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TheGreatDebateWellnessNutrients.pptxWellness Nutrients
Nutritional Supplementation
SWU 351 Sustainable Living and Mindful Eating
Objectives
By the end of class you should be able to:
Identify a variety of “wellness supplements”
Identify populations who may and may not benefit from taking a multivitamin
Define “functional foods”
The Problem
The vast majority of Americans do not meet minimum RDA standards of vitamins and minerals
93% of vitamins D and E miss recommendations from diet
61% not enough magnesium
50% not enough Vitamin A and Calcium
Many subpopulations have lower than recommended intake
older adults (over 65+)
African Americans
Obese individuals
Those who are ill or injured
Do We Need Supplements to be “Well”?
Health maintenance and prevention of disease
Almost 1/2 of the adult population takes supplements of one form or another
What supplements do people take to be well?
Deficiency Issues
Micronutrients (vitamins and minerals) provide:
maintenance of normal cell and tissue function, metabolism, growth and development
True Deficiency Diseases are Rare in the United States
more problems from over nutrition, not malnutrition
Supplements offer an unregulated promise of health in a bottle
It is BIG BUSINESS, with BIG PROFITS
Can a healthful diet provide adequate protection? Or, are supplements the answer?
Common Wellness Supplements
MVI’s
Fish Oil and Flax Oil
Vitamin D
Antioxidants such as vitamins C and E and beta carotene
Gene Polymorphisms
Since the mapping of the human genome, multiple single nucleotide polymorphisms (SNPs) have been identified that can affect nutritional status and potentially, overall health
Common SNPs
MTHFR
Vitamin D receptor
Fatty Acid Desaturases (FADS)
PEMT (choline)
Lipoprotein polymorphisms…
FASEB J. 2005 Oct;19(12):1602-16
Healthy Eating Index 2005
Measures adequacy, moderation and variety
(fat, cholesterol, sodium , FGP…)
Data set is from 1999 - 2000
74% of population has a diet that “needs improvement”
10% have a “good diet”
16% of population has a “poor diet”
http://www.cnpp.usda.gov/publications/HEI/HEI99-00report.pdf
Americans Do Not Meet Federal Dietary Recommendations
2001 – 2004 NHANES (16,338 ppl aged 2 and older)
24 hr recall translated into food groups using My Pyramid Equivalents Database
The population did not meet recommendations for all of the nutrient rich food groups except for total grains, meat and beans (categories: fruits, veg, dark green veg, orange veg, legume, starchy veg, other veg, milk, total grains, meat and beans, oils)
Dark greens, orange veg, legumes and whole grains had the poorest showing and 90% of the population did not meet recommendations for total veg and milk.
80 – 90% of Americans are over-consuming fat, sugar, & ETOH
Krebs-Smith et al. J Nutr. 2010 Oct;140(10):1832-8.
Toxic World?
Textbook of Functional Medicine. Institute for Functional Medicine. Gig Harbor, WA. 2005
Do we have evidence that taking MVI’s / Supplements provide benefit?
Observational studies vs. RCT’s
Food sources of nutrients vs. supplements
Safety vs. Efficacy
Journal of the American Medical Association 2002
Harvard and Brigham and Women’s Study
“Most people do not consume an optimal amount of all vitamins by diet alone”
For some vitamins nutrients there is evidence that supplementation reduces the rate of clinical events (some cancers, some cardiovascular risk factors NTD’s, bone fractures, .
“We recommend all adults take one MVI daily”
Fletcher. Vitamins for Chronic Disease Prevention in Adults. JAMA. 2002;287(23):3127-3129
Long Term Supplement Users
Convenience sample of people taking multiple Shaklee supplements (N=278)
Matched with single MVI users (N=176) and non supplement users (N=602) from NHANES 2001 – 2002 and NHANES III 1988 – 1994
Block et al. Usage patterns, health and nutritional status of long term multiple dietary supplement users: a cross sectional study. Nutr J. 2007 Oct 24;6:30.
Long Term Supplement Users
Multiple supplement users had been taking supplements for more than 20 years
Information was obtained from on line questionnaires and physical exams (FBS, BP, body weight)
Results:
Serum nutrient contents increased with dietary supplement use
After adjustment for age, gender, income, education, and BMI, greater use of supplements was associated with more favorable serum concentrations of homocysteine, CRP, HDL, and Tg as well as lower BP and lower risk for DM2
Multivitamin-Multimineral supplements effect on total nutrient intake
Hawaii-Los Angeles Multiethnic Cohort (N=100,196 subset without chronic disease)
48% of men and 56% of women reported use of MVI at least weekly
The prevalence of nutrient adequacy was calculated for 17 nutrients
Multivitamin-Multimineral supplements effect on total nutrient intake
Prevalence of nutrient adequacy from food was slightly higher in the MVI users – the supplement users also had better dietary intakes
The prevalence of nutrient adequacy increased for multiple nutrients when supplements were included (esp Vit E, calcium, zinc, B6, Vit A)
MVI users were more likely to have excessive intakes of iron, zinc, vitamin A and niacin
Participants reported using 1246 different products and nutrient values differed greatly
Multivitamin-Multimineral supplements effect on total nutrient intake
Conclusions:
Using composition data on MVI’s is preferable to using a standardized default MVI in research
More information needs to be known about the distribution of nutrients in OTC MVI’s
Murphy, S. et al. Multivitamin-Multimineral supplements’ effect on total nutrient intake. Am J Clin Nutr. 2007;85(suppl):280S – 284S
What about other studies on the topic?
