Vitamin D - What Level is Right?

A listener on KGO radio in San Francisco recently emailed this question in after hearing Todd Whitthorne talk on the Joanie Greggains show.

"I'm really worried that I'm going to overdose on Vitamin D. The bottles still claim that 400 IU Vitamin D is 100 percent of the daily value, but the Cooper expert said that 2,000 IU vitamin D is in all their multivitamins. What's the right amount for me. If I take a multivitamin with 2,000 IU vitamin D AND calcium with vitamin D, am I getting way too much?"

Todd responded with this message:

The only way to truly know how much vitamin D you need to take is to have a blood test called 25-hydroxy-vitamin D. Anything below 20 ng/ml is defined as deficient; anything between 20-30 is insufficient. Approximately 80% of Americans are believed to have D levels below 30 ng/ml.

At Cooper we like to see our patients with a D level of at least 40 ng/ml….. higher is better. I personally want my level to be at least 60 ng/ml. How much you need to take is dependent on what your blood level is. Most experts, including our Cooper Complete scientific advisory team, believe that 2,000 IU/day of vitamin D-3 should be the starting point for everyone. This is why we have 2,000 IU of vitamin D in all of our adult multivitamin formulations.

Our research shows that most Americans (unless you are a lifeguard in San Diego), will need more than 2,000 units/day to get to goal (target). I take 7,000 IU of D per day and my last blood test showed by blood level to be 62 ng/ml. That said, keep in mind that everyone is different so based on diet, sun exposure, time of year, latitude, age, complexion, etc…, all those things will impact vitamin D level.

D controls the uptake of calcium which means we really need to make sure our D level is where it should be so that we can effectively address bone health issues/concerns.

Chewable Calcium - with or without food?

We recently received this question:

"I take Cooper Complete Chewable Calcium. My question is may I take them at any time of the day or night, and do I need to take them with food?"

Our Chewable Calcium is in the carbonate form, so it’s preferable to take the product with your meal. Calcium carbonate is not well absorbed by people with reduced levels of stomach acid, so taking this supplement with meals improves absorption because of the stomach acid generated to digest the food in the meal.

We received received this question via email:

"Since vitamin aren't regulated, how would I know that the calcium and B-12 vitamins I am taking contain the exact amount of ingredients as stated on the label?"

The only way to know for sure if your calcium and B-12 contain the exact amount of ingredients as stated on the label is to send the product off to a laboratory for analysis. The process typically takes several weeks and can cost from a few hundred dollars to well over a thousand dollars, depending upon the number of ingredients being tested.

Another option is to ask the consumer affairs department of your supplier supplier (Cooper Complete, Centrum, CVS, NOW, etc.) to provide you with a certificate of assay for the products. (This is an easy process in a small company like Cooper, but it may be difficult to find someone in a larger company who knows what you’re talking about and can provide you with the information.)

When a supplement is made, good manufacturing standards will have the facility test the raw materials used in the product before mixing to make sure the product is actually what it says it is. If we think of this like baking, and bread calls for yeast, salt, flour and water, the process essentially making sure that the ingredients we’re pulling out of our cabinet are actually yeast, salt and flour (not sugar or corn starch, for example). In the world of supplements, the manufacturer will also test the product to make sure that the ingredient is in the concentration that was specified and that there aren’t any additives or contaminates. After the manufacturer has determined that the ingredients are “as stated” they can then be used in a product. Once the product is blended together and in tablet/capsule/softgel, it’s going to be tested again to make sure that the completed product looks right.

All this said – blending together products is not that different from making chocolate chip cookies. Even if we use a scoop or measure out the portion so that each cookie is the same size, it’s not that unusual to find a slightly different number of chocolate chips in each particular cookie. So, on average each cookie may have 5 chocolate chips. There are slight variations in supplements, no differently than in cookies. When we have a batch of product (which can be thousands of bottles) we’ll pull a couple of bottles from the line and test the finished product.

