Operations

Dietary Supplements Can Help Providers with a Busy Schedule

Issue 8 and Volume 40.

Most of us know enough about nutrition to know that vitamins and minerals are good things. We read about people who have low energy related to vitamin B12 deficiencies. We see patients with anemia caused by iron deficiencies or broken bones related to calcium deficiencies. We see stories on the news about how we’re overfed and undernourished—that is, we’re told we’re eating too much of the wrong food and not getting enough nutrients.

Dietary supplements sound like an easy solution to health problems, and they’re often marketed as such. In reality, no supplement is perfect for everyone. It’s important to factor yourself into the equation to figure out what—if anything—you need.

A good rule of thumb is “food first.” A healthy, balanced diet that meets the recommendations of the Dietary Guidelines for Americans will, in general, provide enough vitamins and minerals to meet the needs of a healthy person.1,2 If you know your diet is heavy on fast food and EMS room goodies, you might be able to guess that the foods you eat aren’t meeting those guidelines (which include plenty of fruits and vegetables, whole grains, low-fat dairy and lean protein). The first step is to make some food-based changes—add more fruits and vegetables, choose more whole grains, and incorporate lower-fat dairy and protein whenever possible. Whole foods give you more than just vitamins and minerals. They provide fiber, antioxidants and other health-promoting substances that are most effective when you have the food in its unprocessed form. But if you know your diet isn’t perfect, a supplement could be a good fit for you to try to fill some gaps.1

For most healthy people, a standard multivitamin with minerals is a safe option. This type of multivitamin is affordable and convenient, and it can provide enough of the vitamins and minerals you may be lacking without giving you more than you need. When you’re choosing a multivitamin, consider the following:

>> The basics: Most multivitamins contain vitamins A, C, D and E; vitamin B12 and other B vitamins (thiamin, niacin, riboflavin, B6); folic acid; calcium; magnesium; and iron.

>> The amount: Aim for your multivitamin to provide about 100% of recommended daily values for the elements it contains. For most people, there’s no benefit in taking more than 100%; getting more than that amount from a supplement can potentially be both expensive and dangerous.

>> The formulation: Choose a multivitamin that’s targeted at your sex and age range. These factors impact how much of each element you need—a menstruating woman, for example, needs more iron than a man or a postmenopausal woman.

There can be too much of a good thing when it comes to vitamins and minerals. Many have established upper limits that would be very hard to reach from food alone, but can be exceeded with high doses from supplements. This is particularly true with fat-soluble vitamins A, D, E and K, which are stored in your liver and fatty tissues.3Water-soluble vitamins pose lower risk of toxicity, but there’s still no great benefit to taking in more than 100% of your daily needs. If you take in too much from supplements, your body will most likely excrete the excess, giving you a lighter wallet and very expensive urine.

INDIVIDUAL NEEDS

When it comes to choosing supplements of individual vitamins and minerals, it’s extremely important to tailor them to your needs. The safest choice is to talk with your physician or a dietitian who can help you examine your dietary intake and factor in health conditions that may increase your nutrient needs or cause you to lose more of certain vitamins or minerals. Consider the following factors when choosing a supplement.

Disease conditions: Do you have a known nutrient deficiency? Do you have a disease that inhibits absorption from your gastrointestinal tract, such as celiac disease or short bowel syndrome? Do you have a condition that requires you to limit certain minerals, such as kidney disease (which requires monitoring potassium, magnesium and phosphorous intake)? If any of these is the case, your physician may recommend a supplement that provides more than 100% of the daily value either to replete your stores or to allow for a greater chance of absorbing the minimum amount you need.

Medications: Do you take any medications that interact with vitamins or minerals? If you aren’t sure and you take medications on a daily basis, this is a good question to ask your doctor or pharmacist. Examples include warfarin, which requires consistent daily intake of vitamin K; corticosteroids, which can increase needs for calcium if taken long-term; or proton pump inhibitors, which can interfere with absorption of vitamin B12.

Dietary restrictions: Do you avoid certain food items or food groups? If you restrict certain food groups, you may be cutting out individual nutrients without knowing it. Vegan diets, for example, don’t provide any animal foods, so they are extremely low in vitamin B12.

