If I am eating a reasonably healthy diet, what other vitamin
supplemnts are necessary?  I am taking multivitamin, vitamin C and E
daily.  Is that enough or too much?  My white blood count is low even
though there is no apparent health issues.  Am I deficient on some
vitamin or minerals?

First of all, the next explanation doesn't substitute the opinion of
your personnal physician. For any medical condition you are concerned
with, you should contact your physician for a complete evaluation.
Please apologize my English quality since the Shakespeare language
isn't my first language...

As a last year medical student currently studying for his board exams,
I can however give you some informations.

There are two parts in your question.

Part 1

If you eat a healthy diet
(http://www.nal.usda.gov/fnic/etext/000105.html for US dietary
Reference Intakes), I can confirm that you need NO vitamin supplements
at all. For example, the amount of vit C required in a day can be
taken only by one glass of 250ml of orange juice... If you take more,
it'll only go straight into your urine since vit C is not stored into
your body.
HOWEVER, vit E is lipophilic (as vit A, D and K are), so the dynamic
isn't the same. It means that you'll store in your body fat, your
liver and your muscles most of it and you'll accumulate its
metabolites. If you accumulate too much vit E, you could have adverse
effects and even toxicity symptoms. Vit E can interfere with vit K
metabolism, which can cause bleeding. It also interferes at high
concentrations with platelets (reduced production of thromboxane).
Sides effects at usual dosage are mostly gastro-intestinal. The US
recommended dietary allowance is 30 mg/d. Death by vit E toxicity is
extremely rare and stays in the case report category. It's however
well know that vit E interferes with prescribed medications such as
warfarin so talk to your physician or pharmacist if you take any
prescription drugs to be sure there are no interactions with your
vitamin. Vit E is in no way in relation with your white blood cells.
There are some kind of anemia that can be threated by vit E (ie
hemolytic anemia secondary to vit E deficiency) but it's in relation
with your red cells, not white cells.
In summary, if you suffer of no medical condition involving vitamin
metabolism or absorbtion, you are in no need if vitamin supplement,
assuming that you have an healthy diet.
Ref. 
Harrisson, et al., Principles of internal Medicine
Lexi-comp. inc
http://www.emedicine.com
http://www.uptodate.com
http://www.nal.usda.gov/fnic/etext/000105.html

Part 2

What do you mean by low white blood cell? Is it low within the
reference interval or under it? If it's within the reference interval,
there is a normal variability of those values in the population. If
you are low in WBC but are still within the reference interval, it
doesn't mean that you have an immune deficiency.
However, if you really have a low white cell count, you should be
evaluated by your physician. The differential diagnosis of those
conditions is very large and the internet isn't the adequate place for
such an evaluation. You should know that there is no dietary
supplementation available to "boost" your WBC (or at least, not
safely). If someone wants to sell you such products, be careful, your
immune system isn't something to mess with...

I hope those informations will help you and if you need further
clarification, I'll be glad to help you!

Jondays-ga

Thanks for your explanation.  I would like to learn a little more on
my second question from other people's experience.  The refrence
interval for WBC is 4.0 - 10.5.  Mine has laways been 3.0 or a little
over.  I have gone to hemotologist/
oncologist for further evaluation.  There is nothing really wrong with
me from the preliminary tests.  The doctor told me that Asian women
tend to have lower WBC.  I have a girlfriend who had similar issues
before.  But, after taking high dosage of vitamin and minerals, her
WBC seems to be boosted.  I am not aware of any deit or supplemnts
that are asoociated with the WBC, but it works
for her.  Shoudl Itake some antioxidants to booste up my immune system?  Thanks.

I know you don't want to hear from me anymore but a little question...
Why would you like to boost your immune system if it's already
efficient? I mean, the WBC count is only a number based on average
american population. What really matters with this number is: are you
symptomatic? Do you have recurrent infections such as sinusitis, skin
infections, etc. ? If you don't, why taking risks of side effects with
stuff that is not recommended for that purpose? If your physician
tells you that everything is fine, if you have no recurrent
infections, no effects of that low WBC, why bother?

Only my opinion...

Good luck!

The only symptom I have is felling tired most of the time.  I am not
sure if it is related to the low WBC.  There has to be some reasons
that my WBC is consistently low.  Don't you think so?

