Accurate Education – A Quick Look at Vitamins & Minerals

Nutrition & Supplements

A Quick Look at Vitamins & Minerals

This section represents a brief overview of vitamins and minerals.  It is not meant to be exhaustive, but rather a quick reference for confirming recommended indications and doses. There arelinks to pages that will serve as more in depth sources of information for those who want to pursue greater knowledge of a subject.

See:

• Diet & Diets
• Diet & Fasting
• Diet & Pain
• Diet & Fibromyalgia
• Supplements

 

See also:

• Integrative, Complimentary and Alternative Medicine
• Nutrition: Amino Acids
• Nutrition: Carbohydrates

 

Key to Links:

• Grey text – handout
• Red text – another page on this website
• Blue text – Journal publication

Page Links:

Vitamins:

• Vitamin A
• Vitamin B complex
• Vitamin C
• Vitamin D (D3)
• Vitamin E
• Vitamin H (Biotin)

Minerals:

• Magnesium
• Zinc

 

A Quick Look at Recommended Vitamins & Minerals

 

Vitamins

Vitamin A (Beta-carotene)

For more information,,see: Vitamin E

Beta-carotene is a yellow-red-orange pigment found in plants and fruits, especially carrots and colorful vegetables that is converted into vitamin A. In a human study with 29,000 participants, elevated serum beta-carotene levels were associated with lower cardiovascular and heart disease. Other human studies have demonstrated that higher beta-carotene is associated with lower incidence of metabolic syndrome and lower body weight.

Vitamin A has been identified as an antioxidant and may reduce inflammation. It may have synergistic benefits when taken with with PEA and BCP (also included here).

•  Dose: No specific supplement recommendations at this time.

Vitamin B complex

B vitamins are required for optimum functioning of the nervous system as well as other functions. Except for Vitamin B12, there are no special recommendations or concerns for the individual B vitamins but a high dose B-Complex supplement is recommended with the following considerations:

Vitamin B1 (Thiamine)

• Dose: 15 mg/day
• Special Considerations:
  • Thiamine deficiency is increased in those with liver problems or drink a lot of alcohol

 

Vitamin B2 (Riboflavin)

• Dose: 400 mg/day
• Special Considerations:
  • Riboflavin deficiency is more likely in with diets lacking dairy products, meat and fortified grain products
  • Prevalence of riboflavin deficiency in those over 65 is estimated between 10% and 27%
  • Symptoms of peripheral neuropathy may occur with riboflavin deficiency
  • Migraines: Riboflavin @400 mg/day may reduce duration, frequency and severity

 

Vitamin B3 (Niacin or Nicotinamide)

• Dose: 50 mg/day
• Special Considerations: none

 

Vitamin B5 (Pantothenic Acid)

• Dose: 23 mg/day
• Special Considerations: none

 

Vitamin B6 (Pyridoxine)

• Dose: 1 mg/day
• Special Considerations: none
• Risks for deficiency:

• 50 y/o
• Obesity (BMI >30)
• Diabetes
• Coronary Artery Disease (CAD) – Angina, Previous heart attack (MI)
• Inflammatory Bowel Disease (IBD)  – Crohns, Ulcerative Colitis
• Rheumatoid Arthritis
• History of stroke (CVA)
• Medications: theophylline, hydralazine, isoniazide

 

Vitamin B9 (Folate or Folic Acid)

• Dose: 400 mcg/day
• Dose: 1 mg/day
• Special Considerations: Genetic risks (PGT) – MTHFR and COMT
• Risks for deficiency:

• 50 y/o
• Celiac disease
• Dialysis
• Sickle Cell Disease
• Inflammatory Bowel Disease (IBD)  – Crohns, Ulcerative Colitis
• Leukemia
• Medications: NSAIDs, metformine, barbiturates (Fioricet), birth control, methotrexate, carbamazepine, valproate

 

Vitamin B12 (Cyanocobalamine or Methylcobalamine)

For more information, see: Vitamin B12

1. Dose: 1 mg/day
2. Dosing guided by blood levels
3. Route:  Sublingual, has small advantage over oral. No advantage with injection

Risks for deficiency:

• 50 y/o
• Vegetarian
• Alcohol use
• Impaired absorption: post-gastrectomy, gastric bypass, ileal resection, pernicious anemia, gastritis
• Inflammatory Bowel Disease (IBD)  – Crohns, Ulcerative Colitis
• Medications: metformin, H-2 blockers (Pepcid), PPIs (prilosec, Nexium)

Benefits purported for:

• Diabetic peripheral neuropathic pain
• Low Back and neck pain
• Herpetic Neuralgia, Trigeminal Neuralgia & Glossopharyngeal Neuralgia
• Spontaneous pain, hyperalgesia, and allodynia.