I’m attaching a certificate of assay for calcium where you can see that in our latest batch of calcium, there are 264.50 mg of calcium citrate in each tablet checked. Our ingredient panel for Cooper Complete Calcium Citrate states that each tablet is 250 mg of calcium citrate. Because of variances in blending/mixing the product together, the specifications for the manufacturer are actually that the tablet contain a minimum of 225 mg calcium citrate and a maximum of 312.5 mg calcium citrate. With 264.50 mg of calcium citrate, this batch of product passes and is approved.

Calcium Citrate takes several minutes to dissolve in water; should I be worried?

We recently received this question via email:

"I have read that Calcium Citrate is the easier form of calcium to digest. When I place the pill in water, it takes several minutes to dissolve. Is that a problem? Would it be easier to digest if I dissolved the calcium pill in water?"

It’s honestly not a problem for it to take some time for any of your supplements (or prescription pills/capsules/softgels/tablets, etc.) to dissolve in water or any other fluid. On the certificate below, USP (Pharmacopia) 30 is used to test the dissolution of the tablet. USP 30 protocol allows 45 minutes for a calcium citrate tablet to dissolve. For this particular batch, the samples dissolved in 19 minutes. When we consider that in healthy adults, it typically takes the foods we eat anywhere from 24- to 72 hours for the full digestive process, the time it takes for the tablet is very small.

Liquid products are absolutely faster at dissolving – hitting the blood stream in seconds; however, in the greater scheme of things it honestly doesn’t matter how quickly the calcium hits the blood stream and starts the absorption process, just that it does.

If Cooper Complete Is Good, Is Elite Athlete Better?

We recently had this question: "My doctor has suggested that I (female) take Cooper Complete With Iron, and that my husband take Cooper Complete Iron Free. I noticed that there is a Cooper Complete Elite Athlete which seems to have more of certain key ingredients. What is the difference for us between the two kinds of multivitamins?"

Cooper Complete Iron Free and Cooper Complete With Iron are our most comprehensive multivitamin/mineral supplements. These two products are identical save for the 18 mg of iron in the "With Iron" formulation. The daily "serving" is 8 tablets (4 in the morning with breakfast and another 4 in the evening with dinner). The level of the ingredients in these products is typically much higher than you'll find in a one-a-day product. For example, in addition to great levels of vitamin D (2,000 IU) and robust levels of the B vitamins, we also have 10 mg lycopene, 6 mg lutein, and 50 mg CoQ10.

Cooper Complete Elite Athlete has been for formulated for those who exercise at least 5 hours per week at 80% (or higher) of their maximal heart rate. The average person who is exercising an hour most days of the week just isn't going to hit the baseline for Elite Athlete because of the heart rate level.

For this product (Cooper Complete Elite Athlete), we define 80 percent of maximal heart rate as 205 - 1/2 age x 0.8. (You'll may see the maximal heart rate equation elsewhere as 220 - age (instead of 205 - 1/2 age), but we use this formula for Elite Athlete because of the higher overall level of fitness of these individuals.)* The foundation of Elite Athlete is the original formulation (described above) to which we have a higher level of vitamin C (2,000 mg instead of 500 mg) and E (800 IU instead of 400 IU). This product also contains 18 mg Iron (like Cooper Complete With Iron).

The iron in Elite Athlete is important for athletes, but not needed for men and postmenopausal women who are not exercising at these high levels.

*Both of the calculations for maximal heart rate are really rough estimates but the best you can do the gold standard treadmill stress test, available at Cooper Clinic as part of the overall preventive exam.

Omega-3 – Please explain all the numbers on the label

We recently received an email with this question: “Can you help me understand why on fish oil capsules the ingredients do not seem to add up? On most fish oil capsules the front of the bottle will say 1,000 mg or 1,200 mg, but when you add up the EPA and DHA they add up to much less. On your capsule, I see Fish Oil concentrate listing of 2,258. Then I see Omega 3 fatty acids of 1,400 mg. When I add up the omega-3 fatty acids EPA and DHA, I get 1,200 mg. My doctor has recommended I take 1,000 mg of Omega 3 daily. The way these ingredients are listed is very confusing.”

