontinued.

Vitamin E

Although vitamin E is a fat-soluble vitamin, it has a fantastic safety record. Clinical trials of vitamin supplementation as high as 3,200 IU per day have not shown any adverse effects. In addition studies have shown that vitamin E inhibits platelet aggregation and decreases the risk of blood clots in much the same way aspirin does. This property of vitamin E is actually a benefit in reducing heart disease. Researchers believe that vitamin E actually improves the effectiveness of aspirin in patients with heart disease [11].

Vitamin C

Vitamin C is safe even at very high doses, although some people may experience abdominal bloating, gas, or diarrhea. At one point, there was concern that vitamin C supplementation might increase the risk of kidney stones. This was found in only one clinical trial, however, and the last four similar trials did not substantiate this concern [12].

Vitamin D

Vitamin D has great potential to cause toxicity. Dosages greater than 1,500 IU are not recommended. In most cases I do not recommend supplementing with vitamin D in doses greater than 800 IU per day. Vitamin D toxicity may increase the blood levels of calcium, cause deposits of calcium in internal organs, and increase the risk of kidney stones [13].

Interestingly, recent studies reported in the New England Journal of Medicine have shown that 93 percent of the people in Boston are deficient in vitamin D, even those taking multivitamins [14]. Other studies are now revealing that the RDA of vitamin D is too low (200 IU) and patients need to take 500-800 IU of vitamin D, which is again is an optimal level. This dosage is still considered to be well within a safe range [15].

Niacin (Vitamin B3)

High doses of niacin supplementation may create flushing to the skin, nausea, and liver damage. Clinical studies have shown slow-released products with niacin may decrease the risk of flushing, but they may also increase the risk of liver damage [16].

Many people use high doses of niacin as a natural way to decrease their cholesterol levels. Using pharmaceutical levels of niacin supplementation should always be done under the direction of a physician. The levels of niacin recommended in Chapter 17 are in a very safe range. Niacin is now also being used along with the statin drugs, which are especially effective in lowering cholesterol.

Vitamin B6 (Pyridoxine)

Vitamin B6 is one of the few water-soluble vitamins with a possible risk of toxicity. Doses greater than 2,000 mg can cause symptoms of nerve toxicity. But people using doses between 50 and 100 mg daily have not reported any cases of toxicity [17]. Definitely be careful when using higher doses of vitamin B6.

Folic Acid

Folic-acid supplementation may mask an underlying vitamin B12 deficiency. Therefore, people should always take vitamin B12 supplements in tandem with folic acid. However, there has not been reported any serious problems of taking folic acid even up to 5 grams per day. This is another reason that cellular nutrition is a safe way to supplement your diet.

Choline

Choline is generally well tolerated, although at very high doses (20 g per day), it can create a fishy odor and cause some nausea, diarrhea, and abdominal pain [18].

Calcium

People tolerate doses of calcium supplements of up to 2,000 mg. It was once thought that high levels of calcium supplementation could lead to an increase in kidney stones; however, a recent study showed that higher levels of calcium actually decreased the risk of kidney stones. In other words those patients who had the highest intake of calcium actually had the lowest risk of kidney stones [19].

Iodine

Iodine supplementation greater than 750 mcg can suppress thyroid hormone secretion. Reports have also been made of acne-like skin eruptions at higher levels of iodine intake [20].

Iron

Concern about the use of iron (especially inorganic iron) in supplementation has increased. Americans generally get plenty of iron, and supplementation of this nutrient may create an iron overload, which has been associated with increased risk of heart disease in males. There is some concern iron supplementation may actually increase oxidative stress [21].

Manganese

Manganese taken in supplementation is very safe, although there are reports of people who develop manganese toxicity from their environment. This is usually seen in those who mine manganese or are exposed to high levels in the environment. These individuals may begin to hallucinate and become very irritable [22].

Molybdenum

Molybdenum is quite safe. A daily intake of greater than 10-15 mcg, however, may lead to goutlike symptoms [23].

Selenium

Several clinical trials, which used doses in the range of 400-500 mcg daily, have found selenium to be safe [24]. I believe, however, doses of selenium supplementation should be less than 300 mcg daily. Symptoms of selenium toxicity include depression, irritability, nausea, vomiting, and hair loss [25].

No toxic effects have been associated with supplementation of vitamin K, vitamin B1 (thiamin), vitamin B2 (riboflavin), biotin, vitamin B5 (pantethine), inositol, vitamin B12, chromium, silicon, CoQ10, boron, and alpha-lipoic acid [26].

A Physician's Defense

I am certain my medical training was not much different from that of the overwhelming majority of physicians practicing medicine today. I essentially received no formal medical training in nutrition. It was not a required class at my medical school. This is not shocking, since, as I mentioned in Chapter 1, a course in nutrition is still required in only a few of the medical schools around the country.

Elective courses in nutrition are offered in about 50 percent of the medical schools [27]; however, as I mentioned in the introduction, recent studies have shown that only about 6 percent of the graduating medical students have received any training in nutrition. I would boldly state that even those students who received a course in nutrition did not study much about nutritional supplementation. This simply is not the focus of our medical training. Physicians learn about the diagnosis and treatment of diseases. It wasn't until I spent the last seven years devouring the medical literature on this subject that my opinion changed.

For the last twenty-three years of my practice, I was a typical physician in regard to my knowledge and opinion about nutritional supplements. My opinions about vitamins were strong and filled with emotion, and my patients truly believed me. Maybe that was because I wow an M.D. and we are supposed to know everything about health. We don't!

Physicians base their use of medications, and is turn nutritional supplements, on reliable clinical trials reported in the medical literature. And not every study involving nutritional supplements has showed significant benefit. In some cases they've actually shown potential harm. Both the public media and medical literature publicize these negative studies.

As I described in the introduction of this chapter, when I was not a fan of nutritional supplementation, I knew about these negative studies and quoted them frequently to my patients. At that time, one negative study seemed to negate hundreds of good-quality studies that showed supplements' health benefits. Because any individual who reads the medical literature will encounter several of these studies, I feel it is important to address a few of the most publicized ones.

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