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Vitamin A is a fat-soluble vitamin with four major functions in the body: (1) It helps cells reproduce normally—a process called differentiation (cells that have not properly differentiated are more likely to undergo pre-cancerous changes). (2) It is required for vision; vitamin A maintains healthy cells in various structures of the eye and is required for the transduction of light into nerve signals in the retina. (3) It is required for normal growth and development of the embryo and fetus, influencing genes that determine the sequential development of organs in embryonic development. (4) It may be required for normal reproductive function, with influences on the function and development of sperm, ovaries and placenta.
Where is it found?
Liver, dairy products, and cod liver oil are good sources of vitamin A. Vitamin A is also available in supplement form.
Vitamin A has been used in connection with the following conditions (refer to the individual health concern for complete information):
Who is likely to be deficient?
People who limit their consumption of liver, dairy foods, and beta-carotene-containing vegetables can develop a vitamin A deficiency. Extremely low birth weight babies (2.2 pounds or less) are at high risk of being born with a deficiency, and vitamin A shots given to these infants have been reported in double-blind research to reduce the risk of lung disease.1 The earliest deficiency sign is poor night vision. Deficiency symptoms can also include dry skin, increased risk of infections, and metaplasia (a precancerous condition). Severe deficiencies causing blindness are extremely rare in Western societies.
Less severe deficiencies are more likely to occur with a variety of conditions causing malabsorption. A high incidence of vitamin A deficiency in people infected with HIV has also been reported. People with hypothyroidism have an impaired ability to convert beta-carotene to vitamin A.2 3 For this reason, some doctors suggest taking supplemental vitamin A (perhaps 5,000–10,000 IU per day) if they are not consuming adequate amounts in their diet.
Very old people with type 2 diabetes have shown a significant age-related decline in blood levels of vitamin A, irrespective of their dietary intake.4
How much is usually taken?
For most people, up to 25,000 IU (7,500 mcg) of vitamin A per day is considered safe. However, people over age 65 and those with liver disease should probably not supplement with more than 15,000 IU per day, unless supervised by a doctor. In women who could become pregnant, the maximum safe intake is being re-evaluated. However, less than 10,000 IU (3,000 mcg) per day is generally accepted as safe. There is concern that larger intakes could cause birth defects. Whether the average person would benefit from vitamin A supplementation remains unclear.
Are there any side effects or interactions?
Since a 1995 report from the New England Journal of Medicine,5 women who are or could become pregnant have been told by doctors to take less than 10,000 IU (3,000 mcg) per day of vitamin A to avoid the risk of birth defect. A recent report studied several hundred women exposed to 10,000–300,000 IU (median exposure of 50,000 IU) per day.6 Three major malformations occurred in this study, but all could have happened in the absence of vitamin A supplementation. Surprisingly, no congenital malformations happened in any of the 120 infants exposed to maternal intakes of vitamin A that exceeded 50,000 IU per day. In fact, the high-exposure group had a 50% decreased risk for malformations compared with infants not exposed to vitamin A. The authors noted that some previous studies found no link between vitamin A and birth defects, and argued the studies that did find such a link suffered from various weaknesses. A closer look at the recent study reveals a 32% higher than expected risk of birth defects in infants exposed to 10,000–40,000 IU of vitamin A per day, but paradoxically a 37% decreased risk for those exposed to even higher levels. This suggests that both “higher” and “lower” risks may have been due to chance.
Excessive dietary intake of vitamin A has been associated with birth defects in humans in fewer than 20 reported cases over the past 30 years.7 8 Presently, the level at which vitamin A supplementation may cause birth defects is not known, though combined human and animal data suggest that 30,000 IU per day should be considered safe.9 Women who are or who could become pregnant should consult with a doctor before supplementing with more than 10,000 IU per day.
Vitamin A supplements can both help and hurt children. Many people have heard that vitamin A supplements support immune function and prevent infections. This is true under some circumstances. However, vitamin A can also increase the risk of infections, according to the findings of a double-blind trial.10 In a study of African children between six months and five years old, a 44% reduction in the risk of severe diarrhea was seen in those children given four 100,000–200,000 IU applications of vitamin A (the lower amount for those less than a year old) during an eight-month period. On further investigation, the researchers discovered that the reduction in diarrhea occurred only in children who were very malnourished. For children who were not starving, vitamin A supplementation actually increased the risk of diarrhea compared with the placebo group. The vitamin A-supplemented children also had a 67% increased risk of coughing and rapid breathing, signs of further lung infection, although this problem did not appear in children infected with AIDS. These findings should be of concern to American parents, whose children are not usually infected with AIDS or severely malnourished. Such relatively healthy children fared poorly in the African trial in terms of both the risk of diarrhea and the risk of continued lung problems. Vitamin A provided no benefit to the well-nourished kids. Therefore, it makes sense to not give vitamin A supplements to children unless there is a special reason to do so, such as the presence of a condition causing malabsorption (e.g., celiac disease).
