Beyond the Bedside: Essential vitamins for Primary Prevention
During patient consultations, I often address questions about vitamins and supplements.
Vitamins and minerals provide the body with essential nutrients necessary for its normal functions. For the majority of individuals, a balanced diet can supply all the required vitamins and minerals. Yet, the prevalence of convenient, fast-food options in the American diet often leads to a deficiency in essential nutrients. It’s important to note that supplements are not subject to FDA approval, meaning they do not undergo the rigorous safety and efficacy testing that most pharmaceuticals do. Despite this, there are cases where supplements might be necessary, such as in cases of known nutrient deficiencies due to age or financial constraints, intestinal malabsorption issues, thyroid disorders, post-operative recovery, etc. In this edition of Beyond the Bedside, I’ll delve into the importance of vitamin D and calcium.
Vitamin D and calcium are crucial for bone health, playing a pivotal role in the primary prevention of bone-related conditions such as osteoporosis.
Fractures, especially of major bones like the hips and spine, can lead to severe impairment, chronic pain, and even life-threatening complications. Even fractures of smaller bones can impair daily activities and enjoyment of hobbies. To strengthen bones, regular weight-bearing exercises like weight lifting, swimming, and yoga are recommended. It is also recommended to limit alcohol consumption and the use of oral steroids in order to mitigate bone damage.
The general recommendation for calcium intake is 1000mg daily for most adults, increasing to 1200mg for post-menopausal women with osteoporosis. The decline in estrogen production during menopause, a hormone that supports bone formation, can lead to weakened bones. Calcium-rich foods include dairy products, almonds, tofu, and dark green leafy vegetables like kale, spinach, and broccoli. For those considering supplements, calcium carbonate is best taken with food, while calcium citrate is suited for an empty stomach or for those on reflux medication. However, excessive calcium intake can lead to complications such as constipation and an increased risk (17%) of kidney stones, particularly with doses exceeding 2000mg daily.
Vitamin D facilitates the absorption of calcium and has seen increased usage during the COVID pandemic as a preventative measure against related illnesses. Research suggests that individuals with low levels of vitamin D may be at an increased risk of infections, cancer, autoimmune diseases, and cardiovascular conditions (UpToDate). Although fortified milk is a primary source of vitamin D in the United States with an 8oz glass containing 100 IU. But it can also be found in fatty fish, beef liver, egg yolks, cheese, mushrooms, and through sunlight exposure. The use of sunscreen, while crucial for skin cancer prevention, can inhibit vitamin D absorption through the skin. Therefore, it’s essential to ensure adequate dietary intake of vitamin D, with a recommended daily intake of 600-800 IU for adults, increasing to 1000-2000 IU for post-menopausal women. For supplementation, Vitamin D3, the active form, is recommended. While rare, excessive intake of this fat-soluble vitamin can lead to toxicity, with symptoms including nausea, vomiting, confusion, and muscle weakness.
Jones, T. (2023) 7 Nutritious Foods That Are High in Vitamin D. Healthline.com.
Manson, J.E. & Bassuk, S.S. (2012). Calcium supplements: Do they help or harm?
UpToDate. 2024. Uptodate.com.
