From: altar@beaufort.sfu.ca (Ted Wayn Altar)
Subject: Re: vitamins and hot flashes
Organization: Simon Fraser University, Burnaby, B.C., Canada
Date: Mon, 14 Dec 1992 19:14:31 GMT

sj@netcom.com (Suzanne Jacobs) writes:

>I've always taken Schiff veg multiple vitamins, but they've
>recently begun giving me hot flashes.  You're supposed to take
>2 per day, so I've started taking 1 in the morning and 1 at night.
>Sure nuff, I get smaller hot flashes.

>Any ideas?  I'd hate to go w/o vitamins, but I don't think hot
>flashes are healthy either.


     What you describe may just be a coincidental relationship
but the vitamin most likely associated with such flushes would 
be niacin (so-called B3).

     The toxicity of niacin is in general considered "low" (non-
ruminant animals can tolerate in the short run some 10-20 fold
their normal requirements for this vitamin), but it does exist.
Niacin been many undesirable side effects with its overuse.  Hunt
&  Groff (1990) list the following as among those effects:

     1.  release of histamine, which causes an uncomfortable
     flushing and which may be injurious to persons with asthma
     and/or peptic ulcer disease
     
     2.  possible injury to the liver, as indicated by elevated
     serum levels of enzymes of hepatic origin (e.g.,
     transaminases and alkaline phosphatases) and by obstruction
     of normal bile flow from the liver to the small intestine
     
     3.  competition of niacin with uric acid for excretion,
     thereby raising serum uric acid levels
     
     4.  development of dermatologic problems
     
     5.  elevation of plasma glucose levels

     Other problems include itching urticaria, severe
gastrointestinal discomfort (heartburn, nausea, vomiting, rarely
diarrhea). Usually, these problems are only seen with patients
consuming large does (approx. 3g/d), but no doubt there exist
individual variations in sensitivity.

     Now, another question to consider might be the usefulness of
consuming multivitamins to begin with.  The following is from a
Consumer Reports 1986 review article on "The Vitamin Pushers:
From Drug Company to Drug Store, Sellers Tell You That you Need
Vitamin Supplements. Do You Really?":

     Fat-soluble vitamins are not excreted efficiently.  They are
     generally stored until they can be used up, and thus can
     accumulate to toxic levels.  For example, prolonged
     excessive intake of vitamin A can cause headache, increased
     pressure on the brain, bone pain, and damage to the liver.
     Excessive vitamin D can cause kidney damage.
     
     Though the water-soluble vitamins are generally excreted
     quickly when taken in excess, some of them can cause
     trouble.  Large doses of niacin can cause liver damage,
     severe flushes, and skin rash.  High doses of vitamin C can
     cause diarrhea.  And high doses of vitamin B6 over long
     periods can cause permanent damage to the nervous system.
     
     Reports of cases of vitamin toxicity are uncommon. But they
     are particularly sad because most people who get into
     trouble with vitamins have essentially poisoned themselves
     in the pursuit of health.

     Consumer Report's medical consultants then point out that
the best way to get vitamins is from foods.  There is no known
and documented advantage for healthy adults to take vitamins,
unless they enjoy seeing their urine turn a brilliant yellow ;-)
One would do better to spend the money not on vitamin pills but
on quality, fresh fruits and vegetables, organically grown if
possible.

     Yet, we are constantly told by vested interests like the
General Nutrition Corp. (they operate about 1300 health-food
stores) that vitamin pills are "nutritional insurance" and that:
     
     "It would take a computer and a good deal of conscious
     effort to devise a diet that each day would give all the
     nutrients in optimal amounts . . . From the viewpoint of  .
     . . nutrition, a complete supplement may be the best
     possible buy in health insurance"
     
Experts like Victor Herbert, however, strongly disagree:

     Vitamin pushers use deception by omission.  They list all
     the terrible things that can happen if your diet is lacking.
     But they never tell you that vitamin deficiency is RARE
     unless a person's diet is extremely unbalanced.  Most
     important, they never tell how to measure whether or not
     your diet is adequate.  If they did, they'd lose customers.
     Determining dietary adequacy is actually quite easy.
     
     Vitamin needs may rise with certain physical conditions but
they generally do not rise above RDA levels and are easily meat
by proper eating.  We should also remember that RDAs are not
"minimums" or "requirements".  The level for each nutrient is
deliberately set higher than most people need so that a safety
factor is built in for those individuals at the high end of the
range of need.

There is simply no justification for the indiscriminate use of
multivitamins by healthy individuals who would do much better to
maybe reduce their intake of fat, expand their range of good
quality whole foods, and increase their levels of physical
exercise,.  Maybe at least consider using only specific vitamin
supplements that can be better justified given your particular
individual situation (e.g., iron for woman during menstruation or
pregnant women, B12 for vegans, etc.)

Reduction of fat, whole foods (e.g., eating more fresh vegetables
and quality fruits) and exercise are the three simple things that
will produce the greatest benefit for the greatest number of
people, but which are also the the very things that most Westerns
can fail to sufficiently heed.  :-(

                                       ted