Hello,
  you pose an interesting question that has far reaching implications.
  Personally, I am a doctor working in A+E in London and Australia,
with an interest in diet and vitamins. The comment/answer that follows
includes some data from the medical literature (where I will reference
it) or my own thoughts.
  The previous comment is valid... to a point.
  Please not, this is not a definite answer, as that is impossible
considering the amount of research and it's scope at the moment
involving your question.

1. Should you take vitamins.
  I think so.
  Let's assume your "reasonably healthy diet" involves the recommended
5 vegetables and 2 fruits a day and a portion of red meat a week and
grains etc.
  At this point you MIGHT not need vitamins... but...

  A. " Organic crops contained significantly more vitamin C, iron,
magnesium, and phosphorus and significantly less nitrates than
conventional crops" (see...
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11327522&query_hl=9&itool=pubmed_DocSum).
Similarly, they have been shown to have "higher levels of ascorbic
acid, lower levels of nitrate, and improved protein quality compared
with conventionally grown crops"
(http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9439021&query_hl=18&itool=pubmed_docsum)
  Also, "animal feeding experiments indicate that animal health and
reproductive performance are slightly improved when they are
organically fed." (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12907407&query_hl=18&itool=pubmed_docsum).
 
  The soil that grows the vegetables and fruit that we consume has
probably/definately been tilled for hundreds of years, reducing it's
mineral/vitamin content.  Unfortunately, I don't have the time to find
the reference this so take it as a "maybe" for now.
  Take the case of selenium:
    Selenium is an essential micro-nutrient that has been shown to be
in very low levels in many soils around the world, due to excess
agriculture or location.
(http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=3059285&query_hl=1&itool=pubmed_DocSum)

  Selenium deficiencies occur. "They can lead to a cardiomyopathy
(Keshan disease), increase the risk of cardiovascular diseases or
cancer. Se deficiencies are found in chronic renal failure,
malnutrition malabsorption, long term parenteral nutrition. At the
present time it is not known how Se deficiency interfers with chronic
infections which often go with these diseases." Strangely enough, a
Swedish study has found " The lowest levels were found in vegan diets,
based on locally-grown products"
(http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=3717875&query_hl=1&itool=pubmed_DocSum).
As you can imagine, we need more studies in all of these issues.

I'm not even going to dwelve into food preparationa and cooking
leading to loss of nutritional value
(http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9167134&query_hl=18&itool=pubmed_DocSum).


2. Your WCC count.
  When did you haev your blood test/tests. There is an early-morning
low level and late-pm high peak. Were you having a viral infection at
the time of the test? This also may reduce you WCC (white cell count).
Have you eben stressed?
  Black men have normal values from 3.2.
  

The medical students' answer is a valid answer from the point of view
of convential medicine.
  No, you don't need vitamins because a "healthy" diet should provide
you with the RDA (recommended daily allowance). But,as you can see,
the answer is actually multi-facetted and complciated and we aren't
close to solving it.

  Should you have your low WCC investigated? Have at least 3 blood
tests at different times during the day, including a Blood Film (so
they can look at individual cells and spot any abnormalities).
  
  Who knows if your tiredness is due to a slightly deficient immune
system due to a slightly imbalanced diet, stress, too little sun, etc
etc?

  If you decide to take the supplements find some good quality ones
with decent doses. Most MultiVitamin combinations have pitiful doses
of, say, The Vitamin B complex. Find one with at least 50mg for the
major B classes.
  Find one with selenium, Zinc (immune system, tissue repair),
magnesium (muscle relaxant), vit C... the list is quite long.

Hope this helps.
Must run I have a patient to see!
Cheers

Thanks for your thorough answer and good information.  I need
clarification on the comments that the doctor has made about finding a
supplement with good quality.  I have heard that intake of vitamin
above the minimum daily requirement may actually prevent heart
disease, cancer and other chronic disease.  Do you agree with this? 
Should I take extra-strngth vitamins above the suggested RDA?  Do you
have a good refrence that shows teh maximum amount of vitamin that can
be taken without any adverse side effects?  Any feedback is greatly
appreciated.

