woman with omega 3 vitamins

Do Healthy Eaters Need Supplements?

By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.

Myth: If you eat a good, balanced diet, you don’t need supplements!

Fact: Much scientific evidence validates the benefits − even lifesaving benefits − of many nutritional supplements.

My Recommendation: Go for optimum health. Supplement smartly.

Many doctors are uncomfortable when their patients take supplements. Why? In most cases, it’s fear of the unknown. They haven’t been trained in nutrition. They know little about supplements. So their first impulse is dismissal.

This common attitude shortchanges patients because today so many patients have undiagnosed nutritional deficiencies.

Moreover, what exactly is a balanced diet, and who eats one? And is the food most people eat today capable of delivering a balanced diet?

To me, it’s fantasyland. What’s for sure is widespread public confusion because of a constant crossfire of contradictory dietary opinions from all the so-called experts. People dart hither and fro, seeking a beachhead of simple understanding in the latest book, magazine article, or tip from a dieting friend.

As a doctor who emphasizes nutrition and optimal supplementation, I know first-hand how confused most individuals are about this issue. So let me share some information with you that I hope may clear up any confusion you have.

Today’s food and eating habits are problematic

  • The nutritional status of Americans, if you look at all the surveys over the years, is frightening. One of the reasons there is so much chronic illness is precisely because of what we eat and don’t eat.
  • Two-thirds of our food is processed, and processed almost always sacrifices nutrient content for taste. As an example, the refining of wheat to make white flour removes 87 percent of the fiber and vitamin B6, 84 percent of the magnesium, 81 percent of the manganese, and 80 percent of the zinc. All essential to health. Even so-called enrichment and fortification by manufacturers leaves food products seriously imbalanced and depleted. More is always taken out in processing than is put back in.
  • Through intensive farming, poor crop management and chemical fertilizers, the soil in which our crops are raised has been seriously depleted of nutrients. Pesticides have left harmful chemical residues on crops and further destroyed the soil by killing earthworms and other necessary organisms in the food chain.
  • Much commercial produce is harvested before ripening so the produce survives shipping and distribution, yet the natural ripening of plants is essential for high nutrient quality.
  • Sweeteners are widely used in the American diet, empty calorie ingredients that contribute not only to obesity but to nutrient deficiencies as well.

Other reasons to take supplements

Before 1990, vitamins and minerals were seen by most physicians as substances in food that prevented nutritional deficiency states such as scurvy, beriberi, rickets, and pellagra. For decades, only a small minority of nutritionally-oriented physicians recommended supplements as a potent, safe, and inexpensive medical option.  Most conventional doctors opposed supplements as unnecessary or not backed by science. Some said supplements were even dangerous.

Today, a global wave of positive nutritional research has rendered the conventional viewpoint on supplementation utterly obsolete. Many thousands of published studies have shown that individual nutrients at doses higher than those usually present in food have a significant preventive and therapeutic effect for serious diseases, and not just nutritional deficiency states.

In 2002, the standard-bearer for mainstream U.S. medicine, the Journal of the American Medical Association (JAMA), published a report from Harvard researchers acknowledging that “most people do not consume an optimal amount of all vitamins by diet alone.” Because of this suboptimal intake and the “strong evidence of effectiveness” from controlled trials, “it appears prudent for all adults to take vitamin supplements.”

The wealth of nutritional supplement research greatly influenced the way I have practiced cardiology. While integrative medicine doctors like me use or recommend medication and surgery, we also optimize patients’ nutritional status − with vitamins, minerals, antioxidants, and other natural substances − to help the body heal itself and attain a higher level of health.

The supplements address specific cardiovascular shortcomings and simultaneously strengthen overall physiology to fight off infection, and inflammation, nourish the nervous and endocrine systems, and give extra oomph to the whole body.

Sick people need this nutritional upgrade…and they benefit magnificently. It often keeps them out of the hospital. I saw this benefit many times. Sometimes the supplements work rapidly like magic. Patients suddenly become rejuvenated as their nutritionally-starved bodies respond to healing nutrients missing for years. Other times I would see a steady but remarkable return to health by patients who previous sputtered along on near-empty tanks. Now, with their tanks full, they could move actively forward in life, feeling better than they have in years.

