Chronically ill patients may benefit from supplementation. There is no need to supplement the already healthy patient. However, chronically ill or malnourished patients may benefit from supplementation.
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Certain medications may also contribute to vitamin loss via urinary loss, etc.
Here are some examples. We often supplement folate and thiamine to the alcoholic patient but forget about niacin and B6 among other vitamins. Patients taking diuretics are often deficient in many water soluble vitamins including vitamin C and thiamine.
Patients after gastric bypass are prone to copper deficiency and can present with a peripheral neuropathy and myelopathy that can be confused with B12 deficiency.
Don’t forget about the elderly patient who has just sustained a hip fracture. We are quick to start a bisphosphonate but forget to ensure adequate vitamin D stores before doing so ( check the 25 hydroxy vitamin D level, not the 1,25 vitamin D OH level). I empirically load these patients with at least 100,000 units vit D while inpatient.
Alternative therapies have become very attractive as treatments for a variety of medical conditions. While it is true that no treatment is without risk, medical professionals are particularly unsure as to the safety of many of these products. People are essentially self-medicating, without the proper knowledge of the substances that they are using. Good nutrition uses a number of these substances in limited amounts. Most times, when nutrients are consumed in their natural form in food, they are considered safe. However, when we start to consume mega doses of these nutrients in addition to our regular diet we can create some potential risks. Supplements promise to slow aging, improve memory, clean kidneys, protect the heart, and even prevent cancer, and there is evidence that some herbs, vitamins, and minerals do help. Folic acid, Calcium, garlic, and ginger are just a few of these beneficial supplements. However, there are a large number of other products that have few, if any, reports of substantial data to support their claims of health benefits. These products are sold with very little information as to the potential side effects, or even how the product works.
Dietary supplements came into their greatest popularity when Congress shielded them from government oversight in 1994. They are able to be sold without prior certification or purity inspections. The law prohibited supplements from advertising that they directly treat or prevent disease, but allowed them to boast vague claims of "supporting bodily functions". This law has been enabling the sale of billions of dollars in sales of supplements until recently. A presidential commission called last fall for changes to clear the confusion, urging the FDA to aggressively review herbal supplements, clearly labeling those that work with some benefit to the user.
Just remember: "natural" does not necessarily mean "safe".
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