It is remarkably difficult to accurately assess individual nutrient intakes
Supplements improve the serum levels of nutrients of those who take them
Supplement users tend have higher overall nutrient intake from foods and improved diet quality than non users
NIH State if the Science Conference Statement. Multivitamin/Mineral Supplements and Chronic Disease Prevention. May 2006; Vol 23:2
Murphy et al. Multivitamin-multimineral supplements effect on total nutrient intake. Am J Clin Nutr.2007;85(suppl)
What about other studies on the topic?
Because MVI’s have widely varied compositions and characteristics, it is difficult to assess true effect of one over another
http://ods.od.nih.gov/Health_Information/Dietary_Supplement_Ingredient_and_Labeling_Databases.aspx
Most MVI’s are safe with few reported side effects
Many people take supplements (esp elders) with prescription drugs and may be at risk of DNI
Quato et al. Use of prescription and OTC medications and dietary supplement among older adults in the United States. JAMA. 2008;300:24
Safety
Results from the 2002 Health and Diet Survey from the FDA (Timbo. Dietary Supplements in a Natl Survey: Prevalence of Use and reports of Adverse Events. J Am Diet Assoc. 2006;106)
Survey tracks information on consumer awareness, attitudes and practices related to diet and health
Adults 18 and older who speak English in all 50 states (N=2743)
73% of the participants used dietary supplements in the past 12 months
4% had adverse events
Safety
Do Supplements Reduce the Risk of Disease (intervention studies)?
Reasonable Evidence
Vitamin D and calcium and bone fracture
Folate for NTD’s and primary prevention of some cancers
MVI and cancer and cataracts
Fish oil and CVD, cancer, DM, depression, anxiety
Probiotics and diarrhea and IBD
Antioxidants and macular degeneration
Poor Evidence
Antioxidants and CVD and cancer
B12 and folic acid and cognitive decline
MVI’s and CVD and Cancer
MVI’s for prevention of chronic disease (except perhaps for long term users?)
Who Might Be at Risk from taking Supplements?
Smokers and Beta Carotene (ATBC and CARET trials)
NEJM 1994;330:1029-35
NEJM 1996;334:1150-5
Antioxidants and All Cause Mortality
JAMA Feb 28 2007;298(8)
Vitamin E in high doses
Ann Intern Med;2005. 143:155-156
Vitamin E and Selenium (SELECT trial)
JAMA 2009;301(1):39-51
Sometimes hard to assess excess intake with supplements and fortification of foods…
Antioxidant Supplements
Most common
Vitamin E
Selenium
Vitamin C
Beta-Carotene
A large meta-analyses of 68 trials revealed increased mortality with supplemental antioxidant use
Bjelakovic et al. Mortality in Randomized Trials of Antioxidant Supplements for Primary and Secondary Prevention. JAMA. 2008. 297:8
Bjelakovic et al. Antioxidant Supplements for Prevention of Mortality in healthy participants and patients with various diseases. Cochrane Database Review. 2008. Apr 16;(2):CD007176
Calcium
Bolland. Vascular events in healthy older women receiving calcium supplementation: randomized controlled trial. BMJ: 2008;336:262
1471 post menopausal women
732 took 1000 mg calcium citrate
739 took placebo
After 5 years there was an increased risk for MI, TIA, CVA and Sudden Death in the calcium group
Who Might Benefit from Taking a Multivitamin / Multimineral?
Women of reproductive age (Folate)
Elderly (B12 and Vit D)
Vegans (B12)
Alcohol Dependent Individuals (Folate, B6, B12, Thiamin)
People with malabsorption diseases (multiple nutrients)
Hospitalized individuals (multiple nutrients)
Pregnant women (increased need of some nutrients like Iron and Folate)
People with eating disorders or following fad diets
People on hemodialysis (iron, vitamin E)
People with SNPs
Functional “Phoods”
Foods enhanced with added nutrients, herbals or other dietary supplements
Everyone is taking supplements….
http://www.acsh.org/factsfears/newsID.396/news_detail.asp
Our Food Has Nutrients…. Naturally!
Bone broth
Fish
Nutritive Herbs
Calcium, Iron, Vitamin A, omega -3’s
Nettles
Dandelion
Purslane
Lambs quarters
Berries
Garlic
Ginger
Brazil nuts
Rose Hips
Kale
Sea Vegetables
Whole grains
Nuts, seeds and legumes
The question remains…
Do we or do we not need dietary supplements / multivitamins?
Multivitamins
How to choose a MVI
Dietary intake
State of health
Life cycle needs
Age
Budget
How many pills willing to swallow
Capsules, tablets, liquid
Where is the supplement sold? Accessible?
Single Vitamins / Minerals
Megadosing
More chance for interactions, toxicity
Nutrients of potential concern
B6
Potassium
Niacin
Retinol
Vitamin K
Iron or no iron?
Balance
How do we know what the correct ratios are?
“Special” Forms of Vitamins
Water miscable fat soluble vitamins
Vitamin D2
Phosphorylated vitamins (PLP)
Methylcolbalamin
Algae source DHA
Your Assignment
Choose a supplement
Choose a side, for (PRO) or against (CON)
Research, using evidence based, peer reviewed journal sources, or scientific websites provided by the instructor
Build your argument for or against supplementation based on scientific evidence, not your or someone else’s opinion
Requirements
1. For what condition is it recommended?
2. For what people is it recommended?
3. What is the recommended dose?
4. Any research on safety or efficacy?
5. Any third party certification available?
750-1500 words
Five (or more) evidence based peer reviewed sources; or websites provided by Instructor
Supplement Choices
Vitamin D
Melatonin
Collagen Peptide Powder
Turmeric
Probiotics
Magnesium
Biotin
Fish Oil
Creatine
Whey Protein Powder