Special Considerations:

    Methylcobalamine may have advantage over Cyanocobalamine with:

• • Irritable Bowel (IBS), Inflammatory Bowel Diseases (Celiac, Colitis)
  • Gastric Bypass
  • Metformin use

 

Vitamin C (Ascorbic Acid)

For more information, see: Vitamin C

• Dose: 250-500 mg/day
• High Dose: 500-1000 mg/day
• Vitamin C is generally non-toxic, but at very high doses (2000–6000 mg/day) it can cause gastrointestinal disturbances or diarrhea.
• Dosing guided by blood levels:

 Vitamin C Levels <1.9 mg/L (<11μM )

The deficiency is severe enough to potentially precipitate symptoms of scurvy, including bleeding sums, nosebleeds, skin that bruises easily, weakness, fatigue, rash, joint pain and reduced ability to fight infection. Other symptoms include hair that grows in bent or coiled shapes, loose teeth, poor wound healing, anemia, and small red spots on the skin Signs of scurvy began to appear about 40 days after Vitamin C withdrawal.

Vitamin C Levels <3.5 mg/L  (<20μM )

Likely to be deficient and may be associated with weakness, fatigue, sore arms and legs.

• Risks for deficiency:

• 50 y/o
• Obesity (BMI >30)
• Smoker: Tobacco AND cannabis (marijuana)
• Chronic infection
• Pregnant or breastfeeding women
• Medications; Aspirin, estrogen or birth control pill users

 

• Special Considerations:

Prevalence of scurvy in the U.S. is 7.1%, but the prevalence of vitamin C deficiency is 14% in males and 10% in females. The number of individuals with inadequate intakes of vitamin C is estimated to be as high as 31%.

1.    Those who need higher intakes of Vitamin C (500-1000 mg/day:

1. • Smokers or those exposed to secondhand smoke
   • Pregnant or breastfeeding women
   • Estrogen or birth control pill users
   • People taking aspirin
   • People with chronic infection (hepatitis, herpes, HIV etc.)

1. Conditions which may benefit from higher intake of Vitamin C (500-1000 mg/day:

1. • Pre-operative and Acute post-operative and post-injury pain
   • Chronic pain – Arthritis, Post-Herpetic Neuralgia, Chronic Regional Pain Syndrome (CRPS)
   • Opioid Tolerance and Withdrawal
   • Stress and conditions associated with increased oxidative stress
   • Obesity
   • Colds and Respiratory Infections
   • Ischemic strokes
   • Dental extractions
   • Cancer
   • Bone pain.    )
   • Type 1 diabetes: Individuals with type 1 diabetes may experience increased vitamin C requirements
   • Malabsorptive disorders: Conditions such as inflammatory bowel disease, celiac disease, and cystic fibrosis can hinder vitamin C absorption
   • Bariatric surgery: Individuals who have undergone bariatric surgery may be at risk of vitamin C deficiency due to reduced absorption capacity.

 

Vitamin D (D3)

For more information, see: Vitamin D

• Dose: 2000 IU/day
• High Dose: up to 5000 )U/day or 50,000-100,00 IU/week
• Dosing guided by blood levels (Optimal level 50-80ng/ml)
• Special Considerations: 
• Benefits: 

• • Low quality evidence for benefit for all types of chronic pain
  • Helps preserve cartilage in knee osteoarthritis, improves function
  • Decreases pain in chronic widespread pain and fibromyalgia
  • Reduces inflammatory cytokine and prostaglandin release
  • Important to maintain immune system
  • Important to maintain healthy bones

• Risks for deficiency:

• 50 y/o
• Obesity (BMI >30)
• Dark skin
• Diet: low intake dairy products, lactose intolerance
• Medications: glucocorticoids (prednisone, cortisone etc.)

 

Vitamin E

For more information, see:  Vitamin E

• The main function of vitamin E is to protect the body against lipid peroxidation. However, the effect of Vitamin E supplementation in the prevention of cardio-vascular diseases is controversial.
• Vitamin E deficiency can cause nerve pain (neuropathy).

Risks for deficiency:

• Smoker: Tobacco AND cannabis (marijuana)

Benefits:

• Some studies show that vitamin E given alone significantly decreased myocardial infarction while other studies also showed that supplements containing vitamin E significantly reduced cardiovascular mortality risk. Another analyses of 15 trials reporting data on 188,209 participants showed that antioxidant vitamin supplementation (vitamin E, β-carotene, and vitamin C) has no effect on the incidence of major cardiovascular events, myocardial infarction, stroke, total death, or cardiac death.
• However, a dose-response analysis of multiple studies showed a statistically significant relationship between vitamin E dosage and all-cause mortality, with an increased risk of death at dosages greater than 150 IU/day. Moreover, It has been shown that high-dosages(≥400 IU/day or more for at least 1 year) can be dangerous and can increase the risk of death.

