Ask Dr. Murph!

{cute medical image via}

As promised, here is the first in a new series on Little Bit of Class Little Bit of Sass: Ask Dr. Murph!

Through college and every now and then I have asked my sorority sister/brilliant doctor friend random questions about health and fitness from a medical point of view rather than typical blog and magazine suggestions. Dr. Murph is a great sport and agreed to let me publish her answers to my most recent random questions.

The topic today is vitamins. I take quite a few and wondered if my vitamin regimen made sense. Have fun reading our conversation below. Yes it's long but I assure you it is totally worth it (that's what she said!). In all I had 9 questions, so here are the first four. I will post the next five tomorrow.

Have questions for Dr. Murph? Let me know! Let's keep this series going!

First, her disclaimer:

DISCLAIMER- I have an M.D but I am far from an expert! The following is what I have synthesized from med school and residency lectures, attending mentors, textbooks, and journal articles. Many doctors have differing opinions on vitamins because there can be an overwhelming amount of unfortunately small studies that show opposing results. To me, this seems to be the case with anything that enters the arena of "complementary or alternative medicine." I will try to differentiate what is accepted as medical fact and when I venture off into opinion. If other health care people read these answers, I'm sure plenty of people will disagree with me. (I think I could fight with Dr. Oz for a week straight about almost all of his opinions!) Overall, I tend be on the skeptical side - As one of my favorite attendings taught me - Read the study and Ask yourself, What does this author WANT to be true?

Okay, on to the questions!

1. Will taking Vitamin D in the winter prevent winter blues?

Unfortunately, this will probably not help. Many studies show that depressed people are more likely to have low levels of Vitamin D, but whenever they try to give people vitamin D for depression, it doesn't work. Association does not mean causation. It makes sense to me that the depression comes first, which results in people staying in and getting less sunlight, which is your primary source of Vitamin D, so then your levels are low. The same thing comes to mind with the studies that associate higher Vitamin D levels with healthy body weight - The running around outside probably came first, eh? One thing is for sure: Vitamin D is essential for the absorption and metabolism of calcium and phosphorus, which have many important functions in the body, especially maintaining healthy bones (We'll get to this later.) When its sunny, most young healthy people get enough Vitamin D to get by, but Ohio isn't exactly sunny for a good portion of the year, so I do think its a good thing to have in your multivitamin. The most common recommendation is at least 800 IU per day.

2. I take Calcium because women are supposed to. Right?!?!

Yes, you're supposed to! To prevent osteoporosis.. a potentially debilitating disease, as well as a major obstacle to living well into your 80s, 90s, 100s. A women only has until age 30 to build her peak bone mass. From there, we start to lose bone at a slightly faster rate than we can build it. Finally at menopause, without the support of estrogen, bone mass really starts to decline. After your peak at age 30, you will end up losing half of your trabecular bone mass (think inside spongy bone) and 30% of your cortical bone (think hard outside shell). So make that peak as high as you can! And keep taking your Calcium and Vitamin D to keep the decline as slow as you can. Other risk factors for osteoporosis include white race, smoking, low BMI, lack of exercise, and steroid medications. Try to get 1,200mg per day and bump it up to 1,500/day at menopause. Dietary Calcium is great, but I have found that many of us need to supplement if we are trying to watch our calories as well. (If only this gave us permission for unlimited cheese, milk, yogurt, and ice cream yumm)! Calcium supplements come as calcium carbonate, calcium phosphate, or calcium citrate. On the bottle there will be a milligram of the tablet, but what you care about is the milligrams of elemental calcium to meet your daily goal. If you want to be really obsessive about it, Calcium can also be tough for your body to absorb all at one time, so separating out doses can help. Calcium carbonate needs food to absorb but most supplements are calcium citrate now, and those can be taken without food. As an OB/GYN I beg you, take your calcium. Osteoporosis sucks.

3. I take B Complex because I was told it helps with digestion...oh and P.S. why does it make my urine the color of yellow gatorade?!?!

lol - I'm not sure If I've heard this one before! I was wondering what you might ask about B complex vitamins because they seem to be touted as a cure for pretty much anything and everything. B vitamins are important for countless biochemical processes in the body, but overall I'm not sure if there is convincing evidence for supplementation.

Time out! for a quick high school bio review of vitamin definitions:

• Fat-soluble vitamins - surplus stored in the liver, extremely high doses can cause toxicity - A, D, E, & K
• Water-soluble vitamins - not stored in the body, kidney simply excretes the extra - such as B vitamins and vitamin C, and others.

So the answer to "why does it make my urine turn into the color of yellow gatorade?" is essentially, that it is all the B complex that you paid good money for that your body didn't use.

A much less skeptical view is this -- B vitamins have many complex functions in the body, so it is difficult to be sure what the manifestation of a "deficiency" would be. So each day, you take a little extra to make sure your body is "topped off" and your kidney gets rid of the surplus with possible benefit or no harm done. :)

4. I take Vitamin C for my immune system. I started to take it every day when I moved to Chicago and haven't been sick yet! Yay!

I hate to break it to you, but its definitely not the Vitamin C. I say this confidently because in medical school for some reason they taught some literature searching topic using the question "What vitamins and supplements can help with the common cold?" The result was many many painful presentations of journal artciles, including at least a few fairly well done studies, showing that Vitamin C made no difference in immune function. That being said, Vitamin C is a moderately good antioxidant, and my comments about B vitamins also apply to this water-soluble vitamin. (You may choose the skeptical version or optimistic version)

More tomorrow!!