Be Well - December 2011 Issue

Feature: The ABCs of Vitamins and Minerals – What You Need to Know

Feature: Vitamins & Minerals – Know Your ABCs

Vitamin and mineral supplements not only fill the stores shelves…they fill the news. You may be questioning which dietary supplements you really need.

We asked three experts – Cleveland Clinic internist Keith Fuller, MD, registered Wellness Institute dietitian Kristin Kirkpatrick, MS, RD, LD, and women's health specialist Judith Volkar, MD – to comment on six popular supplements:

1. B vitamins

Collectively, the B vitamins – B1, B2, B3, B5, B6, B9 (folic acid) and B12 – can reduce stress and improve mood. Who needs to supplement their B? Three groups of people:

  • Vegans need the B12 found in meat, chicken, fish, dairy and eggs to prevent anemia and ensure healthy nervous system function.
  • People 65 and older may need B12 because it becomes hard to absorb from food as we age.
  • Women who are pregnant or trying to conceive need folic acid to help guard against birth defects.
2. Vitamin C

Vitamin C supplements may shorten the duration and misery of colds but are unlikely to prevent them. “I don’t think people need C on a daily basis, but taking a large dose at the onset of a cold can be helpful,” says Dr. Fuller.

It’s easy to get C from fruits and vegetables. But “think beyond the orange,“ advises Ms. Kirkpatrick. That morning glass of orange juice is full of sugar and carbs; look instead for C from bell peppers, broccoli, papaya and kiwi.

Avoid taking vitamin C with aspirin – both can irritate the stomach. And remember that high doses of C may interfere with cholesterol medication.

3. Calcium

Best known for improving bone health, calcium is easy to find in milk, cheese and yogurt. “We think ‘calcium’ and imagine the cow, but there are plenty of plant-based sources as well, like spinach and collard greens,” notes Ms. Kirkpatrick. Another source is sardines. “They are a nice, lean fish. If you eat the bones, they won’t crunch and you’ll get your calcium,” she says.

Know which type of calcium supplement you’re taking and when to take it. Calcium citrate can be taken at any time. Calcium carbonate must be taken with food. And because the body can absorb only so much calcium at one time, it’s best to take half in the morning and half at night.

4. Vitamin D

This is the supplement most healthcare providers recommend. Important for bone and muscle health, “vitamin D is difficult to find in natural food sources,” explains Dr. Fuller. Fortified dairy products, cereals and breads usually don’t provide enough vitamin D. Sunshine – the other source of D – can be scarce.

Vitamin D, which works with calcium, is important for women as they age to prevent bones from becoming fragile. “Women often take a calcium supplement that has vitamin D in it. We recommend additional D to get their levels up,” says Dr. Volkar. “D3 is better absorbed than D2.”

A Cleveland Clinic study recently found that vitamin D is best absorbed when taken with the largest meal of the day — preferably one containing healthy fats because vitamin D is fat-soluble.

5. Vitamin E

Daily vitamin E supplementation has been touted for preventing cancer and heart disease. However, a large, seven-year national study by Cleveland Clinic experts proved that men who took vitamin E every day actually increased their risk of prostate cancer by 17 percent. The longer the supplement was taken, the higher their risk.

The message: For most men, taking vitamin E supplements may do more harm than good.

Other studies have failed to show that vitamin E supplements protect against heart disease. For heart health, it’s safer to get vitamin E from dietary sources – safflower, sunflower and wheat germ oils; nuts and seeds; olives; and green veggies.

At high doses, vitamin E supplements act like a blood thinner and can increase the risk of bleeding and stroke.

6. Magnesium

Magnesium, the fourth most abundant mineral in the body, can help with muscle cramps, migraines and sleep problems. “People are often deficient in magnesium and don’t realize it,” says Dr. Fuller. Halibut, almonds, soy products and pumpkin seeds are great dietary sources of magnesium. Magnesium is typically found in calcium supplements to enhance absorption.

Benefits may not add up

A growing body of research seems to reinforce the role of dietary supplements as just that: supplements to our diet, taken to correct a deficiency.

