Thoughts on vitamins and supplements

[Chrish]

What are your thoughts on taking vitamins and other supplements? If you work in retail, you will get this question almost daily. I am not aware of any proven benefit of taking multivitamin in trials. However, I don’t necessarily advise against it if someone asks me about multivitamins.

Conversely, what is your opinion on B12 or Vit D supplants? If someone complains about lethargy and asks for recommendations, I advise them to try b12 supplement for a month and see if that makes a difference. Similarly if someone asks about bone supplements, I recommend calcium/ vit d combo.

We used to think in worst case scenario, these supplements just wouldn’t work and pt might end up wasting few bucks. However, after that Zantac recall I feel weary of recommending something that pt may not benefit from and might end up actually causing harm to someone. What are your thoughts? What does literature say about benefits vs harm of these products? I know people who ask for these products are firm believers and will get them anyways even if you try to steer them away. If anything they will benefit from placebo effect of taking something “natural”.

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[WorthlessOxygen]

I have a roughly similar view to you. I'm in an area where the majority of my patients actually have a decent chance of benefitting from vitamin d since we have a high prevalence of vitamin d deficiency.

I generally recommend b complex over B12, if they're going to spend the money on a water soluble vitamin they might as well get the complex for the same price.

As far as brands, I recommend ours if the patient is very price conscious and nature made if not since that's the only brand that we carry with USP certification.

 

[JustFillIt]

What are your thoughts on taking vitamins and other supplements? If you work in retail, you will get this question almost daily. I am not aware of any proven benefit of taking multivitamin in trials. However, I don’t necessarily advise against it if someone asks me about multivitamins.

Conversely, what is your opinion on B12 or Vit D supplants? If someone complains about lethargy and asks for recommendations, I advise them to try b12 supplement for a month and see if that makes a difference. Similarly if someone asks about bone supplements, I recommend calcium/ vit d combo.

We used to think in worst case scenario, these supplements just wouldn’t work and pt might end up wasting few bucks. However, after that Zantac recall I feel weary of recommending something that pt may not benefit from and might end up actually causing harm to someone. What are your thoughts? What does literature say about benefits vs harm of these products? I know people who ask for these products are firm believers and will get them anyways even if you try to steer them away. If anything they will benefit from placebo effect of taking something “natural”.

If you are an individual who has normal meal consumption and you have no digestive disorders which would prevent the proper absorption of vitamins/minerals - it is silly to supplement multivitamins. Not to mention that most of our foods come fortified with tons of minerals (just look at the additives of fruity pebbles).

The only exception to this rule is vitamin D and calcium in the elderly. Sometimes magnesium if you are deficient. Sometimes I recommend magnesium/vit b supplement with long term ppi.

If you do not have a documented lab test showing you are deficient and you eat 3 square meals a day - it’s just silly to take multivitamins. Or - if there is no obvious clinical rationale for supplementation.

One supplement that I do believe has a host of mild/moderate benefit is a good DHA/EPA supplement.

This is my opinion, and this opinion has caused many frustrated discussion with providers that believe that their multivitamins will elevate them to a celestial level especially if you combine it with a gluten free diet, no carb whatsoever, and drink that bacteria water infused with aloe and pomegranate extract.

They see me sitting there with my bag of Doritos and a regular coke and think I am beneath them. Thats when I save a big chips/soda burp to release sometime mid meeting. Follow up with “oh man…. Excuse me”

PS: don’t forget - these supplements are not without adverse effects. Over supplementation with multivitamins can cause some serious nausea to mention one.

 

[owlegrad]

It’s unnecessary (and costly) at best and harmful at worst. When I worked retail I just gave people the best information I had and let them make their own decisions. I did recommend that people buy the cheapest option since their is no evidence that the more expensive brands are better.

I do admit it was a little annoying watching people buy airborne after I wasted my time explaining how pointless the product is. If you’re going to buy it anyway, don’t waste time asking me to affirm your decision.