Many people, including doctors, who argue against taking supplements, often claim that the supplements do little more than promote expensive urine, but that’s not what I found. Far from it, I found that they’re some of the best weapons I had for patients. I’ve seen the lab work for thousands of people documenting their nutrient deficiencies. As those deficiencies were corrected − with supplementation − I’ve personally watched the health status of those patients improve, and often dramatically.

Suboptimal levels of vitamins and minerals can contribute to many diseases. Here are just a few examples: CoQ10 and magnesium are deficient in patients with heart failure. Magnesium in diabetics. Low levels of vitamin B12, commonly deficient in the elderly population, can contribute to Alzheimer’s and prostate cancer. Vitamin D, important for good bone health and muscle strength, is another widespread deficiency. Low levels are associated with hypertension, heart attack and stroke, chronic kidney disease, diabetes, and increased inflammation.

As we get older our bodies tend to produce less of certain nutrients, making supplementation really important.

Are you an exerciser? If so, you need to know that even moderate exercise can generate oxidative damage from free radicals − known factors in heart disease and other illnesses. But antioxidant supplementation can help offset the damaging effects of free radicals.

As far as the danger of supplements is concerned, that’s a bogus claim. The American Association of Poison Control Centers reports 11 deaths, supposedly, from supplement use during the last 27 years. I say “supposedly” because the circumstances linking the supplements to actual deaths are questionable. This is a tremendous safety record. Compare that to prescription drugs. A 2011 study revealed that each year, side effects from medication usage in the U.S. cause about 4.5 million visits to doctors’ offices and hospitals. In fact, prescription drugs are the fourth leading cause of death, killing more than 27,000 people (2007) − more than heroin and cocaine combined.

Keep in mind also that we are a prescription society. Medications, from statin drugs to birth control pills, deplete the body of a variety of important vitamins and minerals. If you are taking pharmaceutical drugs, supplementation is a good way to protect your nutritional status.

The Sinatra Solution

There you have just a few reasons why I believe supplementation, in tandem with other preventative lifestyle habits (see Lifestyle for Longevity), is not only a good idea but a necessity.

What should you take?

Everybody is different. But I feel comfortable in making some general recommendations.

  • For most people, start with a high quality state-of-the art multi vitamin, mineral and antioxidant formula. A one-a-day multi doesn’t have the necessary ingredients or firepower. Good formulas usually require you take more than one tablet.

Children and teens may also take a multivitamin formula (those under 12 may prefer it in liquid or powder-based form); however I don’t feel supplementation is a “must” for the very young… In general, children (by virtue of their youth) have not been exposed to as many toxins as most adults have, and are less likely to be taking pharmaceutical drugs which deplete nutrients.

Pregnant women should, of course, look for a good prenatal formula (this is one group to whom doctors routinely recommend supplements).

  • The “awesome foursome” of CoQ10, magnesium, L-carnitine, and D-ribose. These four supplements act like an elixir of youth. They directly feed trillions of aging, starving cells deficient in the metabolic raw materials that cells need to produce the body’s primary source of energy: adenosine triphosphate (ATP).  Whenever cellular energy declines, so does the function of those cells. Anything from the beating heart to thinking or seeing or breathing can be affected.

Here are the daily amounts I recommend for most people over the age of 35:

CoQ10: 60-120 mg for prevention, double or more if you have a heart condition (use hydrosoluble soft-gels for better absorption);

Magnesium: 400-600 mg; post-menopausal women, especially, need magnesium;

L-carnitine: 50 to 500 mg, if you’re healthy, and from 1 to 3 grams if you have cardiovascular disease or kidney insufficiency (take on an empty stomach);

D-ribose: 5 grams for cardiovascular prevention, and 10-15 grams for patients with heart failure, cardiovascular disease, peripheral vascular disease, and stable angina (take in divided doses).

