Susan Fishbein, M.D. is a gastroenterologist in Cliffside Park, New Jersey affiliated with Holy Name Medical Center in Teaneck. She received her M.D. from SUNY Downstate Medical Center in Brooklyn. Dr. Fishbein completed a residency in internal medicine and a fellowship in gastroenterology at the Ichan SUNY Downstate Medical Center.
Dr. Fishbein has been in practice for more than 25 years.

The topic of “nutrition supplements” comes up frequently with patients at Nutritional Transformations. There seems to be a lot of information and disinformation out there. Dr. Fishbein helps to clarify.

Jenn: In terms of normal absorption of water-soluble vitamins are there any concerns with taking large dosages?

There are nine water soluble vitamins: B1 (thiamine), B2 (riboflavin), B3 (niacin), B5 (pantothenic acid), B6 (pyridoxine) B7 (biotin), B9 (folate/folic acid), B12, (cobalamin) and C (ascorbic acid).

Hypervitaminosis: vitamin toxicity due to too much of a vitamin or multiple vitamins in the body.

Acute hypervitaminosis: the result of taking an extremely high dosage of a vitamin(s) at one time, resulting in an “overdose.”

Chronic hypervitaminosis: ingestion of mega dosages of a vitamin(s) over time. Clinical symptoms can be seen over extended periods of time.

Dr. Fishbein: Toxicity from mega dosing water-soluble vitamins, although infrequent, can occur. Generally, the body will excrete excess water-soluble vitamins and there’s no problem.

Hypervitaminosis due to water-soluble vitamins has a less pronounced manifestation and is not life-threatening. It can be normalized by increasing the urinary output and restricting the intake of such supplements.

Jenn: Some symptoms of water-soluble vitamins toxicities are as follows:

Skin: hypersensitivity, itching, burning or prickling sensations, numbness, skin rashes, ulcers in the corners of the mouth.

Stomach: vomiting, nausea, intestinal ulcers, indigestion, diarrhea.

General: headaches, restlessness, convulsions. Cardiac failure/cardiomyopathy, respiratory failure, hypotension, fatigue, sleep disorders, fatty liver, hypoglycemia, hyperuricemia, lightheadedness, gout, water retention, edema, photosensitivity, and neuropathy.

Jenn: In your opinion is there a limit to the dosages of fat-soluble vitamins?

Dr Fishbein: Hypervitaminosis due to fat-soluble vitamins has a more pronounced course because these vitamins accumulate in the body tissues and cause severe intoxication. Vitamins A, D, E and K are fat-soluble vitamins. They accumulate in the body, particularly in the liver.

Jenn: Many people take vitamin supplements daily, believing that excess vitamins are harmless. This misconception and the prolonged intake of high dosages of vitamins may cause toxic effects or hypervitaminosis.

Poison control data in the U.S. indicates that more than 60,000 people, including children under the age of 6, are subjected to life-threatening outcomes due to vitamin toxicities.

Jenn: Some symptoms of fat-soluble fat vitamin toxicities are the following:

Headache, vomiting, skin rashes, abdominal pain, visual disturbances, fever, dry fissured lips, hair loss, brittle nails, alterations in bone metabolism, sharp pain in the back, dehydration, subcutaneous hemorrhage, problems with dental enamel clotting problems, fatigue, and delayed wound healing.

Jenn: What about minerals. Can they become toxic in high dosages over time?

Dr. Fishbein: At just five times the Recommended Dietary Intake (RDI) recommendations, zinc, iron, chromium and selenium can rise to toxic levels in the body. Excessive fluoride (especially in childhood) may stain and even weaken teeth. Very large doses of fish oil can lead to decreased blood clotting. Iron toxicity can cause gastrointestinal upset, nausea, and block bowel actions. Severe toxicities of minerals can lead to coma and death.

The top nine major and trace minerals are as follows: calcium, magnesium, sodium, chloride, potassium, selenium, iron, zinc, and chromium.

Jenn: To avoid hypervitaminosis of minerals, don’t take more than the recommended daily allowance of each vitamin

Jenn: In terms of gluten sensitivity and/or celiac disease, is normal digestion and absorption, including vitamins, adversely affected. Please elaborate.

Dr. Fishbein: With untreated gluten sensitivity and/or celiac disease, the intestinal villi can be adversely affected and absorption of nutrients impaired.

Jenn: What would you recommend for a person who may have a compromised gut microbiome? (Trillions of microorganisms and their genetic material that live in the digestive tract. Mostly bacteria, they contribute to critical functions in our health and well-being).

Dr. Fishbein: Control diet to prevent flare ups. Take doctor prescribed medication. For some, probiotics may be helpful but discuss with your physician. There are different types of probiotics. And probiotics are not FDA regulated. Some are better products than others for example: Allegan and Foraster are considered better products to select.

Jenn: Improve your microbiome:

1. Avoid sugars and processed foods, antacids and artificial sweeteners.

2. Consume naturally fermented foods and supplement with probiotics, plenty of fiber, organic and local products, and have a diversified diet.

Jenn: In terms of nutrient absorption, is there any value in consuming a homemade fresh liquid fruit and vegetable juice drinks versus eating a healthy balanced diet made of regular consistency foods?

Dr. Fishbein: In my opinion, drinking a homemade vegetable-fruit fusion is not better versus eating a healthy well-balanced diet.

Jenn: In terms of nutrient absorption and health benefits, is it better to take a daily multivitamin or consume a juice-vegetable drink?

Dr Fishbein: A multi-vitamin that is RDA approved is more than enough to prevent nutrient deficiency. Eating a balanced diet with variety is also recommended. However, fresh juice-vegetable drinks have no benefit over a vitamin-mineral supplement or even a well-balanced diet.

Jenn: In terms of general health, what is your opinion of indulging in foods known to have antioxidant or anti-cancer qualities even if they add excess calories to your waistline?

Dr Fishbein: Consuming anti-cancer source foods in excess amounts that add extra unwanted calories and weight is not warranted.

Jenn: In your opinion, how important is being in a healthy weight category even if a person consumes healthy types of foods?

Dr Fishbein: Being in a healthy weight category is very important for general health and well-being. If a person is overeating, even healthy foods, that’s not good either…too much of any good thing is not good, including excess calories.

Jenn: In terms of diabetes, can you elaborate on how absorption of nutrients may be adversely affected due to the disease’s process?

Dr Fishbein: Uncontrollable diabetes can result in many serious medical problems. Uncontrollable diabetes affects the vascular system. That is the reason many people with uncontrollable diabetes have gangrene and require amputation of fingers, toes and feet. Blindness and loss of kidney function is a side effect of long-term out of control high blood glucose. The stomach (or GI tract) also has a vascular system and can be negatively affected. Motility is slowed, causing constipation or bowel habit issues and other GI-related discomforts.

Jenn: Please comment on anything that may help our reader understand more about gastroenteric health?

Dr Fishbein: Eating a variety of healthy foods in adequate amounts helps prevent nutrient deficiencies or toxicities. Consuming adequate fiber helps eliminate unwanted wastes. Keeping weight in check and exercising helps keep the body healthy. Eating and living healthy is the key to good health.

Jenn: Thank you, Dr. Fishbein, for your time and availability. Your expertise in explaining gastro-nutrient relationships is very appreciated and educational.

By Jenn Chapler