Vitamin Supplements

Introduction to Vitamin Information

Vitamins work as regulators or modulators and insure biological reactions in the body function properly. Thus, vitamins are vital for growth, maintenance, immune function, and reproduction. Insuring adequate nutrient levels in the body will optimize energy and overall health.

Vitamins Must be Consumed

Although there is one exception, vitamin D which can be synthesized from sun exposure, our bodies cannot synthesize vitamins. Therefore, to maintain adequate levels, all vitamins must be consumed daily from foods and/or supplements.

Vitamins Are Divided into Two Groups

There are water-soluble vitamins and fat-soluble vitamins. Water-soluble vitamins are vitamins B1, B2, B6, B12, C, niacin, pantothenic acid, folic acid and biotin, while fat-soluble vitamins are vitamins A, D, E and K. Based on solubility, some vitamins are absorbed differently. For example, fat is required for vitamins A, D, E and K and is an intrinsic factor for vitamin B12. In addition, since some vitamins are labile during food processing and cooking, ways of consuming and timing must be considered for proper nutrition.

Vitamins Are Not Broken Down by the Body

Unlike proteins, carbohydrates or fats, vitamins are not metabolized to build tissues or organs. On the contrary, vitamins act as coenzymes for enzymes so that nutrients such as amino acids and glucose are enzymatically utilized for muscle growth or energy.

Vitamin Dosages

Recently, new dietary guidelines (the Dietary Reference Intakes) have been set by the National Academy of Sciences. In this vitamin section, new recommendations, as well as the functions of vitamins, will be described. In addition, a portion of text will describe how lifestyle and medication affect individual nutritional status.

Folic Acid Prevents Age-Related Hearing Loss
By Maureen Williams, ND

Healthnotes Newswire (March 15, 2007) A vitamin found in typical B-complex and multivitamin supplements might play a role in preventing or slowing one aspect of aging: a new study found that supplementing with folic acid can slow age-related hearing loss in seniors.

Hearing loss is one of the most common ailments of older people, and most hearing loss is related to aging and the cumulative effects of environmental exposures and physiologic changes that occur over a lifetime.

Homocysteine, an amino acid breakdown product linked to diseases of the heart and blood vessels, may play a role in age-related hearing loss. Folic acid lowers homocysteine levels and might be able to slow hearing loss as we age.

Folic acid deficiency is the most common vitamin deficiency in the world. Because the deficiency contributes to a group of birth defects known as neural tube defects, some commercial foods in the United States, including breakfast cereals and other grain products, are fortified with folic acid.

The new study, published in the Annals of Internal Medicine, took place in the Netherlands where foods are not fortified with folic acid. The 728 men and women who participated in the study were 50 to 70 years old and had moderately high blood levels of homocysteine. They were assigned to receive either 800 mcg of folic acid per day or placebo for three years.

Although hearing loss was noted in both groups at the end of the study, the people using folic acid had less hearing loss compared with those taking placebo. This difference was more pronounced in people whose folic acid levels were lower at the beginning of the study. There was also a 26% drop in homocysteine levels in the folic acid supplemented group.

Good sources of folic acid include leafy green vegetables, legumes (such as beans), nuts, and whole grains, but folic acid can be destroyed by many kinds of processing, including cooking. Eating raw salads made from dark greens is a good way to add folic acid to the diet. In addition, most multivitamins have the recommended daily amount of folic acid.

Despite the many sources of folic acid, the researchers point to the Netherlands lack of a fortification program as the reason that participants starting folic acid levels were about half of that typically seen in people in the United States. Whether supplements can add extra protection in people who have access to folic acid fortified foods should be the subject of future research.

Commented Dr. James Bernat, a neurologist at Dartmouth Hitchcock Medical Center in New Hampshire, "This is an important article showing that some cases of hearing loss in elderly persons may be preventable with adequate folic acid in their diet or with folic acid dietary supplementation."

Killer Antioxidants? New Study Contains Serious Flaws
A Healthnotes Newswire Opinion
By Alan R. Gaby, MD

Healthnotes Newswire (March 8, 2007) A new study published in the Journal of the American Medical Association has concluded that taking antioxidant supplements does not prolong life, and that using certain antioxidants may slightly increase the risk of death. But do not clear the vitamins from your medicine cabinet: a review of the study reveals serious flaws that call its widely publicized conclusions into question.

