Dr. Fuhrman Discusses Vitamins and Supplements

In his books and in his practice, Joel Fuhrman, M.D. advocates eating foods that deliver optimal health. Yet he also recommends taking certain vitamins and supplements, like his Gentle Care Formula multiple. Here he discusses that recommendation.

Why Take Vitamins and Supplements?
Since most people's diets are not ideal and individual absorption and utilization varies from person to person, it makes sense to recommend that all people take a high-quality multiple to assure most favorable vitamin D, B12, zinc, iodine, and selenium status, to name a few.

Even if your diet is ideal, some people require more of certain nutrients than others. For example, it is not uncommon for some people to need extra vitamin D, or extra B12, even when their diets contain typical amounts of these vitamins. This is especially true regarding vitamin D because of the depletion of the atmosphere's ozone layer and subsequent increase in skin damage from the sun. Because of this, many people practice sun avoidance and wear sunscreen, which decreases their vitamin D production.

I also took into consideration my recommendation to avoid all salt added to food. Salt is iodinated, making it the primary source of iodine in most people's diets. Therefore, a multiple will assure adequate iodine intake in those who avoid adding salt to their diet.

Are there any problems with taking supplements?
The main problem with taking a typical multivitamin is that it may expose you to extra nutrients that you do not need. Sometimes too much of certain nutrients can have toxic or harmful effects. For example, I do not recommend taking supplements that contain vitamin A, isolated beta-carotene, or iron, because there are risks associated with consumption of these nutrients above what we receive in our diet.

Ingesting vitamin A or beta-carotene in isolation--from supplements, instead of from food--may interfere with the absorption of other crucially important carotenoids, such as lutein and lycopene, thus potentially increasing cancer risk. 1

The precursor to vitamin A, beta-carotene once was regarded as a safe and beneficial antioxidant and even recommended as an anti-cancer vitamin, but it has recently been shown to increase the risk of certain cancers when administered as an isolated supplement. Scientists now suspect that problems may result when beta-carotene is ingested without other carotenoids that would have been present had it been ingested from real food. Beta-carotene is only one of about 500 carotenoids that exist. Beta-carotene supplements are poor substitutes for the broad assortment of carotenoid compounds found in plants.

Why did researchers think that beta-carotene had such a powerful anti-cancer effect?
They had found that populations with high levels of beta-carotene in their bloodstream had exceedingly low rates of cancer. Recently, it was discovered that the reason these people were protected against cancer was because of hundreds of carotenoids and phytochemicals in the fruits and vegetables they were consuming. It wasn't that beta-carotene alone was responsible for the benefit; it was merely that it had served as a flag or marker for those populations with a high fruit and vegetable intake. Unfortunately, many scientists confused the flag for the ship.

In Finnish trials, those using beta-carotene supplements failed to prevent lung cancer, and there was actually an increase in cancer in those who took the supplement. 2 This study was halted when the physician researchers discovered the death rate from lung cancer was 28 percent higher among participants who had taken the high amounts of beta-carotene and vitamin A. Furthermore, the death rate from heart disease was 17 percent higher in those who had taken the supplements compared to those just given a placebo. 3 Another recent study showed similar results, correlating beta-carotene supplementation with an increased occurrence of prostate cancer.

As a result of these European studies, as well as similar studies conducted here in the United States, 4 articles in the Journal of the National Cancer Institute, 5 the Lancet, 6 and the New England Journal of Medicine all advise people to stop taking beta-carotene supplements.

How have supplement manufacturers responded?
As a result of these studies, I expected many manufacturers to drop beta-carotene from their vitamins and substitute plant-derived carotenoids, but it never happened. This is one of the reasons I felt impelled to design my own formula.

Are there any other problems with standard formulas?
Yes. Since beta-carotene gets converted into vitamin A by your body, there is no reason why a person eating a reasonably healthy diet would require any extra vitamin A. The ingestion of extra vitamin A (retinyl palmatate) may be even more risky than the ingestion of supplemental beta-carotene.