In a study of people with retinitis pigmentosa (a degenerative condition of the eye), participants received 15,000 IU of vitamin A per day for 12 years with no signs of adverse effects or toxicity.11 For other adults, intake above 25,000 IU (7,500 mcg) per day can—in rare cases—cause headaches, dry skin, hair loss, fatigue, bone problems, and liver damage.12 At higher levels (for example 100,000 IU per day) these problems become more common.
A controlled clinical trial showed that people who took 25,000 IU of vitamin A per day for a median of 3.8 years had an 11% increase in triglycerides, a 3% increase in total cholesterol and a 1% decrease in HDL cholesterol compared to those who did not take vitamin A.13 Although the significance of these findings is not clear, people at risk for cardiovascular disease should use caution when considering long-term vitamin A supplementation.
One study found that increasing the intake of vitamin A in the diet was associated with bone loss and risk of hip fracture, possibly due to a vitamin A-induced stimulation of cells that break down bone.14 In this study, a vitamin A intake greater than 5,000 IU per day, when compared to a lower intake, was associated with a reduction in bone mineral density that approximately doubles the risk of hip fracture. Beta-carotene (which can be used by the body to make vitamin A) has not been linked to reduced bone mass. Until more is known, people concerned about osteoporosis may consider taking beta-carotene supplements rather than supplementing with vitamin A.
Data from test tube, animal, and human studies show that excessive vitamin A intake can accelerate bone loss and inhibit formation of new bone, increasing the risk of osteoporosis.15 In humans, small studies have found these effects at about 85,000–125,000 IU per day. 16 17
Taking vitamin A and iron together helps overcome iron deficiency more effectively than iron supplementation alone.18 Supplementation with zinc, iron, or the combination has been found to improve vitamin A status among children at high risk for deficiency of the three nutrients.19
Are there any drug interactions?
Certain medicines may interact with vitamin A. Refer to drug interactions for a list of those medicines.
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 Beta Carotene (Vitamin A) -Beta-carotene is a substance from plants that the body converts into vitamin A. It also acts as an antioxidant and an immune system booster.
Where is it found?
Dark green and orange-yellow vegetables are good sources of beta-carotene. It is also available in supplements.
Who is likely to be deficient?
People who limit their consumption of beta-carotene-containing vegetables could be at higher risk of developing a vitamin A deficiency. However, because beta-carotene is not an essential nutrient, true deficiencies do not occur. Nevertheless, very old persons with type 2 diabetes have shown a significant age-related decline in blood levels of carotenoids, irrespective of their dietary intake.
Most beta-carotene in supplements is synthetic, consisting of only one molecule called all trans beta-carotene. Natural beta-carotene, found in food, is made of two molecules,all trans beta-carotene and 9-cis beta-carotene.
Researchers originally saw no meaningful difference between natural and synthetic beta-carotene. This view was questioned when the link between beta-carotene-containing foods (all natural) and lung cancer prevention was not duplicated in studies using synthetic pills. In smokers, synthetic beta-carotene has apparently caused an increased risk of lung cancer and disease of the blood vessels in double-blind research. Animal research has begun to identify the ways in which synthetic beta-carotene might cause damage to lungs, particularly when animals are exposed to cigarette smoke.
Much of natural beta-carotene is in the all trans molecule form, the same as synthetic beta-carotene. Moreover, much of the 9-cis molecule found only in natural beta-carotene is converted to the synthetic molecule before it reaches the bloodstream. Also, absorption of 9-cis beta-carotene appears to be poor, though some researchers question this finding.
Despite the overlap between natural and synthetic forms, natural beta-carotene may possibly have activity that is distinct from the synthetic form. For example, studies in both animals and humans have shown that the natural form has antioxidant activity that the synthetic form lacks. Also, in one trial, pre-cancerous changes in people reverted to normal tissue with natural beta-carotene supplements, but not with synthetic supplements. Israeli researchers have investigated whether the special antioxidant effects of natural beta-carotene might help people suffering from asthma attacks triggered by exercise. People with asthma triggered by exercise were given 64 mg per day of natural beta-carotene for one week. In that report, 20 of 38 patients receiving natural beta-carotene were protected against exercise-induced asthma. However, because synthetic beta-carotene was not tested, the difference between the activity of the two supplements cannot be deduced from this report.