Exclusion of certain trials skewed results

The new study looked at 68 clinical trials involving antioxidants and categorized them as either a high or low risk for error. The 21 clinical trials that the researchers put in the high-bias risk category were excluded from the study but the reasons they used to exclude these trials may not be valid and, unfortunately, excluding them significantly impacted the results.

When the data from the remaining 47 trials (involving a total of 180,939 people) were pooled, taking any antioxidant increased the risk of death by 5%. For individual supplements, the risk was increased by 4% with vitamin E, 7% with synthetic beta-carotene, and 16% with vitamin A. All of these increases were statistically significant. Vitamin C and selenium had no significant effect on mortality.

And why the exclusion? The researchers chose trials for inclusion based on how participants were assigned to receive antioxidants or placebo and whether the trial was double-blind. While these methods are usually the standard to which we agree most studies should be held, a study of this type probably does not require that kind of strict research design because a subtle imperfection in randomization method or a researcher's awareness of treatment assignments is unlikely to influence a result as objective as death. In other words, a researcher assigning a participant to a particular treatment or knowing which treatment someone is getting probably will not affect whether that person dies.

In the case of the current study, including the high-bias risk trials probably would not have endangered the reliability of study results, so there does not appear to have been a good reason to exclude them. Had the researchers included those trials, there would have been no significant effect of antioxidant use in general, or of any specific antioxidant, on mortality.

Combining divergent studies not appropriate

Another weakness in this study was the pooling of the results of trials that had crucial differences, which led to inappropriate conclusions about the overall effects of antioxidants. Even though this study was published in a reputable and well-known medical journal, JAMA is not a publication that specializes in nutrition, and neither the authors nor the reviewers who read the material prior to publication appear to have been aware of how failing to adjust for the differences between these trials may have affected the study conclusions. (For specific examples of how these oversights might impact interpretation, see Study details at the end of this article.)

Previous research can not be ignored

Antioxidant supplements are used by tens of millions of people, with many uses supported by a wide body of research developed over many years and published in reputable medical journals including JAMA and others that are dedicated more specifically to managing health through nutrition. Studies have shown, for example, that vitamin C may prevent or help treat heart disease, diabetes, high blood pressure, asthma, and more. Vitamin E is beneficial for intermittent claudication (difficulty walking caused by hardened arteries) and rheumatoid arthritis. Selenium may help prevent heart disease and certain types of cancer. Only rarely could a single study negate an entire body of research; rather, each new study adds to the medical conversation and helps determine the direction of future investigation.

Even within this study, despite its negative overall conclusions, some of the low-bias risk trials that were included showed a clear benefit from antioxidant supplementation. For example, in a study that lasted 7.5 years and included more than 13,000 people, modest doses of a combination of vitamin C, vitamin E, beta-carotene, selenium, and zinc reduced the death rate in men by 37%, although no effect was seen in women. Results like these should encourage further research to determine what doses and combinations of nutrients are safest and most effective for people of different ages and different genders and with different health concerns and lifestyles.

Lastly, even the most enthusiastic nutritional supplement supporters recognize the importance of a broad-spectrum approach to managing wellness and preventing disease that includes eating well, exercising, limiting exposure to toxins, and supplementing with nutrients that may not be obtained from the typical diet. Despite the widespread attention to this new study, it is important to put its findings into context and remember that there is well-demonstrated evidence that antioxidants may improve or prevent certain medical conditions and improve overall quality of life.

Vitamin D May Prevent Multiple Sclerosis
By Jeremy Appleton, ND, CNS

Healthnotes Newswire (February 8, 2007) The Journal of the American Medical Association reports that multiple sclerosis risk can be lowered by high amounts of vitamin D, according to a new study that included more than 7 million active-duty US military personnel.

"Our results converge with a growing body of evidence supporting a protective role for vitamin D in MS development", said Alberto Ascherio, MD, DrPH, Associate Professor of Nutrition and Epidemiology at the Harvard School of Public Health and an author of the study. "Vitamin D is a potent immune system modulator."