Doctor,

I have no doubt that what you say is the result of numerous years of
practice and, maybe, research. However, in cases such as this one,
even if the question is interesting and the "traditional answer" might
not be completely acurate in your point of view, from your very
specialized point of view, I think we must keep in mind what is, for
the moment, evidence based medicine. I know that we must keep an open
mind, continue research, etc., but we must recommend to our patients
what is best for them, from what we know until now. What you say in
your previous comment is completely investigational. It might be true,
but it's investigational, which mean that we don't know. I've read the
abstracts of your references and I can do no better than to quote an
author of one of the previously cited study:

"[...]There are only few well-controlled studies that are capable of
making a valid comparison and, therefore, compilation of the results
is difficult and generalisation of the conclusions should be made with
caution.[...] With respect to the rest of the nutrients and the other
food groups, existing evidence is inadequate to allow for valid
conclusions. Finally, animal feeding experiments indicate that animal
health and reproductive performance are slightly improved when they
are organically fed. A similar finding has not yet been identified in
humans. Several important directions can be highlighted for future
research; it seems, however, that despite any differences, a
well-balanced diet can equally improve health regardless of its
organic or conventional origin."

We can't recommend to our patient to take this or this drug or
supplement based on some hypothesis or premilinary reports. Maybe in a
few years we'll be able to say to our patients that "selenium" or an
excess of I don't know which vitamin can prevent this or this illness,
but for the moment I think it's premature to recommend anything else
in a larger scale. We know for very specific conditions that
supplements can be useful (ie vit E + premature babies and others) but
to recommend multivitamins to healthy people? There is no evidence for
the moment to go into that direction. If we fall into that trap, it
would be quite easy to recommend a bunch of products because one study
said so... and then say to the same patient some months later to
discontinue his supplementation because a new study said otherwise...

I would like to remember, by the way, that I do the hypothesis that
khristena-ga is in fact healthy. I can only say again what I said
earlier: if she thinks that something is wrong with her immune system,
which nobody can say via the Internet, she should be investigated by
her physician (as you also said in your comment) with the tests
adequate to her situation.

Yes, I'm still at the begining of my career. But I'm aware that in
2006 patients are more and more informed, internet gives lot of
contradictory, biased and even false informations. It's then even more
important to stay evidence based, do clinical trials if we think the
practice should change, wait for the results, and then, based on those
results, make our recommendations. If we don't, I doubt we'll be able
to give the best care that our patients deserve.

Have a nice day!

Jondays-ga
P.S. Sorry again for the quality of my english! It's hard to argue in
a foreign language!

1.  There will always be different opinions on this.  I say that with
a balanced diet, no vitamin supplement is necessary.

Despite reasonable speculation that antioxidant and other properties
of vitamins would be beneficial, various studies have not provided
evidence to reach a consensus opinion to suggest routine vitamin
supplementation.

I do recommend vitamin D supplementation for peri- and post-menopausal
women along with calcium supplemenation to decrease osteoporosis risk.

Otherwise, vitamin replacement or supplementation would only be
indicated if symptoms led to diagnosis of a vitamin deficiency.

A folic acid/B-12/B-6 combination has been used more routinely
recently for those with or those at high risk for cardiovascular
disease in whom elevated homocysteine levels are found
(hyperhomocystinemia).  Even among cardiac patients, this is not done
universally as is cholesterol treatment.

2.  Neutropenia or leukopenia, lower than normal white cell count, is
not an uncommon condition.  Cyclic neutropenia or chronic mild
neutropenia is common and usually harmless.  Dangerous white blood
cell (WBC) counts are really less than 1000, though anything near or
below 2000 will get your doctor's attention.

Neutropenia can represent dangerous conditions like leukemia or bone
marrow failure; fortunately, this is rare.  (These are usually
associated with "pancytopenia", depression of all the components of
blood including red cells and platelets.)  It can also be associated
acutely with either mild or moderately severe viral infections or
severe bacterial infections; these conditions are usually easily
recognizable by symptoms, whereas the benign mild chronic neutropenia
is found on routine testing.  Neutropenia is more prevalent in certain
ethnic groups.  It can also be due to certain drugs, especially ACE
inhibitors for hypertension.

The art of medicine lies in knowing when to avoid unnecessary, 
costly, sometimes uncomfortable, expensive, and always
anxiety-provoking testing.

My approach when 1. no obvious underlying condition is present, 2. no
reversible cause apparent (BP meds), and 3. exam and symptoms are not
worrisome is to monitor periodically.  Maybe in a month, quarterly a
few times, every six months and then eventually once a year.  The
patient is counselled to be more quick to seek medical attention for
infections or febrile illnesses than he or she might be otherwise, and
I would have a lower threshhold to check a WBC for such a patient.