A presentation of clinically useful vitamins
SUBCLINICAL VITAMIN DEFICIENCY IS BEING IGNORED TODAY just as Ignaz Semmelweis was ignored when he suggested surgeons wash hands between patients. This article explores some vitamins you may find clinically useful.
The earliest signs of deficiency show up in the eyes. You will see poor night vision, dry eyes and problems with the cornea. One of the treatable forms of blindness in third world countries is vitamin A deficiency. This vitamin is often helpful to patients with problems with the skin or mucus membranes.
It is well-known that vitamin A levels plummet with infection and with chemical exposure. There are some studies that show it to be of value in protecting against viral infections. Vitamin A is important for membrane health.4-6 It may increase IgA in membranes, making them more resistant to infection.5 It helps the immune system function more optimally, especially when it comes to resisting viruses.7-9
Vitamin B1 (thiamin)
Thiamin is depleted by sugar consumption, alcohol and processed foods. A person who needs thiamin will tend to wake up in the middle of the night and have trouble falling back to sleep (thiamin is also necessary to help bring insulin insensitivity under control). Deficiency can lead to depression, nervousness and insomnia. All of the B vitamins play a role in protecting the nerves and improving function of the nervous system.
Also, if a person is taking diuretics, they are likely to be deficient in thiamin. Beriberi is the disease of thiamin deficiency. Wet beriberi affects the cardiovascular system and is characterized by an enlarged heart and congestive heart failure. Subclinical vitamin deficiency is a concept that exists in natural medicine, but does not exist in traditional medicine. Compared to the pathology of full deficiency, subclinical deficiency can cause similar symptoms, only less so. It makes sense; if you look at a patient who does not get enough thiamin six months before the definitive diagnosis of beriberi can be made, is the heart larger? Is the heart working normally? Of course, the heart is larger than normal, and it is not functioning at 100% — logic tells you that.
Patients on the diuretic furosemide (sold under the brand name Lasix) tend to be deficient in thiamin (the drug also depletes magnesium). A high thiamin pyrophosphate effect, which indicates thiamin deficiency, was found in 21 of the 23 subjects taking the drug. Thiamin deficiency was only found in two out of 16 controls.1 This result was confirmed by other research, which found that 33% of 100 hospitalized patients with congestive heart failure were thiamin deficient. Only 12% of healthy controls were found to be thiamin deficient.2
Research indicates supplementation with thiamin may be of benefit to patients with congestive heart failure. One study looked at 30 patients with severe congestive heart failure who were also taking furosemide. In a double-blind study, the patients were given either IV thiamin (200 milligrams per day) or a placebo. The thiamin group experienced improvement in left ventricular ejection fraction — increasing by 22% in 27 patients who completed the full seven-week therapy. The authors of the study concluded thiamin supplementation would be a beneficial addition to conventional therapy for congestive heart failure.3
Vitamin B2 (riboflavin)
Riboflavin facilitates vasodilation and has been shown to reduce blood pressure in studies.10,11 Poor riboflavin status is a risk factor for stroke.12 Riboflavin deficiency can affect glutathione and detoxification. Riboflavin is important for hepatic function and protection from oxidative stress.14,15
Riboflavin deficiency may play a role in some migraines. Several studies have shown it can prevent and even treat migraines in some cases.13-17 In some of these studies, a high dose was used (200-400 mg/day). A knee-jerk approach to helping a patient with migraines is to simply give him or her riboflavin and magnesium; coupled with the Roadmap to Health diet, it should be effective for a lot of your patients.
Vitamin B3 (niacin)
Pellagra is a systemic disease that results from severe vitamin B3 (niacin) deficiency. Mild deficiency may go unnoticed, but a diet chronically low in or without niacin may result in the four Ds: diarrhea, dermatitis, dementia and possibly even death. Usually, diarrhea will occur before the other Ds. Patients needing niacin may have a rough appearance to the skin, a bright red tongue, depression, poor memory and circulatory problems. They may experience fatigue or apathy.
High doses of niacin have been shown to lower cholesterol. It is common among health practitioners to believe too much niacin can cause liver damage. This is only true of sustained-release niacin.1 In studies, niacin potentiated the effectiveness of cholesterol-lowering medication. It helped to not only lower cholesterol, but also improve the lipid profile in the studies that combined it with a statin. LDL was lowered, triglycerides were lowered and HDL was increased.19-22 Some of the studies demonstrated improvements in the vascular endothelium and arterial health.23,24
Niacin is a vasodilator (which is why high doses can cause ‘niacin flush’ in some people). It improves circulation. One study has even shown it to improve erectile dysfunction.25 The authors concluded, “Niacin alone can improve the erectile function in patients suffering from moderate to severe ED and dyslipidemia.” This vasodilatory effect was shown to be beneficial to patients with macular degeneration in one study.26
More information on various vitamin deficiencies will be available in a future issue of Chiropractic Economics.