Multiple sclerosis, or MS, is one of the most common neurological diseases affecting young adults. About 350,000 people in the United States and 2 million worldwide have the disease. MS symptoms vary unpredictably from person to person and from time to time in the same person. They can include fatigue, muscle weakness, vision problems, loss of balance and muscle coordination, slurred speech, tremors, stiffness, and bladder problems.

Symptoms are caused by a loss of the insulating myelin sheath that surrounds nerve fibers, which impairs the nerve fibers ability to transmit signals. MS is considered an autoimmune disease because myelin loss is the result of an inflammatory attack by the immune system, but what triggers the attack is unknown.

As researchers have accumulated more data about MS, some striking patterns have emerged: the disease is much more prevalent in higher latitudes, to both the north and the south. Because these locations get less sunlight, people who live there tend to have more problems with vitamin D deficiency (vitamin D is synthesized in the skin upon exposure to the sun's ultraviolet light). Since vitamin D has hormone-like anti-inflammatory activity, researchers speculated that the heightened prevalence of MS in these regions could be due to vitamin D deficiency. It appears they were right.

The study identified 257 MS cases through Army and Navy physical disability records from 1992 through 2004; each was matched to two controls (people with similar characteristics such as age, sex, ethnicity but without the disease). Vitamin D status was determined by averaging levels of 25-hydroxyvitamin D (the circulating form of the vitamin) in two or more blood samples collected before the date of initial MS symptoms.

MS risk decreased with increasing blood levels of vitamin D. The association was not seen among blacks, but because there were fewer of them in the study, and because they tended to have substantially lower 25-hydroxyvitamin D levels, the study may have been inadequate for detecting an association in that group. Among whites, MS risk was cut nearly in half for those with the highest blood levels of vitamin D. The risk reduction was particularly strong for vitamin D levels measured before age 20.

Since food sources provide scant amounts of vitamin D, the main source for most people is through sun exposure. However, at latitudes of 42 degrees or higher (for example, Boston, MA, or Detroit, MI), most ultraviolet radiation is absorbed in winter months by the atmosphere, and even extended sun exposure is inadequate to make enough vitamin D.

"A key question is whether it may be possible to reduce the incidence of MS in populations at high risk by increasing circulating levels of 25-hydroxyvitamin D", said Dr. Ascherio. "However, until the efficacy of increasing vitamin D intake either in the diet or with supplements is proven for MS prevention, we cannot make broad recommendations."

Folic Acid Might Prevent Alzheimers Disease
By Maureen Williams, ND

Healthnotes Newswire (January 25, 2007) Folic acid, a B vitamin found in leafy greens, fortified grains, and multivitamins, has been shown to reduce the risk of heart disease, depression, and some cancers, but can it also protect against Alzheimers disease? A new study suggests it can.

Alzheimers disease is a common form of dementia that affects mostly elderly people, causing a significant decline in mental functioning and lapses in memory, especially short-term memory.

The new study from Columbia University, published in the Archives of Neurology, interviewed 965 seniors about their health, lifestyle, and diet, and tested them on physical and neurological function. Participants were then monitored for signs of dementia for several years. After an average of six years, the people with the highest total intake of folic acid had the lowest incidence of Alzheimers disease, and those with the lowest intake had the highest incidence.

The effects of Alzheimers disease on afflicted people and their families can be devastating. Most people with Alzheimers disease eventually require round-the-clock care. Although genetic factors play a major role in causing the disease, there is some evidence that there are other, more controllable, influences. In addition to getting plenty of folic acid, exercise has been shown to protect against Alzheimers and other forms of dementia; smoking, on the other hand, can increase risk.

Based on the study's findings and those from previous research, people who want to minimize their Alzheimers disease risk would be wise to consider taking a multivitamin containing folic acid and to eat more folic acid rich foods, such as spinach, kale, broccoli, dark green lettuce, beans, wheat germ, and fortified cereal grains.

"Because there is no known cure for Alzheimers disease, all methods for prevention are important to study, and positive findings such as these should be shared with people who are concerned about this disease", commented Dr. Bernat, a neurologist at Dartmouth Hitchcock Medical Center. "Methods such as quitting smoking, exercising, and increasing folic acid intake are inexpensive and safe, and have other benefits for healthy aging", he added.

