By Joan Haynes, NMD

Fatigue can have many causes, but a fairly easy cause to figure out and treat involves iron. Iron deficiency is an under-recognized cause of fatigue and can be missed on standard lab work.

Symptoms which may be linked to iron depletion are:

• Fatigue
• Poor work productivity
• Poor attention and memory
• Sore tongue
• Poor condition of skin or nails
• Hair loss
• Restless leg syndrome
• Cracks on the corners of mouth
• Pica – cravings for non-foods such as ice or even dirt

Iron does some important things in the body:

• Carries oxygen to tissues
• Needed in the mitochondria which makes energy
• Helps synthesis of thyroid hormone
• Converts tyrosine to dopamine (one of our feel good neurotransmitters)
• Important in immune function

Testing

Most clinics order a CBC (Complete Blood Count) which will pick up the advanced form of iron deficiency anemia with a low hematocrit and/or hemoglobin (the color and volume of your red blood cells). But an earlier form of low iron levels can be detected with a serum ferritin test. The “normal” range for serum ferritin is broad, from 8 – 250 ng/mL, but hair loss, fatigue and other symptoms can occur when the number gets below 90.

Uncover the Cause of the Low Iron

Besides just identifying the problem, we need to discover and address the causes of the iron deficiency. It could be the patient just doesn’t eat enough iron-rich foods, but it could be something more serious. For example: heavy menstrual bleeding, low stomach acid, celiac disease, low B-12 and folate levels, hidden bleeding in the colon (a potential sign of colon cancer), small intestinal bacterial overgrowth (SIBO), chronic disease, inflammation, high lead levels and more.

Iron Supplements

Many people complain about gastrointestinal symptoms when taking supplemental iron, usually the ferrous sulfate form. But there are easier forms to absorb. At Boise Natural Health Clinic we use iron bis-glycinate with Vitamin C, between meals. It can take months for iron levels to come back up.

Iron absorption is inhibited by:

Low stomach acid, acid blocking medication, H. pylori infection, coffee, tea, soy products, wheat bran, wheat gluten, oat, nuts, casein, egg white, whey protein, some herbal teas.

Iron absorption is enhanced by:

Hydrochloric acid and vitamin C

Caution is advised with iron supplementation can be toxic, it is the leading cause of poisoning in children. In general, men and non-menstruating women should not take iron supplements or even a multi with iron in it unless they test low.

If you are suffering with any of the above symptoms, come in for a visit with and we’ll do a thorough health history and run labs to discover if iron deficiency, or something else, could be contributing to you not feeling well.

Joan Haynes, NMD

Did you know that 75% of Americans are chronically dehydrated?   

Here are 5 warning signs and symptoms of chronic dehydration, and tips on optimizing your water intake so you can feel your best all year long.  

1. Fatigue
   Dehydration is the number one cause of daytime fatigue. Dehydration of the tissues causes enzymatic activity to slow down (slowing the metabolism.)
2. Constipation
   When chewed food enters the colon, the body absorbs excess water via the colon walls, allowing the stool to form properly. In chronic dehydration, the body sacrifices the ideal consistency of the stool in order to give water to more vital parts of the body. The result: hard dried out stool that is difficult to pass.
3. Excess weight
   Thirst is often confused with hunger. One glass of water shut down midnight hunger pangs for almost 100% of the dieters studied in a University of Washington study.
4. Pain
   Pain can be a localized sign of dehydration. Headaches are commonly caused by lack of adequate water. Preliminary research indicates that 8-10 eight-ounce glasses of water a day (half of that coming from food and drinks other than plain water) could significantly ease back and joint pain for up to 80% of sufferers.
5. Brain-fog
   A mere 2% drop in body water can trigger fuzzy short-term memory, trouble with basic math, and difficulty focusing on the computer screen or on a printed page. Obvious signs of dehydration include dry mouth, crinkled skin, excessive thirst, or absence of urination for over 6 hours. These are more serious symptoms and need to be corrected immediately.

