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Published September 02, 2012, 11:40 PM

Too much of a good thing: Finding the right amount of vitamins isn’t always an easy task

FARGO - Linda Bartholomay has simple advice for getting the right mix of vitamins and minerals each day: “Enough is good; way too much is not good.”

By: Ryan Johnson, INFORUM

FARGO - Linda Bartholomay has simple advice for getting the right mix of vitamins and minerals each day: “Enough is good; way too much is not good.”

Bartholomay, a licensed registered dietitian who manages Outpatient Nutrition Therapy and Diabetes Education at Sanford’s Southpointe Clinic, said most people aren’t getting enough vitamin D, calcium and the other necessary building blocks of a healthy life from their regular diet.

That’s why many turn to multivitamins and supplements. But she said it is possible to go overboard, and overloading on otherwise good things could cause health problems or even death.

Take calcium, for example. The mineral is especially important for women and older men to help prevent osteoporosis; it also helps regulate the heart.

But taking too much could increase the risk of kidney stones or even lead to a heart attack.

“Your body needs to deal with it somehow,” she said. “So, if it doesn’t have the right components to just shove it into your bones, which is where we’d like it to go, it can contribute to calcium deposits in blood vessels.”

Complicated science

Bartholomay said the interaction of vitamins, minerals, fatty acids and other healthy parts of a diet is complicated – which is why it’s hard for the average person, and even doctors, to keep up with research and know how much they should be taking.

In recent decades, experts have put the focus on vitamin D just as much as calcium when it comes to bone health because the two work together.

Newer findings suggest they also should keep an eye on vitamin K, a fat-soluble vitamin abundant in kale, spinach and other leafy green vegetables. Without enough, calcium can’t get to the bones and could cause heart problems.

But people taking popular blood thinner Coumadin had been told for years to avoid vitamin K supplements and cut it from their diet because of its clotting effect, which could keep the pill from working.

“What we’ve created is a good chunk of people out there who are taking extra calcium, and maybe even taking vitamin D, but the calcium can’t get into the bone because we’ve made them deficient in K,” Bartholomay said. “It’s a really strong interplay of stuff.”

It’s just one example of the rapidly changing recommendations for a daily dose, and those guidelines continue to be modified as more research shows just how important these vitamins and minerals are working together toward overall health.

“It does change, and it has changed definitely in the last five years,” she said.

The right amount

Bartholomay said there are patients who come to Sanford who have tried to take too much of a good thing only to cause other problems.

Too much zinc on a long-term basis could cause a deficiency in copper, she said. Too much retinol, one form of vitamin A, can lead to low levels of vitamin D and birth defects.

A high level of vitamin E could impact heart disease, according to some research, and a heavy dose of vitamin C over a long period increases the risk of kidney stones.

Omega-3 fatty acids are “really important supplements,” she said. But they can thin blood, so people on blood thinners might need to avoid them.

Some supplements like beta carotene act as antioxidants, helping protect the cells. But that could be a problem for people undergoing chemotherapy – a cancer treatment that kills harmful cells.

A psychologist once referred a patient to Bartholomay after discovering she was overmedicating herself for health benefits. The woman was on 35 supplements, all with a purported health boost by themselves, but the potential for dangerous reactions when taken together.

“You read on the Internet that this this is good and this thing is good, and so you start taking all these weird herbal things,” she said. “The problem is it’s not regulated, so when you’re buying a supplement, you really don’t know how much you’re getting.”

Be reasonable

Bartholomay said it’s far more common to see patients on the other end of the spectrum – people with poor diets, who aren’t getting the vitamins and minerals they need.

Underlying medical issues can make it tricky to find a healthy amount. She said many people with Type 2 diabetes could be low on vitamin B-12, and people who have a gastric bypass often need to take staggering amounts of vitamin D because their body no longer absorbs nutrients as well.

But even healthy people with no medical conditions have a hard time getting the proper mix of vitamins and minerals from their diet alone.

Bartholomay said she takes about 2,000 International Units of vitamin D each day, and many people would benefit from this supplement.

To get that much, she would have to drink 20 cups of milk each day – which would be loaded with calories and has too much calcium for a healthy daily dose.

That’s why, for most healthy people and especially picky eaters, taking a comprehensive multivitamin can help cover the bases.

“I don’t think it would hurt anybody to do that,” she said.

There are exceptions, and anyone who is pregnant, has medical conditions or is concerned about the issue should talk with a doctor or dietitian before starting any supplements.

Bartholomay said following a proper diet can go a long way, too. She recommends adding more beans, legumes, nuts, whole grains, fruits and vegetables, fish and lean meats to meals. Cutting back as much as possible on heavily processed foods, which often have few nutritional benefits, also is important.

Drinking plenty of water is another major part of a healthy diet, she said. Experts recommend drinking about eight glasses of liquid a day, and most of that should be water.

But that doesn’t mean if eight glasses is good, 16 glasses is even better – too much water can cause electrolyte imbalances.

“We have definitely seen that in elderly people who just don’t eat well and try to drink too much water,” she said.

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