You Ask, I Answer: Depression & Vitamin D

I just got my blood labs done to test for vitamin D deficiency.

My doctor said that my recent depression symptoms and joint pain could be resulting from that.

I knew about rickets and vitamin D deficiency in children, but what is this chronic pain/fatigue/depression stuff in adults?

How does vitamin D deficiency play a role in that?

-- Christine (last name unknown)
Via the blog

Thanks to more funding -- which means more research -- we are finally getting a glimpse at all of Vitamin D's important functions.

Many people don't realize that the term "vitamin" isn't even 100 years old (that anniversary will occur in 2012).

Vitamin D, meanwhile, wasn't discovered until 1922.

In any case, recent research on vitamin D status, depression, and joint pain appears promising (more studies are needed before any of this can be established as fact, though).

As far as depression is concerned, this is the reasoning:

* Blood samples of individuals experiencing clinical depression show lower levels of
25-hydroxyvitamin D (the active form of vitamin D measured in blood).

* The brain contains vitamin D receptors, which vitamin D uses in the synthesis of vital peptides and compounds.

* Recent studies on individuals suffering from Seasonal Affective Disorder (SAD) concluded that those who supplemented 600 International Units of vitamin D reported feeling better more quickly than those who did not supplement. It is worth noting that neither group used special UV lamps for the study.

This is not to say that vitamin D "cures" depression. The current line of thinking is that low vitamin D status can exacerbate some types of depression, and that correcting this inadequacy may be one factor than can help speed up recovery.

As for the second half of your question -- since Vitamin D is tightly linked with calcium and phosphorus in bone metabolism, it only makes sense that inadequate levels could have an effect on joints.

The latest studies theorize that deficiencies of vitamin D make it more difficult for the body to repair cartilage and joint damage from arthritis.

I completely side with scientists and researchers who recommend daily supplementation of 2,000 International Units of vitamin D for the following groups of people:

* Dark-skinned individuals
* Adults over the age of 65
* Anyone living north of Atlanta (from October to April)
* Anyone with limited sun exposure

You Ask, I Answer: Supplements

Do you object to supplementation in general via a basic multivitamin/mineral product?

I recall [reading in the Center for Science in the Public Interest's] Nutrition Action Healthletter that adult males [should] avoid iron supplementation (perhaps due to a possible link between excessive iron intake and the development of a certain type of cancer?).

Is iron something that adult males should indeed avoid in a supplement?

[Lastly,] do you see any merit to taking curcumin or cumin supplements (especially for someone with an inflammatory disease such as asthma)?

Obviously, a whole food is preferable, but I think that massive amounts of curry would need to be ingested in order to derive any possible benefits.

-- Rob White
Boston, MA

My stance on supplementation varies depending on context.

I despise the notion that as long as you take a multivitamin once a day, you don't need to worry about the nutrient composition of what you eat the rest of the day.

Multivitamins do not offer the vast amount -- literally THOUSANDS -- of healthy phytonutrients and other compounds naturally found in foods.

Additionally, absorption from multivitamins is often lower -- and less effective -- than if that same nutrient is derived from actual foods that contain those nutrients.

I do, however, fully support the supplementation of Vitamin D. Unless you live near the Equator, your body can not synthesize this nutrient from sunlight between the months of October and April.

For the record, I recommend supplementing 2,000 International Units of Vitamin D a day.

I also don't have a problem with individuals supplementing a specific vitamin or mineral that they would otherwise be deficient in (i.e.: vegans without access to fortified foods and B12).

The issue of iron supplementation and men can also apply to post-menopausal women. Since iron is very hard for the body to excrete (menstruation being the exception), supplementation in these two populations raises the risk of a condition known as iron overload.

Iron overload can cause a variety of symptoms and problems, from heart arrhythmia and hypothyroidism to impotence and arthritis.

This is why, if you examine the label on a "men's formula" multivitamin, you will find that iron is MIA.

As far as curcumin supplements in regards to asthma, it gets complicated. There is very little data on the efficacy of these supplements. Consequently, dosage values have not been clearly determined.

Additionally, certain individuals (those with weakened immune systems, diabetes, and stomach ulcers) are advised to steer clear of these supplements, as they can aggravate those conditions.