Tips to Optimize Water Intake

1. How much is enough?
   Thirst is not always a reliable indicator, so it’s good to keep track. Experts disagree on the exact amount of water each person needs. A commonly used calculation is to divide your weight in pounds by two, then convert this figure to ounces, and drink that many ounces of water daily. Example: 150 pounds/2 = 75 ounces of water per day. A simpler version is the 8-10 (8 oz) glasses per day rule. Learn to read your body’s signs, be willing to experiment, and you will find the right amount for yourself.
2. What counts?
   Contrary to popular belief, caffeine is only a mild diuretic so a cup or two of coffee and/or tea can count toward your total fluid intake. Avoid energy drinks that often have huge amounts of caffeine and sugar. Alcohol subtracts from your daily fluid total, as it is a diuretic and will cause dehydration. In general, filtered or spring water is best but if you are having trouble getting it down, consider using some diluted fruit juice or lemon slices to add some flavor.
3. What are the best times to drink?
   Good times to drink water are on rising, at least 1/2 hour before meals and 2-3 hours after. If you don’t like waking at night to urinate, stop drinking after 6 pm.  It is recommended by some health experts that you not drink much water with meals as it is thought to dilute the digestive juices.
4. When is more needed?
   You need more if the temperature is hot or if you exercise. A general rule is to add an extra 2 glasses per day for every 5°F over 85°F if you are at rest, and more if you exercise.
5. What about electrolytes?
   Adding electrolytes is important with exercise, in hot weather, and if you have become dehydrated. Electrolytes increase water absorption, and replace vital minerals lost in sweating. Instead of Gatorade, consider a healthier version called Recharge available in natural food stores. Coconut water is a good (although expensive) option. Another option is to eat salty snacks on heavy exercise days.  Some people hydrate regularly, but still feel thirsty and dehydrated and adding electrolytes work wonders for them.  

Here is my own favorite way to get myself to drink water regularly and to rehydrate if I’ve gotten low:

This tasty drink goes down much easier than water, rehydrates me quickly, relieving muscle tension and headache, and increasing my energy and alertness.

In a quart mason jar or large glass, fill it 80-90% of the way with filtered water.

Fill the remaining 10-20% with Simply Lemonade (or another grocery store lemonade with real lemons and real sugar – you can use other brands or other juices, the little bit of sugar is important to absorb the water more quickly, so don’t use just lemon juice for best effect.)

Add 1/8 – ¼ teaspoon salt (I prefer Celtic sea salt or an electrolyte supplement).   

I find that adding a (reusable) straw and ice in warm weather helps me drink more. 

Joan Haynes, NMD

This article is not intended to tell you which vitamins to buy specifically, but rather how to make an informed decision. You are making a financial choice in your vitamin purchase; choosing the highest quality vitamin makes your purchase worthwhile.

Why do I need to take a multiple vitamin and mineral (MVM) supplement?

In theory, we should be able to receive all the nutrition we need from diet alone. But the fact is that most of us do not.

• Few of us eat the recommended 5 – 8 servings of fresh fruits and vegetables a day.
• Our food is often picked before it is ripe and transported long distances.
• The soil in which our food is grown has become depleted of nutrients.
• We rely on quick, processed foods with our busy lifestyle.
• We live in a highly toxic world.
• We have individual health needs and challenges.

A multiple vitamin and mineral (MVM) supplement does not replace a good diet. There are compounds in food that just can’t be replaced in a pill. Evidence shows that a good diet is still your best tool for staying healthy. However, a good MVM supplement is important insurance for optimal health.

How will I know its working?

You may experience higher energy levels, improved brain function, fewer colds or infections, reduced symptoms and other health benefits, or you may feel nothing.

Just because you may not feel anything doesn’t mean that the higher nutrient levels you are ingesting are not being used by your body. One study has shown that children taking a MVM supplement increased non-verbal intelligence (1). Another has shown that the elderly had significantly fewer infections compared to a placebo group (2). Use of a MVM supplement has also been associated with decreased mortality rates due to cardiovascular disease (3). The evidence for taking a MVM supplement is becoming overwhelming.

How much do I really need to take?

You will notice on supplement bottles the amount of each nutrient followed by the % DV. This number is the percent of the total daily amount recommended by the Federal Drug Administration (FDA). (There are nutrients for which a %DV has not been established.) %DV on labels can be misleading because it is an average amount needed for most healthy people and does not reflect age, gender or health status.