Supplement information can be very confusing! Since a picture helps, here is the ingredient panel for Cooper Complete Advanced Omega-3:

On the ingredient panel, we have 2,258 mg of “fish oil concentrate,” a blend of anchovies and sardines. Below that, we list Omega-3 fatty acids at 1,400 mg. The 1,400 is actually 1,200 mg EPA (eicosapentaenoic acid) and 200 mg DHA (docosahexaenoic acid) plus 200 mg omega-3 fatty acids in unspecified form. The 200 mg of omega-3 fatty acids in “unspecified form” isn’t that unusual when we consider nutrition labels. For example, when we look at “fat” on an ingredient panel, we’ll often see that the “total fat” line is larger than the breakdowns of saturated, poly-unsaturated, mono-unsaturated, and trans fats shown below, because there are other lesser known type of fats that are also included.

While most of us think of our omega-3 softgel as being 100 percent “omega-3” the reality is that the level of EPA and DHA vary from as little as 30 percent to as high as 70 percent in over-the-counter products, with a prescription level containing a concentration of EPA and DHA that’s 84 percent. The 1,000 mg EPA, 200 mg of DHA and 200 mg in “other omega-3 fatty acids” in Cooper Complete Advanced Omega-3 comprise 60 percent of the overall softgel. The remaining 40 percent of the product is simply fish oil.

We have evaluated moving to a 70 percent concentration of EPA/DHA in our product as it’s the most concentrated option currently available over-the-counter. However, the 70 percent concentration from our manufacturer (Ocean Nutrition) is significantly more expensive than the 60 percent concentration, and we would have to pass the cost along to you. At this point, it is more cost effective to take an additional softgel of our existing product if higher levels of EPA and DHA are needed.

There are many “1 gram” fish oil products (billed as omega-3) on the market. In many cases, the brands screaming “1,000 mg” or “1 gram” on the front of the bottle are also the products that contain the lowest 30 percent concentration of EPA and DHA. When you look at all of the omega-3 products on the market, our recommendation is to use the ingredient panel to add up the levels of EPA and DHA. With FDA labeling standards, if the product doesn’t list EPA and/or DHA, you can trust that EPA and DHA are not in the product.

The omega-3 fatty acids EPA and DHA are the compounds in fish oil researched so extensively. Since the EPA and DHA in fish oil are what’s so important for us, when someone tells us they’ve been advised to take 1,000 mg “fish oil” per day, we get to that level by adding up the EPA and DHA, which means with our product we would expect you to take two softgels daily.

To purchase Cooper Complete multivitamins and supplements, visit the Cooper Store at www.CooperComplete.com.

Jill Turner is VP Operations for Cooper Concepts, the company that markets Cooper Complete nutritional supplements. Email (jsturner@cooperwellness.com) or call 800-980-6311 with your questions and comments regarding supplements.

Reference

If you'd like to see the certificate of assay (COA) from Ocean Nutrition, our raw material provider, for the latest batch of Cooper Complete Advanced Omega-3, send us an email and we'll send the COA to you.

Chia Seed

We've recently had several questions about Chia seed.

Chia is a member of the mint family and was historically used as a staple food in the ancient Aztec diet. In the popular book Born to Run: A Hidden Tribe, Superathletes, and the Greatest Race the World Has Never Seen, author Christopher McDougall describes a fermented energy drink that includes chia.

Chia ads promote the product as being rich in omega-3 fatty acids, and a good source of fiber, protein, minerals and antioxidants. Unfortunately, market interest is far ahead of published research on the product.

While there's a study in animals suggesting that chia may lower LDL (the lousy) blood cholesterol and triglycerides while increasing HDL (the healthy) cholesterol, the study hasn't been replicated in humans.

However, Chia is a good source of fiber, so adding it to smoothies or breakfast cereal might be a good way to increase your fiber intake. If you elect to go this route, our recommendation would be to price various Chia products in your grocery store.

Here’s a nice write-up on Chia from the American Dietetic Organization - http://www.eatright.org/WorkArea/DownloadAsset.aspx?id=9682. You can search for "chia" within the article, or simply go to page 13.

Email us with your supplement questions at Questions@CooperWellness.com.