Part of taking a full history from a patient is learning
what medications they are on. I think it is also important to know what
vitamins/supplements patients are taking. There are some interesting ‘cure all’
remedies out there (many of which are completely ridiculous). Are there any vitamins/minerals that should be taken? Definitely, for certain populations anyway…
I don’t commonly dissuade patients from taking vitamins or
supplements, but I will take a stand if I think they are wasting their life savings,
or causing them harm. Most of us in developed countries will get the
required vitamins and minerals from eating a healthy diet (and so a
multivitamin is really unnecessary). So what do I commonly recommend?
Vitamin D – This is the only
vitamin I consistently recommend to all patients. Most, if not all of us, will
be deficient in Canada (because of the lack of sunlight exposure during the
winter months). Vitamin D is important for bone health, and may also be good
for our mood, cancer prevention and cardiovascular health (although studies are
ongoing). How much? 1000-2000 IU/day. (The guidelines actually recommend 600-800 IU/day, but it seems the
trend among family doctors is to ‘prescribe’ slightly higher doses).
Folic Acid – Women who are
PLANNING on getting pregnant should take folic acid. This helps to prevent neural tube defects (NTDs) like spina
bifida. Since these defects occur within the first month of pregnancy, it is recommended
to start taking folic acid (or a prenatal vitamin) at least 3 months prior to
conception. How much? 400-800 mcg/day for women who have not previously had a
child with a NTD. I often recommend taking a prenatal vitamin like Materna
that has folic acid and other vitamins that pregnant ladies may need.
Calcium – In postmenopausal
women, especially those with osteoporosis, 1200 mg (total diet plus supplement)
of calcium is recommended. In
premenopausal women and men 1000 mg is recommended. Calcium is also important
for bone health. Often if you are eating a balanced diet with dairy and green
leafy vegetables you are meeting the quota without needing supplementation.
Here is a link with calcium content of some common foods: http://www.dietitians.ca/Nutrition-Resources-A-Z/Factsheets/Osteoporosis/Food-Sources-of-Calcium.aspx.
Some people may need to take other vitamins/minerals
depending on their situation. For example, a lot of young woman require iron.
Or those with dietary restrictions, celiac disease, crohn's disease etc may
require a number of different supplements. In those situations it is important
to talk to your doctor. Just be careful of different 'elixirs' that are marketed
for exuberant amounts that are really not necessary. And remember vitamins,
minerals and supplements are not all harmless, so let your doctor know what you
are taking! I will do another post discussing remedies used for disease and disease prevention that seem to be popular, and if there is any evidence that they work (ie - glucosamine for arthritis).
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| Vitamins galore! (market in Barcelona) |
Next up: As winter approaches (I am living in Yellowknife at
the moment and we actually had snow last night), what can you do to prepare? We
want to get this blog back up and running so we are going to try at least twice
weekly posts!
