Melanie Cole (Host): According to the National Institutes of Health, Office of Dietary Supplements, the majority of adults in the United States take one or more dietary supplements either everyday or occasionally. My guest today is Dr. Jessica Heckman. She’s a family practice doctor at Family Medicine of Lincoln, part of Bryan Physician Network. Welcome to the show, Dr. Heckman. Does everybody need to take vitamins?

Dr. Jessica Heckman (Guest): You know, honestly, I do think that everyone really can benefit from vitamins. We find that a lot of people, though they do a great job with their nutritional intake, can utilize, boost through their vitamin intake here and there.

Melanie: It’s such a confusing, dizzying world of vitamins supplements. How does a person standing in front of all those millions of supplements know which ones to take?

Dr. Heckman: Oh, absolutely. Well, I always encourage people to come in and talk with me about the different vitamins that they’re taking because it does vary kind of person to person who should be taking what and how much even. When deciding what vitamins to take, I always go back to our initial research to say, “What’s our best research? What do we have the most insight into?” You know, the number one that I like to talk about is vitamin D. There’s been a lot of research into that into saying, “Okay, you know, which are the best vitamins to take? How much to take?” And, I know there are a lot of different options there, honestly. So, I’m sorry. I kind of got off track for a second but you’re right, it is a dizzying world of deciding what vitamins to take when there are so many options out there.

Melanie: So, how do we know which ones are considered safe? Which ones are better than some others because there’re so many brands, for example, of vitamin D. There are gels and there are oils and there’s tablets and caplets and how does somebody know?

Dr. Heckman: Well, so, when looking at that, the safety aspect to address first. A lot of the water-soluble vitamins like vitamin B and C, you’ll notice that sometimes they will be appearing at 1000% needed for your daily equivalent. And, those, when you look at that are still fairly safe because you’re going to. . . The water soluble vitamins, your body tends to just lose those in your urine. The fat-soluble vitamins, I’m talking about the safety, vitamins A, vitamins D and E, those tend to be more dangerous when you’re talking about varying dosages of them. Caplets, gels, all of those different formats are great ways to get your vitamins in. The more tightly packed that vitamin is, like a tablet, the harder it is for your body to break it down often and get the vitamin in. And, that’s another reason why, obviously, getting it through your natural food is the best way to go but if you aren’t going to be able to obtain that, then I talk about getting a gel tablet or a caplet as the next way, as the next best option. Any way that you can get it in is the best route to go. If you’re like, “I can’t tolerate a capsule. I need to take a tablet”, that’s just fine.

Melanie: And, what do you say when people say, “But we should be getting it through our food but is our food source still containing the same amount of macronutrients and vitamins that they used to”?

Dr. Heckman: They really, you know, they are really well supplemented, especially our breads, our pastas. They do have a good amount of vitamin A in it and they do have a good amount of vitamin E. It’s vitamin D that I tend to see being under repleted in because it is somewhat difficult to get. And, then, especially, you know, here in at least my practice in the Midwest, in my whole career I’ve only had maybe four people naturally have enough vitamin D in their system because we have overcast clouds and people need the sunlight to help take it in in addition to their food sources. And, that’s when it’s chronically under repleted. So, for the most part, I think we do get a lot of our macronutrients in through breads and pastas but vitamin D and sometimes iron, I tend to see unrepleted.

Melanie: Where do you like people to purchase their vitamins because there are vitamin stores, there’s Whole Foods, there’s Walgreen's, there’s all kinds of places to get them today. Is there any difference?

Dr. Heckman: You know I will say that I tend to favor some of the pharmacies just because the major brands do have their inactive ingredients scrutinized more closely. We do notice that with vitamins, they don’t have to adhere to as strict a standard as medications by the FDA because they’re not meant to cure any illness. So, we try and make sure that it’s in its purest form possible for people. And, so, I tend to notice that some of the wider known brands and not to you know be trying to promote anyone over another, those sometimes undergo greater scrutiny. So, that’s why I sometimes go towards the pharmacy.

Melanie: Do you feel there’s any difference between synthetic vitamins or the plant-based or food-sourced vitamins?

Dr. Heckman: You know, I will say that I have had a number of patients who have been on all of those options and I have found that they do all seem to work well. I think it has a lot of person to person variability when it comes to monitoring the levels through looking at serum blood levels for like vitamin B12 or you know, looking and seeing how iron is repleted, just different things along those lines. I think some of the plant-based vitamins sometimes you need to have a little higher dosing on occasion with people but, for the most part, as long as we’re monitoring things in the office, we can still get to an appropriate range.

Melanie: If you had to pick your top vitamins that you think are most important for people including probiotics, fish oil, a multivitamin, name some of the top ones that you think are most important.