I don’t generally recommend these supplements for children or young adults, because they don’t have the same needs for them. Our endogenous production of CoQ10, carnitine and ribose begins to wean in our 30s, and research has shown levels to have fallen by age 40. Of course, I do recommend the awesome foursome for children who unfortunately suffer from cardiac conditions like cardiomyopathy. People taking statin drugs should also supplement with CoQ10 and carnitine to prevent deficiency.

Anyone who exercises a lot can benefit from taking ribose, as heavy exercise depletes energy substrates in peripheral muscles; ribose can help prevent muscle cramping and delayed onset muscle soreness. Children who play competitive sports can benefit from taking 5 grams a day.

To get an idea as to why I refer to these supplements as “awesome,” just check out the reviews at amazon.com for my book Metabolic Cardiology that spotlights the science and my clinical experience with them. The comments are not from my patients, but from people who read the book and then started using the supplements to help their own cardiac conditions. The four are indeed awesome. They profoundly improved the heart and health status of many hundreds of my own patients over the years.

  • Vitamin C, a basic vitamin that does so much, including keeping body tissues and the immune system strong. Studies how it helps prevent coronary artery disease, strengthens blood vessel walls, and improves vasodilation. Take 1g daily.

As vitamin C can increase iron absorption, no one with the gene for hemochromatosis (an estimated 36 million people) should take more than 200 mg of Vitamin C a day.

  • Fish or squid oil, for its omega 3 fatty acid anti-inflammatory content and heart-healthy properties. Omega 3s help lower your risk of heart disease by promoting normal triglyceride levels, keeping blood pressure in the normal range, and supporting circulation, blood flow, and blood viscosity (blood thickness). I recommend 1 g. daily for people over 18.
  • Curcumin, the powerful anti-inflammatory agent in turmeric. Take 100 mg daily.

Don’t do this…

There’s another side to the supplement story.

A lot of people think they can eat anything they want as long as they take their supplements. One patient stands out in my mind. He was a middle-aged professional man who came to see me just before going on a cruise.

“Hey doc,” he said, “now that I’m taking your CoQ10 and other vitamins I guess it’s OK for me to eat anything I want, right?”

Absolutely not, I told him.

And, like many others like him, I gave him the following advice. No, it’s not OK to wolf down sweets, fried food, and junk food willy-nilly and think you are protected just because you also take vitamins. Yes, supplements are protective but not a license for eating poorly and certainly not a license for overeating. You can easily overwhelm their positive effect.

I also am generally not a big fan of “megadosing.” It can end up having a pro-oxidant effect. For example, taking more than 400 IU Vitamin E can lead to the oxidation of HDL cholesterol, which can impair the immune system. In addition to limiting Vitamin E supplementation, no one should take over 12,500 IU beta carotene or 10 mg manganese per day.

Q & A

Q. Can a vitamin B deficiency be a cause of coronary artery disease?

A. Yes, as demonstrated by Dr. Kilmer McCully, the pioneer researcher on B vitamins and heart health at Harvard University. If you have a vitamin B deficiency, particularly folate, B-6 and B-12, you are at risk for developing heart disease. This is because when you eat large amounts of red meat, your body becomes overwhelmed by methionine, an amino acid in red meat. Without adequate B vitamins, the body is unable to metabolize, or break down the overload of methionine and a toxic byproduct known as homcysteine is formed. Homocysteine disrupts the cell membranes in your blood vessels, causing premature fat and cholesterol buildup (atherosclerosis).

You can prevent this accelerated aging of your circulatory system by getting enough B vitamins. It may seem inconceivable that in our society we are seeing evidence of a deficiency of B vitamins, but, sadly, not everyone eats enough daily servings of fresh fruits and vegetables. Processed foods are stripped of these nutrients and microwave ovens destroy the B vitamins.

The best way to make sure you are not B vitamin deficient is to drink fresh squeezed orange juice and eat plenty of leafy green vegetables such as spinach and kale. For extra “healthy-artery insurance,” take a daily multivitamin with folic acid and the other B vitamins. By taking these simple steps early in life, you can avoid being one of thousands who continue to have heart attacks and/or strokes often occurring in those with high homocysteine levels.


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