Multivitamins and supplements have pros and cons. The main problem with taking a typical multivitamin is that it may expose you to extra nutrients that not only are unnecessary for your body but could actually be harmful too. Excessive quantities of some vitamins and minerals can be toxic or have long-term negative health effects. We know it is important to avoid vitamin and mineral deficiencies, but it is just as important to avoid consuming too much of certain nutrients.
Folate and folic acid are members of the B vitamin family. Folate is the form found naturally in foods, especially green vegetables and beans. Too much folate obtained naturally from food is not a concern. It comes naturally packaged in balance with other micronutrients, and the body regulates its absorption. Folic acid is the synthetic form that is added to food or used as an ingredient in vitamin supplements. Folic acid is also added to most enriched, refined grain products like bread, rice, and pasta in the United States and Canada in an attempt to replace the nutrients lost during the processing of the whole grain. Recently, there have been troubling studies connecting folic acid supplementation with increases in breast, prostate, and colorectal cancers. A diet rich in green vegetables is high in folate, so supplemental folic acid is not necessary on this kind of diet. It is important for our health to eat vegetables to obtain the folate (and other nutrients) we need and avoid the significant risks associated with supplemental folic acid.
Vitamin A is also risky to take in supplemental form. Ingesting vitamin A or beta-carotene from supplements instead of food has been shown to increase the risk of certain cancers. In Finnish trials, using beta- carotene supplements failed to prevent lung cancer, and there was actually an increase in cancer in those who took the supplement. 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. The death rate from heart disease was also 17 percent higher in those who had taken the supplements compared to those just given a placebo. Another recent study showed similar results correlating beta-carotene supplementation with an increased occurrence of prostate cancer. Furthermore, a meta-analysis of antioxidant vitamin supplementation found that beta-carotene supplementation was associated with an increased all-cause mortality rate. As a result of these European studies, as well as similar studies conducted here in the United States, articles in the New England Journal of Medicine, the Journal of the National Cancer Institute, and the Lancet all advise people to stop taking beta-carotene supplements.
Taking extra vitamin A (retinyl palmitate and retinyl acetate) may be even more risky than using supplemental beta-carotene. Because beta-carotene is converted to vitamin A by the body, there is no reason a person eating a reasonably healthy diet should require any extra vitamin A. There is solid research revealing that supplemental vitamin A increases calcium loss in the urine, contributing to osteoporosis. One study found that subjects with a vitamin A intake in the range of 1.5 milligrams had double the hip fracture rate over those with an intake in the range of 0.5 milligrams. For every 1 milligram increase in vitamin A consumption, hip fracture rate increased by 68 percent. Vitamin A supplementation has also been associated with a 16 percent increase in all-cause mortality.
In spite of the huge volume of solid information documenting the deleterious effects of betacarotene, vitamin A, and folic acid, it is still almost impossible to find a multiple vitamin that does not contain these substances.
Iron, Copper, and Selenium
Although iron is crucial for oxygen transport and other physiological processes, in excess iron is an oxidant that may contribute to cardiovascular disease and cognitive decline in older adults. Iron should be taken as a supplement only when a deficiency or increased need exists, such as during heavy menstrual bleeding or pregnancy.
Recent studies have also shown that excess copper could be associated with reduced immune function, lower antioxidant status, atherosclerosis, and accelerated mental decline. For these reasons, I also exclude copper from my supplements and those I recommend. A healthy diet gives us enough copper.
Selenium, of course, is essential, but a healthful diet gives us enough. There is some evidence that high selenium levels may contribute to diabetes, hyperlipidemia, prostate cancer, cardiovascular disease, and impaired immune and thyroid function. Therefore, supplementation beyond what is present in natural foods is likely not beneficial and may result in overexposure.
Some people, even when consuming an ideal diet, may need more of certain nutrients. Individual absorption and utilization of nutrients varies from person to person, and some people simply require more to maximize their health. For example, B12 is always low on a near vegan or vegan diet, and some individuals require iodine or more vitamin D due to differences in absorption and utilization.
Likewise, some people may also require more minerals such as zinc for maximizing their health and longevity. I have designed a few supplements that conveniently supply the micronutrients of value, leaving out any potentially risky or controversial elements.
I do recommend taking a high-quality multiple vitamin/mineral supplement to supply extra vitamins D and B12, zinc, and iodine because ideal amounts of these are hard to acquire even in an excellent diet. As discussed above, the main issue here is making sure you do not ingest supplemental ingredients that are potentially harmful in your quest to optimize your levels of these valuable micronutrients. Most vitamins and minerals have a window of optimal intake, so the goal is to take the right amount, not too much or too little.