 

[ValeRx]

Vitamins are kinda like guaifenesin - pretty much useless.

 

[zelman]

If you have lab values that indicate the need for a vitamin, take that vitamin. If you don’t, take vitamin D.

 

[RxPreceptor]

If you have lab values that indicate the need for a vitamin, take that vitamin. If you don’t, take vitamin D.

Same belief/practice....otherwise, one is just shooting in the dark without a target. Another train of thought is that vitamins (multi-vitamins) are a lot like insurance...might be a complete waste of money, seldom pays off, completely unnecessary if one follows a pretty good diet. Sure might be useful for someone on an excessively restrictive diet (for whatever reason)...again, objective info (lab values) are ideal for making decisions as to what's truly necessary

 

[Xenophylia]

I always told patients "they will successfully make your wallet lighter" and let them proceed from there.....

 

[zelman]

Same belief/practice....otherwise, one is just shooting in the dark without a target. Another train of thought is that vitamins (multi-vitamins) are a lot like insurance...might be a complete waste of money, seldom pays off, completely unnecessary if one follows a pretty good diet. Sure might be useful for someone on an excessively restrictive diet (for whatever reason)...again, objective info (lab values) are ideal for making decisions as to what's truly necessary

Oh yeah. Diet matters, too. Vegetarians need B12.

 

[MatCauthon]

Fish oil is one of the most questionable supplements, largely useless yet also harmful to environment due to the large numbers of fish required. Since fish have no oil glands, whole fish are basically juiced to extract the oil. 2 or 3 small fish to make one capsule.

I have tested around many supplements. Trace minerals and magnesium are supplements that may be beneficial to many people. For magnesium, there are books of information about how many enzymes magnesium is a cofactor for. If uses the upper range of the magnesium lab test as a reference very few people get in this range. Most people will be on the lower end of this lab

 

[Old Timer]

Absent lab values that indicate a need for supplementation, they are a total fraud and there is less than no evidence to support their use.

 

[ValeRx]

Fish oil is one of the most questionable supplements, largely useless yet also harmful to environment due to the large numbers of fish required. Since fish have no oil glands, whole fish are basically juiced to extract the oil. 2 or 3 small fish to make one capsule.

I have tested around many supplements. Trace minerals and magnesium are supplements that may be beneficial to many people. For magnesium, there are books of information about how many enzymes magnesium is a cofactor for. If uses the upper range of the magnesium lab test as a reference very few people get in this range. Most people will be on the lower end of this lab

If memory serves, there are more studies that show that fish oil supplementation is useless than the ones that show they actually have any sort of cardiovascular benefit (which is basically none).

 

[Heroic Combo]

It’s unnecessary (and costly) at best and harmful at worst. When I worked retail I just gave people the best information I had and let them make their own decisions. I did recommend that people buy the cheapest option since their is no evidence that the more expensive brands are better.

I do admit it was a little annoying watching people buy airborne after I wasted my time explaining how pointless the product is. If you’re going to buy it anyway, don’t waste time asking me to affirm your decision.

Can you elaborate on Airborne being pointless? Now, I am all about the cheaper option, not getting raked over the coals by expensive brand names. However, this product has echinacea in it, which has data for improving outcomes of colds, etc. Obviously the zinc and Vitamin C is in there, and we know those have data which show their benefit. Airborne is the only product I know of (that's readily available where I work) that combines the three components in 1 product. Emergen-C does not do this.

However, I admit I'm not totally keyed in as to whether or not the content of echinacea in the herbal blend is actually enough to make a difference..

Anyway, if one wanted to obtain C/Zn AND echinacea, it would cost far more $$ to get them separately, than to buy them contained in Airborne (or Airborne generic).

 

[Old Timer]

Can you elaborate on Airborne being pointless? Now, I am all about the cheaper option, not getting raked over the coals by expensive brand names. However, this product has echinacea in it, which has data for improving outcomes of colds, etc. Obviously the zinc and Vitamin C is in there, and we know those have data which show their benefit. Airborne is the only product I know of (that's readily available where I work) that combines the three components in 1 product. Emergen-C does not do this.