D Is for Diabetes
By Jeremy Appleton, ND, CNS

Healthnotes Newswire (December 28, 2006) Vitamin D deficiency may be an underlying cause of type 1 diabetes, according to Swedish researchers. Blood levels of vitamin D, which are primarily obtained by sun exposure, were low in young adults recently diagnosed with the disease.

"Several studies suggest that vitamin D supplementation in early childhood decreases the risk of developing type 1 diabetes", wrote Bengt Littorin of the Department of Clinical Sciences, University of Lund, in Malm, Sweden. Dr. Littorin and colleagues suggest that there is an immunological mechanism behind the association between vitamin D and type 1 diabetes. They conducted research designed to demonstrate whether or not low vitamin D in the circulation promotes the development of type 1 diabetes.

In addition to its better-known functions in supporting bone health, vitamin D also has effects on immune function. Researchers believe that insufficient vitamin D may trigger the immune system to attack its own insulin-producing cells. In previous studies, women who got low amounts of vitamin D during pregnancy were more likely to have children with antibodies against the insulin-producing cells in the pancreas, called islet cells. Antibodies against islet cells initiate a process that leads to destruction of these cells, and the resulting lack of insulin impairs the body's ability to handle glucose, leading to type 1 diabetes.

Littorin and colleagues recruited volunteers, both healthy and with type 1 diabetes, for the study. The people with diabetes, ages 15 to 34, all had confirmed antibodies against islet cells. Blood levels of vitamin D were measured in samples taken from all participants at the start of the study, and eight years later. The results compared those with diabetes to those of the same age and gender who did not have the disease.

Blood levels of vitamin D were found to be significantly lower in the people with diabetes. "It could be that the initiation of type 1 diabetes is related to low vitamin D concentrations", Dr. Littorin concluded. With more studies, researchers may find that adequate sun exposure and vitamin D supplementation contribute to the prevention of this serious autoimmune disease.

Ginkgo Improves Some Glaucoma
By Maureen Williams, ND

Healthnotes Newswire (May 14, 2003)?Ginkgo biloba extract can partially restore visual field losses in people with normal tension glaucoma, according to a new study in Ophthalmology (2003;110:359?64).

Glaucoma is a disease of the eyes characterized by deterioration of the optic nerve that results in diminished field of vision and eventual blindness. It is a leading cause of blindness around the world. Factors that increase the risk of developing glaucoma include older age, African descent, nearsightedness, and family history of the disease. High intraocular pressure (pressure inside of the eye), which prevents normal function of the optic nerve, is a common feature of glaucoma. In normal tension glaucoma, however, the intraocular pressure is normal and the cause of optic nerve damage and visual field loss is unknown, although reduced blood flow to the optic nerve is believed to play a role. Eyedrops that lower intraocular pressure are typically used to treat cases of glaucoma in which the intraocular pressure is elevated, but these medications have no effect on progressive vision loss in normal tension glaucoma.

In the current study, 27 people with normal tension glaucoma and visual field losses were randomly assigned to one of two groups. One group received 40 mg of Ginkgo biloba extract three times per day for four weeks, followed by eight weeks with no treatment and finally four weeks of placebo. The other group received placebo for four weeks, followed by the same eight weeks with no treatment and ending with four weeks of Ginkgo biloba. Both groups experienced significant improvement (approximately 24%) in indices used to evaluate visual fields after treatment with Ginkgo biloba. There were no improvements for either group during placebo phases. Intraocular pressures remained normal throughout the trial, and no side effects from Ginkgo biloba were noted.

Ginkgo biloba extract has several properties that might have contributed to the beneficial effects observed in this trial. Its antioxidant activity might have protected the optic nerve from oxidative damage, and its ability to increase blood flow and oxygen utilization might have protected the optic nerve from damage due to lack of oxygen. In fact, a previous trial found that people with glaucoma experienced increased blood flow in the artery supplying blood to the optic nerve after treatment with Ginkgo biloba extract. Furthermore, its ability to increase blood flow to the brain might have improved eye sensitivity, resulting in improved visual function.