Increasingly, doctors are recommending that people supplement only with natural beta-carotene. However, no studies have explored whether the adverse effect of synthetic beta-carotene in cigarette smokers would also occur with natural beta-carotene supplementation. Until more is known, smokers should avoid all beta-carotene supplements and others should avoid synthetic beta-carotene.
In supplements, the natural form can be identified by the phrases "from D. salina,""from an algal source,""from a palm source," or as "natural beta-carotene" on the label. The synthetic form is identified as "beta-carotene."
How much is usually taken?
The most common beta-carotene supplement intake is probably 25,000 IU (15 mg) per day, though some people take as much as 100,000 IU (60 mg) per day. Whether the average person would benefit from supplementation with beta-carotene remains unclear.
Are there any side effects or interactions?
Beta-carotene supplementation, even in very large amounts, is not known to cause any serious side effects, however, excessive intake (more than 100,000 IU, or 60 mg per day) sometimes gives the skin a yellow-orange hue. People taking beta-carotene for long periods of time should also supplement with vitamin E, as beta-carotene may reduce vitamin E levels.18 Beta carotene supplementation may also decrease blood levels of lutein, another carotenoid.
Warning: Synthetic beta-carotene has now been linked to increased risk of lung cancer in smokers. Until more is known, smokers should avoid all beta-carotene supplements.
Preliminary studies in animals indicate that beta-carotene supplementation, when combined with heavy alcohol consumption, may enhance liver toxicity. Until more is known, alcoholics and persons who consume alcohol on a daily basis should avoid supplementing with beta-carotene.
One study showed a slightly increased risk of vascular surgery among people with intermittent claudication who took beta-carotene supplements. Until more is known, persons wishing to use beta-carotene supplements should first consult with their doctor.
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Vitamin B2 is a water-soluble vitamin needed to process amino acids and fats, activate vitamin B6 and folic acid, and help convert carbohydrates into the fuel the body runs on—adenosine triphosphate (ATP). Under some conditions, vitamin B2 can act as an antioxidant.
Where is it found?
Dairy products, eggs, and meat contain significant amounts of vitamin B2. Leafy green vegetables, whole grains, and enriched grains contain some vitamin B2.
Who is likely to be deficient?
Vitamin B2 deficiency can occur in alcoholics. Also, a deficiency may be more likely in people with cataracts1 2 or sickle cell anemia.3 In developing countries, vitamin B2 deficiency has been found to be a risk factor for the development of preeclampsia in pregnant women.4 People with chronic fatigue syndrome may be deficient in vitamin B2.5
How much is usually taken?
The ideal level of intake is not known. The amounts found in many multivitamin supplements (20–25 mg) are more than adequate for most people.
Are there any side effects or interactions?
At supplemental and dietary levels, vitamin B2 is nontoxic.
Vitamin B2 works with vitamin B1, vitamin B3, and vitamin B6. For that reason, vitamin B2 is often taken as part of a B-complex supplement.
Are there any drug interactions?
Certain medicines may interact with vitamin B2. Refer to drug interactions for a list of those medicines.
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   B2 100 mg. 100 caps. $2.99 Vitamin B6 is the master vitamin for processing amino acids—the building blocks of all proteins and some hormones. Vitamin B6 helps to make and take apart many amino acids and is also needed to make the hormones, serotonin, melatonin, and dopamine.
Where is it found?
Potatoes, bananas, raisin bran cereal, lentils, liver, turkey, and tuna are all good sources of vitamin B6.
Who is likely to be deficient?
Vitamin B6 deficiencies are thought to be very rare. Vitamin B6 deficiency can cause impaired immunity, skin lesions, and mental confusion. A marginal deficiency sometimes occurs in alcoholics, patients with kidney failure, and women using oral contraceptives. Some doctors believe that most diets do not provide optimal amounts of this vitamin. People with kidney failure have an increased risk of vitamin B6 deficiency.1 Vitamin B6 has also been reported to be deficient in some people with chronic fatigue syndrome.2
How much is usually taken?
The most common supplemental intake is 10–25 mg per day. However, high amounts (100–200 mg per day or even more) may be recommended for certain conditions.