However, I admit I'm not totally keyed in as to whether or not the content of echinacea in the herbal blend is actually enough to make a difference..

Anyway, if one wanted to obtain C/Zn AND echinacea, it would cost far more $$ to get them separately, than to buy them contained in Airborne (or Airborne generic).

There is not proof that Airborne does anything at all except make large profits for Schiff Nutrition International

If you wish to boost your immune system, you need to eat a healthy diet, reduce stress and get plenty of sleep. You cannot boost your immune system with supplements. There is not one single well done RCT that supports this crap.

 

[panicatthepharmacy]

There is not proof that Airborne does anything at all except make large profits for Schiff Nutrition International

If you wish to boost your immune system, you need to eat a healthy diet, reduce stress and get plenty of sleep. You cannot boost your immune system with supplements. There is not one single well done RCT that supports this crap.

bUt iT wAs iNvEntEd bY a tEAcHer!

 

[RxPreceptor]

bUt iT wAs iNvEntEd bY a tEAcHer!

Let me guess...an English teacher? Philosophy, liberal arts, humanities, ethics, "educational" subject that really isn't education or have any objectivity whatsoever

 

[panicatthepharmacy]

Let me guess...an English teacher? Philosophy, liberal arts, humanities, ethics, "educational" subject that really isn't education or have any objectivity whatsoever

A second grade teacher!

 

[Old Timer]

A second grade teacher!

She is so dumb she is a milluinare and you are counting pills and eating raman to pay off your student loans.

 

[Sine Cura]

TJ Parker's net worth is more than that of anyone posting here

What matters that some sucker's gonna pay for it

 

[BidingMyTime]

I go the opposite route of most of you. People will ask about wanting to take megadoses of some vitamin or mineral, and I just tell them to take a multi-vitamin. Most people don't have good diets, so a multi-vitamin might help and won't hurt. But I can see lots of problems from taking megadoses of a single vitamin (ie kidney stones from Vitamin C)

As for Zantac, who knows if anyone was actually hurt by it. The impurity in the zantac had the potential of causing cancer, but so does many other things in our life. I wouldn't lose any sleep over having recommended zantac to someone.

 

[Old Timer]

I go the opposite route of most of you. People will ask about wanting to take megadoses of some vitamin or mineral, and I just tell them to take a multi-vitamin. Most people don't have good diets, so a multi-vitamin might help and won't hurt. But I can see lots of problems from taking megadoses of a single vitamin (ie kidney stones from Vitamin C)

As for Zantac, who knows if anyone was actually hurt by it. The impurity in the zantac had the potential of causing cancer, but so does many other things in our life. I wouldn't lose any sleep over having recommended zantac to someone.

Couldn't disagree more. Multi vitamins are a horrific waste of money. If they have diet issues refer them to an RD.
As for Zantac, this is a complete scam. This is a testing artifact

 

[panicatthepharmacy]

She is so dumb she is a milluinare and you are counting pills and eating raman to pay off your student loans.

Millionaire*
Ramen*

 

[RxPreceptor]

Just demonstrates the evils of marketing, twisting of facts with emotional drivel/nonsense from low level anecdotal evidence.

This is "Mare-Cuuh" God Damn it, people have the right to waste their money how they see fit and God forbid anyone judge them for their faulty illogical beliefs manifested from Marketing

 

[alpha12]

and won't hurt.

There are plenty of studies that say the opposite.

 

[PharmDBro2017]

If memory serves, there are more studies that show that fish oil supplementation is useless than the ones that show they actually have any sort of cardiovascular benefit (which is basically none).

