It's been a while, hasn't it?  Has the absence of "Ask Dr. Rob" posts left you feeling empty inside?  Has it made you feel incomplete?

Or has it been similar to the absence of leprosy?

Either way, I am back to answer the questions that you send me.  Our latest question comes from Sid, who asks the following question:

Dear Dr Rob:

I have such respect for your knowledge as a primary care physician, knowing so much more than those snooty specialists.  You are the smartest person I have ever met...except for my mom.

Speaking of mom, she used to always tell me to take my vitamins.  Was she right about this?

richThanks for the question, as well as the astute observations.  Vitamins are a hot topic that I feel don't get enough attention by the mainstream medical community.  This is probably because they are two busy getting the mud out of their shoes to think about much.  Just as to why they would be in the main stream (and not some tributary) has always mystified even me.  I usually stand in a tributary.  But I suppose you already figured out that I am not quite mainstream.

In answer to your question, Sid, I have to side with your mother on this one.  Vitamins are very important to make you be very strong and healthy, as well as giving you a firm butt and washboard abs (like me) - the guy in the picture kind of looks like Bill Gates, doesn't he?

So which vitamins are most important for you to be taking?  As my mom used to say, Just remember your ABC's.

Vitamin A -  Retinoic Acid

How something called "Retinoic Acid" got to be called "vitamin A" is a sordid tale of the highest scientific intrigue.  You would expect it to be called "Vitamin R," be named after some egotistical scientist (like "Vitamin Ralph"), or at least be called something cool (like "Mega Voltron"). But this did not happen, and the name "Vitamin A" was given this molecule.  This happened through a complex series of political and bureaucratic maneuvering (involving both the Kennedys and Clintons).

MittmanYou may have heard that vitamin A is important to maintain good eyesight.  My mom used to say that if I ate enough carrots I would not have night blindness.  Both of these are true, as it is used in the retina to turn photons into nerve impulses to the brain.  This happens in cells called "Rods" and "Cones."

The picture on the right is an actual picture of the rods and cones taken by a really little guy with a teeny-tiny camera.  I think the rods look more like burritos and the cones like Lava Lamps, but nobody asked me when they were naming them.

george400 It is worth noting that people who eat excess vitamin A can get an orange hue to their skin.  This may seem like a bad thing, causing them to be cruelly mocked and callously discriminated against, but they have the last laugh - as their eyesight is so keen that they actually develop x-ray vision. 

In very large amounts, Vitamin A is actually toxic.  Polar bear liver has such high levels of vitamin A in it that people who eat it actually die from it.  Just why people might be driven to eat polar bear liver is difficult to determine.  Clearly the spleen of the polar bear is far more tasty than the liver.

polar-bear-butler-3

B Vitamins

Once the die was cast and Retinoic Acid was named "Vitamin A," it only seemed a matter of time before some unlucky molecule was named "Vitamin B."  But fate would have it that eight molecules ended up as B vitamins! 

ap_howard_dean_f It seems that the B Vitamins are the Iowa Caucus of the Vitamin world.  Once the bid to be Vitamin B was opened up, multiple molecules threw their hat to become the next vitamin (as did Howard Dean, but he could not keep his temper in check).  The high-stakes scientific run-off ensued and vote after vote ended up in a deadlock.

Finally, at the vitamin convention (which, coincidentally, was held in Denver, CO), a deal was struck for the naming of B Vitamins.  The list is as follows:

  • Vitamin B1 (thiamine)
  • Vitamin B2 (riboflavin)
  • Vitamin B3,(niacin, includes nicotinic acid and nicotinamide)
  • Vitamin B5 (pantothenic acid)
  • Vitamin B6 (pyridoxine)
  • Vitamin B7, also called vitamin H (biotin)
  • Vitamin B9, also vitamin M and vitamin B-c (folic acid)
  • Vitamin B12 (cobalamin)

As is the case in many political fights, there were some very angry molecules when this compromise came out.  Vitamins B 4, 8, 10, and 11 immediately withdrew their bids to be vitamins and instead moved to a commune in Montana.  Howard Dean's lobbying to be written in as B4 was rebuffed as well.

M&M'S DARK CHOCOLATE The best source for the B vitamins is breakfast cereal.  Breakfast cereals contain all of the vitamins and minerals known to man, and some that are known only to animals.  Folic acid is also found in M&M candies.  One bag of M&M's contains 2% of the daily supply of folic acid, so most doctors recommend eating 50 bags of them each day.

Vitamin C - Caffeine

meet_linus_big It is commonly thought that vitamin C is comprised of the molecule ascorbic acid.  This is a myth.  Clearly the word ascorbic begins with an "a" and not a "c."  Vitamin A was taken already by Retinoic acid.  Ascorbic acid is actually not even a real molecule, but instead is a very tangy form of chewable candy made famous by the Nobel Laureate Linus Pauling.

The real Vitamin C is caffeine.  This is not technically a vitamin, but is clearly a nutrient.  It has always been obvious to clinicians that children have high basal caffeine levels.  The energy and vitality of children is witness to these levels.  Anyone who has tried to get their child to go to bed is well aware of endogenous caffeine.

sleepy As a person ages, however, caffeine levels drop.  This necessitates supplementation with caffeinated beverages and/or snacks to get caffeine back to physiological levels.  In ancient times, the availability of caffeine supplements was sometimes poor, resulting in severe caffeine deficiency.  Many have noted that on the ships that explored the new world, vitamin C deficiency was a real problem, resulting in a very sleepy mutiny by the sailors.  Thankfully, with the appearance of Starbucks on every corner in the United states, caffeine deficiency is largely a thing of the past (except in those decaffeinated religious cults).

Conclusions

There are other vitamins I could discuss (D, E, and K), and controversies I haven't mentioned (like the mysterious disappearance of vitamins F-J), but I think you get my point.  Vitamins are necessary in your diet.

Your mother knew best, Sid.  When she served you those carrots with Coke sauce with the M&M garnish, she was taking care of you.  This is the way all moms work - doing whatever they can to do what's best for their little babushkas.  I know my mom did.  I may not have understood it when she insisted on those M&M's, but now I know that Mom really did always know best.

Thanks for the question, Sid.

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