A quality MVM supplement will show a %DV that may exceed or go below 100%. This is because there is a difference between the amount of nutrients needed to ward off illness and the amount needed for “optimum” nutrition. The amounts of nutrients that are recommended by different experts will differ if their goal is to simply avoid signs of nutrient deficiency or if their goal is to allow a person to function at the highest degree possible. The %DV also does not take into account the form of the nutrients and its bioavailability.

What does a good multiple vitamin and mineral supplement look like?

Choose Capsules, not Tablets

Capsules: A capsule is usually made of animal or vegetable derived gelatin. Capsules are free of binding agents, glaze, and coloring allowing the nutrients to be more easily available and absorbable.

Tablets: Tablets are made by combining all the ingredients and compressing them together. Sometimes these tablets are then coated with pharmaceutical glaze. To obtain the nutrients, the body has to digest this highly compressed tablet. If you have digestive weaknesses, you may or may not digest the entire vitamin.

An easy test to determine if you are digesting your MVM supplement is to check if your urine turns bright yellow. If your urine is not bright yellow after taking the vitamin, either you are not absorbing the vitamin, or there are not enough B vitamins in the product to spill over into the kidneys.

Number of Capsules

A one-a-day pill cannot give you all the nutrients you need, making it a poor value. The dose of a high-quality encapsulated MVM supplement is usually 6-8 capsules a day.

Age and Gender Specific

Your age and gender, along with your health status will determine the amount of nutrients you specifically require. This is best determined in conjunction with your health care provider. You can also do your own research. We recommend the book Prescription for Natural Cures, by James F. Balch, M.D. and Mark Stengler, NMD

Bioavailable Forms

There are better forms of individual nutrients than others. You get what you pay for. Many lower cost products will use cheaper forms of vitamins and minerals. Unfortunately, many times cheaper forms also mean nutrients which are poorly absorbed or not usable by the body. Below are a few examples of nutrient choices.

• Vitamin D: Cholecalciferol, D3, is the active form of Vitamin D and is the preferable form.
• Vitamin E
  • The best form of Vitamin E is d-alpha tocopherol with mixed tocopherols (dalpha, gamma, beta, and delta).
  • The synthetic form of Vitamin E is dl-alpha tocopherol. Note that the difference in labeling is “d” vs. “dl” before the alpha. “dl” is not a healthy choice.
• Vitamin B12: The best form of Vitamin B12 is methylcobalamin. Cyanocobalamin is the form in most vitamins and is usually fine for most people. If someone has chronic disease however, a methylcobalamin form is recommended.
• Vitamin B6: The active form of B6 is pyridoxine 5-phosphate. This is usually designated at P-5-P.
• Minerals: There are many forms of minerals which are bonded to compounds; the physical form of a mineral is usually designated by the last word of the name. Example: magnesium citrate or magnesium oxide. Each form has different amounts of the basic elemental mineral as compared to the size of the whole compound and will determine how absorbable the mineral is.
  • For example: calcium carbonate (this includes coral calcium) is a large molecule with a lot of elemental calcium. The large size of this molecule means that it is not easily absorbed. Calcium carbonate also tends to be constipating for some people. Calcium citrate, by contrast, is a smaller form of elemental calcium, and is much more easily absorbed than the carbonate form. (An interesting note is that certain antacid medications contain calcium carbonate and are marketed as a source of calcium. However, because the purpose of an antacid is to inhibit stomach acid, and stomach acid is necessary for making minerals available for absorption, the body has a harder time actually utilizing the calcium!)
  • Similarly, magnesium oxide is poorly absorbed and causes water to stay in the intestines, thus causing a looser stool. Thus, magnesium oxide can be useful to treat occasional constipation. Alternatively, magnesium citrate is a better choice because it is more easily absorbed. (Caution, however, the citrate form may also cause loose stools for some people.)
  • There are other forms of mineral compound chelates including gluconate, aspartate, asparotate, and lactate. The gluconate form is not recommended.

Hypoallergenic

A good multivitamin will be hypoallergenic, meaning it does not contain wheat, dairy, corn, soy, or artificial dyes or colorings.

Other Ingredients

Before you read what the active ingredients are, read the label for “other ingredients.” Many supplements contain extra ingredients that may cause side effects or impair absorption. If you have lots of unnecessary “other ingredients”, it does not matter how much active ingredients you have, the MVM supplement is already a poor choice. We recommend researching any ingredient that is unfamiliar to you.