PAUL VARNAS, DC, DACBN, is a graduate of the National College of Chiropractic and has had a functional medicine practice for 34 years. He is the author of several books and has taught nutrition at the National University of Health Sciences. For a free PDF of “Instantly Have a Functional Medicine Practice” or a patient handout on the anti-inflammatory diet, email him at email@example.com.
- Seligmann H, et. al. Thiamine deficiency in patients with congestive heart failure receiving long-term furosemide therapy: A pilot study. The American Journal of Medicine. 1991;91(2):151-155. AJM website. https://www.amjmed.com/article/0002-9343(91)90007-K/pdf. Accessed Aug. 31, 2023.
- The prevalence of thiamin deficiency in hospitalized patients with congestive heart failure. Journal of the American College of Cardiology. 2006;47(2):354-61. JACC website. https://www.jacc.org/doi/abs/10.1016/j.jacc.2005.08.060. Accessed Aug. 31, 2023.
- Shimon H, et. al. Improved left ventricular function after thiamine supplementation in patients with congestive heart failure receiving long-term furosemide therapy. The American Journal of Medicine. 1995;98(5):485-490. AJM website. https://www.amjmed.com/article/S0002-9343(99)80349-0/fulltext. Accessed Aug. 31, 2023.
- Esteban-Pretel G, et. al. Vitamin A deficiency alters rat lung alveolar basement membrane: Reversibility by retinoic acid. J Nutr Biochem. 2010;21(3):227-36. Pub Med website. https://pubmed.ncbi.nlm.nih.gov/19269151/. Accessed Aug. 31, 2023.
- Vitamin A supplements alleviate inflammatory responses in reproductive tracts of male mice infected with pseudorabies virus. Int J Vitam Nutr Res. 2010;80(2):117-30. Pub Med website. https://pubmed.ncbi.nlm.nih.gov/20803426/. Accessed Aug. 31, 2023.
- Surman SL, et. al. Oral retinyl palmitate or retinoic acid corrects mucosal IgA responses toward an intranasal influenza virus vaccine in vitamin A deficient mice. Vaccine. 2014;32(22):2521-4. Pub Med website. https://pubmed.ncbi.nlm.nih.gov/24657715/. Accessed 31, 2023.
- Kawasaki Y, et. al. The efficacy of oral vitamin A supplementation for measles and respiratory syncytial virus (RSV) infection. Clinical Trial. 1999;73(2):104-9. Pub Med website. https://pubmed.ncbi.nlm.nih.gov/10213986/. Accessed Aug. 31, 2023.
- Semba RD, et. al. Effect of periodic vitamin A supplementation on mortality and morbidity of human immunodeficiency virus-infected children in Uganda: A controlled clinical trial. Nutrition. 2005;21(1):25-31. Pub Med website. https://pubmed.ncbi.nlm.nih.gov/15661475/. Accessed Aug. 31, 2023.
- Patel N, et. al. Baseline Serum Vitamin A and D Levels Determine Benefit of Oral Vitamin A&D Supplements to Humoral Immune Responses Following Pediatric Influenza Vaccination 2019;11(10):907. Pub Med website. https://pubmed.ncbi.nlm.nih.gov/31575021/. Accessed Aug. 31, 2023.
- Wilson CP, et. al. Riboflavin offers a targeted strategy for managing hypertension in patients with the MTHFR 677TT genotype: a 4-y follow-up. Am J Clin Nutr. 2012;95(3):766-72. Pub Med website. https://pubmed.ncbi.nlm.nih.gov/22277556/. Accessed Aug. 31, 2023.
- Wilson CP, et. al. Blood pressure in treated hypertensive individuals with the MTHFR 677TT genotype is responsive to intervention with riboflavin: findings of a targeted randomized trial Hypertension. 2013;61(6):1302-8. Pub Med website. https://pubmed.ncbi.nlm.nih.gov/23608654/. Accessed Aug. 31, 2023.
- Gariballa S, Ullegaddi R. Riboflavin status in acute ischaemic stroke. Eur J Clin Nutr. 2007;61(10):1237-40. Pub Med website. https://pubmed.ncbi.nlm.nih.gov/17299470/. Accessed Aug. 31, 2023.