Dose:

• The recommended daily amount (RDA) of vitamin E for adults is 15 milligrams a day. 
• No other specific recommendations, other than to avoid doses of 150 IU/day or greater, and emphasize intake of foods rich in vitamin E:

 

Vitamin H (Biotin)

• Dose: 150 mcg/day
• Special Considerations:
•   May reduce high sugar (hyperglycemia)-induced damage to nerves. 

Minerals

Magnesium (Magnesium threonate)

For more information, see:  Magnesium

• Dose: 500 mg 2x/day
• Dosing guided by blood test (red blood cell levels)
• Risks for deficiency:
  

  • Diabetes
  • Cirrhosis
  • Fibromyalgia
  • Migraine headaches
  • Osteoporosis
  • Gastrointestinal diseases: Inflammatory Bowel Disease (IBD)  – Crohns, Ulcerative Colitis
  • Medications: methadone, antacids, PPIs (prilosec, Nexium), statins, diuretics, glucocorticoids (prednisone, cortisone etc.), birth control pill

• Special Considerations:

• • Recent studies show that 70-80% of Americans diets may be deficient in magnesium
  • Magnesium threonate (vs. magnesium oxide or citrate) is more bioavailable to the brain and may better enhance nerve function, memory and cognition and better reduce anxiety and stress
  • Acts as an NMDA receptor antagonist, which can help reduce pain
  • Required for the conversion of vitamin D into the active form
  • Reduces frequency and severity of migraine
  • The effectiveness of CGRP inhibitor drugs such as Nurtec and Ubrelvy for migraine may be reduced in those who are magnesium deficient.
  • Reduces pain of fibromyalgia
  • Improves chronic back pain “with nerve component”
  • Improves sleep
  • Improves mood and depression

Some selected foods and their magnesium & omega fatty acids contents:

• • Chia seeds: 1 tablespoon – 24 mg of magnesium, 2400 mg omega three 800 mg omega six
  • Black seeds: 1 tablespoon – 40 mg magnesium 2350 mg omega-3 600 mg six
  • Fresh spinach: one cup – 24 mg magnesium
  • Salmon fillet: 4 oz – 26 mg magnesium 1500 mg omega-3 200mg omega-6
  • Medium sweet potato: 300 mg magnesium
  • Pumpkin seeds: one handful – 150 mg magnesium, 50 mg Omega-3, 6000 mg, Omega-6

Zinc

For more information, see: Zinc

• RDA: 8 – 11 mg/day
• Dose: 15 mg/day
• Dose: 15.8 mg/day may reduce migraine frequency by 30% (vs <6 mg/day)
• Dose: 19.3 – 32.5 mg daily, may reduce migraine frequency by 38% (vs <6 mg/day)
• Dosing guided by blood levels:
  •    The optimal range of plasma zinc is 13.8 – 22.9μmol/L (90-150μg/dl)
  •     Clinical signs of zinc deficiency may occur with zinc levels below 9.9μmol/L (65 μg/dl)
• Forms:
  • Zinc sulfate is the least expensive form, but is the least absorbed and may upset the stomach. More easily absorbed forms of zinc include zinc carnosine, zinc picolinate, zinc citrate, zinc acetate, zinc glycerate, and zinc monomethionine.
  • Avoid nasal sprays purported to reduce nasal and sinus congestion – they have been reported to possibly damage the sense of smell.

• Special Considerations:  Zinc is not stored in the body so it must be ingested on a regular basis
• Up to 12-40% of the U.S. population is at risk for zinc deficiency:
  • Age >60
  • Chronic pain, especially myofascial (muscle and trigger point) pain
  • Fibromyalgia
  • Liver disease
  • Oxidative stress
  • Anxiety
  • Depression
  • Heavy alcohol use
  • Those with loss of appetite (anorexia)
  • Those on very restricted diets, including vegetarians
  • Those with impaired intestinal function including malabsorption syndromes (Crohn’s disease or celiac disease)

 

 

Purchasing Supplements

To purchase supplements reviewed on this web site or discussed with Dr. Ehlenberger, a discount can be applied to usual commercial pricing by purchasing from Accurate Clinic’s online Supplement Store after acquiring the discount code from Accurate Clinic. Please note that Dr. Ehlenberger does not receive any financial rewards from sales through this store, it has been set up as a means to allow purchase of quality supplements more accessible and more affordable for his patients.