I think you are better off implenting more curry-spiced dishes into your diet. After all, populations that are believed to benefit from this spice include it in their recipes, not swallow it in pill form.

In The News: Supplementing Their Way Through The Recession

I'm slightly alarmed by this New York Times article that details the surge in supplement and multivitamin sales since last October's infamous stock market crash.

"Sales of vitamins and nutritional supplements, which have grown consistently for years, have surged in recent months. The Vitamin Shoppe has tracked a rise in new customers of about 20 percent over the last six months," the paper reports.

Facing unemployment and rising healthcare costs, some of the consumers interviewed for the piece are turning to echinacea, oregano oil capsules, and protein supplements to stay healthy.

One woman even repeats a classic myth, explaining how "energetic" and "strong" she feels as a result of taking vitamins.

Eek! I am most disturbed by the notion that people in financial hardship are throwing away their money on products that have not been shown to promote health.

The vast majority of studies on echinacea, for example, have not shown much of a benefit compared to a placebo.

Oregano oil? There have been no human studies, and at best it is touted as a way to possibly, perhaps, maybe minimize the symptoms of sinus infections.

Protein supplements, meanwhile, have absolutely nothing to do with health.

As I have said before, there is no reason why anyone consuming enough calories from many food groups should be concerned with getting more protein.

And then there's this: "Amy Breslin, who is 33 and studying to be a physician’s assistant, has pared back on fresh fruits and vegetables and stocked up instead on fish oil capsules and antioxidant supplements."

Her reasoning? Organics are expensive, so she gets a better "bang for her buck" with capsules and supplements.

I hear this line of logic many times. Here are my problems with it:

* While the lack of pesticides used in organic farming is wonderful , conventional fruits and vegetables offer plenty of nutrition. Many people erroneously think that conventional produce is akin to eating rat poison.

* Fish oil capsules and antioxidant supplements do not offer the same health benefits as eating actual fish and produce.

* Eating fruits and vegetables does not need to be expensive. Store-brand frozen fruits and vegetables are inexpensive.

Many people also forget that one of the most important things you can do for your immune system is FREE -- get 7 to 8 hours of sleep a night!

In any case, I need to send my crystal ball in for repairs. A few months ago I "predicted" to friends that The Vitamin Shoppe and/or GNC would suffer as a result of the recession.

You Ask, I Answer: Weightlifting Supplements

I keep hearing from fellow women weight-lifters about supplements like creatine, branch chain amino acids, ZMA [zinc monomethionine aspartate] and the role they play in muscle gains and repair.

I have my concerns about their long-term health effects, especially on women.

Do you think a casual weight-lifter like me (I lift 2 to 3 times a week to stay in shape) should stay away from them?

-- Mandy [last name withheld]
Halifax, Canada

It depends on which particular supplement you are talking about.

Creatine phosphate is one of the most well-known lifting supplements.

Creatine monohydrate and creatine citrate are also available; for all intents and purposes, they are the same thing (think of one as white sugar, another as brown sugar, and the other as cane juice crystals.)

It seems that any college student moderately interested in gaining muscle mass has a container of it in their dorm kitchen.

Although it may sound foreign, creatine is an amino acid produced by our bodies. It is also naturally found in significant quantities in all animal proteins -- particularly red meat, poultry, and fish.

Creatine serves as a backup reserve for short bursts of energy (no more than 8 to 10 seconds).

When you're banging out that last rep, it's creatine that comes to the rescue to give you a final jolt of strength.

Some people erroneously think that simply taking creatine is enough for adding muscle mass. Not so.

All creatine does is allow your muscles to work a little harder for a little longer. In other words, you still have to put in consistent time at the gym.

Keep in mind that although creatine is the best researched of the three supplements you ask about, none of them are regulated.

This is quite a problem, as it means that manufacturer A's creatine can differ greatly (i.e.: contain fillers and other useless ingredients) from manufacturer B's.

Although creatine can be helpful for bulking up, some of the accomplished results have more to do with muscular water retention than actual extra mass.

Branch chain amino acids can help delay muscle fatigue, but its effect has only been considered significant in very long endurance situations, like marathons.

For someone who works out two to three times a week to stay in shape, I find BCAA's to be a complete waste of money.

As for ZMA, there is very little literature on it. The only study I know of that has found it to be helpful was, not surprisingly, funded by its manufacturers.