Dr. Heckman: Oh gosh, yeah, you really hit a lot of the heavy ones. I know I’ve already mentioned twice that vitamin D. I think because it’s so chronically under repleted, it’s a big one. I do appreciate that. And, interestingly with vitamins, an adult multivitamin only has 400 iu in it. Usually, an adult human being is going to need to be taking 2000-3000 iu daily to get in an appropriate range for that. Fish oil is another fantastic one that I love having people take. It does wonders for cholesterol. It has a lot of good cardiovascular properties to it. I would caution people. If you’re going to undergo surgery, a lot of people forget that it can have some procoagulant effects, so I tell people to stop that generally two weeks before surgery. So, I really appreciate that one. B12 is another one that I like to tell my patients to take. Just from an energy perspective, it does wonder for repleting their levels there. And, an important thing to note there is that if you do take medicines for reflux, a lot of times it can block their absorption, so we want to be paying attention to that. On top of that, calcium would be a big one for me because, especially for women, you are going to only be laying down new bone mass until you’re about 35 years of age and so that calcium is very important to get into your body, as we talked about, naturally through spinach, eggs, orange juice, almonds, and then trying to supplement with vitamins as well. So, those would kind of be my big ones but as I said it’s not only important to get them in your body through varying different ways but to know that you’re taking it appropriately and that you’re taking it as efficiently as possible; like I said, avoiding taking it with certain medication.

Melanie: When talking about vitamin C, because people eat those little tablets like they’re candy, and so you mentioned that they’re excreted in your urine if you take too much of them. Does vitamin C really help to boost the immune system?

Dr. Heckman: You know, I will say that there is a lot of varying data on whether or not it does boost the immune system. We know that it is an antioxidant and it is going to prove beneficial to our bodies’ cells for fighting stress. I think to state that it’s going to absolutely prevent viral illness or bacterial illnesses, it might overstate things based upon where I think the research is so far but do I think it does boost your ability to fight off physiologic stressors? I do.

Melanie: And, what about probiotics?

Dr. Heckman: Oh, yes, probiotics. So probiotics, I think it’s going to be interesting to look in twenty years and see where we eventually end up with probiotics. I do recommend them in a lot of my patients. There’s a lot of good research in treating chronic abdominal pain, constipation in pediatric and adult patients with probiotics. The best probiotic that I’ve seen in terms of the amount of research that’s out there is lactobacillus. And that generally is in most probiotic formulations but that’s kind of the one that I, if I’m going to recommend someone for the probiotic strain to take, to include lactobacillus is the usual one that I recommend. And, definitely, if someone’s having issues with diarrhea or being put on an antibiotic, I generally recommend they make sure they’re taking a probiotic.

Melanie: Should men and women take different vitamins? And, you mentioned for women, calcium? What about folic acid, do men need that? Speak about the difference a little.

Dr. Heckman: Well, folic acid is especially good for women. We know pregnant and lactating women, it’s very good for them. Folic acid at certain levels helps prevent cardiovascular disease and it is good for men in that realm as well because we know that they have a high prevalence of that. There is some new data that’s suggesting possibly super high dose folic acid for a very long time can actually increase your risk of heart disease but that’s still in kind of its infancy. So, I generally say the amount of folic acid that is included in a multivitamin usually is what I recommend. That would be for a woman in a prenatal vitamin or just that’s in a men’s multiday vitamin.

Melanie: So, wrap it up for us, Dr. Heckman, with your best advice on the questions that people have about vitamins and who’s responsible for overseeing the regulation of dietary supplements. Just give your best advice on vitamins.

Dr. Heckman: Well, my best advice is it’s always a good idea to talk with your physician about what you’re taking. Just because something is natural and occurring does not always mean that you’re taking it in the appropriate dosage and you want to be cognizant of that. Again, if you’re trying to maximize how you’re taking your vitamins too, it’s still good to talk with your doctor to make sure should you be taking it in the morning and taking your medicines at night because if you’re taking the trouble to take a vitamin, you want to make sure that it’s worth your while. So, that’s the number one advice that I give to people is make sure you’re telling your doctor your vitamins you’re taking and how you’re taking them. If I had to give anyone advice to say what is the most under repleted vitamin, I see, again, not to keep harping on it, but that vitamin D is right there. Sometimes, you know, usually we’ll see 400 iu in a pill bottle in just a multivitamin. There are some people that I have to have on 50,000 iu once a week to get to an appropriate level. So, really, I can see the benefits for everyone having some supplementation of vitamins from breastfed infants, to adults, to the elderly. Your needs do change throughout so it’s good to maintain an open dialogue with your provider, in my opinion.

Melanie: Thank you so much for being with us today, Dr. Heckman. It’s really great and such important information. You’re listening to Bryan Health Radio. And for more information, you can go to bryanhealth.org. That’s bryanhealth.org. This is Melanie Cole. Thanks so much for listening.