“The bottom line is to get most of your vitamins and minerals from dietary sources rather than from a pill,” says Dr. Volkar. “The majority of us don’t need to spend a lot of money on supplements. For overall health, we’re better off exercising instead.”

Ms. Kirkpatrick heartily agrees: “As a dietitian, I believe you can get 99 percent of all your nutrients from food. You’re not just getting one specific nutrient from a pill; you’re getting a variety of nutrients from a whole food.”

A word on multivitamins

What if you aren’t consistently eating a well-balanced diet? “A multivitamin is good for most adults who are not getting all the nutrients that they need every day,” says Dr. Fuller.

Although a recent study found multivitamins to be dangerous for postmenopausal women, “you have to take that study with a grain of salt,” says Dr. Volkar. The study relied on questionnaires rather than on rigorous scientific method.

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Tip: Watching Your Weight? Watch Your Alcohol Intake

Tip: Liquid Calories Count, Too

A higher lifetime alcohol intake leads to a larger waistline. Alcohol is second only to fat in providing dietary calories. A 12-ounce bottle of standard beer has about 150 calories, a 5-ounce glass about 130, and 1.5 ounces of hard liquor about 90. Sweeter drinks have even more. To cut back, consider lower-calorie drinks, abstaining during the week, alternating glasses of water with alcohol, and drinking on a full stomach to avoid munching.

Be Well – December 2011 Issue

Feature: Help for Hard-to-Control Blood Pressure

Feature: Resistant Hypertension Requires Expert Help

If you have high blood pressure and are taking more than three medications to control it, you may want to see a hypertension specialist.

“According to current guidelines, having to take more than three blood pressure medications from different groups – including a diuretic – at maximally tolerated doses is considered resistant hypertension,” says George Thomas, MD.

Resistant hypertension is often treatable, adds Dr. Thomas, a nephrologist and certified hypertension specialist in the Center for the Study of Blood Pressure and Electrolyte Disorders in Cleveland Clinic’s Department of Nephrology and Hypertension.

Current guidelines – based on the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) – recommend a goal blood pressure of 140/90 mmHg or less. The goal blood pressure is 130/80 mmHg or less if you have diabetes or chronic kidney disease.

Tackling the problem three ways

Look for a specialist recognized by the American Society of Hypertension to help get resistant blood pressure under control. Dr. Thomas explains that it takes:

  • Education about medications, diet and lifestyle changes
  • In-depth testing at a specialized center to uncover the cause of the problem
  • Tailoring the treatment plan for optimal blood pressure management by matching medications to the underlying problem(s)
Going over medications

“We look at how well patients are taking their medications, whether they are taking them in the correct dosage, and whether the combinations of different medications are appropriate for a particular patient,” says Dr. Thomas.

Because of complicated dosing schedules, it can be easy to forget to take your medications, he explains. Also, if you're like many patients with hypertension, you may not realize that other medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), can increase blood pressure.

Examining diet

You may not use the salt shaker, but perhaps you’re eating processed foods or cooking with canned foods that contain high levels of sodium, aggravating hypertension. Registered dietitians can teach you how to read nutrition labels to better manage your sodium intake. They will also advise you about the DASH (Dietary Approaches to Stop Hypertension) eating plan.

Looking at lifestyle changes

Losing weight if you are overweight or obese, increasing your physical activity and moderating your alcohol consumption can help to lower blood pressure. Smoking cessation is also important to lower your overall cardiovascular risk.

Ensuring accurate readings

“Pseudo-resistant” hypertension can occur when blood pressure is not being measured properly. Dr. Thomas and his colleagues emphasize that it is important to measure your blood pressure correctly – and to have home blood pressure machines checked for accuracy by your healthcare provider.

Cleveland Clinic hypertension specialists prefer to take six blood pressure readings in a row in their outpatient clinic using an automated machine, the BpTRU®. The first reading is observed by a healthcare provider and the remaining five are taken when the patient is alone in the room. The average of the last five readings is calculated to get the result.