I also find it rather comical ZMA is advertised as some "amazing breakthrough" when it's simply a combination of three minerals -- magnesium, zinc, and vitamin B6.

As far as long-term health effects of these supplements, there isn't enough information to truly know.

What we do know is that creatine appears to exacerbate dehydration. A few studies have also mentioned an increased risk for kidney problems, but that appears to only affect individuals who already have compromised kidneys.

I'm of the belief that the best thing you can do for your health -- and your training -- is eat a diet rich in fruits, vegetables, heart-healthy fats, whole grains, and lean protein.

No supplement is going to override a poor diet.

In The News: Eat Food, Not Vitamins

I fear how some members of the mainstream media will report on the latest finding from the Physicians Health Study that "Vitamin C or E pills do not help prevent cancer in men."

I certainly hope I don't come across any "why oranges may not be as healthy as you might think," teasers on any news shows.

I am actually quite glad these well-publicized studies are arriving at these firm conclusions.

They make it absolutely clear that simply isolating nutrients in pill form and downing them with a glass of water every morning has very little to do with disease risk reduction.

In fact, this is precisely why dietitians have been recommending the consumption of fruits, vegetables, legumes, and whole grains for decades.

It is not just one vitamin or mineral that helps lower disease risk.

Rather, it is the interaction and interplay between vitamins, minerals, antioxidants, polyphenols, and other compounds in food that provide health benefits. An orange is much more than vitamin C in a refreshing package.

Don't expect the multivitamin companies to let you in on that tidbit anytime soon.

FNCE 2008: Out of Towners

Some of the booths at this year's American Dietetic Association Food & Nutrition Conference and Expo struck me as very out of place:

Slimshots: A vanilla-flavored appetite suppresant. Maureen McCormick (Marcia Brady) istheir spokesperson. Appetite suppresants at a food conference?

Corn Refiners Association: Despite current ADA president Martin Yaddrick's statement that "The American Dietetic Association had no involvement with the recent Corn Refiners Association advertisements. ADA did not review or approve the ad in question, nor any wording in it; nor did ADA have advance knowledge of the advertisement,” the people behind this campaign were present at FNCE with all sorts of literature claiming high fructose corn syrup is just dandy.

GNC and Vitamin Shoppe: Although these stores sell legitimate vitamins and minerals, they also hawk supplements (which are unregulated) that often succumb to nutrition quackery in their advertising.

Coca Cola: I am completely at a loss as to how carbonated water with high fructose corn syrup or artificial sweeteners belongs at a nutrition conference. Sprinkling corn fiber into it does not make it "healthy."

Thoughts?

You Ask, I Answer: Fish Oil Supplements/Metal Toxicity Cleansings

Yesterday I attended a talk given by an "applied clinical nutritionist" who works at a local pharmacy.

She really advocated the use of supplements for everyone (probably because the pharmacy she works at generates a lot of revenue through the sale of herbs/supplements and homeopathic remedies).

She recommended taking fish oil instead of flax because she said that flax requires an extra step to be processed by the body.

She said that some people's bodies aren't able to perform this extra step and you would never know one way or another, so she just prefers to stick with fish oil.

Since you often recommend flax, what are your thoughts?

She also talked about "cleansing" (the colon in particular).

Her recommendation wasn't about losing weight, but rather to flush out toxins, no matter how healthy your diet.

She said this is needed to flush out "toxins" that accumulate in our bodies from pesticides in food, air pollution, etc.

The cleanse involves eating certain kinds of foods (she wasn't specific) and taking some sort of supplements that help flush your colon, like magnesium (I think).

All of this sounded sort of unnecessary to me.

Is there any evidence that this type of cleanse is beneficial for people whose diets are already consist of nutritious, whole foods?

-- Kristin (last name withheld)
Austin, TX

Before I begin, let me thank Kristin for following up her question with an e-mail revealing the results of her own investigative research.

Turns out that acquiring the "applied clinical nutritionist" title is a simple task.

"It's a self paced certificate program through the Texas Chiropractic College. To earn the certificate, you must be a health care professional, or the staff or student of a health care professional (I suppose you could be a dental receptionist). You have to attend 7 seminars (100 hrs), take a test and pay $1400. In return, you get a shiny wall plaque," writes Kristin.

