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Health Talk: Dietary Supplements
Hosted by Craig Stoltz
Washington Post Health Editor

Tuesday, March 7, 2 p.m. EST
Craig Stoltz
Craig Stoltz

If you've picked up a bottle of vitamins or nutritional supplements recently, you've probably noticed the fairly new, official-looking labels listing product nutrients. What do you need to know about dietary supplements and these new labels?

Dr. Joel Mason, director of the Nutrition Support Service at the New England Medical Center, is our guest for this week's "Health Talk." Dr. Mason discussed the issues raised in this week's Health cover story.

Please read the trascript below.

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Craig Stoltz: Good afternoon, Dr. Mason, and thanks very much for joining us to answer visitor questions today on Health Talk.

In today's Health section in The Washington Post, Sally Squires reports on the benefits--and the difficulties--that the newish Supplement Facts labels present to consumers of vitamins and nutritional supplements. (To read the story, go to the Washington Post home page at www.washingtonpost.com, and click on Health to find a link.) We know the story has raised plenty of questions about supplements generally, and we're pleased that Dr. Mason has agreed to share his expertise.

Before we get to reader and visitor questions--and we have plenty already, but please feel free to send more as the forum continues between now and 3 p.m.--let me start with one:

Dr. Mason, do you take any vitamins or dietary supplements yourself?

Dr. Joel Mason: Yes, I do take a single multivitamin, multimineral supplement.


Rockville, MD: There seem to be many dietary supplements that claim to improve your memory. Do any of them work?

Dr. Joel Mason: I do not know of compelling scientific data that any particular dietary supplment will improve memory in people with good underlying health. Of course, in an individual with an underlying nutrient deficiency, such as B12 deficiency, supplementation with the vitamin may help restore their memory. Similarly, providing enough iron to young children with a mild iron deficiency may help improve their cognitive(thinking) skills and improve school performance.


Washington, DC: For a healthy adult with no major health concerns who eats a relatively well-balanced diet, do you think that it is a good idea to supplement with a multivitamin each day? Also, do you think multivitamins should be used for children and teens, whose eating habits sometimes leave a lot to be desired?

Dr. Joel Mason: This is a matter of contention even among experts in the field. My personal perspective is that the 'typical american diet' is reasonably likely to leave a person somewhat short of adequate in regard to meeting all their needs. Therefore, I believe it is likely to be beneficial for adults, teens and children to take a single multivitamin/multimineral each day and I believe there is little potential harm in such an approach.


Charlottesville, VA: A comment: Nurtitional supplements cause almost no problems compared to the devastation of prescription drugs. Many of us are more knowlegable than our physicians. We should emphasize getting vitamins and supplements through reliable companies, which would prevent all this guess work about what is in the tablets!

Craig Stoltz: Thanks for the comment, Charlottesville.


Washington, DC: I am 28 years old, I take a multi-vitamin, anitoxidant, b-complex, vit c and vit e daily. I was told you can never get enough antioxidants. Is this true?

Dr. Joel Mason: I believe that there is such thing as too many supplemental antioxidants. As the science of nutrition advances, we are finding out a lot more about the 'therapeutic window' of vitamins, ie: what range of intake is beneficial such that less than the window or more than the window is less than optimal. Several large scientific trials investigating the potential cancer preventive benefits of antioxidants now suggest that amounts that are too large may actually PROMOTE cancer rather than prevent it. Similarly, extraordinarily large doses of vitamin E can interfere with blood clotting which is particularly dangerous for people who are taking drugs which thin the blood.


Washington, DC: Is there always (or sometimes) a nutritional difference between getting a vitamin or mineral through a natural food source and getting it through a pill or other supplement? Is there a difference between getting a nutrient through a "fortified" food source, such as orange juice with added calcium,and getting calcium through a natural source such as milk? How do consumers get reliable information on these differences?

Dr. Joel Mason: An excellent question with a rather complicated answer. Although I am a strong proponent of using foods as sources of vitamins rather than supplements, it is usually true that the supplements are just as effective as the natural foodstuffs in providing for your body's needs for that particular nutrient (although you then miss all the other healthy contents of the food). Navigator.tufts.edu is a website that rates the quality of nutrition-related websites on the web in terms of helpfulness and accuracy and is one way to obtain an idea of how good information might be.


Annandale, VA: Yesterday a report on Vit. C research indicated that just 500 mg of Vit C was linked to "thicker" arteries in the neck. Last week there was negative research released about Vit. E. Just last year, extra doses of anti-oxidants were supposed to be a part of everyone's diet. Is there always going to be contradictory research results?

Dr. Joel Mason: Although it is frustrating, scientific knowledge rarely progresses in clear steps. Rather it advances by the consensus of many independently conducted studies. It frequently takes an analysis of 3 or 5 or 7 studies to make a final decision as to the 'truth' of a scientific fact. At Tufts University, we have established a graduate degree program in Nutrition Communication to train journalists to responsibly report studies in a manner that does not confuse the public to the degree that it is now confused.