Advanced testing

If your doctor determines that you are correctly taking medications and following dietary guidelines, and that office blood pressure readings are high, you may be a candidate for further specialized tests. For example, the Center for the Study of Blood Pressure and Electrolyte Disorders offers:

  • 24-hour blood pressure monitoring. Also called ambulatory blood pressure monitoring, this equipment goes home with you to measure blood pressure over a 24-hour period – every 20 minutes during the day and once an hour at night. This provides information about your blood pressure during daily activities and during sleep, which correlates better with organ injury than single office measurements. Night-time blood pressures also provide more information about cardiovascular risk.
  • Impedance cardiography. Similar to the way electrocardiography (EKG) uses sensors to track electrical activity in the heart, impedance cardiography uses sensors to track blood flow through the large blood vessels in the chest. This helps to assess your hemodynamic profile, which can be used to select medications that may work better for you.
  • SphygmoCor® technology. This device measures central blood pressure – blood pressure closer to the heart – to better gauge your risk of cardiovascular events.
  • Evaluation of secondary causes of hypertension. This includes looking for hormone-related and vascular causes of high blood pressure.

The results of such specialized tests allow doctors to tailor a more precise treatment plan. “They help us decide which medications to try that would best help our patients control their hypertension,” Dr. Thomas says.

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Be Well – December 2011 Issue

Free Guide: Eye Diseases of the Retina

Free Guide: Eye Diseases of the Retina

Diseases of the retina, the light-sensitive lining in back of the eye, are the leading cause of blindness among U.S. adults. Learn more about age-related macular degeneration, diabetic retinopathy and other diseases, and how our experts treat them.

Recipe: Lasagna Rolls

Recipe: Healthy Lasagna Rolls

Make a hearty batch of lasagna rolls for your family using whole-grain noodles, fat-free ground turkey breast and low-fat mozzarella cheese. Serve with a side dish of steamed vegetables or a tossed salad for a healthy, filling meal.


12 long whole-grain lasagna noodles
6 ounces ground turkey breast (skinless white meat, extra lean)
10 ounces frozen chopped spinach, thawed and drained
1/4 teaspoon red pepper flakes
1 cup low-fat ricotta cheese
2 cups marinara sauce
3/4 cup shredded low-fat mozzarella cheese

  1. Bring a large pot of water to a boil. Add lasagna noodles and follow cooking instructions on package. Drain water and let noodles cool. Once cool enough to touch, place each noodle flat and cut in half crosswise.
  2. While the pasta cooks, brown the ground turkey in a large nonstick sauté pan over medium heat until cooked thoroughly. Drain any liquid, then add spinach and red pepper flakes to the cooked ground turkey. Heat until the spinach is warmed.
  3. Remove turkey and spinach mixture from heat and let cool slightly. Place in a mixing bowl, add the ricotta cheese, and mix thoroughly.
  4. Preheat oven to 400 degrees. Spread ½ cup of marinara sauce on the bottom of a 13x9″ baking dish. Add 1 tablespoon of mixture onto each lasagna noodle at one end, then roll into a tight package. Place each roll into the baking dish.
  5. Top the lasagna rolls with the remaining 1-½ cups marinara sauce; sprinkle with the mozzarella cheese.
  6. Cover with foil and bake 15 minutes. Remove foil and bake for another 10 minutes, until the cheese and sauce are bubbling.

Makes 8 servings


6 servings (4 roll-ups per serving)
Calories: 320
Total carbohydrate: 44 g
Protein: 24 g
Total fat: 8 g
Saturated fat: 3 g
Cholesterol: 34 mg
Sodium: 604 mg
Potassium: 406 mg
Dietary fiber: 8 g
Sugar: 6 g

Recipe from our Children's Hospital Pediatric Nutrition Support Team

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Be Well – December 2011 Issue

Let's Move It! Free Mobile App

Let Cleveland Clinic and your mobile phone keep you motivated. More than just a pedometer, our free mobile app offers walking challenges, a calorie tracker and videos to encourage and inspire.