There is solid research revealing that supplemental vitamin A induces calcium loss in the urine, contributing to osteoporosis. Too much vitamin A is known to be toxic to the liver, and to cause birth defects. The most common effect of toxic doses of vitamin A in animals is spontaneous fracture.

In humans, excess vitamin A is potentially a problem, even in ranges not normally considered toxic. 7 One study found that subjects with a vitamin A intake in the range of 1.5 mg had double the hip fracture rate of those with an intake in the range of .5 mg. 8 For every 1 mg increase in vitamin A consumption, hip fracture rate increased by 68 percent. Physicians don't permit expectant mothers to take more than 5,000 IU's of vitamin A (retinyl palmatate) because too much vitamin A has been linked to birth defects. These are some of the reasons why--for years--I have recommended supplements with the lowest possible dosage of vitamin A.

Is vitamin A still included in most formulas?
Yes. In spite of a huge volume of solid information documenting the deleterious effects of vitamin A, it is still impossible to find multiples without it. That is why it was important for me to recommend a multiple that included a wide range of natural, plant-food carotenoids (containing the entire family of carotenoids and not just beta-carotene). It was important for me to create a multiple with no isolated vitamin A.

What about vitamin C? How much is too much?
The current popularity of high-dose vitamin C supplementation is a possible concern. Researchers at the University of California found that men who took 500 mg of vitamin C daily had thickening of their arterial walls 2.5 times greater than men who did not take the supplement. 9 Increased arterial thickening increases risk of hypertension and heart disease.

Keep in mind this is only one study. Hundreds of others have shown benefits of supplemental vitamin C for those on the vitamin C deficient diet that the vast majority of Americans eat. Other studies are needed to confirm these findings. However, healthy diets are already rich in vitamin C and contain over 500 mg just from their food. Since people on healthy diets need so little extra, I have included only 50 mg of vitamin C in each of my tablets.

Is excess a problem with any other nutrients?
Nutritional immunologists have shown that nutrient supplementation beyond what can be obtained from the diet is often necessary to optimize immune function, especially in the elderly. 10 The downside to supplementation has been the potential risk present from consuming too much of certain nutrients. These include B6, iron, vitamin A, and beta-carotene. Iron is an oxidant and can contribute to infection and even increase heart attack risk. It only should be taken as a supplement when a deficiency exists, which is almost always due to blood loss.

Care to avoid consuming too much of certain nutrients is just as important as too little. I frequently find that patients who take an assortment of nutritional supplements consume potentially harmful levels of iron, vitamin B6, and even selenium or zinc. I designed my own multiple with special care to avoid issues from too much of potential risky nutrients, while utilizing quality whole-food, plant sources of those nutrients that offer nutritional insurance. It is unique for what it contains and for what it does not contain.

Because of these features, Dr. Fuhrman's Gentle Care Formula is an excellent prenatal vitamin as well. It also is designed so an elderly individual with increased vitamin D needs can take three or four a day (instead of two a day) and still not be concerned about the toxicity issues from too much of certain nutrients.

Do vegetarians have any special nutrient needs?
A total vegetarian (vegan) diet is deficient in meeting the nutrient needs of most individuals for vitamin B12. If you choose to follow a vegan diet, it is essential to consume supplemental B12. My multiple supplies the extra B12 and vitamin D that vegan patients almost always need, while still maintaining the vegan purity of the product. This was not easy. I was extremely careful and diligent to make my supplement totally vegan because I have become aware that the vast majority of supplements advertised as vegetarian or vegan are not vegan. For example, the vitamin D in most "so-called" vegan supplements is made from sheep wool fat. Similarly, many supplement ingredients use fish emulsion as a stabilizer. The documentation of ingredient sources and methods of manufacturing was carefully researched.

Can supplements make up for an unhealthful diet?
It is critical to recognize that all dietary supplements are supplements to and not substitutes for a healthful diet. To the extent that they offer some people the confidence to eat less wholesome vegetation, they are hurtful, not helpful. The point to be emphasized is that supplements alone cannot offer optimal protection against disease, and you cannot make an unhealthy diet into a healthy one by consuming supplements.

