You're eating a balanced diet, taking note of the food groups and the Recommended Dietary Allowances (RDAs). But you’re still wondering: Do you need vitamin and mineral supplements? Yes, you do, says Louis Tobian, Ph.D., a University of Minnesota scientist who has spent years studying diet and its relationship to heart disease and blood pressure.
“If you’re living in the real world—with people eating out more and so forth—it’s really hard to eat a perfect diet,” Tobian says. “Take a multivitamin a day,” he says, and if you take a good one, that might be all the supplementation you need.
Mary Ellen Camire, associate professor of food science at the University of Maine, says that a lot of people use multivitamins as a safety net, “in case they have a bad day and eat a lot of junk food.”
“Americans like a quick fix,” she says. “The multivitamins provide this.”
But, she says, “recommended intakes are for the whole population,” and depending on age or health, “you may need more or less.”
Determining what nutrients to take “depends on the individual,” Camire says. For example, some people staying out of the sun may need supplemental vitamin D.
“Women have different needs; they lose iron with their periods.
And calcium is very important to young girls,” says Camire, the
mother of a teenage daughter who is going through a phase of eating
only instant mashed potatoes. Camire has to make sure her daughter
is getting what she needs. Tobian, a professor emeritus who reveals he is “kind of old” but
still “very active,” suggests a “One-A-Day” multivitamin and
mineral supplement. He says people should also consider taking
extra antioxidants, such as vitamins E and C. “No multivitamin pill
has enough E,” he says. “E is a genuine antioxidant—the evidence
shows that it’s advantageous.”
Camire and Tobian agree that, along with multivitamins, minerals, and antioxidants, eating right and exercising are still important.
“Supplements are good,” Tobian says, “but the big thing is to eat a lot of fruits and vegetables. I really believe in a good diet and exercise. . . . It’s highly abnormal and unhealthy for our bodies to be sedentary.”
According to the American Dietetic Association, complete multivitamin and mineral supplements are effective, safe, and may be helpful, especially when:
• The rush of everyday life prevents you from eating the U.S. Food Guide Pyramid’s recommended number of servings from each food category, especially grains, fruits and vegetables.
• You’re on a weight loss program that is very low in calories.
• You’re elderly and not eating as much or as well as you should.
• You’re a strict vegetarian.
• You don’t drink or eat calcium-rich foods such as milk, cheese or yogurt.
• You’re a woman of child-bearing age who doesn’t eat enough fruits, vegetables and beans.
The Council for Responsible Nutrition, a trade association representing more than eighty dietary supplement companies, has published two booklets on nutritional supplements. Optional Nutrition for Good Health: The Benefits of Nutritional Supplements (1998) compiles scientific evidence supporting the health benefits of nutritional supplements. Vitamin and Mineral Safety (1997) defines safe levels of intake for twenty-four nutrients, presenting scientific evidence about intakes above the RDA.
To order a copy of either booklet, write to the Council for Responsible Nutrition, 1300 19th St., N.W., Suite 310, Washington, D.C. 20036; phone: (202) 872-1488. Cost is $10 for each publication. (A summary review of Vitamin and Mineral Safety is available for $5.)
Adult men and women should increase their dietary intake of folic acid, a member of the B vitamin family that is also called folate, according to the latest report on Dietary Reference Intakes (DRIs) from the Institute of Medicine. The report is the second in a series from U.S. and Canadian scientists and provides Recommended Dietary Allowances (RDAs) and additional dietary reference values for all the B vitamins. Adults need 400 micrograms daily, according to the report; a survey taken at the end of 1997 shows that many U.S. adults aren’t meeting this requirement.
The committee based its recommendation on values shown to guard against anemia or other conditions that can develop when B vitamins are lacking or missing. The DRI committee set its maximum amount of synthetic folic acid for adults at 1,000 micrograms, or 1 mg, noting that adults with vitamin B12 deficiency who take too much folic acid have an increased risk of neurologic damage. Some studies have shown that folic acid and vitamin B6 may reduce blood levels of homocysteine and thus may lower the risk of vascular and heart disease. Given conflicting evidence, however, the DRI committee found that the research wasn’t solid enough to serve as the basis for nutrient intake.