Sigh. Of course.

This is precisely why I strongly (I'm talking "The Incredible Hulk" strong) believe the American Dietetic Association needs to launch a multimillion dollar campaign raising awareness of what makes Registered Dietitians different from all these other empty titles.

Unfortunately, the vast majority of individuals in charge of booking and hiring speakers for wellness events, health fairs, and media outlets have absolutely no clue what the difference is between a Registered Dietitian, a "naturopath," or an applied clinical nutritionist.

Anyhow, time to answer Kristin's question.

As far as the fish vs. flax issue, I agree with the speaker... to a point.

It is true that the Omega-3 fats found in flaxseed (ALA) need to be converted by the body to DPA and EHA.

It is also accurate to say that the majority of people do not convert ALA efficiently.

A significant factor inhibiting conversion is that Omega 6 fatty acids compete with Omega 3 fatty acids for the same desaturase (conversion) enzymes.

Keeping in mind that our current food supply contributes an abundance of Omega 6, you can see why ALA --> DHA/EPA conversion isn't happening as optimally as we would expect.

That being said, I still recommend ground flax simply because most people don't consume much of ANY Omega-3's.

Simply put, ground flaxseeds are an effortless way to add some Omega 3's to a variety of foods (not everyone likes fish or wants to eat it.)

I also hope that the speaker's recommendation of taking fish oil supplements was mainly targeted at people who do not consume fish.

I would much rather you get your DHA and EPA from actual food (i.e.: tuna, salmon, sardines) first, and consider supplements a "second best" choice.

Furthermore, I hope she stressed that non-DHA/EPA sources of Omega-3's offer a wide array of nutrients.

Ditching walnuts and flaxseed and instead swallowing a spoonful of fish oil every morning isn't necessarily a smart swap.

What I COMPLETELY disagree with her on (and why I doubt she is an RD) is her colon cleanse recommendation. Ugh. Ugh. UGH!

It is unnecessary and not particularly healthy.

If people want to "flush out" their colons, all they need to do is consume more insoluble fiber and liquids. Plain and simple.

Not to mention, I would love to ask this woman how exactly toxins accumulate in a body with a regularly functioning liver and kidneys.

There is no evidence whatsoever supporting the belief that we need to cleanse ourselves of toxins.

What I find most illogical is that people who furiously support colon cleanses are self-proclaimed "health experts," who apparently fail to realize that colon cleansing eliminates all the HEALTHY bacteria in the human gut and can cause electrolyte imbalances!

If you'll excuse me, I now need to go center myself.

Health Store Hazards

In some situations, supplements can be helpful (i.e.: DPA and EHA Omega-3 fatty acids for pregnant women who do not eat fish; vitamin D supplements for most people in Northern climates).

However, the supplement market mostly preys on consumer fear ("There aren't enough nutrients in the food I'm eating") and ignorance ("I won't gain muscle unless I down 300 grams of protein a day.")

You certainly can't rely on "health stores" for advice!

Watch the latest video on the YouTube Small Bites channel for more information.

You Ask, I Answer: Omega-3 Supplements

I'm taking fish oil supplements (two 1000mg capsules with my prenatal vitamin, taken with food) because I can't eat fish without getting nauseous.

Am I absorbing even close to the same amounts of EPA/DHA as my body would get from a serving of cold water fish?

-- Anonymous
Via the blog

Fish oil supplements greatly vary.

Remember, the values to be on the lookout for are EPA and DHA.

I have seen 1000 milligram products that offer anywhere from 180 to 1,000 milligrams of DHA and 120 to 400 milligrams of EPA pero two capsule serving.

Since supplements are not regulated by the FDA (a direct result of the 1994 Dietary Supplement Health and Education Act), you'll find that some "1,000 milligram" capsules offer that amount of fish oil per two capsule serving, whereas others contain that in each individual capsule.

In any case, you want to aim for 1.5 to 2 grams grams of combined EPA and DHA per day.

A 3-ounce piece of wild salmon (as large as the palm of your hand and no wider than your pinkie finger) delivers approximately 400 milligrams of EPA and 1.3 grams of DHA.

Remember that as wonderfully protective of cardiac health as Omega-3 fatty acids are, more is certainly not better -- overconsumption can overly thin the blood.

