Vitamin Therapy and Singers

Self-administered vitamins have become so ubiquitous that they no longer qualify as “alternative” medicine. Multiple-vitamin tablets form part of almost everyone’s morning routine. The use of large doses of Vitamin C for prevention and treatment of colds, advocated by Dr. Linus Pauling, has pretty well entered conventional medical wisdom. In addition, the new interest in reducing free radicals using anti-oxidant vitamins such as vitamins C and E has led to the ingestion of quantities of vitamins far in excess of what is conventionally recommended, and the validity of these recommendations has itself been questioned.

While a great deal of research has been done on the benefits of vitamin therapy, potential problems remain for the average consumer. Most traditional research has focused on treatment of vitamin deficiencies and the benefits of vitamins in this context is clear. However, most of us in the Western World are not frankly vitamin deficient unless we’re ill, or on restrictive or “fad” diets.

Vitamin therapies typically involve taking a variety of vitamins, many times in excess of the “daily required” amount. While there may be some question about how much is really required, greatly excessive vitamin intake may also be harmful. Vitamins are generally water-soluble (C and B complex) or fat-soluble (A, E, and D). While it is difficult to overdose on water-soluble vitamins (the excess is simply excreted in the urine), fat-soluble vitamins accumulate in the body and may become toxic. So you should be less worried about taking too much Vitamin B than about too much Vitamin E. Although I am a proponent of Vitamin C supplements, there are two specific issues for singers taking Vitamin C. Since Vitamin C can irritate the stomach, if you are prone to heartburn (acid reflux), you should be careful. Either take a lower dose, or spread it out over the day. Time-release formulations, which dissolve in the small intestine instead of the stomach, are another option. A second problem has to do with excretion of excess Vitamin C. As the vitamin is excreted by the kidneys, it pulls water with it. This can lead to mild dehydration and dryness of the vocal folds. Further, if you are prone to kidney stones (oxalate stones), Vitamin C supplements may be actually harmful for you.

Niacin, one of the B vitamins, is often taken as a general supplement to lower the cholesterol, or to reduce stroke and heart attack. Its main side effects, tingling or hot flushes of the face, can be minimized by using the time-release formulation. For singers, the potential problem has to do with niacin’s ability to dilate the blood vessels. If you are prone to vocal fold hemorrhage, you should not take niacin, particularly if you are also taking pain medications such as aspirin or ibuprofen. Ginkgo, a current favorite among supplements, also thins the blood, and an excess amount of ginkgo, especially taken with niacin or aspirin, can cause bleeding. Be especially careful during the menstrual period, when the blood is somewhat thinner already, and can compound the potential for hemorrhage of the vocal folds or nosebleeds. Vitamin B12 is a particular favorite among singers. While conventional medical dogma scoffs at any use except for treating Vitamin B12 deficiency, in fact the medication seems to give an energy boost in various forms of fatigue. Some physicians recommend B12 injections as part of the treatment for chronic fatigue syndrome, a form of Epstein-Barr virus infection. B12 is water soluble and therefore can normally not be taken in excess, and the injectable form seems to be more effective than the oral form. While treating the underlying cause of fatigue is important (which could be anything from depression or sleep deprivation to hypothyroidism), B12 injections are a useful adjunct in the overall management of the symptom.

In summary, vitamins are a useful supplement to a good diet. Vitamins are not food, and do not replace adequate and varied nutrition. This means a diet high in dark leafy vegetables, fiber, and protein. With vitamins, as with any medication, more is not necessarily better. For example, many authorities agree that up to 800 units of Vitamin E are beneficial, but this does not mean that 1600 units are twice as good. If embarking on megadose vitamin therapy, know something about how the substance is stored and metabolized. In the presence of kidney or liver disease, you may have to limit your vitamin intake.

Most importantly, take vitamins purposefully, not indiscriminately. Understand what they do and know exactly how much you are taking. If you take multiple vitamins and fish oil capsules as part of your routine, calculate how much of each vitamin is contained in each capsule in addition to specific vitamins you may be taking.

Anthony Jahn, M.D.

Anthony Jahn M.D. is an otolaryngologist with a subspecialty interest in ear diseases, disorders of hearing and balance, and disorders of the voice. He is a professor of clinical otolaryngology at Mount Sinai School of Medicine and is the noted author of Care of the Professional Voice. For more resources, go to his website