Dupont Circle: Welcome Dr. Mason:

I'm looking to control my high blood pressure and high cholesteral by starting to eat right and lay off the beers. Is there any supplement, other than a multi-vitamin, that I should consider. FYI, 36 yr. old, black female with very few stresses in my life. I take two pills for the hypertension - aiming to take none. Thanks in advance and you too Craig.

Dr. Joel Mason: Lowering blood pressure and cholesterol take a dedicated approach to changing your entire diet and is not as simple as adding a supplement. Many (but not all) people with high blood pressure respond to a low sodium diet and cholesterol reduction can be effected by reducing saturated animal fat in the diet. If you are overweight, both of these problems will be helped enormously if you lose a substantial amount of weight.


Mitchellville, MD:
I'm a 57 year old woman and I'm wondering if I should increase or decrease my vitamin intake. At present I'm taking:

senior multiple vitamin
calcium with vitamin D 1200 mg
B-12 250 mg
C 250 mg
I'm also taking a perscription drug, Fosmax

Dr. Joel Mason: I do not think you need to increase your supplemental vitamin intake beyond what you are presently taking. You are probably getting more than you need of a few vitamins but I see no reason to change because there is little potential for harm in your present regimen


Reston, VA: Recently I received a solicitation for a course of parasite-expelling supplements. Supposedly, it includes herbal teas, fibers and also capsules containing such herbs as black walnut hulls, pumpkin seeds, wormwood, cloves, garlic, fennel and many others.
1. Since I in fact had ascarids in childhood (successfully expelled) and do like rare steaks, I wonder if their claims about the majority of Americans being infected with parasites are true.
2. Is there harm in taking this or similar supplements? They claim that such are recommended to take yearly or every half of a year. I do not take any medications.
Thank you very much for your opinion.

Dr. Joel Mason: If you were sucessfully treated for ascarids when you were previously infected, there is no reason to keep taking a anti-parasite regimen. It is feasible you will get infected by eating rare steak but it will probably be a bacterial infection (eg: E. coli) rather than a parasite.

Lastly, I generally am discouraging of the 'herbal supplements' that contain a wide range of poorly described herbs because you don't know what you are ingesting and some of these herbs can have side effects.


Arlington, VA: What about vitamins and drug interactions, such as antibiotics?

Dr. Joel Mason: vitamins can interact with some drugs. One that comes up rather frequently is the use of large amounts of vitamin K in people who are taking 'blood thinnners' (such as warfarin or Coumadin). The vitamin K partly reverses the warfarin effect. Generally, however, there are few interactions between antibiotics and vitamins. One that comes to mind, however, is isoniazid (used for tuberculosis)-this partially inactivates vitamin B6 activity in your body and therefore people taking this antibiotic should take a B6 tablet.


Potomac, MD: Many of the multivitamin-multimineral supplements are now excluding iron in their formulas, especially those formulas created for people over 50. In general, if you have not been shown to have a specific iron deficiency, what age groups--male or female--should be taking iron, or avoiding it?

Dr. Joel Mason: Vegetarians are very prone iron deficiency because the iron present in vegetables is poorly absorbed so it is worth considering for those individuals.

The individuals in most populations that are most prone to iron deficiency are women of child-bearing ages because of the additional needs incurred by menstruation, pregnancy and lactation.

Iron is being taken out because a small, but substantial minority of the population is prone to iron overload when they are supplemented-and this can have negative health consequences.


Washington, DC: The Council for Responsible Nutrition (CRN) would like to take this opportunity to correct inaccuracies in Sally Squires article on dietary supplements.

1. The opening paragraph of the article says that the new label on dietary supplements is "official-looking". The label is official, as its content and format is required by FDA regulation.

2. The information on natural versus synthetic vitamin E is inaccurate. Ms. Squires' article stated that synthetic vitamin E is better absorbed than the natural form. This information is wrong. Natural vitamin E (d-alpha-tocopherol) is more bioavialable than synthetic vitamin E (dl-alpha-tocopherol).
There are many scientific references that will attest to this; a recent publication is by Margaret Traber, Oregon State University, in the journal Biofactors (1999, vol. 10: 115-120). Natural vitamin E is at least 1.36 times more biologically potent than the synthetic form.

3. The information on outdated daily values inplies that this is the fault of the dietary supplement industry. The industry uses the government daily values. When FDA updates this information, industry will respond with new label information.

Cathy Fomous, PhD
Senior Science Writer
Council for Responsible Nutrition

Craig Stoltz: Thanks for your response, Dr. Fomous. By way of rejoinder: Points 1 and 3 require no response other than to say they are not inaccuracies, but potential misreadings we're happy to have you clarify. As for the Vitamin E issue, what you're saying here is contrary to what our sources, and they are good ones, told Sally Squires. We're researching the discrepancy now. Should the story require correction, we will of course correct it on our pages.