Are there any side effects or interactions?
Vitamin B6 is usually safe, at intakes up to 200 mg per day in adults.3 However, neurological side effects can sometimes occur at that level.4 Levels higher than 200 mg are more likely to cause such problems. Vitamin B6 toxicity can damage sensory nerves, leading to numbness in the hands and feet as well as difficulty walking. The National Academy of Sciences performed an analysis of vitamin B6 studies. They determined the safe upper limit for long-term use is 100 mg per day. However, under supervision of a healthcare professional, up to 200 mg per day of vitamin B6 can be safely taken by most men and nonpregnant women for limited periods of time. Pregnant and breast-feeding women should not take more than 100 mg of vitamin B6 per day without a doctor’s supervision.
Since vitamin B6 increases the bioavailability of magnesium, these nutrients are sometimes taken together.
Are there any drug interactions?
Certain medicines may interact with vitamin B6. Refer to drug interactions for a list of those medicines.
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Vitamin B Complex The vitamin B-complex refers to all of the known essential water-soluble vitamins except for vitamin C. These include thiamine(vitamin B1), riboflavin (vitamin B2), niacin (vitamin B3), pantothenic acid (vitamin B5), pyridoxine (vitamin B6, biotin, folic acid and the cobalamins (vitamin B12).
"Vitamin B" was once thought to be a single nutrient that existed in extracts of rice, liver, or yeast. Researchers later discovered these extracts contained several vitamins, which were given distinguishing numbers. Unfortunately, this has led to an erroneous belief among non-scientists that these vitamins have a special relationship to each other. Further adding to confusion has been the "unofficial" designation of other substances as members of the B-complex, such as choline, inositol, and para-aminobenzoic acid (PABA), even though they are not essential vitamins.
Each member of the B-complex has a unique structure and performs unique functions in the human body. Vitamins B1, B2, B3, and biotin participate in different aspects of energy production, vitamin B6 is essential for amino acid metabolism, and vitamin B12 and folic acid facilitate steps required for cell division. Each of these vitamins has many additional functions. However, contrary to popular belief, no functions require all B-complex vitamins simultaneously.
Human requirements for members of the B-complex vary considerably,from 3 mcg per day for vitamin B12 to 18 mg per day for vitamin B3 in adult males, for example. Therefore, taking equal amounts of each one,as provided in many B-complex supplements,makes little sense. Furthermore, there is little evidence supporting the use of megadoses of B-complex vitamins to combat everyday stress, boost energy, or control food cravings, unless a person has a deficiency of one or more of them. Again, contrary to popular belief, there is no evidence indicating people should take all B vitamins to avoid an imbalance when one or more individual B vitamin is taken for a specific health condition.
Most multivitamin-mineral products contain the B-complex along with the rest of the essential vitamins and minerals. Since they are more complete than B-complex vitamins alone, multiple vitamin-mineral supplements are recommended to improve overall micronutrient intake and prevent deficiencies.
Are there any side effects or interactions?
Vitamin B-complex includes several different components, each of which has the potential to interact with drugs. It is recommended that you discuss the use of vitamin B-complex and your current medication(s) with your doctor or pharmacist.
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Vitamin B1 is is a water-soluble vitamin needed to process carbohydrates, fat, and protein. Every cell of the body requires vitamin B1 to form the fuel the body runs on—adenosine triphosphate (ATP). Nerve cells require vitamin B1 in order to function normally.
Where is it found?
Wheat germ, whole wheat, peas, beans, enriched flour, fish, peanuts, and meat are all good sources of vitamin B1.
Who is likely to be deficient?
A decline in vitamin B1 levels occurs with age, irrespective of medical condition.1 Deficiency is most commonly found in alcoholics, people with malabsorption conditions, and those eating a very poor diet. It is also common in children with congenital heart disease.2 People with chronic fatigue syndrome may also be deficient in vitamin B1.3 4 Individuals undergoing regular kidney dialysis may develop severe vitamin B1 deficiency, which can result in potentially fatal complications.5 Persons receiving dialysis should discuss the need for vitamin B1 supplementation with their physician.
How much is usually taken?
While the ideal intake is uncertain, one study reported the healthiest people consumed more than 9 mg per day.6 The amount found in many multivitamin supplements (20–25 mg) is more than adequate for most people.
Vitamin B1 is nontoxic, even in very high amounts.
Are there any side effects or interactions?