Vitamin D and Calcium
Even though most people are deficient in Vitamin D, too much can also be suboptimal, so blood tests are often recommended to assure the proper level of supplementation. The multivitamin/mineral I make available at www.drfuhrman.com contains 2,000 IU of vitamin D3, an appropriate amount for the majority of individuals, even though some people could require more. Vitamin D is a critical nutrient, not just for your bones but also for general protection against heart disease, cancer, autoimmune disease, and many other health problems. Taking this higher level of Vitamin D has been shown to offer benefits to diabetics. The ideal amount of vitamin D supplementation is best determined by blood work. The 25-hydroxy vitamin D level ideally should be between 30 and 50 ng/ml. I do not recommend high-dose calcium supplementation under the false pretense that it is good for the bones. In fact, too much calcium can weaken bones and can even contribute to calcifications in the vascular system. Extra calcium is not required for people following my nutritional guidance because the diet has adequate calcium already.
Long-Chain Omega-3 (EPA and DHA)
I also recommend a supplement supplying the long-chain omega-3 fatty acids EPA and DHA. DHA is essential for optimal brain and eye function, and EPA is particularly protective and therapeutic for depression. Deficiency poses increased risks to diabetics. Conversely, adequate intake of longchain omega-3 has been shown to benefit diabetics. This can pose a challenge, however, because most DHA and EPA are derived from fish oil, and fish has been demonstrated to actually worsen diabetes. In fact, fish intake showed a 22 percent higher risk for diabetes when comparing five or more servings per week with less than one serving per week. Therefore, I recommend fish only in limited quantities, which are sufficient to assure adequacy in these fats. Though the body can make some EPA and DHA from walnuts, flaxseeds, and greens, the conversion is variable from person to person and the levels in most vegans are suboptimal. Besides, few people consume enough walnuts and flaxseeds every day to assure adequate DHA production. Supplemental DHA and EPA is a good idea for nutritional assurance, especially for diabetics.
However, I do not recommend fish oil capsules regularly because each capsule contains about 1,000 milligrams of oil, and this high dose of fish fat may have a negative effect on diabetes. The goal is to prevent deficiency, not supply excess. Instead, 150 to 300 milligrams a day is sufficient. Consider the algae-sourced DHA supplements available or DHA/EPA Purity, which provides a clean and effective source of these omega-3s without harvesting fish and without overdosing on fatty acids. I do not recommend the pharmacologic use of high-dose fish oil to lower cholesterol and triglycerides, because those dosages are not without risks.
Thiamine (Vitamin B1)
Another supplement to consider taking if you have diabetes is thiamine (Vitamin B1). Studies indicate thiamine deficiency often accompanies diabetes. The higher the glucose levels, the more likely you are thiamine deficient, as thiamine is lost as glucose is excreted. Furthermore, even a mild deficiency of thiamine can promote complications of diabetes.
Supplemental thiamine can help protect the kidney in the diabetic. Thiamine deficiency in diabetics is linked to increased oxidative stress and damage to kidney and nerves. Studies have demonstrated that diabetics benefit from taking extra thiamine. Diabetic nephropathy, neuropathy, and possibly retinopathy have been shown to improve with thiamine supplementation.
I typically recommend that people with active diabetes in the process of reversal ingest about 10 to 20 milligrams a day of extra thiamine, that is about ten times the normal recommended daily intake. However, once the diabetic issues are resolved, this need not continue. Many health professionals use a much higher dose, which would only make sense if the glucose was very high and uncontrolled even with medications, but this is not the case with people following my nutritional guidelines.
Alpha Lipoic Acid
Even though alpha lipoic acid is commonly touted as an important supplement for diabetics, its use is questionable. When given intravenously, it has been shown to have some benefit to diabetic neuropathy, but its usefulness orally is not proven. Alpha lipoic acid is already available among the hundreds of beneficial compounds in green vegetables. The bottom line is that if you are following this program to reverse diabetes, it is unlikely that adding an alpha lipoic acid supplement will offer additional protection. However, people with neurological problems from their diabetes, especially if they are eating a diabetes-promoting diet, would be reasonable candidates for this type of therapy.
