Mike Foxworth, 9/30/2022, 10-minute read
People with Peripheral Neuropathy, like people with any chronic health problem, have their antenna up to detect news or claims that something can help them. This makes them high-value targets for those ready to sell stuff. Supplements are a good example.
“If you take supplements, take them seriously.” “These are not risk-free products.”
My Advice: Spend a few dollars to watch the documentary “Vitamania,” source of the above quotes. Go to the movie website and pay your $4. (It may also be available on streaming services, such as Curiosity.)
If, after watching that, you still want to take supplements, protein powders, sports drinks, and promise-the-moon cure-alls, at least find some that have been tested and evaluated by third parties. Consumer Labs sells comparison reports on some of the 85,0000 supplements being sold. It is very common for them to find supplements that do not contain what is advertised or otherwise have bad stuff in them.
Quality in supplements is very hard to achieve, especially supplements with combinations of ingredients, such as multivitamins. USP (United States Pharmacopeia) works to help consumers and manufacturers with a verification and certification program, but, as this article in Scientific American describes, this is far more complex than with a regular single-ingredient medicine.
Bottom Line: Eat
If you have a single well-balanced meal a day and get a modest amount of sunshine every week, you will probably get all the vitamins and minerals your body needs. The planners for astronauts going to Mars will be sending food. But no supplements except Vitamin D (because they will not have access to sunlight inside their capsule)
Humans spread all over the world while getting all the substances they needed from food. It was found that some specific diseases, such as Beri-Beri, rickets, scurvy and pellagra were caused by people living in circumstances that did not give them access to balanced diets. That led to the discovery of vitamins and other chemicals and minerals. Foods that contain these substances also contain many other “micro-nutrients” that are not contained in supplements.
Food is better.
If food is not available or affordable (including millions of Americans and uncounted millions in other countries), supplements are a poor substitute but perhaps better than nothing (if they are what they say they are). The most frequently used supplements are “multivitamins.” They contain a wide variety of substances. There are no standard multivitamins (though USP and FDA do make recommendations for daily requirements from all sources, including food). There is no way to know if any person needs the amounts dispensed in a multivitamin. It seems highly unlikely if the person has anything close to a balanced diet. Because children are a challenge to feed and because many families struggle to afford nutritious food, many parents give their children multivitamins. This hardly seems relevant to adults with PN.
It is very common for processed foods in the US to be “fortified” with certain minerals and vitamins. Milk with vitamin D. Bread and bread flour with vitamin B-9 (folate) to prevent a rare birth defect. For the average consumer, this further weakens the argument in favor of supplements.
The one vitamin that is often cited as needed is vitamin D. It does not take much sun exposure to make enough.
- A massive multiyear study in Australia with 21,000 older participants ended in 2021 that looked at benefit of vitamin D supplements. Their thought was that since cancer patients often have low vitamin D, maybe causation runs from low vitamin D to causing cancer. Or vice versa, perhaps cancer causes low vitamin D. Results are in. Death rate was the same, vitamin D or not. Even the number of bone fractures was the same (supposedly the big benefit of vitamin D). Didn’t help prevent colds or flu either.
- A 5-year study in the US with 25,000 older participants also ended in 2021. It looked at vitamin D and a combination of D and fish oil. Results suggest that the combination reduced the incidence of autoimmune disease, but otherwise did not make much difference. Vitamin D by itself did not make any difference. But it did confirm that being deficient in vitamin D is bad, especially if the person is overweight, since some of the people who were randomized to not take the supplement were probably deficient in their dietary consumption of vitamin D.
Some adults have poor dietary habits or specific diseases or take medicines that rob their bodies of specific nutrients or make it hard to absorb the nutrient from food. They can develop low levels of specific nutrients. Testing can be done that shows such deficiencies. When the testing shows a need, supplements can be very helpful if a dietary change is not possible, effective or acceptable. Vitamin B12 deficiency is a common problem with older adults, caused by a variety of issues, including diet.
Note
It can be difficult to persuade insurance companies to authorize testing for nutrients. Persistence may be required. Again, you are mostly on your own.
Two Types of Vitamins
There are two main types of vitamins:
- Fat soluble, vitamins A, D, E and K. These are especially subject to overdose since excess amounts are not easily excreted.
- Water soluble, vitamin C and the 8 B-vitamins. Excess amounts are usually excreted in urine, but excess amounts can still cause problems. Excess vitamin B-6 is known to cause nerve damage.
- All nutrients (including, but not limited to, vitamins) have toxic levels, that is, levels beyond which they can cause harm. Many have toxic levels that are not much higher than the recommended dose.
- Those risks increase dramatically when a person takes multiple products, especially when combined with multi-vitamins. The technical term is “polypharmacy” There are online tools (drug interaction checkers) you can use to enter the details about what you take. They will generate reports estimating your total intake of various substances and perhaps generate warnings about possible overdosing or interactions. For instance, https://reference.medscape.com/drug-interactionchecker and https://www.drugs.com/drug_interactions.html. They may not have the less popular supplements (and cannot protect you if the supplement label is inaccurate).
You are on Your Own – Your Government’s Not Planning to Help You
Supplements are not regulated by the government in any meaningful way. To be sold,
- They need not contain the ingredients listed on their labels
- They can contain ingredients not listed
- They can contain much less than the listed amounts
- Especially dangerous, they can contain far more than the listed amounts
- They can have amounts far larger than recommended by researchers and agencies like USP
- They can contain ingredients that are known to be dangerous
- They can have poor quality control when manufactured, including introducing contaminants and, as indicated, not the amounts of ingredients claimed
- They can strongly interact with prescription medicines to increase or decrease the effect of those medications or otherwise harm the patient. That is why doctors ask you to list ALL medicines and supplements. That makes poor quality control or inaccurate labeling especially dangerous
- They can make or imply health claims that are not supported by research
- They can say their health claims are supported when they are not. Prevagen is advertised as something to increase memory abilities but is supported by only one small study sponsored by its manufacturer that has been heavily criticized and never supported by third party researchers
- They can cite irrelevant support. For instance, Prevagen is heavily advertised as “#1 Pharmacist Recommended Memory Support” as if pharmacists had some secret source of information about what substances were good for memory
- They can claim to be “natural”. Supplements are made using ingredients manufactured in factories using artificial chemical processes. That is true regardless of the word “natural” on their labels.
Attempts to federally regulate supplements have been defeated. This is mainly because consumers were worried, based on loud cries from the industry, that doing the necessary research and quality control would make the products too expensive. And consumers translated that worry into demands that legislators heard. Seems like a classic case of throwing out baby with the bath water.
That is not to say that companies that do bad things always get away with it. They can be sued and/or punished as criminals. After the damage has been done.
- One guy was a president of USP labs who used his position to cover crimes at a supplement company. Sent to prison for 5 years
- In 2015 an investigation into a bunch of supplements resulted in a huge outcry in New York and bunches of big retailers (Walmart, Target, etc.) pulled lots of stuff off their shelves. For a little while.
Just do not look to the Food and Drug Administration for any help.
But do watch the “Vitamania” movie. And if you still want to take one, cough up the money for a Consumer Labs report on it. It could save your life.
I don’t agree with some of the statements in this article. I take doctor-prescribed MetaNX, a food supplement that has reduced my stabbing, diabetes-caused neuropathic pain from a 8-9 down to a 1-2. It is not a “cure”, but I take no other supplement or medications. Most days I have zero pain. I understand it doesn’t work for everyone, but it sure works for me. Insurance doesn’t cover it, of course, so I pay about $60 amonth. Expensive but, for me, well worth it.