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Straight Talk from 'Dr. Stephanie' - October 2013

Supplement Soup – What's in Your Diet?
En español

Stephanie Coulter, MD Did you know that $20 billion is spent yearly on dietary supplements such as Folate, Antioxidants (Vitamins A, E, and Selenium), Calcium, Vitamin D, Red Yeast Rice, Fish oil, and Niacin? It's a big business.   

Vitamin supplementation is not necessary for most adults who eat a well-balanced diet and get regular sun exposure.  

Food should be the source of vital nutrients  

I must say this 20 times a day. If you want a sure fire way to get your vitamins and minerals from food, I encourage you to read my Straight Talk blog. We have been preaching the benefits of food choices like olive oil, nuts, beans, fish, and fruits and vegetables for years. This is the basis for The Mediterranean Diet. It should be taught in preschool!  

Supplement Soup - What's in Your Diet?Be cautious about supplements

Supplements can help make up for deficiencies in your diet or supply an extra boost for certain populations. In excess, they can be not only costly but also harmful. They can even interact with medicines you are taking and have side effects just like drugs.

In my practice, patients frequently ask about the 9 nutrients/supplements shown below that get lots of press.  Consider the facts then talk with your physician about what's in your diet and whether or not a supplement might be right for you. 

 Food Sources -
 the Best Choice
 Benefits  Cautions
Folic Acid,
a B vitamin
Green leafy vegetables, fruits, cereals, grains, nuts. Metabolic processes like growth, reproduction, producing red blood cells. Helpful for women of child-bearing age or pregnant to prevent neural tube birth defects. No evidence of cardiovascular benefit with Folate supplementation.
Vitamin A Beta-carotene Vitamin  A: liver, kidney, egg yolk, dairy. Beta-carotene: orange vegetables, carrots, dark-green leafy vegetables.Healthy skin, strong teeth and bones in children, resistance to infection, normal growth, cell structure, normal eyesight.Excess leads to increased risk of early deaths and cancer; causes fetal loss and birth defects during 1st trimester of pregnancy.
Vitamin EGreen leafy  vegetables, nuts, cereals, meats, egg yolks, wheat germ, whole grains.Antioxidant helps protect cells from free-radical damage, and boosts immune system. Good for  elderly women at risk for fracture. Trials showed no evidence of cardiovascular benefit of supplementation and showed  an increased risk of heart failure and stroke.
Selenium Trace elementBroccoli, cabbage, celery, onions, garlic, whole grains, brewer's yeast.Functions not entirely understood, but necessary for optimal health.Can be harmful and increase risk of prostate cancer.
Dairy, green leafy vegetables, broccoli. Fortified products. Healthy bones and teeth, nerve conduction, muscle contraction, blood clotting, production of energy, immunity to disease.It is complicated and excess can be harmful. Read Calcium for Bones at Your Heart's Expense? 
Vitamin D Sunlight; fortified milk and other foods. Helps body absorb calcium for strong bones. Important to body in many other ways and found in virtually every cell. Excess can be toxic, raise blood levels of calcium, lead to heart rhythm disorders and other problems.
Red Yeast Rice
Made by culturing rice with strains of the yeast Monascus purpureus; used in Chinese cuisine or medicinal products. Minimally lowers total cholesterol and LDL, although it does not increase HDL. Varies greatly across commercial preparations. May have same side effects as  lovastatin.
Omega-3 Fatty Acid
Fish Oil
Fatty fish like Salmon or Herring; Tofu and other forms of soybeans. Walnuts, flaxseeds, canola oil contain alpha-linolenic acid (LNA), which converts to omega-3s in the body. Slow the growth rate of atherosclerotic plaques, help lower blood pressure, lower Triglycerides, and decrease risk of arrhythmias (abnormal heartbeats) which can lead to Sudden Cardiac Death.Supplements are not a substitute for eating fish in a balanced diet. Read Omega-3, Fish and Fish Oil Supplements.
Vitamin B3
Lean meats, fish, whole grains. Helps the digestion, skin, and nerves to function; important for converting food to energy. Lowers LDL, Triglycerides; raises HDL. No benefit  when you already take a statin. Excess can raise blood sugar. Read Women & Cholesterol: Top 5 Myths Debunked.
On this website, see Nutrition: Vitamins and Minerals.
And for the kids, see Project Heart Activity Masters for Grade 5: "My Vitamin Dictionary" and "My Mineral Dictionary".

For a quick reference to recommended daily values of key nutrients, see US Food and Drug Administration: Calculate the Percent Daily Value for Appropriate Nutrients.

Want to learn more? Visit the National Institutes of Health - Office of Dietary Supplements

Until next time!
Stephanie Coulter, MD, Director of the Center for Women's Heart & Vascular Health
Stephanie Coulter, MD

Special thanks to Dr. Karla Campos for her assistance in writing Straight Talk.

Do you have a topic that you would like to learn more about from Dr. Stephanie? Send us an email at and your question may be the next Straight Talk topic!

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