I once recommended vitamin B12 for a middle-aged woman who was recently diagnosed with anemia secondary to celiac disease. She was receiving iron infusions to reverse the anemia, and then, mysteriously, the numbness in her fingers that she thought was the result of carpal tunnel syndrome started to spread to the point that she was unable to walk.
I asked her whether her physicians were also giving her cyano-cobalamin infusions along with iron. They were not, so then I knew that the newly forming red blood cells were stealing much-needed vitamin B12 from the nerves to make red blood cells. Vitamin B12, folic acid and iron are essential building blocks for red blood cells. B12 is also needed for nerve function.
I told her to immediately start taking large doses of gluten-free B12 tablets, and the paralysis retreated. She was left with a limp in her left leg, but fortunately she was no longer confined to a wheelchair.
I have heard many stories similar to this, and I believe vitamins and supplements are life-changing when used for the right purpose and under the right conditions; however, it is true that healthy people don’t need vitamins to stay healthy.
I also believe that our bodies are smarter than us and we do not have to micromanage them with synthetic vitamins — we only have to bring them back into alignment when things go wrong.
Vitamins and supplements yield improved health only when they correct a problem. They don’t randomly lead to good health. Many believe adaptogens such as ashwagandha and ginseng yield improved heath.
I adopted this philosophy while working alongside physicians in the hospital. Vitamins and supplements became like drugs to me, as we used them only for a special indication. Now I recommend them only to correct and prevent a deficiency. I also recommend them to correct any sort of problem related to disease or poor lifestyle habits. For example, people who drink alcohol on a regular basis can develop neurological damage from a thiamine deficiency called Wernicke-Korsakoff syndrome.
Other people who benefit from vitamins are those with chronic diarrhea from any cause, vegans, people on long-term drugs that induce deficiencies and people over age 50. People over 50 lose the ability to adequately absorb vitamin B12 and the ability to deficiently make vitamin D and other biochemicals. This process is explained in the epic article published in Cell titled “The Hallmarks of Aging.” It discussed how scientists are looking to cure and slow the aging process. I use that information for recommendations specifically regarding longevity medicine.
In the hospital, we also do daily lab values. We want all the biochemicals and electrolytes to be in the normal range, not too high and not too low. I apply this philosophy to biochemicals and nutraceuticals, as well as electrolytes, vitamins and minerals.
The Food and Drug Administration suggests upper and lower levels on vitamin intake. Everything should be in the natural zone. I also read what the experts say regarding vitamins and minerals, and I do not deviate from their words of wisdom. My go-to experts are the U.S. Preventive Services Task Force (uspreventiveservicestaskforce.org) and the National Institutes of Health (ods.od.nih.gov) for additional information.
After years of reading what the experts say and reading the results of incoming randomized control trials, I now know when vitamins and supplements will yield good results and when they will not. I always pay special attention to the subanalysis because that tells me specifically who is benefiting. Many times, the randomized controlled trials say that the supplement does not work in the general public. However, the subanalysis may reveal that it made a huge difference in smokers, marathon runners or some other subpopulation group.
I also think it’s important to know the difference between overt vitamin deficiency symptoms and subclinical symptoms of vitamin deficiencies. Subclinical vitamin deficiencies mimic signs of old age but are not in fact signs of aging. They include frequent colds and infections, low energy levels, brain fog, blotchy skin and other mysterious symptoms. Overt symptoms of deficiencies are rickets, scurvy, neurologic damage, pellagra and anemia, to name a few.
It is important to dispel the myth that more vitamins are better. When a low vitamin level is restored to normal, miraculous things happen. When a normal vitamin level is elevated, good things do not happen and bad things can happen sometimes. To help people stay safe and healthy, it is also important to know what these bad things are and which vitamins are associated with specific occurrences.
Below is a very simplified chart of the most common supplements I recommend and why.
Over-the-counter diet pills usually leave the buyer disappointed, so I don’t recommend them. However, they might work by the placebo effect, so I never discourage someone who is doing well on them. Herbal products that lower blood sugar can have a stop-and-go effect, which can be dangerous for people on medications for diabetes. I do not recommend those products either. Also, it’s important to know that some probiotics cause weight loss and others cause weight gain. Probiotics are similar to drugs in that there are different mechanisms of action and they should be chosen very carefully.
Happy customers are repeat customers, and success happens from word-of-mouth. I believe that the most successful pharmacies are those that provide good information and products. Now more than ever, people are taking control of their health and making their own health-related decisions. They want to learn about natural products and avoid drugs. No one is better qualified and poised to provide this information than pharmacists.
When experts say vitamins and minerals are a waste of money, that does not apply to the people who frequent pharmacies. These people have health issues, and vitamins can be life-changing for some.
Gunda Siska, Pharm.D., is a staff hospital pharmacist who assists doctors and nurses with drug administration, dispensing, and prescribing, as well as independently dosing and monitoring highly dangerous and toxic drugs.