|Vitamins For Kidney Disease|
THE OPTIMAL DOSAGE
In many cases, the dosage of a particular supplement may need to be changed because of kidney disease. The dose is often reduced, but in other instances the supplement may have more benefits at higher doses. For example, Thiamine, or Vitamin B1, may reduce proteinuria at a higher-than-normal dose. The "optimal dose" of many supplements still needs to be further studied. This should only be used as a guide. Talk with your physician before making any changes in your current nutritional program.
The following vitamins are generally safe in kidney disease; however, the dosage and frequency will depend on your stage of CKD, dietary regimen, and other medical problems. I try to have many of my patients on some combination of the vitamins listed below.
Natural Versus Synthetic
Many types of vitamins and supplements are either natural or synthetic. The synthetic vitamins are harder for the body to break down and digest, whereas the more natural vitamins are easier on the stomach and better absorbed in the body. If possible, it pays to get the more natural form.
If you have been following a low-protein, vegetarian-based diet, you may need to take a vitamin B12 supplement, as it is commonly found in meat and animal products. On a vegetarian diet, you may be deficient in this vitamin. Low levels can contribute to nerve problems and anemia. As you will read below, B12 may also be important in maintaining bone health. If your doctor feels you may be deficient in this vitamin, she may order a blood test that can measure the level of B12 in the body.
Low levels of vitamin B9, or folic acid, may play a role in the development of atherosclerosis. If you are on a vegetarian-based diet, you do not need folic acid supplementation, as B9 is found in many leafy greens - though you may be taking a multivitamin, which will usually contain some amount of folic acid anyway. Vitamin B1, or thiamine, may help in reducing proteinuria. In one study, patients with type 2 diabetes and proteinuria were given thiamine at doses of 300 mg daily compared to a placebo group. After three months, the group taking the higher dose of thiamine experienced a decrease in the amount of proteinuria. This needs further research as the optimal dose and duration of therapy with thiamine is still unknown. However, this study suggests that higher doses of thiamine may lower the protein levels even more.
In a related study, it was suggested that the combination of high dose thiamine and benfotiamine (ben-fo-tya-mine) - a manufactured form of thiamine - decreased the amount of proteinuria.
The B vitamins are important regulators of homocysteine (homosis-teen), an amino acid that is associated with heart disease at high blood levels, although this connection is still somewhat controversial. There may also be an association with elevated hornocysteine levels and osteoporosis; although again, this needs more research. In one study, blood tests showing high homocysteine levels and low vitamin B12 levels were associated with an increased risk of bone fractures. Homocysteine levels can be elevated in CKD. More research is needed, but taking a B-complex vitamin daily seems reasonable pending further research into this area.
If no proteinuria is present, I would recommend taking one B-complex vitamin a day. If your vitamin B12 level as measured in the blood is low, you may need an additional daily B12 supplement. If you have diabetes and proteinuria, supplementing with thiamine at a dose of 200 or 300 mg a day (two to three tablets at 100 mg each) seems reasonable until more studies are done. If you have any type of cancer, talk to your doctor before either starting thiamine or increasing your thiamine dosage. To find out more, you can check out Vitamins For Kidney Disease.