Also noted: Women who are of child-bearing age should take extra folic acid beyond the recommended 400 micrograms—especially in the month prior to conception and during the first month of pregnancy —to reduce the risk of having a child with neural tube defects.
“They can best get folic acid from fortified cereal grains or from a supplement,” said Roy M. Pitkin, DRI committee chair and obstetrics and gynecology professor at the University of California, Los Angeles, in an April 1998 release announcing the report.
Worried about the possible side effects of DHEA? A new product may alleviate that worry. Humanetics Corp. of Minneapolis recently received a U.S. patent for the use of 7-Keto DHEA, a new dietary supplement and a natural derivative of DHEA, or dehydroepiandrosterone. The patent is based on the work of Henry A. Lardy, Ph.D., a biochemist and professor emeritus of the Institute for Enzyme Research at the University of Wisconsin. DHEA is a natural hormone that diminishes with age, says Ronald Zenk, Humanetics president and CEO. DHEA supplements have been used to strengthen the immune system, fight aging, and enhance memory.
But some worries have been raised about the supplements. For instance, the National Institute on Aging, part of the National Institutes of Health, published safety concerns regarding DHEA’s conversion to testosterone and estrogen and has warned about the uninformed use of dietary supplements, singling out DHEA and melatonin. An incorrect dosage may lead to prostate enlargement in men; other concerns include liver damage, masculinization of women, and an increased risk of heart disease. The 7-Keto DHEA, however, provides similar immunomodulatory activity to DHEA but does not covert into the worrisome sex steroids, according to Humanetics.
Lardy found dozens of derivatives of DHEA that he tested and identified, and one of those was 7-Keto, which is far enough down “the path of conversion” that it doesn’t convert into sex hormones, Zenk says. Thus, 7-Keto provides the benefits of DHEA without the worry of the hormones. Humanetics now plans to evaluate “the pharmaceutical path” with its new product, Zenk says. 7-Keto is available through supplement distributors.
“Lite,” “low-fat,” and “calorie-free” are terms that tempt—and may mislead—teens when they shop at grocery and convenience stores.
According to results reported in Adolescence (Spring 1997), teens have become more health conscious but rely too much on front-of-the-label claims—ignoring the actual nutrition information listed in the Nutrition Facts panel. Molly Gee, a registered dietitian and manager of the Institute for Preventive Medicine at The Methodist Hospital in Houston, suggests that the solution may be to take the intimidating Nutrition Facts panel one step at a time.
“It can be your own personal road map,” Gee says. “Pick out the part of the label that is of interest to you.” For instance, if someone wants to lose weight or maintain heart health, that person should look at the “fat” listing.
Percent Daily Value: This replaces the RDA (Recommended Dietary Allowance). “It’s a healthy eating goal,” Gee says. “It specifies how much of a nutrient, vitamin, or mineral a person should have.”
But what may be confusing, Gee says, is that the government computes Percent Daily Value based on 2,000 calories. “If you eat a little less than that, then keep in mind that it won’t take quite as much of that nutrient to meet the daily requirement,” she says.
Serving Size: How much you eat will affect the Percent Daily Value. For example, if you eat two cups of cereal, but the serving size is one cup, you double the Percent Daily Value listed.
Fat: The most concentrated source of calories is fat. If a product is high in fat—say 35 g—then “people can decide if they want to blow their fat allotment for the day on this one item,” Gee says.
Saturated fats are from animals, and polyunsaturated and monounsaturated fats are from plant sources. “If someone has heart disease, taking a look at saturated fats is important because saturated fats elevate blood cholesterol,” she says.
Many people drink cow’s milk for one reason: the calcium it provides. Calcium, an essential nutrient, is necessary for healthy bones. But research has shown that drinking cow’s milk may not be the best way to “do a body good.”
“We certainly need calcium in the diet, but it doesn’t need to come from milk,” says Neal Barnard, M.D., clinical researcher and president of the Physicians Committee for Responsible Medicine and author of five books.