Memory serves wrong, or at least new data is available showing some promise:

In major meta-analysis of clinical trials, omega-3 fish oil supplements linked with lower cardiovascular disease risk

For immediate release: Monday, September 30, 2019 Boston, MA – People who received omega-3 fish oil supplements in randomized clinical trials had lower risks of heart attack and other cardiovascula…

www.hsph.harvard.edu

https://www.ahajournals.org/doi/10.1161/JAHA.119.013543

Effect of Omega-3 Dosage on Cardiovascular Outcomes

To quantify the effect of eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids on cardiovascular disease (CVD) prevention and the effect of dosage.

www.mayoclinicproceedings.org

Effect of Omega-3 Dosage on Cardiovascular Outcomes: An Updated Meta-Analysis and Meta-Regression of Interventional Trials

To quantify the effect of eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids on cardiovascular disease (CVD) prevention and the effect of dosage.T…

www.sciencedirect.com

Examine does a decent job of compiling data on supplements:

Fish Oil: Summary of Scientific Research

Fish oil is a a source of omega-3 fatty acids. It reduces triglycerides, but does not seem to affect the rate of cardiovascular events. It seems to notably reduce the symptoms of depression and improve some painful, inflammatory conditions.

examine.com

 

[Old Timer]

Millionaire*
Ramen*

Sorry my typing skills don't meet your approval. However, you understood my point. Now get back in line for Saint Hood.

 

[BidingMyTime]

There are plenty of studies that say the opposite.

Can you direct me to a study that shows a general multi-dose vitamin hurts people? I have never heard of such a thing, and I find that hard to believe given the prevalence of multi-vitamin's being routinely prescribed in the psychiatric population. But if I'm wrong, I would like to know that.

 

[alpha12]

Can you direct me to a study that shows a general multi-dose vitamin hurts people? I have never heard of such a thing, and I find that hard to believe given the prevalence of multi-vitamin's being routinely prescribed in the psychiatric population. But if I'm wrong, I would like to know that.

New vitamin supplement study finds they may do more harm than good

Folic acid, we are looking at you.

www.smh.com.au

A new study out on Tuesday aimed to examine the benefits of vitamin and mineral supplements for prevention of heart disease, stroke and premature death (termed “all-cause mortality”). This found the most commonly studied ones had no effect, while some less common ones did have an effect. The review also found some supplements can be harmful.

Most people in Western countries don’t have an optimal diet. This review shows taking supplements as an “insurance policy” against poor dietary habits does not work. If it did, there would have been a reduction in early death.

 

[Sparda29]

I don't know if the docs at my hospital actually believe in it or not, but they put Ascorbic Acid 500 mg BID, Vitamin D 5000 units daily, and Zinc 220 daily into the damn Covid order set. I roll my eyes every time I see it.

 

[Old Timer]

I don't know if the docs at my hospital actually believe in it or not, but they put Ascorbic Acid 500 mg BID, Vitamin D 5000 units daily, and Zinc 220 daily into the damn Covid order set. I roll my eyes every time I see it.

What ****ty hospital to you work at Moscow South?

 

[owlegrad]

Yeah most of our homes have a similar order set for COVID. Zinc was all the rage for a minute.

 

[Old Timer]

Do they practice evidence free medicine?

 

[Sparda29]

What ****ty hospital to you work at Moscow South?

They also ordered about 400 bottles of 500 ct Hydroxychloroquine 200 mg. After about a month of it being used, everyone stopped ordering it, and now these pills are about to expire.

Do they practice evidence free medicine?

I guess they feel there is zero risk and unknown benefit.

 

[PharmDBro2017]

I don't know if the docs at my hospital actually believe in it or not, but they put Ascorbic Acid 500 mg BID, Vitamin D 5000 units daily, and Zinc 220 daily into the damn Covid order set. I roll my eyes every time I see it.

The hospitals around here all do the same. If there is no harm, but a "potential" benefit... may as well use it.