Glucose-Lowering Plants and Herbs
Supplementing your diet with herbs and plants to lower glucose is reasonable, both in capsule form and added into dishes. A few grams of cinnamon have demonstrated benefits at lowering blood glucose and improving lipid parameters without apparent side effects. Gymnema sylvestre is also mildly effective. Powdered fenugreek seeds require too large a dose to be effective so are more difficult to utilize. However, fenugreek extract has been found to lower fasting blood glucose and improve HbA1C in diabetics. There are other plants and plant extracts that have little side effects and have been shown to mildly lower blood sugar. They include white mulberry leaf, banaba leaf, green tea, acacia extract, hops, bitter melon, and nopales cactus.
Though these plant extracts are not as strong as blood-glucose- lowering medications are, the advantage of using natural agents is that, by themselves, they do not cause hypoglycemia. On the other hand, they do not address the main cause of diabetes. I find that most of my patients do not need these aids to adequately control their blood sugar because the diet and exercise program is so effective.
However, in cases where extra help is needed, a combination of natural plant extracts can be added to the protocol, which can further reduce or eliminate the need for medications and their significant side-effect profile.
Plant Sterols and Pomegranate Extracts
Plant sterols and pomegranate extracts may also be considered for their lipid-lowering and cardioprotective properties in diabetics. Plant sterols are naturally present in plant foods (especially nuts and soybeans), are structurally similar to cholesterol, and are components of plant cell membranes, similar to cholesterol in animal cell membranes. Plant sterols have long been recognized, and are FDA approved, for their capacity to reduce LDL cholesterol. More than forty human studies have been published confirming their LDL-lowering properties. Plant sterol supplements can produce a decrease of approximately 15 percent in LDL levels. This LDL lowering occurs in the digestive system, where plant sterols inhibit cholesterol absorption. This blocks not only absorption of dietary cholesterol but also reabsorption of the cholesterol produced by the body. An interesting recent finding is that plant sterols have additionally been shown to offer protection against several cancers.
Pomegranates are a delicious and unique fruit that contain a wealth of beneficial phytochemicals. Their potent antioxidative compounds have been shown in medical studies to reverse atherosclerosis and lower cholesterol and blood pressure. Among the antioxidant substances in pomegranates are anthocyanins, catechins, quercetins, and distinctive ellagitannins called punicalagins—punicalagins make up the bulk of the pomegranate’s antioxidant load. These potent antioxidative compounds are believed to be responsible for the pomegranate’s numerous health benefits. In diabetics and nondiabetics alike, pomegranate reduces cholesterol, oxidative stress, and inflammation. In addition, pomegranate acts similarly to ACE-inhibiting drugs, naturally lowering blood pressure. In one study of patients with severe carotid artery blockages, after taking one ounce of pomegranate juice daily for one year, on average these patients experienced a 12 percent reduction in blood pressure and a 30 percent reduction in atherosclerotic plaque. In striking contrast, the participants who did not take the pomegranate juice experienced a 9 percent increase in atherosclerotic plaque. Also look for pomegranates in season, and if you can, freeze some of the seeds for use later in the year.
Chromium is another nutrient commonly recommended to diabetics because those with diabetes are typically overweight and have been eating diabetic-promoting diets low in chromium. In other words, eating refined grains, sweets, and processed foods leads to chromium deficiency and worsens diabetes. A meta-analysis identified forty-one trials that evaluated the effects of various chromium formulations and dosages and found mild benefits, especially among patients whose diabetes was poorly controlled.
Of course, when you eat a nutritarian diet with tomatoes, onions, and greens—foods that are very high in chromium—you protect yourself from chromium deficiency and diabetes. So even though clinical trials show a modest improvement in markers of insulin resistance and glucose levels in patients who supplement with chromium, I am not certain this supplement will be of value for people following my high-micronutrient approach, as they are now receiving adequate chromium and have already curtailed foods that cause chromium deficiency.
Remember, this is not a calorie-counting plan. You can eat as much as you desire of the recommended unlimited foods. You can eat limited amounts of several other foods too. Let hunger be your guide. Do not eat until you’re full. Just eat so your hunger is satisfied. You do not have to eat all the foods in the suggested guidelines and menus, and you can switch around the meals if that’s what works best for you. The most favorable way to eat is to learn from experience so you know the right amount of food that will allow you to be hungry in time for the next meal. If you are not hungry before the next meal, then you have eaten too much at the prior meal. Remember, hunger is felt mostly in the throat and increases your ability to enjoy food. If you are not hungry, do not eat. You will not die if you skip a meal or two or three. Err on the side of undereating so you can make sure you are eating only when you’re hungry. You will enjoy eating more when you feel you have emptied your tank before refueling. As they say, hunger is the best sauce.