There is a good deal of evidence that absorption of these fatty acids is higher in food, so although supplements are fine for the time being, I encourage you to resume eating fish once the nauseous reaction stops.

You Ask, I Answer: Calcium Supplements

I take a pill that [contains] 600 mg Calcium and 400 IU vitamin D.

I'm a 26 year old female. Is this a good decision?

-- Anonymous
Via the blog

If you find that your diet does not provide sufficient calcium, then supplementing it is certainly a good decision.

Having Vitamin D in the same pill as calcium is particularly smart, as this helps facilitate absorption.

However, 600 milligrams is too much for the body to absorb at once. I recommend a supplement containing no more than 500 milligrams.

Also, be sure to check your supplement’s bottle for the amount of “elemental calcium” – this tells you how much of the calcium in the supplement is “up for grabs.”

Some not-so-trustworthy companies advertise themselves as offering large amounts, but read the fine print and you'll see that each pill doesn't offer that much absorbable calcium.

Survey Results: Multivitamins

The latest Small Bites survey found that 45% of respondents pop a multivitamin every day, while 31% feel no need to supplement their diet with an "all in one" pill.

An additional 17% reported taking multivitamins not on a daily basis, and 5% are only concerned with getting specific vitamins and minerals in pill form.

Although vitamin supplementation has its place (i.e.: Vitamin D for almost everyone, several key nutrients for the elderly and people on very low calorie diets, Vitamin B-12 for some vegans, folate for women planning to get pregnant, etc.) it can also lull many people into a fall sense of security.

I recall a conversation with someone who told me he didn't feel the need to eat fruits or vegetables since she was getting every single vitamin and mineral in pill form every day.

Not quite. Many people forget that:

1) No multivitamin offers 100% of every nutrient. Calcium, for instance, takes up a lot of space, so any pill offering an entire day's worth (1,000 milligrams) would be too big. Besides, the body can only assimilate 500 milligrams of calcium at one given time, so a single dose of 1,000 milligrams is ineffective.

2) Since multivitamins fall into the "supplement" category, they are not regulated by the Food & Drug Administration. In other words, the label may say 100% of 23 vitamins and minerals, but no entity is making sure such a statement is accurate.

3) Multivitamins do not offer the hundreds of phytonutrients found in fruits, vegetables, and whole grains. These phytonutrients play important roles in health promotion and help certain vitamins and minerals operate efficiently in the body. Oranges, for instance, aren't just about Vitamin C; they also provide flavonoids that help with blood sugar and cholesterol regulation.

4) Intake does not equal absorption. Synthetic forms of vitamins and minerals are less bioavailable than their naturally occurring brothers and sisters. According to estimates, absorption of most nutrients in multivitamins does not go above the 50% mark.

5) More is not always better. Some multivitamins contain excessive amounts of Vitamin E, which have been show to cause more harm than good.

6) Nutrition and health go beyond simply getting enough vitamins and minerals. Calories, added sugars, saturated and trans fats, and fiber are just as worthy of attention. Getting a day's worth of a handful of vitamins and minerals isn't that spectacular if you aren't consuming enough fiber and eating an overabundance of calories.

I don't think standard multivitamins as insurance for a balanced and adequate diet are cause for alarm, but anybody looking to get optimal nutrition should really look to food first (Vitamin D is the only nutrient I think everybody should be supplementing in their diet).

Smart Supplementation

Although getting nutrients from foods is optimal, there are times and situations in which supplementation is recommended.

Supplementation goes far beyond chewing or swallowing a pill upon waking up or before going to bed, though.

Take calcium, for example.

The best supplemental calcium is in the form of calcium citrate.

Taking a calcium supplement containing more than 500 milligrams? You're doing yourself a disservice.

Although the daily value for the majority of the population is set at 1,000 milligrams, our bodies can assimilate no more than half of that at one time.

If you are supplementing calcium, it is a smart move to consume it in 300 or 400 milligram quantities two or three times a day than to down a supplement containing more than 500 milligrams in one sitting.

It's also highly recommended you take your calcium supplement with a meal, as this reduces transit time, thereby resulting in more efficient absorption.