 

[Sine Cura]

People are getting oral N-acetylcysteine prescribed, too. lmao

Zinc elemental 50 mg + vitamin C 1000mg + NAC 600 + vitamin D3 20 mcg QD

 

[alpha12]

People are getting oral N-acetylcysteine prescribed, too. lmao

Zinc elemental 50 mg + vitamin C 1000mg + NAC 600 + vitamin D3 20 mcg QD

LOL. Is this to treat covid or prevent it?

 

[alpha12]

The hospitals around here all do the same. If there is no harm, but a "potential" benefit... may as well use it.

How do they know there is no harm? People keep saying this but unless it studied no one can say for sure. Remember supplements aint approved by the fda so supplement makers can make any bull**** claim they want.

 

[Sine Cura]

Pt got prescribed codeine cough syrup with the above supplements, so I presume to "treat" COVID-19

 

[PharmDBro2017]

How do they know there is no harm? People keep saying this but unless it studied no one can say for sure. Remember supplements aint approved by the fda so supplement makers can make any bull**** claim they want.

I don't disagree with you. However, these aren't supplements technically, right?

They're pharmaceuticals and not made by some joe blow down the street and put in a bottle. So at least you know you're actually getting vitamin C or zinc... not just grass or sawdust. That minimizes some chance of harm.

Also Zinc/Vit C has been studied for wounds/pressure ulcers and has some decent literature backing it. And they aren't taking this the rest of their lives... short term ain't hurting them.

 

[alpha12]

I don't disagree with you. However, these aren't supplements technically, right?

They're pharmaceuticals and not made by some joe blow down the street and put in a bottle. So at least you know you're actually getting vitamin C or zinc... not just grass or sawdust. That minimizes some chance of harm.

Also Zinc/Vit C has been studied for wounds/pressure ulcers and has some decent literature backing it. And they aren't taking this the rest of their lives... short term ain't hurting them.

The following concoction you mentioned has never been studied together

Zinc elemental 50 mg + vitamin C 1000mg + NAC 600 + vitamin D3 20 mcg QD

And i disagree that they are pharmaceuticals. Many supplements don't go through the rigorous verifications and testing required for medicine so you have no idea if the label claim is correct.

for example the spring valley vitamin c commonly found at walmart has 533mg of vitamin c instead of 500mg.

Spring Valley Chewable Vitamin C Review

This product passed all purity tests and recorded 533 mg of vitamin C per serving (exceeding its label claim by 6.6%).

labdoor.com

Imagine if this was okay for a drug to have higher dose than it claims.

 

[Old Timer]

I don't disagree with you. However, these aren't supplements technically, right?

They're pharmaceuticals and not made by some joe blow down the street and put in a bottle. So at least you know you're actually getting vitamin C or zinc... not just grass or sawdust. That minimizes some chance of harm.

Also Zinc/Vit C has been studied for wounds/pressure ulcers and has some decent literature backing it. And they aren't taking this the rest of their lives... short term ain't hurting them.

Aside from the fact these are NOT pharmaceuticals as Alpha-12 pointed out, these are unproven and there are studies to show they DO NOT work. Why would we pad the bill for a patient or force them to take any medication that will not make them better.

 

[PharmDBro2017]

We purchase from pharmaceutical companies via our wholesaler (Cardinal). I get your point - but I'm just saying we aren't using the Spring Valley stuff where you know they aren't meeting label claims.

Old timer post up some literature if you got it. Haven't seen anything recently on covid vitamin cocktail.

 

[alpha12]

We purchase from pharmaceutical companies via our wholesaler (Cardinal). I get your point - but I'm just saying we aren't using the Spring Valley stuff where you know they aren't meeting label claims.

Old timer post up some literature if you got it. Haven't seen anything recently on covid vitamin cocktail.

Rules for pharmaceutical companies are the same as supplement companies regarding supplements. They don't have to be tested. Some might but I wouldn't count on it. They aren't going to spend extra money they don't have to.