Vitamin B1 works hand in hand with vitamin B2 and vitamin B3. Therefore, nutritionists usually suggest that vitamin B1 be taken as part of a B-complex vitamin or other multivitamin supplement.
Are there any drug interactions?
Certain medicines may interact with vitamin B1. Refer to drug interactions for a list of those medicines.
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Vitamin B12 is is a water-soluble vitamin needed for normal nerve cell activity, DNA replication, and production of the mood-affecting substance SAMe (S-adenosyl-L-methionine). Vitamin B12 acts with folic acid and vitamin B6 to control homocysteine levels. An excess of homocysteine is associated with an increased risk of heart disease, stroke, and potentially other diseases such as osteoporosis and Alzheimer’s disease.
Where is it found?
Vitamin B12 is found in all foods of animal origin, including dairy, eggs, meat, poultry, and fish. According to one report, small, inconsistent amounts occur in seaweed (including nori and chlorella) and tempeh.1 Many researchers and healthcare professionals believe that people cannot rely on vegetarian sources to provide predictably sufficient quantities of vitamin B12. However, another study found substantial amounts of vitamin B12 in nori (at least 55 mcg per 100 grams of dry weight).2
Who is likely to be deficient?
Vegans (vegetarians who also avoid dairy and eggs) frequently become deficient, though the process often takes many years. People with malabsorption conditions, including those with tapeworm infestation and those with bacterial overgrowth in the intestines, often suffer from vitamin B12 deficiency. Malabsorption of vitamin B12 can also result from pancreatic disease, the effects of gastrointestinal surgery, or various prescription drugs.3
Pernicious anemia is a special form of vitamin B12 malabsorption due to impaired ability of certain cells in the stomach to make intrinsic factor—a substance needed for normal absorption of vitamin B12. By definition, all people with pernicious anemia are vitamin B12-deficient. They require either vitamin B12 injections or oral supplementation with very high levels (1000 mcg per day) of vitamin B12.
Older people with urinary incontinence4 and hearing loss5 have been reported to be at increased risk of B12 deficiency.
Infection with Helicobacter pylori, a common cause of gastritis and ulcers, has been shown to cause or contribute to adult vitamin B12 deficiency. H. pylori has this effect by damaging cells in the stomach that make intrinsic factor—a substance needed for normal absorption of vitamin B12. In one trial, H. pylori was detected in 56% of people with anemia due to vitamin B12 deficiency. Successful eradication of H. pylori led to improved blood levels of B12 in 40% of those infected.6 Other studies have also suggested a link between H. pylori infection and vitamin B12 deficiency.7 8 Elimination of H. pylori infection does not always improve vitamin B12 status. People with H. pylori infections should have vitamin B12 status monitored.
In a preliminary report, 47% of people with tinnitus and related disorders were found to have vitamin B12 deficiencies that may be helped by supplementation.9
HIV-infected patients often have low blood levels of vitamin B12.10
A disproportionate amount of people with psychiatric disorders are deficient in B12.11 Significant vitamin B12 deficiency is associated with a doubled risk of severe depression, according to a study of physically disabled older women.12
A preliminary study found that postmenopausal women who were in the lowest one-fifth of vitamin B12 consumption had an increased risk of developing breast cancer.13
Although blood levels of vitamin B12 may be higher in alcoholics, actual body stores of vitamin B12 in the tissues (e.g., the liver) of alcoholics is frequently deficient.14 15
Low blood levels of vitamin B12 are sometimes seen in pregnant women; however, this does not always indicate a vitamin B12 deficiency.16 The help of a healthcare professional is needed to determine when a true vitamin B12 deficiency exists in pregnant women with low blood levels of the vitamin.
Hydroxocobalamin (a form of vitamin B12) has been recognized for more than 40 years as an effective antidote to cyanide poisoning. It is currently being used in France for that purpose. Because of its safety, hydroxocobalamin is considered by some researchers to be an ideal treatment for cyanide poisoning.17
How much is usually taken?
Most people do not require vitamin B12 supplements. However, vegans should supplement with at least 2 to 3 mcg per day.
People with pernicious anemia are often treated with injections of vitamin B12. However, oral administration of 1,000 mcg per day can be used reliably as an alternative to vitamin B12 injections.18 19 20 21 22
Absorption of vitamin B12 is reduced with increasing age. Some research suggests that elderly people may benefit from 10 to 25 mcg per day of vitamin B12.23 24 25 One study of elderly people with vitamin B12 deficiency suggested that as much as 500 to 1,000 mcg of vitamin B12 per day might be necessary to achieve optimal vitamin B12 status.26 Vitamin B12 status was measured in this study using a sensitive laboratory test (the plasma methylmalonic acid concentration).