The leaves of the Ginkgo biloba tree have been used in traditional Chinese medicine for more than 5,000 years. Its traditional uses include the treatment of asthma and bronchitis, and in recent times it has been shown to act as an antioxidant, improve oxygen uptake and use by cells, and increase blood flow to the brain and extremities of the body. Results from clinical trials demonstrate that standardized leaf extracts of Ginkgo biloba reduce the symptoms of age-associated memory impairment and dementia, including early Alzheimer's disease. In addition, preliminary results suggest that it might be useful in preventing and treating cardiovascular disease.

Other studies have suggested that Ginkgo biloba extract may be beneficial for people with age-related macular degeneration, another major cause of visual loss and blindness.

A Standardized Extract of Ginger May Reduce Knee Pain in Elderly
By Darin Ingels, ND

Healthnotes Newswire (December 20, 2001)?Daily use of a highly concentrated extract of ginger by elderly people may reduce the pain associated with osteoarthritis of the knee, according to a new report in Arthritis and Rheumatism.1 Ginger has been traditionally used in herbal medicine for nausea, heartburn, muscle aches, and more recently as a treatment for motion sickness. While the exact mechanism by which ginger relieves pain remains unclear, animal and test tube studies indicate that ginger may inhibit key enzymes that lead to inflammation.

This six-week controlled trial examined the effects of taking either a daily supplement of a standardized ginger extract (510 mg per day from Zingiber officinale and Alpinia galanga) or placebo in 247 elderly men and women with knee pain. In addition to their treatment, all participants were allowed to use up to 4,000 mg per day of acetaminophen, as needed, to control pain. The primary assessment was the degree of pain on standing, measured by the visual analog scale (VAS), a numerical pain scale between 0 and 100, where 0 is pain-free and 100 indicates severe pain and impairment.

The researchers found that knee pain was reduced in 63% of people taking the ginger extract, compared with 50% of those receiving the placebo, a statistically significant difference. People taking ginger reported a 24.5-point decrease in the VAS pain scale, compared with a 16.4-point decline in those taking the placebo. Pain after walking and stiffness in the knee were also reduced in both ginger and placebo groups; however, the effects were greater in those taking the ginger extract. Side effects, including belching, heartburn, and nausea were reported in 59% of those receiving ginger, compared with 37% of the placebo group. None of these effects were described as being serious. Use of acetaminophen was equal in both groups and did not alter the results.

Although the effect of ginger extract on knee pain was only modest, evidence suggests that other nutritional supplements may be even more effective for individuals with osteoarthritis. Studies have shown that 1,500 mg of glucosamine sulfate per day significantly reduced both degeneration in the knee and pain,4 and was as effective as, or more effective than, ibuprofen (Advil).5 6 Other reports have demonstrated that 1,200 mg of S-adenosylmethionine (SAMe) per day decreased pain in the knee and worked as well as naproxen (Aleve).7 8 Despite causing minor stomach and intestinal side effects in some cases, ginger is considered safe, and including ginger extract as part of a comprehensive treatment program may be helpful in controlling the pain of osteoarthritis and in living a more active life.

Encourage Kids to Get More Calcium
By Maureen Williams, ND

Healthnotes Newswire (March 16, 2006) Getting enough calcium in the diet is critical for all children and adolescents, according to a review published in Pediatrics (2006;117:57885).

Calcium is a mineral nutrient that is used by the body primarily to produce and repair bone. As is the case with other minerals, such as zinc, magnesium, and selenium, many children and adolescents do not get the recommended amount of calcium from their diets. Childhood and adolescence may be critical times for getting calcium; about 40% of lifetime bone mass is produced during a growth spurt that accompanies the onset of puberty.

Without adequate calcium, the likelihood of having a healthy peak bone density, which occurs about 10 to 12 years after puberty, and preventing osteoporosis later in life is believed to be low. Furthermore, children with low calcium intake have an increased risk of fractures. Supplementing with calcium has been shown to be an effective way to increase bone mass in adolescents whose diets are calcium-poor; however, its effect on peak bone density and osteoporosis risk is not known.

The recommended dietary allowance (RDA) of calcium generally increases with age: the daily RDA is 210 mg for infants from 0 to 6 months and 270 mg from 6 to 12 months; for children, the RDA is 500 mg from 1 to 3 years and 800 mg from 4 to 8 years; for adolescents, the RDA is 1,300 mg from age 9 to 18; and, for adults over 19 years old, the RDA is 1,000 mg.

