Vitamins

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Endocrine Opinion on Vitamins and Supplements

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The message is simple: Most supplements do not prevent chronic disease or death, their use is not justified and they should be avoided. Additionally there is little to no oversight as to what is actually within supplements so buyer beware. If you ask Dr. Jogi an opinion about any Vitamin or Supplement, the answer will always be the same, "I cannot advise and I would not recommend it in general".
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Good documentary on this subject: https://www.vitamaniathemovie.com/
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Dr. Jogi Book -Reading Recommendation
Title: How Not to Die
Author: Dr. Michael Greger
Expection: Read it (available on Kindle and audiobook) and as part of your treatment plan, feel free to submit to Dr. Jogi a written report via patient portal
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Some general recommendations
  1.  Most women - vitamin D3 1000 units once per night to prevent bone loss, to keep blood vitamin D -25 levels more than 30 and less than 80
  2. Vegetarians/Vegans - Vitamin B12 1000 units three times a week to prevent pernicious anemia.
  3. Planning pregnancy - folic acid prevents neural tube defects. Talk to your gynecologist
  4. Not eating 1-2 fruits per day? You are at risk for Scurvy, even if you receive enough calories. Suggest Vitamin C alone, low doses per day
  5. All humans (without kidney problems and those not on certain blood thinners)- eat your vitamins. We recommend at least 10 servings (this is approximately 5 cooked cups) of fruits and veggies PER DAY for maximum benefits
  6. Patients that have had any kind of gastric weight loss procedure (gastric bypass, sleeve, band, etc) or have intestinal absorption issues/pancreas exocrine deficiency need to consult with their gastroenterologist about proper vitamin supplementations since their requirements will be dramatically different than the average person
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There are numerous well-done studies that show supplementing the diet of well-nourished adults with most mineral or vitamin supplements has no clear benefit and might even be harmful.
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EXAMPLES OF HARM:
Beta-carotene and vitamin E- negative effects on lung cancer and mortality and bleeding risk
The Vitamin C - which started with a suggestion from chemist Linus Pauling made in the 1970s and has peaked with Airborne and Emergen-C - is just hype. Study after study has shown that Vitamin C does little to nothing to prevent the common cold. Plus, megadoses of 2,000 milligrams or more can raise your risk of painful kidney stones.

Vitamin B3 was promoted to treat everything from Alzheimer's to heart disease. But recent studies have called for an end to the over-prescription of the nutrient. A large 2014 study of more than 25,000 people with heart disease found that putting people on long-acting doses of Vitamin B3 to raise their levels of 'good', or HDL, cholesterol didn't reduce the incidence of heart attacks, strokes, or deaths. Plus, people in the study who took the B3 supplements were more likely than those taking a placebo to develop infections, liver problems, and internal bleeding.
Probiotics - pricey bacterial supplements that can cost upward of $1 per pill but are found naturally in smaller amounts in yogurt and other fermented foods. The idea behind them is simple: Support the trillions of bacteria blossoming in our gut which we know play a crucial role in regulating our health. But putting that idea into actual practice has been a bit more complicated. The science is not there yet. Some probiotics may be helpful in one type of patient population but harmful for others. So far, the effects of probiotics have been all over the map. Sometimes they help, sometimes they don't. MAKE YOUR OWN YOGURT AT HOME.
Fat Soluble Vitamins can be dangerous in excess- Buildup of vitamin A, K, E, or D all of which are necessary in low levels can cause problems with your heart and kidneys, and can even be fatal in some cases. 

Desiccated Thyroid Hormone
Armour Thyroid, which is dried pig thyroid glandular tissue, is considered by many to be an alternative treatment to synthetic levothyroxine. Many patients consider this product to be natural, and therefore, better. In truth, however, there are very few studies to support the use of desiccated thyroid hormone in preference to levothyroxine for hypothyroidism. A study from Poland in 1989 compared desiccated thyroid hormone to levothyroxine and found that dried thyroid hormone is ineffective in treating hypothyroidism. In clinical practice, the consistency of this medication is poorly reproducible. This includes Armour thyroid, Naturethroid, etc. 