Accurate Clinic’s Supplement Store or, call Toll-Free: 877-846-7122 (Option 1)

 

Resources:

Online Resources for Nutritional Information

MyFoodData.com

MyFoodData.com provides nutrition data tools and articles to empower you to create a better diet. All data is sourced from the USDA Food Data Central.This site includes many tools related to nutrition including one that allows you to look up any food for a nutritional analysis, including commercial products,

 

www.Nutrition.gov
Nutrition.gov provides easy access to vetted food and nutrition information from across the federal government. It serves as a gateway to reliable information on nutrition, healthy eating, physical activity, and food safety for consumers. Since dietary needs change throughout the lifespan, specialized nutrition information is provided about infants, children, teens, adult women and men, and seniors. Users can find practical information on healthy eating, dietary supplements, fitness and how to keep food safe. The site is kept fresh with the latest news and features links to interesting sites.

 

 National Association to Advance Fat Acceptance
Founded in 1969, the National Association to Advance Fat Acceptance (NAAFA) is a non-profit, all volunteer, civil rights organization dedicated to protecting the rights and improving the quality of life for fat people. NAAFA works to eliminate discrimination based on body size and provide fat people with the tools for self-empowerment through advocacy, public education, and support.

 

Journals & Newsletters

 

Books

“Dopamine for Dinner”

by Joan Borsten, 2014
Available online at Amazon.com: Kindle subscriber: free;  Kindle book: $9.95  Paperback: $149.00

 

“Dopamine for Dinner,” is the first Malibu Beach Recovery Diet Cookbook, based on their famous low-glycemic diet. The recipes developed by four accomplished chefs are both pleasant eating as well as healthy. Based on the use of low glycemic index foods, the recipes emphasize nutritious eating in a manner that promotes maintaining high brain levels of dopamine and serotonin as a means of supporting healthy brain chemistry.

 

Educational Resources:

Genetically Modified Food

• Genetically Engineered Crops- Experiences and Prospects – 2016
• Genetically modified foods- safety, risks and public concerns—a review – 2012

 

Misc.

1. Simopoulos AP. The importance of the ratio of omega 6/omega 3 essential fatty acids. Biomed Pharmacother. 2002 Oct;56(8):365-379.
2. LeGendre O, et al. (-)-Oleocanthal rapidly and selectively induces cancer cell death via lysosomal membrane permeabilization. Mol Cell Oncol. 2015 Jan; 2(4):e1006077.
3. Carvajal-Zarrabal O, et al. Effect of dietary intake of avocado oil and olive oil on biochemical markers of liver function in sucrose-fed rats. Biomed Res Int. 2014;2014:595479.
4. Unlu NZ, et al. Carotenoid absorption from salad and salsa by humans is enhanced by the addition of avocado or avocado oil. J Nutr. 2005 Mar;135(3):431-436.
5. Irandoost P, et al. Does grape seed oil improve inflammation and insulin resistance in overweight or obese women?. Int J Food Sci Nutr. 2013 Sep;64(6):706-710
6. Del Gobbo LC, et al. ω-3 ω-3 polyunsaturated fatty acid biomarkers and coronary heart disease pooling project of 19 cohort studies. JAMA Intern Med. 2016 Aug; 176(8):1155-66.
7. Carvalho M, et al. Human cancer cell antiproliferative and antioxidant activities of Juglans regia L. Food ChemToxicol. 2010 Jan; 48(1):441-447.
8. Deol P, et al. Soybean oil is more obesogenic and diabetogenic than coconut oil and fructose in mouse: Potential role for the liver. PLOS One. 2015 June.
9. O’Keefe S, et al. Levels of trans geometrical isomers of essential fatty acids in some unhydrogenated U. S. vegetable oils. J Food Lipid. 1(3):165-176.
10. Kritchevsky D, et al. Lectin may contribute to the atherogenicity of peanut oil. Lipids. 1998 Aug;33(8):821-3.

Emphasis on Education

 

Accurate Clinic promotes patient education as the foundation of it’s medical care. In Dr. Ehlenberger’s integrative approach to patient care, including conventional and complementary and alternative medical (CAM) treatments, he may encourage or provide advice about the use of supplements. However, the specifics of choice of supplement, dosing and duration of treatment should be individualized through discussion with Dr. Ehlenberger. The following information and reference articles are presented to provide the reader with some of the latest research to facilitate evidence-based, informed decisions regarding the use of conventional as well as CAM treatments.

 

For medical-legal reasons, access to these links is limited to patients enrolled in an Accurate Clinic medical program.

 

Should you wish more information regarding any of the subjects listed – or not listed –  here, please contact Dr. Ehlenberger. He has literally thousands of published articles to share on hundreds of topics associated with pain management, weight loss, nutrition, addiction recovery and emergency medicine. It would take years for you to read them, as it did him.

 

For more information, please contact Accurate Clinic.

 

Supplements recommended by Dr. Ehlenberger may be purchased commercially online

Please read about our statement regarding the sale of products recommended by Dr. Ehlenberger.

 

 

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