 

[Old Timer]

We purchase from pharmaceutical companies via our wholesaler (Cardinal). I get your point - but I'm just saying we aren't using the Spring Valley stuff where you know they aren't meeting label claims.

Old timer post up some literature if you got it. Haven't seen anything recently on covid vitamin cocktail.

Effect of High-Dose Zinc and Ascorbic Acid Supplementation vs Usual Care on Symptom Length and Reduction Among Ambulatory Patients With SARS-CoV-2 Infection: The COVID A to Z Randomized Clinical Trial - PubMed

ClinicalTrials.gov Identifier: NCT04342728.

pubmed.ncbi.nlm.nih.gov

Nah, doesn't work

 

[PharmDBro2017]

Effect of High-Dose Zinc and Ascorbic Acid Supplementation vs Usual Care on Symptom Length and Reduction Among Ambulatory Patients With SARS-CoV-2 Infection: The COVID A to Z Randomized Clinical Trial - PubMed

ClinicalTrials.gov Identifier: NCT04342728.

pubmed.ncbi.nlm.nih.gov

Nah, doesn't work

That study wasn't powered to detect statistically significant results anyway.

I'm not agreeing or disagreeing - just asking for data.

 

[BidingMyTime]

New vitamin supplement study finds they may do more harm than good

Folic acid, we are looking at you.

www.smh.com.au

A new study out on Tuesday aimed to examine the benefits of vitamin and mineral supplements for prevention of heart disease, stroke and premature death (termed “all-cause mortality”). This found the most commonly studied ones had no effect, while some less common ones did have an effect. The review also found some supplements can be harmful.

Most people in Western countries don’t have an optimal diet. This review shows taking supplements as an “insurance policy” against poor dietary habits does not work. If it did, there would have been a reduction in early death.

From your article, "In studies testing the four common supplements of multivitamins, vitamin D, calcium and vitamin C, there was no reduction in incidence of heart disease, stroke or premature death. This means there was no benefit from taking them, but also no harm."

I specifically said I only recommend multivitamins, and do not recommend single dose vitamins. Then I got a response that multivitamins can be harmful, which I find hard to believe. The article you linked proves my point, it specifically says there is no harm in multivitamins.

 

[Old Timer]

From your article, "In studies testing the four common supplements of multivitamins, vitamin D, calcium and vitamin C, there was no reduction in incidence of heart disease, stroke or premature death. This means there was no benefit from taking them, but also no harm."

I specifically said I only recommend multivitamins, and do not recommend single dose vitamins. Then I got a response that multivitamins can be harmful, which I find hard to believe. The article you linked proves my point, it specifically says there is no harm in multivitamins.

Why would you recommend something that has no benefit? There is a financial cost. I don't recommend things that do not work.

 

[alpha12]

Why would you recommend something that has no benefit? There is a financial cost. I don't recommend things that do not work.

His wallet is huge. he needs to lessen the weight so I am guessing its the best way for him the lighten his wallet.

 

[BidingMyTime]

Why would you recommend something that has no benefit? There is a financial cost. I don't recommend things that do not work.

Because the people were going to buy a high dose, single dose vitamin, and the lesser harm is in convincing them to take a multivitamin that is safer. I do add in that most people in the US will get all the vitamins they need from food, but the people checking on vitamins are already convinced they need a vitamin.

It is the same with people buying placebos (homeopathy,) I learned early on in my career that I wasn't going to be able to talk people out it. So now when they ask me what I think about it, I tell them straight up it is a placebo and there is no way it could work, but it won't hurt them if they want to try it. If they ask me about something dangerous such as ear candling, I straight up tell them it is dangerous. Even then, most people don't care, they still want to know where they can by an ear candler at.

 

[Old Timer]

Just came across your post from a couple of years back. Isn't it fascinating how our perspectives evolve over time? The question of vitamins and supplements is indeed a complex one and still as relevant as ever in 2023.

It is just as irelevent as before. Multiviatmains are marjeting scam with abosuletely no clinical data to support their use