- Sandor PS, et. al. Prophylactic treatment of migraine with β-blockers and riboflavin: differential effects on the intensity dependence of auditory evoked cortical potentials. 2000;40(1):30-35. Pub Med website. https://pubmed.ncbi.nlm.nih.gov/10759900/. Accessed Aug. 31, 2023.
- Boehnke C, et. al. High-dose riboflavin treatment is efficacious in migraine prophylaxis: an open study in a tertiary care centre. Eur J Neurol. 2004;11(7):475-477. Pub Med website. https://pubmed.ncbi.nlm.nih.gov/15257686/. Accessed Aug. 31, 2023.
- Maizels M, et. al. A combination of riboflavin, magnesium, and feverfew for migraine prophylaxis: a randomized trial. Headache. 2004;44(9):885-890. Pub Med website. https://pubmed.ncbi.nlm.nih.gov/15447697/. Accessed Aug. 31, 2023.
- MacLennan SC, et. al. High-dose riboflavin for migraine prophylaxis in children: a double-blind, randomized, placebo-controlled trial. J Child Neurol. 2008;23(11):1300-1304. PubMed website. https://pubmed.ncbi.nlm.nih.gov/18984840/. Accessed Aug. 31, 2023.
- Bruijn J, et al. Medium-dose riboflavin as a prophylactic agent in children with migraine: a preliminary placebo-controlled, randomised, double-blind, cross-over trial. 2010;30(12):1426-1434. Pub Med website. https://pubmed.ncbi.nlm.nih.gov/20974610/. Accessed Aug. 31, 2023.
- LiverTox: Clinical and research information on drug-induced liver injury. [Internet] Bethesda, Md. National Institute of Diabetes and Digestive and Kidney Diseases. Niacin. 2012. Updated Jul. 9, 2020. https://www.ncbi.nlm.nih.gov/books/NBK548176/. NIH website. Accessed Aug. 31, 2023.
- Bays HE, et. al. Comparison of once-daily, niacin extended-release/lovastatin with standard doses of atorvastatin and simvastatin (the ADvicor Versus Other Cholesterol-Modulating Agents Trial Evaluation [ADVOCATE]). Am J Cardiol. 2003 Mar 15;91(6):667-72. Pub Med website. https://pubmed.ncbi.nlm.nih.gov/12633795/. Accessed Aug. 31, 2023.
- Brown BG, et. al. Moderate dose, three-drug therapy with niacin, lovastatin, and colestipol to reduce low-density lipoprotein cholesterol <100 mg/dl in patients with hyperlipidemia and coronary artery disease. Am J Cardiol. 2003 Mar 15;91(6):667-72. Pub Med website. https://pubmed.ncbi.nlm.nih.gov/9230143/. Accessed Aug. 31, 2023.
- Ballantyne CM, et. al. Comparison of the safety and efficacy of a combination tablet of niacin extended release and simvastatin vs simvastatin monotherapy in patients with increased non-HDL cholesterol (from the SEACOAST I study). Am J Cardiol. 2008;101(10):1428-36. Pub Med website. https://pubmed.ncbi.nlm.nih.gov/18471454/. Accessed Aug. 31, 2023.
- Boden WE, et. al. Niacin in patients with low HDL cholesterol levels receiving intensive statin therapy. N Engl J Med. 2011;365(24):2255-67. NEJM website. https://www.nejm.org/doi/full/10.1056/NEJMoa1107579. Accessed Aug. 31, 2023.
- Hamilton SJ. Niacin improves small artery vasodilatory function and compliance in statin-treated type 2 diabetic patients (tested in combination with statin). Diab Vasc Dis Res. 2010;7(4):296-9. Pub Med website. https://pubmed.ncbi.nlm.nih.gov/20667937/. Accessed Aug. 31, 2023.
- Goldberg AC. Clinical trial experience with extended-release niacin (Niaspan): dose-escalation study.Am J Cardiol. 1998;82(12A):35U-38U; discussion 39U-41U. Pub Med website. https://pubmed.ncbi.nlm.nih.gov/9915661/. Accessed Aug. 31, 2023.
- Ng CF, et. al. Effect of niacin on erectile function in men suffering erectile dysfunction and dyslipidemia. J Sex Med. 2011;8(10):2883-93. Pub Med website. https://pubmed.ncbi.nlm.nih.gov/21810191/. Accessed Aug. 31, 2023.
- Barakat MR, et. al. Effect of niacin on retinal vascular diameter in patients with age-related macular degeneration. Curr Eye Res. 2006;31(7-8):629-34. Pub Med website. https://pubmed.ncbi.nlm.nih.gov/16877271/. Accessed Aug. 31, 2023.