In The News: D-Mistifying D

Vitamin D -- affectionately called "Sunny D', since sunlight is our primary source-- is undoubtedly the hottest nutrient these days, so it is no surprise The New York Times is dedicating more space to it today.

Not only is its importance in a variety of body functions consistently becoming more clear, traditional recommendations suggesting a daily intake of 400 International Units are being questioned.

Recent research has led dietitians to establish a much-higher 1,000 International Units as the desired daily intake.

Since Vitamin D is found very scarcely in foods (a cup of fortified milk provides 100 IU's), it is one of the few nutrients I highly recommend people who do not get enough sun (either because of winters with little hours of sunlight or because of the use of UV protection creams) supplement in pill form.

Research studies showing the benefits of sufficient Vitamin D intake is a dime a dozen:

"A Swiss study of women in their 80s found greater leg strength and half as many falls among those who took 800 I.U. of vitamin D a day for three months along with 1,200 milligrams of calcium, compared with women who took just calcium. Greater strength and better balance have been found in older people with high blood levels of vitamin D."

And then there's this one:

"Researchers at Creighton University in Omaha conducted a double-blind, randomized, placebo-controlled trial... among 1,179 community-living, healthy postmenopausal women. They reported last year in The American Journal of Clinical Nutrition that over the course of four years, those taking calcium and 1,100 I.U. of vitamin D3 each day developed about 80 percent fewer cancers than those who took just calcium or a placebo."

According to current estimates, as much as 60 percent of the United States adult population is Vitamin D deficient -- and that's based on the starting-to-be-considered-low 400 IU figure!

Celebrity Diet Secrets: Hillary Swank

Oy. Here we go again with ridiculous nutrition statements by celebrities. This time, it's Hillary Swank's turn to talk nonsense.

In a recent interview with W Magazine, Swank proudly boasts that she takes 45 supplements a day! That's right, in 24 hours.

"This is my Aloe C, which I dissolve in water. Here's my flax. This one's for my immune system, and this one is my BrainWave -- it's great, like if I have a lot of lines to memorize," she explains to the reporter.

All this advice comes from Dr. Oz Garcia, nutritionist to the stars, who Hillary credits with changing her life.

Before I go on to talk about Hillary's pill regimen, allow me to shed some light on Dr. Garcia.

Specializing in "progressive nutrition, life extension, and anti-aging", Dr. Garcia caters to Hollywood's A-list and has had his number of television appearances. He also oversees nutritional services for Equinox Fitness Clubs.

Between that bio and his splashy website, you might think this guy knows his stuff.

Well, as we all witnessed with the Dr. Jan Adams debacle (who, despite being a media darling and even having his own show on The Discovery Health network, turned out to lack board accreditation and had a long history of malpractice claims by several patients), not everything is as it appears.

For starters, a 1987 Time magazine article describes Dr. Garcia as a "self-taught" nutritionist. That same article states that Dr. Garcia claims he can tell someone what to eat after analyzing a strand of their hair.

As far as I know, a strand of hair does not give you the same information as a blood test. Would Dr. Garcia advocate a high-protein diet to someone simply based on a hair sample, not knowing one of their kidneys is malfunctioning (and, therefore, need to be on a low-protein diet)?

Dr. Garcia predictably hawks his own water, described as "99.9%" pure and containing "three times the electrolytes found in sports drinks".

The electrolytes in drinks like Gatorade are two minerals you all have heard of -- sodium and potassium. Since Gatorade provides approximately one percent of a day's potassium requirement, then this special water contains, at most, 3 percent of the daily requirement.

A much smarter idea would be to get this mineral in much higher quantities from food. A cup of cantaloupes provides 10 percent, as does half a cup of Swiss chard or butternut squash. Throwing in half a cup of black beans into a salad provides 9 percent.

Dr. Garcia also sells colon cleansing, fat-burning, and even anti-aging products, all in pill form.

If this is the man Hillary Swank looks up to, it's no wonder she thinks nothing of swallowing 45 pills a day.

The excess of vitamins and minerals she is consuming is simply being excreted.

Just for the record, let me note that there are no mentally-sharpening magic pills that help anyone with memory.

Lastly, why is Hillary Swank taking flax in pill form? How about just sprinkling some milled flaxseed into a smoothie, salad, soup, or cereal bowl?