When vitamin B12 is used for therapeutic purposes other than correcting a deficiency, injections are usually necessary to achieve results.
Sublingual forms of vitamin B12 are available,27 but there is no proof that they offer any advantage to oral supplements.
Are there any side effects or interactions?
Oral vitamin B12 supplements are not generally associated with any side effects.
Although quite rare, serious allergic reactions to injections of vitamin B12 (sometimes even life-threatening) have been reported.28 29 Whether these reactions are to the vitamin itself, or to preservatives or other substances in the injectable vitamin B12 solution, remains somewhat unclear. Most, but not all, injectable vitamin B12 contains preservatives.
If a person is deficient in vitamin B12 and takes 1,000 mcg or more of folic acid per day, the folic acid supplementation can improve the anemia caused by vitamin B12 deficiency. The effect of folic acid on vitamin B12 deficiency-induced anemia is not a folic acid toxicity. Rather, the folic acid supplementation is acting to correct one of the problems caused by B12 deficiency. The other problems caused by a lack of vitamin B12 (mostly neurological) do not improve with folic acid supplements, and can become irreversible if vitamin B12 is not provided to someone who is vitamin B12 deficient.
Some doctors are unaware that vitamin B12 deficiencies often occur without anemia—even in people who do not take folic acid supplements. This lack of knowledge can delay diagnosis and treatment of people with vitamin B12 deficiencies. This can lead to permanent injury. When such a delayed diagnosis occurs in someone who inadvertently erased the anemia of vitamin B12 deficiency by taking folic acid supplements, the folic acid supplementation is often blamed for the missed diagnosis. This problem is rare and should not occur in people whose doctors understand that a lack of anemia does not rule out a vitamin B12 deficiency. Anyone supplementing 1,000 mcg or more per day of folic acid should be initially evaluated by a doctor before the folic acid can obscure a proper diagnosis of a possible B12 deficiency.
Are there any drug interactions?
Certain medicines may interact with vitamin B12. Refer to drug interactions for a list of those medicines.
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Folic acid is a B vitamin needed for cell replication and growth. Folic acid helps form building blocks of DNA, the body’s genetic information, and building blocks of RNA, needed for protein synthesis in all cells. Therefore, rapidly growing tissues, such as those of a fetus, and rapidly regenerating cells, like red blood cells and immune cells, have a high need for folic acid. Folic acid deficiency results in a form of anemia that responds quickly to folic acid supplementation.
Where is it found?
Beans, leafy green vegetables, citrus fruits, beets, wheat germ, and meat are good sources of folic acid.
Who is likely to be deficient?
Many people consume less than the recommended amount of folic acid. Scientists have found that people with heart disease commonly have elevated blood levels of homocysteine, a laboratory test abnormality often controllable with folic acid supplements. This suggests that many people in Western societies have a mild folic acid deficiency. In fact, it has been suggested that increasing folic acid intake could prevent an estimated 13,500 deaths from cardiovascular diseases each year.1
Folic acid deficiency has also been common in alcoholics, people living at poverty level, those with malabsorption disorders or liver disease (e.g., cirrhosis), and women taking the birth control pill. Recently, elderly people with hearing loss have been reported to be much more likely to be folic acid deficient than healthy elderly people.2 A variety of prescription drugs including cimetidine, antacids, some anticancer drugs, triamterene, sulfasalazine, and anticonvulsants interfere with folic acid.
Deficiency of folic acid can be precipitated by situations wherein the body requires greater than normal amounts of the vitamin, such as pregnancy, infancy, leukemia, exfoliative dermatitis, and diseases that cause the destruction of blood cells.3
The relationship between folic acid and prevention of neural tube defects is partly thought to result from the high incidence of folate deficiency in many societies. To protect against neural tube defects, the U.S. Food and Drug Administration has mandated that some grain products provide supplemental folic acid at a level expected to increase the dietary intake by an average of 100 mcg per day per person. As a result of folic acid added to the food supply, fewer Americans will be depleted compared with the past. In 1999, scientific evidence began to demonstrate that the folic acid added to the U.S. food supply was having positive effects, including a partial lowering of homocysteine levels.4 In the same year, however, a report from the North Carolina Birth Defects Monitoring Program suggested the current level of folic acid fortification has not reduced the incidence of neural-tube defects.5 Many doctors and the Centers for Disease Control in Atlanta6 believe that optimal levels of folic acid intake may still be higher than the amount now being added to food by several hundred micrograms per day. A low blood level of folate has also been associated with an increased risk of miscarriage.7
People with kidney failure have an increased risk of folic acid deficiency.8 Recipients of kidney transplants often have elevated homocysteine levels, which may respond to supplementation with folic acid.9 The usual recommended amount of 400 mcg per day may not be enough for these people, however. Larger amounts (up to 2.4 mg per day) may produce a better outcome, according to one double-blind trial.10
Folate deficiency is more prevalent among elderly African American women than among elderly white women.11
Which form is best?