“Greens and beans—that’s all you need,” Barnard says. “Those are calcium-rich foods. . . . You can use supplements if you want.”
He says there are several reasons to avoid milk and dairy products as a source of calcium. Serious problems may occur from the proteins, sugar, fat, and contaminants in milk.
“For children, the greatest concern is juvenile growth-onset diabetes,” Barnard says. A 1992 report in the New England Journal of Medicine adds evidence to previous theories that cow’s milk proteins encourage the production of antibodies that, in turn, destroy the insulin-producing pancreatic cells. For babies under a year old, milk products may possibly cause colic. “Cow’s milk is not mother’s milk,” Barnard says. “Human babies are designed for human milk, not giraffe’s milk or rat’s milk. It makes no sense.”
A 1991 study published in Pediatrics suggests that breast-feeding moms may also have colicky babies if they drink cow’s milk; the cows’ antibodies can pass through the mother’s bloodstream into her breast milk. Most importantly, he says, milk doesn’t seem to reliably prevent osteoporosis. According to studies, maintaining strong bones depends more on preventing calcium loss than on boosting calcium intake. As people get older, the body goes into “negative calcium balance” and the bones start to lose more calcium than they take in. This leads to osteoporosis, or soft bones.
According to the Physicians Committee for Responsible Medicine, almost all the calcium in the body is in the bones, but there is a small amount— controlled by hormones—in the bloodstream that’s used for muscle contractions, the maintenance of the heartbeat, and other functions. The body loses calcium through urine, sweat, and feces, and the calcium is renewed from the bones; the bone calcium has to be restored from food. Diets high in protein, most notably animal protein, “cause calcium to be lost through the kidneys,” or urine, Barnard says. Dairy products are high in protein. “If you eliminate animal protein from your diet, you cut your calcium losses in half,” he says.
Eight hundred milligrams of calcium per day is the U.S. Recommended Dietary Allowance; but, Barnard says that the needed amount may vary, depending on age. Higher recommendations are for people who are losing a lot of calcium, he says. Calcium is found in all kinds of plant foods, which are moderate in protein and low in fat. For instance, one cup of broccoli has 178 mg of calcium; a half-cup of firm tofu has 258 mg. Calcium-fortified orange juice has about 300 mg.
“There just isn’t a requirement for milk at all,” he says. “Want something to splash on your cereal? Try soy or rice milk.”
Visit the Physicians for the Committee for Responsible Medicine Web site at http://www. pcrm.org/ nutrition, or write to P.O. Box 6322, Washington, D.C. 20015; phone: (202) 686-2210.
Why buy organic milk when regular milk costs less? Lots of reasons.
Amy Barr, R.D, M.S., of Horizon Organic Dairy says that organic milk is produced using no hormones, antibiotics, or pesticides. Horizon, of Boulder, Colorado, is the leading producer of U.S. organic dairy products—items that are certified organic by a third-party certification organization. These “clean-living” cows eat only 100 percent organically grown feed and never receive antibiotics, so chemicals and drugs don’t end up in the milk. Hormones are not used for any purpose; organic milk producers say that injecting hormones to mimic pregnancy and force cows to produce more milk is unnatural and may harm the cows. Most cows get pregnant the “regular” way—without the help of artificial insemination.
“A cow can’t produce milk unless it’s had a baby,” Barr says. “And bulls know what to do. The cows (give) milk, dry out, and rest, then they get pregnant again.” Plus, a low-stress cow is a happy cow, Barr says. “We milk them three times a day. Regular cows get milked twice a day. They get plenty of fresh air and sunshine. We don’t keep them inside.”
Vickie Parker's grandson was diagnosed with attention deficit hyperactivity disorder (ADHD) when he was seven years old.
“My daughter had great pressure from the school system to put him on Ritalin,” says Parker, of Friendship, Maryland. “She felt she had no choice—and she knew of no alternatives.”
Parker’s grandson was given Ritalin. He became depressed; he was put on antidepressants. He developed insomnia; sleeping pills were suggested. Parker’s daughter, a nurse, shuddered; she didn’t want her son to take more drugs. Parker’s daughter isn’t alone. Many parents whose children have been diagnosed with ADHD or attention deficit disorder (ADD) have the same concerns. Adults who have been diagnosed do too.