My Gentle Care Formula supplement is the only one I know that has been designed to be gentle on the digestive tract, non-stimulating, and formulated to be added to a relatively healthy diet. It was not designed to take the place of healthful eating.

References
1 Mayne ST. Beta-carotene, carotenoids, and disease prevention in humans. FASEB. 1996;10(7):690-701.

Goodman GE. Prevention of lung cancer. Current Opinion in Oncology 1998;10(2):122-126.

Kolata G. Studies Find Beta Carotene, Taken by Millions, Can't Forestall Cancer or Heart Disease. New York Times, Jan 19, 1996.

Omenn GS, Goodman GE, Thornquist MD, et al. Effects of a combination of beta carotene and vitamin A on lung cancer and cardiovascular disease. New England Journal of Medicine 1996;334(18);1150-1155.

Hennekens CH, Buring JE, Manson JE, et al. Lack of effect of long-term supplementation with beta carotene on the incidence of malignant neoplasms and cardiovascular disease. New England Journal of Medicine 1996;334(18):1145-1149.

Albanes D, Heinonen OP, Taylor PR, et al. Alpha-tocopherol and beta-carotene supplements and lung cancer incidence in the alpha-tocopherol, beta-carotene cancer prevention study: effects of base-line characteristics and study compliance. Journal of the National Cancer Institute. 1996;88(21):1560-1570.

Rapola JM, Virtamo J, Ripatti S, et al. Randomized trial of alpha-tocopherol and beta-carotene supplements on incidence of major coronary events in men with previous myocardial infarction. Lancet 1997;349(9067):1715-1720.

2 Goodman GE. Prevention of lung cancer. Current Opinion in Oncology 1998;10(2):122-126.

3 Kolata G. Studies Find Beta Carotene, Taken by Millions, Can't Forestall Cancer or Heart Disease. New York Times, Jan 19, 1996.

4 Omenn GS, Goodman GE, Thornquist MD, et al. Effects of a combination of beta carotene and vitamin A on lung cancer and cardiovascular disease. New England Journal of Medicine 1996;334(18);1150-1155.

Hennekens CH, Buring JE, Manson JE, et al. Lack of effect of long-term supplementation with beta carotene on the incidence of malignant neoplasms and cardiovascular disease. New England Journal of Medicine 1996;334(18):1145-1149.

5 Albanes D, Heinonen OP, Taylor PR, et al. Alpha-tocopherol and beta-carotene supplements and lung cancer incidence in the alpha-tocopherol, beta-carotene cancer prevention study: effects of base-line characteristics and study compliance. Journal of the National Cancer Institute. 1996;88(21):1560-1570.
6 Rapola JM, Virtamo J, Ripatti S, et al. Randomized trial of alpha-tocopherol and beta-carotene supplements on incidence of major coronary events in men with previous myocardial infarction. Lancet 1997;349(9067):1715-1720.

7 Whiting SJ, Lemke B. Excess retinol intake may explain the high incidence of osteoporosis in northern Europe. Nutr Rev 1999;57(6):192-195.

8 Melhus H, Michaelson K, Kindmark A, et al. Excessive dietary intake of vitamin A is associated with reduced bone mineral density and increased risk of hip fracture. Ann Intern Med 1998;129(10):770-778.

9 Supplemental vitamin c may hasten atherosclerosis. Geriatrics 2000;55(5):15-16.

10 Meydani SN, Barklund MP, Liu S, Meydani M, Miller RA, Cannon JG, Morrow FD, Rocklin R, Blumberg JB. Vitamin E supplementation enhances cell-mediated immunity in healthy elderly subjects. Am J Clin Nutr 1990; 52:557-563.

Meydani SN, Wu D, Santos MS, Hayek MG. Antioxidants and immune response in aged persons: overview or present evidence. Am J Clin Nutr 1995; 62;1462S-1476S.

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Comments (6) Read through and enter the discussion with the form at the end
ilene boling - November 2, 2005 3:24 PM

i take the gentle care, ldl protect, dha and i am about to try the osteo-sun. will the osteo-sun be too much vitamin d in conjunction with the gentle care? also, i take 800mg calcium malate/day. should i discontinue this? i am 55 years old and menopausal. my done density is borderline normal/ostepenia which has positively risen from mid osteopenia/osteoporosis since i began your diet 3 years ago.