Charlottesville, VA: First, thanks to the Health section for an excellent article (ditto for last week's story on gastric bypass). Here's my question for Dr. Mason: Has any particular vitamin or combination proved to be helpful in treating Irritable Bowel Syndrome?

Dr. Joel Mason: As a practicing gastroenterologist with plenty of patients suffering from irritable bowel syndrome, I would LOVE IT if such a vitamin supplement were shown to be effective. Unfortunately, I know of no such vitamin.

Interestingly, a good scientific study which appeared two years ago suggests that Chinese herbs, specifically designed for the stomach, can be helpful and some of my patients have obtained benefits from this approach. However, please use a respected and knowledgeable herbalist for such an approach.


Vienna, VA: Whats the deal with Creatine? I've heard both ends of the story. Whats your opinion?

Dr. Joel Mason: I'm not a heavy supporter of supplements for sports medicine. However, I must admit that there is very good evidence that creatine supplements help improve strength performance OVER THE SHORT TERM. There is no good evidence that it helps build muscles, it merely temporarily improves performance for a few hours after it is taken to a small, but signficant, degree.


Alexandria, VA: HI,

I'm a 30 year old woman, and I live a generally healthy life -high veggies and fruits, low meats, no caffeine, lots of complex carbs-, excercise 3x per week, and am not overwieght, and take 1 multivitamin, 1 B-complex, 1 C, 1 calcium, 1 echinacea, and some bee pollen during allergy season. I still, however, seem to get every infection that comes down the pike, both viruses and other stuff. Is there anything I can add or delete to change this?

Thanks!

Dr. Joel Mason: I see no benefit in increasing your intake of supplements in regard to warding off infections. Nutrition helps but please don't expect it to be a panacea!!


Washington, DC: I've heard that there is a vitamin therapy in place for alcoholics? Have you heard of this?

Dr. Joel Mason: My days of working in a alcoholic rehabilitation center ended over two decades ago so I won't pretend to be up on all the latest trends in such treatment. However, I know of no vitamin supplements that help wean a problem drinker off of alcohol. On the other hand, heavy drinkers are very prone to develop vitamin deficiencies and therefore taking a multivitamin would be very helpful to ward off any such deficiencies.


Washington, DC: I have a long history of taking antidepressants and have recently been reading articles on how this can upset the chemical balance of the body over time. I know this is a pretty general question but I would like to know if you have any knowledge on this and if so what type of minerals, vitamins etc... would be affected.

Dr. Joel Mason: I'm not aware of any good evidence that antidepressants lead to specific vitamin deficiencies although people prone to depression frequently have inadequate or unbalanced diets and therefore they might very well benefit from a conventional multivitmain/multimineral supplement each day.


Gaithersburg, MD: In last one year, I have experienced rise in blood pressure (which otherwise is normal), whenever I have taken Multi-Vitamins and other supplements. B. P. becomes normal on stopping these. I have tried Centrum, Theragun & Multi-II. Is this a common problem or is it limited to certain brands only. Any advice in this matter will be helpful. Thanks,

Dr. Joel Mason: I must admit that I have not been confronted with this issue in the past. I am not aware of any component in such tablets that would raise the blood pressure. Perhaps it is one of the inactive 'filler' components that do this to you.


Gaithersburg, MD: Various forms of given vitamin or a given mineral differ in their ability to actually deliver the substance in question into blood stream. This is compunded by interaction with food and-or other minerals-vitamins present in the intestinal tract at the same time.

Where can I find information regarding bioavailability of various forms of vitamins and minerals?

Where can I find information about interactions both with food and with other vitamins (specifically multi formulas)?

In the case of minerals, do current labels show amount of specific element (calcium, zinc etc) or amounts of compound (for example calcium oxide versus calcium citrate)?

Dr. Joel Mason: This is an extremely complex topic and you would need to seek out an expert in the field with specific questions if you want state-of-the-art knowledge on the topic. I suggest going to one of your local universities and talking to someone on the nutrition faculty.

You have to read labels carefully to see whether the content is in the form of the compound or the element. For instance, a 325 milligram tablet of ferrous sulfate will frequently be followed by a statement that it contains 65 milligrams of elemental iron. The key words here are ELEMENTAL IRON


Craig Stoltz: Unhappily, we're out of time for today. First, thanks again to Dr. Mason, for taking the time to answer users' questions. And of course thanks to all of you for tuning in with your comments and notes. You sent far more questions than we could handle today, and we're certain to return to the topic of supplements again, both on the pages of The Post and in these online forums. For our next edition of Health Talk, held precisely six days and 23 hours from now, we'll take questions surrounding our special Family and Child issue of the Health section. Look for it in your paper next Tuesday. Meantime, have a great day, and supplement it as wisely as you know how.


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