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Tips on Vitamins in Psychiatry

The Carlat Psychiatry Blog, Volume , Number ,

In The Carlat Psychiatry Report‘s 2016 update on Complementary Alternative Medicine, Dr. Lila Massoumi, an expert in integrative psychiatry, gives provides a timely and practical overview of the vitamins, supplements, and herbal adaptogens that you should consider prescribing. As a preview. Here are some tips from the first part of her article “Using Natural Supplements.”

As an integrative psychiatrist, Dr. Massoumi orders the following serum levels in many of her patients:

  • Vitamin B12 level
  • Vitamin D level–specifically 25-hydroxyvitamin D (not 1,25-di-hydroxyvitamin D)
  • Ferritin level (level of storage iron)
  • RBC magnesium level (intracellular magnesium)
  • RBC zinc level (intracellular zinc)

Based on the lab results, here are some of her suggestions:

  • Vitamin B12: To avoid overt peripheral neuropathy or dementia, staying above 200 picogram/milliliter (pg/mL) is standard practice. But some preliminary studies endorse keeping B12 levels above 500 pg/mL in order to protect against dementia.
  • Vitamin D: For general health, a level of vitamin D above 30 ng/mL is generally considered normal, but integrative practitioners shoot for levels of at least 50 ng/mL.
  • Magnesium: Mg is the best natural supplement for the treatment and prevention of headaches, including migraine headaches. Approximately 40% of Americans are deficient in magnesium. Shoot for RBC magnesium level in the upper half of normal, or >5 mg/dL.
  • Iron: Low iron levels are one of the nutritional deficiencies that can cause restless leg syndrome. Keep ferritin levels above 30 ng/mL.
  • Zinc: Zinc supplementation has been shown to (modestly) reduce hyperactivity and impulsivity. If the zinc is in the lower half of normal (with a typical lab’s normal range being 9-15 mg/L), prescribe a zinc supplement.

Hopefully you find this helpful! Let us know if you have any thoughts.

To read the full issue, subscribe to The Carlat Psychiatry Report here.

Daniel J. Carlat, MD