How much is usually taken?
Many doctors recommend that all women who are or who could become pregnant take 400 mcg per day in order to reduce the risk of birth defects. Some doctors also extend this recommendation to other people in an attempt to reduce the risk of heart disease by lowering homocysteine levels. Since the FDA mandated addition of folic acid to grain products, many people who eat grains have followed the new recommendation of supplementing only 100 mcg of folic acid per day. However, studies have found that this amount of folic acid is inadequate to maintain normal folate levels in a significant percentage of the groups assessed.13 It now appears that, for pregnant women, supplementing with at least 300 mcg (and optimally 400 mcg) of folic acid per day is sufficient to prevent a folate deficiency, even if dietary intake is low.
Are there any side effects or interactions?
With the exception of rare cases of allergic reactions,14 folic acid is not generally associated with side effects.15 However, folic acid supplementation can interfere with the laboratory diagnosis of vitamin B12 deficiency, possibly allowing the deficiency to progress undetected to the point of irreversible nerve damage.16 Although vitamin B12 deficiency is uncommon, no one should supplement with 1,000 mcg or more of folic acid without consulting a doctor.
Vitamin B12 deficiencies often occur without anemia (even in people who do not take folic acid supplements). Some doctors do not know that the absence of anemia does not rule out a B12 deficiency. If this confusion delays diagnosis of a vitamin B12 deficiency, the patient could be injured, sometimes permanently. This problem is rare and should not happen with doctors knowledgeable in this area using correct testing procedures.
Folic acid is needed by the body to utilize vitamin B12. Proteolytic enzymes inhibit folic acid absorption.17 People taking proteolytic enzymes are advised to supplement with folic acid.
Are there any drug interactions?
Certain medicines may interact with folic acid. Refer to drug interactions for a list of those medicines.
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Pantothenic acid, also called vitamin B5, is a water-soluble vitamin involved in the Kreb’s cycle of energy production and is needed to make the neurotransmitter acetylcholine. It is also essential in producing, transporting, and releasing energy from fats. Synthesis of cholesterol (needed to manufacture vitamin D and steroid hormones) depends on pantothenic acid. Pantothenic acid also activates the adrenal glands.1 Pantethine—a byproduct of pantothenic acid—has been reported to lower blood levels of cholesterol and triglycerides.
Where is it found?
Liver, yeast, and salmon have high concentrations of pantothenic acid, but most other foods, including vegetables, dairy, eggs, grains, and meat, also provide some pantothenic acid.
Who is likely to be deficient?
Pantothenic acid deficiencies may occur in people with alcoholism but are generally believed to be rare.
How much is usually taken?
Most people do not need to supplement with pantothenic acid. However, the 10–25 mg found in many multivitamin supplements might improve pantothenic acid status. So-called primitive human diets provided greater amounts of this nutrient than is found in modern diets. Most cholesterol researchers using pantethine have given people 300 mg three times per day (total 900 mg).
Are there any side effects or interactions?
No serious side effects have been reported, even at intakes of up to 10,000 mg (10 grams) per day. Very large amounts of pantothenic acid (several grams per day) can cause diarrhea.
Pantothenic acid works together with vitamin B1, vitamin B2, and vitamin B3 to help make the fuel our bodies run on—ATP.
There is one report of a 76-year-old woman who developed a life-threatening condition (eosinophilic pleuropericardial effusion) while taking 300 mg of pantothenic acid per day and 10 mg of biotin per day.2 However, it is not clear whether the vitamins caused the problem.
Are there any drug interactions?
Certain medicines may interact with pantothenic acid. Refer to drug interactions for a list of those medicines.