Calorie restriction: Are you counting calories? If you’re intentionally restricting the amount of food you’re eating, you could unintentionally be cutting down on your food sources of vitamins and minerals. Discuss weight management plans with a professional to ensure you’re making safe, healthy choices.

Risk factors: Are you at risk for nutrient deficiencies or diseases that are impacted by vitamin/mineral status? You can be at risk before becoming symptomatic. If you chain smoke between calls, you might be at risk for vitamin D deficiency, which can contribute to development of osteoporosis. If you drink heavily on your days off, you could be at risk for thiamine deficiency, which can impact nerve and brain function.

EMS CONSIDERATIONS

Another feature that’s important to consider is your job. For many emergency medical personnel, getting a balanced diet full of fresh fruits and vegetables is a noble aspiration but doesn’t always play out as planned. Smoking and drinking aren’t uncommon coping mechanisms, and getting enough sleep isn’t always a reality. If one or more of these factors sounds all too familiar to you, you might benefit from the safety net of a daily multivitamin and individual supplements as recommended by your physician. Make sure you also factor in the hours that you work. Your work schedule plays a role in your health, and it may impact whether you get enough of certain vitamins—particularly vitamin D.

Shift workers are at increased risk for vitamin D deficiency. A major source of vitamin D is sun exposure, which allows for synthesis of vitamin D by the skin. If you work nights and aren’t awake during peak hours of sunlight, you’re probably missing out. Over the long term, low levels of vitamin D can lead to increased risk of heart disease, osteoporosis and some cancers. Night owls can combat these risks by choosing foods fortified with vitamin D, including milk, yogurt, and some brands of breakfast cereals and orange juice. Most healthy shift workers can benefit from a daily vitamin D supplement. A typical daily dose is 500–1,000 IU, but your physician can tell you how much is right for you. You might also consider a vitamin D supplement if you live in a cooler climate and often wear long sleeves, if you have dark skin, or if you regularly wear high-SPF sunscreen.4

Another popular supplement you may have considered is omega-3. In 2007, about 37% of adults were taking omega-3 supplements. Research shows that regularly consuming food sources of omega-3 such as oily fish (e.g., salmon, tuna and trout), flax seed and walnuts has a protective effect against heart disease. The data is less clear on whether supplements have the same effect.5 As with most things, you’re likely to get the best results if you can get your omega-3 from food first. Try to choose fish as an entrée on your days off, incorporate walnuts as an easy on-the-go snack, or include flax seeds or flax seed oil in a breakfast smoothie.

If you aren’t able to incorporate food sources of omega-3 on a regular basis (at least once a week), you might consider an omega-3 supplement. They generally don’t have significant negative side effects; those who do complain of side effects note minor gastrointestinal upset. Be sure to talk to your primary care provider before adding an omega-3 supplement, particularly if you take medications that impact your blood clotting, as omega-3 supplements can have an impact on bleeding time.

CONCLUSION

If you’re juggling a hectic schedule, a highstress job and a haphazard diet, supplements can help fill in where you aren’t getting everything you need. Use them wisely, and remember that they’re meant to supplement, not supplant. Continue to strive for healthy dietary choices, thinking of your supplements as a backup plan rather than a primary solution. Make sure to factor in your lifestyle, work schedule, budget, medical conditions and restrictions. What works for your partner is different from what works for you. Your needs are yours alone.

REFERENCES

1. American Dietetic Association. Position of the American Dietetic Association: Nutrient supplementation. J Am Diet Assoc. 2009;109(12):2073–2085.

2. United States Department of Agriculture and Department of Health and Human Services. (Jan. 11, 2011.) Dietary guidelines for Americans, 2010. Retrieved March 19, 2015, from www.cnpp.usda.gov/DietaryGuidelines.

3. Nelms M, Sucher K, Lacey K, et al. Nutrition therapy and pathophysiology. Wadsworth: Belmont, Calif., 2011.

4. National Institutes of Health Office of Dietary Supplements. (Nov. 10, 2014.) Vitamin D. Retrieved March 25, 2015, fromhttp://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/#h6.

5. United States Department of Health and Human Services. (June 2013.) Omega-3 supplements: An introduction. Retrieved March 19, 2015, fromhttps://nccih.nih.gov/health/omega3/introduction.htm.