Henry Abbott - November 3, 2005 5:34 PM

Ilene-

I searched around in the member center of Dr. Fuhrman.com for an answer for your question, and I found this quote from Dr. Fuhrman, which I hope will be helpful to you:

"The dose of Vitamin D is best adjusted to blood levels, but for those not getting regular sunshine 400 to 1200 range is typically ideal."

Also, you might want to check out this new post, which is an overview of his thoughts about treating osteoperosis: http://tinyurl.com/bk945

Eric Maurette - January 7, 2006 9:16 AM

Dear Dr Fuhrman,

I am a french reader of your books and a fallower of your diet for more than 2 years.
As a boulemic and sugar addict I find your diet very effective for getting rid of this toxic habit. With your diet my blood readings (BP, sugar, cholesterol) are good now after years of being quite scary and I am no more tired.

I have a question.
I read in the Life Extension website (http://www.lef.org/magazine/mag2006/jan2006_awsi_01.htm) an article about vegetarian diet. To summerize this article :
Vegetarian diet do reduce premature death but don't extend life expectancy (they cite like you the 7 days adventists study but have different conclusions than you). In their view, vegetarian diet accelerate aging because it is lacking of important nutriements (not only B12) . They advise people to supplement with carnosine (find in animal products only) wich prevent glycation and which is lacking in blood samples of vegetarians.

Also Dr Perricone write he always recognize his patients who are vegetarian by the fact they look much older than their real age. He advise people to stuff themselves with wild alaskan salmon (and amazingly hudge amonts of supplements) to provide theim with enough nutriements hardly find in vegan diet.

So my question is :
Could a vegetarian diet accelerate aging (eventhough it reduce premature death ) ?
And should people supplement with low doses of carnosine ?

Sincerely yours,

E.M.

Jacqueline - June 3, 2006 3:24 PM

Dr. Fuhrman,
The article mentions gentle care vitamins being a good prenatal vitamin. Do they contain enough folic acid @ 200mcg per day for a pregnat woman? Should one also take an iron supplement during pregnancy?

Joel Fuhrman, MD - June 7, 2006 10:13 AM

Jacqueline-

I recently lowered the folate in Gentle Care after reviewing some studies that hinted that excess of supplemented versus food folate may not be ideal. It is best to get most of this from real food. When our folate comes from food, not pills, we get lots of other micronutrients both discovered and undiscovered that are critical for health excellence. Remember the only reason women are instructed to take so much folate during pregnancy is that they don't eat folate-rich vegetables. For those following my nutritional guidelines to eat lots of greens, the folate in the Gentle Care is more than enough. I believe that the advice for women to take folate during pregnancy may not be so admirable. For instance, the leading cause of death in children is acute blastocytic leukemia, bone cancer and brain tumors which are linked in the medical literature to the lack of vegetation (which creates deficiencies of phytochemicals and many more other nutritional factors than merely folate) in the diet during pregnancy and two years prior to conception. Consuming nitrates in luncheon meats, hot dogs and bacon during pregnancy are also associated with these childhood causes of death. Instead of educating pregnant women and women of child-bearing ages how critical vegetables are for the health of their offspring and to prevent birth defects, instead we turn to a folate supplement to remedy the problem. Pills cannot replace mother nature and giving the folate instead of eating the vegetables makes for some serious problems in our children, namely more childhood cancers. Please read my book, Disease-Proof Your Child for more information on this issue, scientific references and more fascinating information about the way we create disease in our children through medical stupidity. Yes, Gentle Care Formula does not contain iron and adding some during pregnancy may be important for some women with low iron stores. That could be added with a low dose supplement taken every other day.

Olga Talamantes - June 25, 2007 2:17 PM

It has been proven that high dosis of folic acid prevents miscarriages and neural defects. It is also a fact that older women may not absorb the necessary amount of folic acid to prevent those problems. I am talking about pregnant women in their 40's. That is why physicians recommend high dosis of 3,000 mcg and above. What you do think about this? Thank you

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