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 Pantothenic Acid 500mg. 250 caps. $8.99
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Cut & clean
Place broccoli in a colander and rinse thoroughly under cool running water. Unless stalks are especially tender, cut off the thick base and peel them. Cut heads into florets.
Skip the heat
Raw broccoli is great tossed in salad or in veggie platters with dips.
Power food
Broccoli is an excellent source of vitamins C and A, and a good source of folic acid.
For your next salad...
Blanch broccoli in boiling water for two minutes, then drain and rinse immediately with cold water to capture the color and develop great flavor.
Best to buy
Look for firm, bright carrots without cracks on the sides or sprouts where the green tops have been removed.
Cut & clean
If desired, peel just before cooking—or, to retain more juices and nutrients, try scrubbing instead. To preserve their natural sugars and sweet flavor, cook carrots in as little liquid as possible.
Power food
Carrots are an excellent source of vitamin A.
Quick & easy recipe: veggie roast
Cut carrots diagonally and combine with diced turnips, potatoes, and onions. Toss with olive oil and rosemary, and bake at 400°F (200°C) until tender.
Best to buy
Kale is available year-round, but it shines as a cold-weather crop and is at its most flavorful and tender in the winter months.
Cut & clean
Thoroughly clean kale by dunking it in tepid water several times and then rinsing under cold running water.
Power food
Kale is an excellent source of vitamins C and A.
Quick & easy recipe
Sauté kale in a little olive oil for 5 minutes over medium heat. Turn down the heat and add garlic, fresh lemon juice, and toasted sesame oil; stir for another 5 minutes.
Best to buy
Look for tightly packed heads with fresh, green leaves that show no sign of wilting or blemishes. Wrap in paper towel and store in plastic in the refrigerator for up to five days.
Cut & clean
Just before using, remove the leaves, rinse in cold water, and spin or pat dry.
Power food
Romaine lettuce is a good source of vitamins C and A.
Quick & zesty salad
Break into bite-sized pieces by hand and toss with seasoned croutons, asiago cheese, tomatoes, and Caesar dressing.
Cut & clean
Trim the base and wash thoroughly in a large bowl of water. Swish the leaves, change the water, and repeat rinsing until water is clear.
In the raw
Baby spinach is best for salads. Toss with bleu cheese, walnuts, red onions, and a vinaigrette dressing.
Power food
Spinach is an excellent source of vitamin A and a good source of vitamin C and folic acid.
Quick & easy recipe
Place clean spinach in a pan with a little olive oil, garlic, salt, and pepper, and cover and simmer until it wilts—usually 2 to 4 minutes.
Whether roasted, sautéed, steamed, or baked, peppers make any dish divine
Cut & clean
Wash peppers just before using; remove the stem, seeds, and interior membranes. Sauté, steam, or bake and add to salads, soups, or stir-fries. Store peppers in a plastic bag in the refrigerator for up to five days.
Power food
Sweet peppers are an excellent source of vitamin C and vitamin A.
Super-simple roasted peppers
Broil peppers close to an open flame or heat source, rotating until they blacken evenly. Put charred peppers in a plastic bag for about ten minutes, pull off the blackened peels, and rinse under cold water. Pat dry, remove seeds and stems, slice, and use in salads, or purée for soups.
Best to buy
Tomatoes should be firm and juicy with bright, unblemished skin. Choose those that have a deep color and give a little when squeezed. And remember: a ripe tomato smells like a tomato; unripe ones have no aroma.
Cut & clean
Rinse tomatoes before using. Quick tip: To peel, drop into boiling water for one to two minutes. Then remove, dunk briefly in a bowl of ice water, and cut out a small cone around the stem end to slip off the skin.
Power food
Tomatoes are an excellent source of vitamin C and a good source of vitamin A.
Quick & easy recipe
For a simple side, slice tomatoes, drizzle olive oil and balsamic vinegar over the top, and then season with a sprinkle of sea salt.
Cut & clean
Rinse off any remaining dirt and slice as you like! Cut into small pieces using the rind as a handle, or slice, scoop, or cube flesh.
To seed or not to seed
For melons with seeds, cut in half to scoop out seeds and then slice. Or cut in half, then in half again, and slice out seeds at a 45-degree angle.
A sweet snack
Cut in half, slice widthwise, and then halve again for an old-fashioned wedge.
Quick & easy recipe
Cut in half, remove seeds, and use melon-baller to scoop balls or shave delicate slices with knife, and toss with fresh baby romaine, balsamic vinegar, and olive oil.
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