To Supplement or Not to Supplement?
That really is the question that consumers are asking themselves these days. The old party line of most dietitians and physicians went something like this: you don't need vitamin supplements you can get everything you need from food. That stock answer doesn't work anymore because the issue has become increasingly complex. A more enlightened response would start with that depends:' Based on what the body of vitamin research tells us, supplement use can be both helpful and harmful, bringing risks as well as benefits. For some people, supplements provide more benefits than risks, so the answer will be different for each person. Let's take a look at just exactly on what the answer depends.
The starting point is the quality of your diet. Most nutrition experts would make the case, and rightly so, that a person should first seek to improve his or her diet before taking supplements. A more compelling reason for optimizing the diet is one that puts supplements in perspective. Food contains thousands of naturally occurring chemicals, some of which are essential nutrients such as vitamins, but many more of which are what scientists call phytochemicals. These compounds are proving to be disease fighters, at least in the laboratory, and evidence is growing that they may protect against disease in the real world as well. Many cannot be duplicated in the lab, and, even more important, it is likely that food contains some phytochemicals that researchers haven't yet identified. The moral of the phytochemical story is that everyone should examine his or her dietary intake and make changes that lead to a healthier diet.
However, people who don't consume many c910ries (for a variety of reasons) are probably missing out on nutrients. These people include perennial calorie counters or dieters as well as individuals who have chronic conditions that affect their food intake (even if only periodically). The most serious conditions are those which affect nutrient absorption such as Crohn's disease, which attacks the small intestine where nutrient absorption takes place. Any disease which causes diarrhea will result in the effective excretion of nutrients before they have a chance to be absorbed. These conditions collectively produce malabsorption and are good reasons for considering vitamin and other nutrient supplementation.
The elderly are another group of people who benefit from supplements. Many elderly people don't take in enough calories, and others may have normal aging problems such as poor dentition which cause them to limit their intake. Good evidence for the benefit of supplements for the elderly are clinical trials which used a variety of vitamins and minerals. Back in the 1980s, immunity researchers first showed that a daily multivitamin supplement prevented the occurrence of infection in the elderly. A recent French study supported the use of a vitamin and mineral supplement in the elderly, demonstrating a lower rate of infections in those taking a supplement. Although research of the elderly population and supplements to reduce infection is fairly well documented, an interesting study on colon cancer indicates that a general multivitamin supplement and extra vitamin E may help youngerrpeople avoid this disease. The study reported that men and women who used multivitamins for ten years had a 50 percent lower risk for colon cancer compared to those who didn't use a supplement. In addition, people who used at least 200 IV of vitamin E enjoyed a 57 percent lower risk compared to those who didn't take extra vitamin E.
The best direct evidence is linked to vitamin E; a study of vitamin E supplementation showed that this nutrient boosted the immune system in a group of elderly subjects. In addition, even more studies have reported that the elderly have special nutritional requirements, with higher demand for some vitamins at a time when energy needs decline. That means that the average elderly person would have to eat an even more nutritious diet than when he or she was younger to meet nutritional needs.
And finally, like Mr. V. at the beginning of this chapter, many Americans are at high risk for early death from heart disease and cancer. Many legitimate nutrition experts are now recommending that, along with a healthy diet, supplements may help push the delicate balance of health and disease in their favor. The clear monarch from. the vitamin kingdom in this regard is vitamin E, which numerous studies have singled out as an aid in the prevention and even treatment of heart disease. Newer on the scene are the B vitamins, folate, BIz, and B6, which can lower the blood level of homocysteine, a compound researchers have linked to heart disease risk.
A few years back, the federal government passed legislation in an effort to help consumers make informed choices about dietary supplements. The Dietary Supplement Health and Education Act of 1994 charged the Food and Drug Administration (FDA) to issue proposals for labeling of dietary supplements. Prior to this law, manufacturers of vitamin and other supplements had weaker labeling standards than dinosaur-shaped fruit snacks! After much debate from all, supplement makers, advocacy groups, and health professionals, the FDA issued these regulations:
- Labels may carry health claims only for approved nutrients and diseases. The FDA is in charge of deciding which claims are valid. Currently two claims are approved: folate helps to reduce risk for neural tube defects (birth defects such as spina bifida); calcium may reduce osteoporosis risk.
- Products can't make claims to "diagnose, treat, cure, or relieve a specific disease."
- Labels may describe nutrient functions in the body and explain how it works, and link the nutrient (if essential) to "general well-being."
- Supplement labels will be entitled "Supplement Facts" to distinguish them from food labels which are called "Nutrition Facts" This alerts consumers to the fact that labeling guidelines are different for supplements.
- A supplement will be labeled "dietary supplement" as part of its statement of identity.
- The term high potency may be used in reference to a particular nutrient if the supplement contains 100 percent or more of that nutrient's Reference Daily Intake (RDI) or Daily Reference Value (DRV).
- The term antioxidants refers to vitamins C, E, and betacarotene when the nutrient claim consists of "good source of antioxidants."
- To be labeled as "high in antioxidants," a product must contain 20 percent or more of the RDI per serving for the aforementioned nutrients.
Is Nature a Better Chemist?
With the current buzz surrounding holistic health and all things natural, people often ask if vitamin supplements from natural sources are better than synthetic ones, which just means made in a laboratory. Vitamins are chemical compounds; the body doesn't discriminate between those that are synthesized in a laboratory and those from food sources. By the same reasoning, vitamins labeled "natural" are indistinguishable to the body from synthetic vitamins, especially in light of the fact that the term natural carries no legal definition.
There are, of course, a few exceptions to date-vitamin E and folate. Vitamin E exists in nature as two groups, the tocopherols and tocotrienols, and together they include at least eight additional compounds called isomers or vitamers. The tocopherols have the most vitamin activity, and of these, alpha-tocopherol is the most potent. The natural form of alpha-tocopherol is known as RRR-alpha-tocopherol, and the synthetic is all-rac-alpha-tocopherol. In the body, RRR-alpha has a higher activity compared to the synthetic all-rac-alpha. However, even this may be a nonissue, since the amount in supplements can compensate for this difference. Additionally, one recent study showed that both forms were equal in their antioxidant ability to fight free radicals.
The other exception, folate, prompted the Institute of Medicine to issue strong language regarding the use of supplements. The Institute of Medicine is currently in charge of revising current nutrient recommendations for Americans.
In general, then, consumers can save themselves quite a bit of money at the checkout counter, since most naturally derived vitamin supplements cost up to double that of their synthetic counterparts. Quality control may also be tighter for synthetics and the supplement more likely to be uniform and less likely to contain contaminants than one from a natural source.
Summarizes the role of each vitamin and symptoms of both deficiency and toxicity. Upcoming chapters will give you more detailed information on all the vitamins.