While nearly 100% of infants get the recommended amount of dietary calcium, that number drops to less than 80% of children 1 to 3 years old, about 55% of children 3 to 5 years old, about 30% of children 6 to 11 years old, and less than 30% of children 12 to 19 years old. Girls tend to have lower intake than boys, especially during adolescence.

Adding to concerns about low calcium intake in this age group is the presence of foods in the diet that cause calcium to be lost in the urine. Eating salty food, such as processed and fast foods, and consuming caffeine, found in soft drinks that kids often drink in large quantities, increase calcium loss. Drinking alcohol, which can be an issue in older children, similarly triggers calcium loss.

Dairy products are a primary source of calcium for many people. Choosing dairy foods that are low in fat, such as skim milk and low-fat yogurt, is important because many dairy foods are laden with saturated fat, which can contribute to increased risks of cancer and heart disease over years. Many people prefer nondairy sources of calcium, either because of milk allergy or lactose intolerance, or because of concerns about other potential long-term negative effects of consuming dairy products.

Leafy green vegetables such as kale and broccoli, tofu, beans, figs, and canned fish with bones are among the many other foods that are naturally rich in calcium. In addition, orange juice, soy milk, and breakfast cereals are sometimes fortified with calcium. In the interest of developing healthy eating habits for a lifetime, a wide array of calcium-rich foods should be recommended to children and teens. They should also be encouraged to limit the amount of salty and caffeine-containing foods they eat.

Exercise has also been shown to enhance the building of bone in people of all ages. Establishing healthy exercise habits during childhood is as important as establishing healthy eating habits.

Chromium Effective for Common Mood Disorder
By Alan R. Gaby, MD

Healthnotes Newswire (October 27, 2005) Chromium supplementation may relieve symptoms in people with a mood disorder known as atypical depression, according to the Journal of Psychiatric Practice (2005;11:30214). These findings are good news for the many people who suffer from this often difficult to treat condition.

A typical depression, the most common form of depression in outpatients, is characterized by increased appetite, excessive sleepiness, sluggishness, and increased sensitivity to being rejected by another person and improved mood when something good happens (mood reactivity). Compared with other forms of depression, atypical depression tends to be more chronic and is associated with more suicidal thoughts and greater disability. Medical therapy usually consists of a specific type of antidepressant drug (monoamine oxidase inhibitors).

The symptoms of atypical depression resemble those of a blood sugar regulation disorder commonly called reactive hypoglycemia or dysinsulinism. This metabolism abnormality results in a wide range of physical and mental symptoms and may be relieved by changes to the diet, such as avoiding refined sugar, caffeine, and alcohol, and eating small meals six times a day.

Chromium is an essential trace mineral that plays a key role in blood sugar regulation by facilitating the action of insulin. Chromium deficiency in animals leads to insulin resistance and diabetes, and chromium supplementation has improved blood sugar control in people with either diabetes or reactive hypoglycemia. It is possible that, in some cases, atypical depression is a manifestation of reactive hypoglycemia or dysinsulinism. If so, chromium supplementation might relieve symptoms by improving blood sugar regulation.

In the new study, adults with atypical depression were randomly assigned to receive 600 mcg of chromium per day (in the form of chromium picolinate) or a placebo for eight weeks. In the chromium group, 54% experienced a clinically significant improvement in depression compared with 36% in the placebo group. While this difference was not statistically significant, the chromium group showed significant improvements in four depression-related symptoms: appetite increase, increased eating, carbohydrate craving, and daily fluctuations of feelings. Because chromium was effective for those specific symptoms, the participants who suffered from carbohydrate cravings at the start of the study were analyzed separately. In that subset, 65% of those receiving chromium but only 33% of those receiving placebo responded to treatment, a statistically significant difference. Chromium treatment did not cause any serious side effects.

References:
Dr. James Bernat
Alan R. Gaby, MD
Darin Ingels, ND
Dr. Bengt Littorin
Maureen Williams, ND
Jeremy Appleton, ND, CNS
Alberto Ascherio, MD, DrPH
Annals of Internal Medicine
National Academy of Sciences
Journal of the American Medical Association