One problem is that there’s no clear-cut test for ADD/ADHD. Diagnosis is based on a combination of chronic behavior problems listed in the 1994 edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Not all practitioners agree with these diagnostic criteria, which include symptoms ranging from “often fidgets with hands or feet or squirms in seat” to “often does not seem to listen when spoken to directly” and “often talks excessively.”
The DSM lists behaviors that correspond with the everyday, typical behavior of children, says Peter R. Breggin, psychiatrist and author of Talking Back to Ritalin (Common Courage Press: Monroe, Maine, 1998).
Breggin—an advocate of counseling whose motto is “educate, not medicate”—says “these children do not have a disorder. . . . Within the past few years, instead of figuring out what our kids need, we have begun a massive drugging of our children to make them fit our needs.”
Ritalin (methylphenidate hydrochloride) is a nervous system stimulant used to treat ADD and ADHD, as well as narcolepsy and other ailments. According to IMS America, a health-care information company, the number of prescriptions for Ritalin in the United States has gone from 4.5 million to 11.4 million in the past five years. Critics believe that Ritalin is overprescribed.
“It’s being used in the 1990s because of extensive marketing,” Breggin says.
Questions also remain about the side effects of Ritalin and other stimulants. According to the Drug Enforcement Administration, Ritalin may cause nervousness, insomnia, addiction, and weight loss. Some parents and diagnosed adults are seeking a variety of alternatives to Ritalin and other drugs. Approaches include counseling, the use of natural supplements, and changes in diet.
”When I found my grandson was having such good results from supplements,” Parker says, “I wanted to let others know that there are other alternatives.” So in 1997 she founded Grandparents and Parents Against Ritalin to spread the word. (The group can be reached at 800-995-2010.)
Nutrition researcher Jacqueline Stordy, another advocate of supplements, found that people with learning disorders such as ADHD may be deficient in essential fatty acids. Other research from Purdue University (1995) hypothesizes this is because of “altered fatty acid metabolism.”
Stordy, Ph.D., a retired professor of nutrition at the University of Surrey in England, is now a nutrition consultant and adviser for Efamol Nutraceuticals, which developed a patented supplement based on her research. The supplement combines DHA-rich fish oil and evening primrose oil, a source of gamma linolenic acid. Stordy says, however, that the supplement isn’t a cure; it’s “natural help” for people who are deficient in long-chain fatty acids. It may be weeks or months before results are noticeable.
Other research has focused on the relationship of certain
minerals to the metabolism of fatty acids. A 1996 study in Turkey
looked at the effects of serum-free fatty acids (FFAs) on
forty-eight ADHD children. The research concluded that blood serum
levels of FFA and zinc are correlated and that a zinc deficiency
may be a cause of ADHD. Low FFA levels may be secondary to the zinc
deficiency. In 1997, a study by Polish scientists linked the development of
ADHD to low blood serum magnesium levels. Another study by the same
team gave children diagnosed with ADHD about 200 mg of magnesium a
day for six months; the researchers noted decreased hyperactivity
in the children. More research is needed, however, on the possible benefits of
the relationship between fatty acids and mineral supplements.
—Herbs for Health technical editor Anne Sundermann contributed to this report.
“Nutrition supplement: vitamins, minerals, and more” is offered
as a bimonthly supplement to Herbs for Health and is written by Lee
Peck, an independent journalist from Fort Collins, Colorado. Design
by Bren Frisch. “Nutrition supplement” is intended as an
educational service, not a source of medical advice or a guide for
self-medication. Please consult a qualified health-care
professional for treatment of any serious health problems.
“The New Food Label” (Backgrounder:BG95-14) can be found on the Food and Drug Administration’s Web page at http://www.fda.gov. To order it by mail, free of charge, write to FDA, HFE-88, Fishers Lane, Rockville, MD 20857; include the title and backgrounder number. Also available: “On the Teen Scene: Food Label Makes Good Eating Easier” (Reprint 98-2294).
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