Commonly Asked Questions, Part II

Commonly Asked Questions, Part II

G. Douglas Andersen, DC, DACBSP, CCN

Volume 10, number 25, 12/4/92, page 20
Are vitamins in capsules better than tablets? Supplemental recommendations for cramping, spasm, surgical recovery, and fracture.

This month I will continue to address some of the most common questions I encounter.

1. What do you think is better, tablets or capsules?

I personally think capsules are better absorbed than tablets, and whenever possible I ingest capsules and recommend them to my patients. There are cases where tablets are better, such as proteolytic enzymes. There are also cases where capsules probably aren't needed. For example, I rarely recommend that a patient buy vitamin C in capsules. Tablets and powders are less expensive and, if there is an absorption problem, this can be solved by simply increasing the dose. Finally, because the micronutrients are compressed, tablets can hold more than capsules. Thus, if you are having a compliance problem, it may be better, if your patient's digestive system is healthy, to go with tablets since it won't be necessary to ingest as many per day to achieve the doses you recommend.

2. If capsules are better, why don't more companies put them out?

It is much more expensive to put your substance in a capsule as opposed to a tablet. Anyone that tells you different is probably a representative selling tablets.

3. What do you supplement for acute muscle spasms?

I found that magnesium is fantastic for hot muscle spasms. I also like to add in a dash of B6.

There are many different forms of magnesium on the market. There are some forms that preliminary studies have shown to improve absorption with less gastric irritation: these include the glycinate and aspartate forms. The standard form is magnesium oxide, which is fine assuming, your patient does not have stomach or intestinal problems. With people who have hot spasms, I dose small amounts of magnesium every hour to bowel tolerance. That is, I will preload them with 300-600 mg of elemental magnesium, and then have them add 100 mg every hour or two. When their stools begin to be loose, I have the patient suspend oral ingestion for a six hour period, and then have them resume ingestion of 100 mg every two or three hours. Usually, you only have to do this for one or two days. Many herbs also have antispasmodic properties. Valerian and passiflora are two of the best; they often will be included in magnesium-based antispasmodic formulas.

4. What do you give for muscle cramps?

Well, there are many different causes of muscle cramps. Without getting into the physiology or pathology of cramps, which should be looked at before you supplement, calcium and vitamin E have a long track record of giving patients marked relief from cramping that is not caused by dehydration.

5. Do you ever give supplements to a patient who is going to surgery?

Yes, absolutely. My surgery protocol is as follows: For three or four days prior to surgery, I will load the patient with the enterically-coated proteolytic enzymes, trypsin, chymotrypsin, papain, and bromelain. Some combination formulas have all of these enzymes. If you are unable to find a combination formula, I then recommend you give your patient two formulas: one animal based (trypsin or chymotrypsin); and one vegetable based (papain or bromelain). I will give the patient: (i) a multimineral supplement that contains at least 100 percent of the RDA of all minerals, including calcium and magnesium; (ii) a B-complex of at least 100 mg, preferably 50 mg b.i.d.; (iii) a broad range antioxidant formula that contains a minimum of 20,000 IU of beta carotene, 10,000 IU of vitamin A, and 400 IU of vitamin E. There are many antioxidant formulas that include eight or 10 substances. I have no problems with these formulas, but would like to stress that the beta carotene, vitamin A, and vitamin E are the most important antioxidants, along with vitamin C; (iv) I will dose with vitamin C to bring the patient's total intake to at least 2,000 mg from all supplemental sources.
I will keep them on this program up to 30 days prior to and at least 30 days following their surgery, after which I have the patient return to a multivitamin, multimineral formula. After surgery I will recommend a rehabilitation formula, the type described in last month's article, for at least one month following their surgery.

6. What do you do if a patient has a fracture?

For fractures, have the patient taking a multimineral supplement that contains at least 1,000 mg of a bioavailable source of calcium and 500 mg of magnesium, along with the RDAs for other trace minerals; add 500-1,000 mg of calcium in the hydroxyapatite form and 600-800 IU of vitamin D. Depending on the nature and extent of the fracture, they will be ingesting this for anywhere from two to eight weeks following trauma.

7. What is the best form of calcium to use?

As you are aware, there are many different types of calcium on the market. The following are my recommendations: (i) calcium carbonate is a cost effective form for normal, healthy individuals; (ii) calcium citrate is good for those over 50, or with gastrointestinal diseases; (iii) for osteoporosis, use a calcium supplement of 1,000 mg that comes from at least four sources including citrate. To this, add another 500 mg of calcium hydroxyapatite along with a minimum of 400 IU of vitamin D; (iv) calcium lactate is the form I use when supplementing for cramps.

8. How much vitamin C do you recommend?

There is more and more research coming out on the positive effects of vitamin C. There is also a great deal of controversy in the amount one should use as a dietary supplement. Traditional medicine continues to insist that 50 mg per day is all you need, but there are some researchers who recommend 10,000-20,000 mg per day as a maintenance dose. I feel the optimum amount of vitamin C falls somewhere in the middle: for children under 12, a minimum of 5 mg per pound of body weight per day. In times of sickness or injury, daily intake may be increased to 10-15 mg per pound of body weight. For kids over 12 and teenagers, a daily 10 mg per pound of body weight, doubling this number in times of sickness or injury. For adults, 1,000-2,000 mg per day with 3,000 mg to bowel tolerance recommended in times of injury or sickness. Remember that these amounts of vitamin C are from all sources.
Almost every multivitamin contains some vitamin C.

Furthermore, many multimineral B complex, and antioxidant formulas also contain vitamin C. So, I tell my patients to add the amounts of vitamin C they receive from the basic supplement they ingest daily, and then if necessary add extra vitamin C to bring them to the desired level.
Finally, I prefer that C be taken in divided doses with meals as opposed to time-release forms. For children who can only take chewable vitamins, I recommend that they consume their C right before a meal to minimize any type of irritation to the teeth and gums of susceptible individuals.

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