The following is not a comprehensive list. Some “other ingredients” to avoid:

• Glucose, fructose, dextrose, maltodextrose, corn syrup, sucrose, lactose. These are sugars and unless these are added for flavor in children’s chewable vitamins, they are not needed. As soon as possible, wean your child from a chewable to a capsule to minimize their dependence on sugar and risk to their teeth.
• Sorbitol. This is a sugar alcohol, and although is not purely sugar, it is not beneficial in a vitamin. For diabetics this is an absolute must for avoidance! Sorbitol can also cause diarrhea.
• NutraSweet, Equal, Aspartame, Sucralose, Splenda. These are artificial sweeteners and are NOT beneficial to the body.
• Polyethylene glycol. Although non-toxic, this chemical, when used in large dosages, is a treatment for constipation. It is unnecessary for use in highly absorbable vitamins.
• Mineral Oil. Mineral oil is derived from petroleum and prevents absorption of nutrients. Given these two facts, taking a vitamin with mineral oil does not seem a good choice.
• Canuba Wax. Canuba wax may inhibit the digestion of the ingredients and make it less absorbable. This is especially true if digestive weaknesses are already present.
• Dextrin. This is a binding product, making the nutrients less available for digestion.
• Di-calcium phosphate. Di-calcium phosphate is an excipient (an inactive ingredient) and is not available to the body as calcium. A vitamin labeling both calcium and phosphorus may be counting the di-calicum phosphate as calcium, but it really doesn’t add much to the calcium content nutritionally.
• Any coloring
• Any pharmaceutical glaze
• Magnesium stearate, calcium stearate, stearic acid. These are not nutritional ingredients but rather fats that act as lubricants, they allow the manufacturing process to run faster and prevent the capsulation/tabulating machines from clogging up. Many times, these lubricants are animal based. Each particle of your vitamin can be coated by the lubricant, which then needs to be dissolved before you can access the vitamin. If you have digestive problems such as irritable bowel, a missing gallbladder, or acid reflux, it may be difficult for you to get benefit from your MVM supplement if these lubricants are present.

I always forget to take my multi. How can I remember?

Find a visual trigger and make it a habit:

• Buy a little shot glass or small candle holder, fill it with your vitamins and set by your usual meal place (we have a basket of free ones at our office)
• Medication holders – found at drug stores
• Small baggies – create a week’s worth on Sunday night
• Involve your family – set out everyone’s supplements at once
• For a month, create a checklist to record each time you take your supplements

When should I take my MVM supplement?

The best time to take a MVM supplement is when you are eating. This is when your gastrointestinal system is optimally prepared to absorb the nutrients. Many people think they cannot tolerate a MVM supplement but it is simply because they’ve only tried taking it on an empty stomach. Divide your daily dose in half and take it with breakfast and lunch or dinner.

In Conclusion

While good supplements are available at reputable stores, it can be overwhelming even for the most knowledgeable consumer to know what to choose. Choosing a MVM supplement may seem as easy as grabbing one off the supermarket shelves, but with a little knowledge, the one you choose can be the right one for you. Read the labels carefully and make an informed decision. Your health is valuable and making informed choices can help your health and your pocketbook.

The supplements available at Boise Natural Health are professional grade and are manufactured by very reputable companies. We strive to bring you supplements that are thoroughly researched and provide the best available ingredients. Please note, we sell only to current patients. You can look at the following links to see some information provided by some of our manufacturers:

• Thorne Research http://www.thorne.com/media/supp_facts_2003.pdf
• Pure Encapsulations http://www.purecaps.com/QualityControl.asp
• Wise Women Herbs http://www.wisewomanherbals.com/about_our-products.html

References

1 Benton D and Roberts G: “Effect of vitamin and mineral supplementation on intelligence of a sample of school children.” The Lancet 1:140-3, 1988
2 Chandra RK: “Effects of vitamin and trace-element supplementation on immune responses and infection in elderly 
subjects.: The Lancet 340:1124-7, 1992
3 Watkins ML, Erickson JD, Thun MJ, et al. Multivitamin use and mortality in a large prospective study. Am J Epidemiol 152:149–62, 2000