Iodine
This is an essential element required for thyroid hormone production. Severe iodine deficiency during pregnancy and early infancy can lead to mental retardation. Although iodine deficiency is uncommon in the United States, overall iodine intake is decreasing and actually may not be adequate for pregnant and lactating women. Excess iodine supplementation can cause thyroid dysfunction as well. The American Thyroid Association recommends supplementing 150mcg per day and encourages manufacturers of prenatal vitamins to include iodine. Many patients try taking extra kelp which is known to be rich in iodine. A study by Clark, et al. in 2003 randomized 36 normal thyroid patients to either a placebo, low-, or high-dose kelp. They found a dose-related increase in serum TSH in patients taking the kelp supplements, thus kelp supplements are not recommended since they seem to worsen hypothyroidism. Another study by Amster, et al. in 2007 showed there is potential arsenic toxicity when using herbal over-the-counter kelp supplementation. 

Tyrosine
Thyroid hormone is composed of iodinated tyrosine residues. Therefore, some have suggested that taking tyrosine may increase thyroid hormone levels. Some internet sources claim these L-tyrosine supplements can boost thyroid hormone levels. There is one study in a small journal Palinkas LA et. Al from 2007 that indirectly evaluated this supplement. They found tyrosine leads to a significant reduction in serum TSH and improvement in mood in winter compared with placebo, while the combined T4-T3 supplement leads to a worsening of mood in summer and no improvement in winter.

Selenium
The thyroid gland has a large concentration of the element selenium. Selenium deficiency is associated with cancer, impaired immune function, neurodegenerative and age-related disorders and disturbances of the thyroid hormone axis. This medication is considered beneficial for some patients with thyroid disease based on a small study by Gartner et al in 2002 that showed a reduction in thyroid antibodies. This was later followed by a study by Negro et al in 2007 screened 2000 pregnant women to show that women randomized to selenium had lower antibody levels and there was a reduction in postpartum thyroiditis. In 2008 a well designed study by Karanikas et al did not show any benefit of selenium in autoimmune thyroid disease. In a study in 2010 by MacFarquhar et al, the FDA found supplements labeled as 200 mcg/ounce actually contained 200 times the labeled concentration. Two hundred of these patients developed selenium poisoning within two weeks; diarrhea (78%), fatigue (75%), hair loss (72%), joint pain (70%), nail discoloration or brittleness (61%), and nausea (58%) 

Zinc
Bucci el al in 1999 showed that zinc sulfate imporved TSH levels in Down Syndrome patients who had nonautoimmune hypothyroidism and low zinc levels. This is the only study that has studied zinc in terms of thyroid disease.
Vitamin A
Deficiency in vitamin A causes thyroid gland hypertrophy and reduces thyroid hormone production. There are small studies in children that show thyroid function improves in patients who receive vitamin A supplementation. There is a narrow therapeutic index for vitamin A levels and excess ingestion can lead to vitamin A toxicity; bleeding, fractures, hair loss, and liver disease. 

Iron
In animals, iron deficiency reduces thyroid hormone metabolism. In areas of the world with endemic iron deficiency, iron supplementation can improve TSH values. 

Soy
Soy does cause malabsorption of levothyroxine hormone when it is taken as an oral treatment for hypothyroidism. Soy should be separated from thyroid hormone by at least 4 hours. There is a long list of foods that also prevent proper absorption of thyroid hormone from the gut. Most clinical trials show that soy does not cause any thyroid problems in patients with normal thyroid function. 

Herbs
There are no clinical data to prove that herbs are useful in the treatment of hypothyroidism. There is a long list of herbs found over the counter for the possible treatment of hypothyroidism. Coleus foreskohlii, fucus vesiculosus, guggol, hawthorne, ginseng, astragalus, bitter melon, bupleurum, scullcap, corydalis, dong quai, eluthero, fo-ti, hypericium, green teal, licorice, ligustrum, maitake, reishi, schisandra, shitake, sweet annie, garlic, ginko biloba, horseradish, equisetum arvense, avena sativa, centella asiatica.
AACE/American Thyroid Association guidelines

Iodine supplementation, including kelp, should not be used in the management of hypothyroidism
Kelp should not be used in the treatment of iodine deficiency in pregnant women
Although selenium supplementation may affect the course of autoimmune thyroiditis, it should not be used to prevent or treat hypothyroidism until proven safe.
Patients taking dietary supplements for hypothyroidism should realize that commercially available thyroid-enhancing products are not meant to treat the disease and may have significant side effects.
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