The wonderfully healthy properties of flaxseed (i.e.: phytochemicals known as lignans, which have been linked to a decrease in bad cholesterol) are not replicated in a flax pill.

And then we wonder why Kevin Trudeau's books become bestsellers....

Measly Metamucil

I can't wrap my head around the logic behind Metamucil.

What's stumping me? The idea that someone would choose to swallow six pills to get a mere three grams of fiber.

That same amount of fiber can be found in:

1 medium apple
1/4 of a medium avocado
1/2 cup cooked broccoli
1/2 cup cooked winter squash
1/2 cup cooked corn
6 Triscuit crackers
1/4 cup kidney beans
3/4 cup oatmeal
1 medium pear
1/2 cup raspberries or blackberries
1 slice whole grain bread

Not only does food taste better than fiber pills, it also provides vitamins and minerals absent from tablets.

Choose food first!

You Ask, I Answer: Multivitamins

What is your response to Dr. Willett, who suggests a multi-vitamin as an inexpensive form of insurance in his book Eat Drink & Be Healthy? My understanding is that a multi-vitamin is a good idea regardless of diet since aside from providing the daily minimum amounts of vitamins it also provides certain things like minerals which even for a smart eater can sometimes be overlooked?

-- Guy Betterbid
New York, NY

For those of you who don't know, Dr. Walter Willett is a professor of Epidemiology and Nutrition at Harvard's School of Public Health as well as Professor of Medicine at Harvard Medical School.

A renowned medical researcher, Dr. Willett is perhaps most famous for his revised dietary pyramid, which places exercise and weight management at the base, plant oils and whole grains on the second level, and red meat, butter, and refined grains as neighbors at the tip.

Along the side, Willett borrows from the Mediterranean food pyramid by including alcohol (in moderation) but then adds his own touch by including multi-vitamin supplements.

I'm not quite as gung-ho as Dr. Willett on the thought of people popping a Centrum once a day.

First off, there is so much fortification in today's food that getting most vitamins and minerals is not too difficult. Even the sweetest and least nutritious of children's cereals provides 100% of many of these nutrients.

On top of that, we have beverages -- such as Vitamin Water and even Diet Coke Plus -- as well as "energy bars" that also throw in a day's worth of vitamins and minerals.

It's crucial to realize that it does not take extreme amounts of food to get a daily supply of certain vitamins and minerals. As I recently posted, just half a cup of red peppers provides 100% of our vitamin C needs.

Meanwhile, half a cup of baby carrots provides 300% of our vitamin A requirements, one cup of raw spinach packs in 181% of the Vitamin K we need each day, and a sandwich made with two slices of whole wheat bread contains 60% of our daily manganese needs.

It is true that the recommended intakes for minerals like calcium, potassium, and magnesium are only achieved by having a combination of foods rich in them.

That being said, I believe it is important to recommend people get as much of their vitamins and minerals from real food as possible.

When you eat a carrot, you aren't just getting Vitamin A. You are also getting fiber, phytonutrients, carotenoids, and antioxidants that are not available in pill form.

Additionally, increasing dietary potassium often correlates with a reduction in sodium intake. That's two birds killed with one stone if vitamin and mineral consumption is first tackled via diet.

I also believe that relying on supplements tends to give people false security, thinking that popping a multi-vitamin in the morning is a free pass for going through the rest of the day without paying attention to the food they are eating.

I think it is much wiser to take a look at what vitamins and minerals one tends to be deficient in and then tackle that problem specifically (ideally by altering one's diet first).

Vitamin D is not readily available in many foods (and most people in the world do not get enough from the sun during winter months), so I do not see anything wrong with supplementation. I also think calcium supplementation is important if the diet does not provide sufficient coverage.

Additionally, people on restricted diets often need to supplement their diets appropriately (i.e.: vegans and vitamin B12).

While we're at it, I would like to clarify that vitamins do NOT provide energy. Calories provide energy. Vitamins do not contain calories.

Yes, the B vitamins are necessary for energy pathways to work properly, but they do not give a boost of energy in and of themselves.

Back to the original question: people eating balanced diets do not need to pop a multi-vitamin every day.

They are better off seeing what nutrients they are actually deficient of, see if they can get them by altering their diet, and, if that's not possible, look to supplement that specific vitamin or mineral by means of a pill.