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Psyllium comes from the crushed seeds of the Plantago ovata plant, an herb native to parts of Asia, the Mediterranean and North Africa. The psyllium seed husks have been used in herbal remedies. Similar to oats and wheat, psyllium is rich in soluble fiber. Traditionally, psyllium husk is used as a gentle bulk-forming laxative for constipation.
Psyllium plays an important role in improving digestion and relieving occasional constipation. It promotes regularity and a healthy colon, helps maintain cholesterol levels that are already within the normal range, and provides cleansing support throughout the day to help maintain healthy functioning in the GI tract.
Psyllium is mainly used as a dietary fiber, which is not absorbed by the small intestine. The purely mechanical action of psyllium mucilage absorbs excess water while stimulating normal bowel elimination. Although its main use has been as a laxative, it is more appropriately termed a true dietary fiber and as such can help reduce the symptoms of both constipation and mild diarrhea. Psyllium mucilage is also used as a thickener and used in ice cream and frozen desserts.
The United States is the world's largest importer of psyllium husk, with over 60% of total imports going to pharmaceutical firms for use in products such as "Metamucil". In Australia, psyllium husk is used to make "Bonvit" psyllium products. In the UK, ispaghula husk is used in the popular constipation remedy "Fybogel". In India, psyllium husk is used to make "Gulab Sat Isabgol" psyllium products.
Psyllium has long been recognized for its potential role in reducing blood cholesterol. As early as in 1998, the FDA already approved a health claim on psyllium:
"3g to 12g soluble fiber from psyllium seed husk when included as part of a diet low in saturated fat and cholesterol, may reduce the risk of heart disease"
Studies have shown that psyllium is effective in lowering total cholesterol and low density lipoprotein or LDL (the bad cholesterol) levels.
Soluble Fiber includes:
* Oat/Oat bran
* Dried beans and peas
* Barley
* Flax seed
* Fruits such as oranges and apples
* Vegetables such as carrots
* Breakfast cereals containing psyllium or oats
* Baked goods containing psyllium or oats
* Psyllium powder or capsules such as Metamucil
Other Benefits of Psyllium
Since psyllium is a type of fiber, it can alleviate constipation. In addition, recent studies also showed positive benefits of psyllium in IBD (Crohn's Disease and Colitis). Psyllium acts as prebiotics - aiding to heal the inner lining of the inflamed intestines.
Here's what you need to know:
Psyllium is very rich in soluble fiber. Therefore, we only need to eat a small serving to contribute the soluble fiber to help achieve the cholesterol-lowering effect. Standard preparations of psyllium are available in dry seed or husk form, to be mixed with water as needed. You will also find them in capsules. Many food products, such as breakfast cereals and baked goods, also contain psyllium. Read the label properly to ensure that you are eating an appropriate amount of psyllium in order to achieve the cholesterol-lowering effect.
Psyllium Warning:
* In general, prescription drugs should be taken one hour before or two hours after psyllium, because the absorption and effectiveness of many drugs may be reduced.
* In addition, all foods bearing a psyllium health claim must also bear a label statement concerning the need to consume them with adequate amounts of fluids.
Safety Concerns and Restrictions of Psyllium
Just like with any drug and herbal ingredient, try not to overdo it. It’s relatively safe when instructions are followed and doctor’s recommendations are observed. Excessive use of Psyllium can cause harm to your bowels; you certainly don’t want that to happen. Diverticulitis, or Diverticulosis, is a contraindication for Psyllium.
In case you have a history of diabetes, it’s recommended that you talk to your doctor prior to taking this herb. Make sure you or your family members carefully monitor the level of glucose in your body, as Psyllium can reduce sugar levels. Do not take more than two tablespoons of this herb per day, as this might negatively affect your health. This is not the case when the more means the better.
Here's what you need to know:
If enough water is not consumed by your body, it is very possible you will become constipated. It is not recommended that you ingest more than two tablespoons of Psyllium per day.
Make sure you talk with your doctor before taking Psyllium!
The Psyllium Product Ranges are:
* Psyllium Seeds: Psyllium seed husks, also known as ispaghula or simply as psyllium, are portions of the seeds of the plant Plantago psyllium or Plantago ovata. Psyllium seed is an agri-farm product of dried ripe seeds of plantago ovata forks and it has been cleaned free for all dust, agro farm fibers, wastes, mud, stones and iron particles.
* Psyllium Husk: The most important Psyllium product is the 'Psyllium husk. The efficacy of Psyllium is due to the dense mucilage, the action of which is purely mechanical, as the husk swells into a jelly like mass in emulsifying with liquids. Psyllium husks are used to relieve constipation, irritable bowel syndrome, diverticular disease, and diarrhea. Psyllium can also be added to food or drink to boost the fiber content of the diet, and some cereals.
* Psyllium Husk Powder: Psyllium Husks Powder is the strongest natural dietary fiber for promoting regularity and supporting heart health. It is most effective for daily use, and can be used as long as desired.
* Psyllium Industrial Powder: Psyllium Industrial Powder is by-product of psyllium husk. When psyllium seeds are processed to make psyllium husk, the extraneous material left is termed as Psyllium Powder i.e. Psyllium Industrial Dust.
Therapeutic Uses of Psyllium
* Constipation: Psyllium relieves constipation. Psyllium speed the passage of stool through the digestive tract by softening the stool and attracting water thereby producing more bulk, which stimulates the transit of waste through the gastrointestinal tract.
* Diarrhea: Psyllium can be used as a bulk-forming agent to help relieve mild to moderate diarrhea. Psyllium soaks up a significant amount of water in the digestive tract, thereby making stool firmer and, under these circumstances, slower to pass.
* High Cholesterol: Soluble fiber psyllium husk have a cholesterol-lowering effect when added to a low-fat, low-cholesterol diet. Psyllium is quite effective in lowering total as well as LDL i.e. bad cholesterol - LDL levels, which can be helpful to those with high cholesterol and those at increased risk for developing hypercholesterolemia, such as people with type 2 diabetes.
* Heart Disease: Incorporating high fiber foods such as psyllium enriched cereals into the diet may help lower heart disease risk.
* High Blood Pressure: The addition of fiber, 12 grams of soluble fiber per day, particularly psyllium, may help lower blood pressure.
* Obesity: Medical studies suggest that psyllium may enhance the sensation of fullness and reduce hunger cravings. Use of Psyllium and other sources of fiber into the diet may aid weight loss.
* Irritable Bowel Syndrome (IBS): Several studies have found that soluble fiber including psyllium helps to regulate stool frequency and consistency in people with IBS. Psyllium also has the additional advantages over other sources of fiber of reducing flatulence and bloating.
* Inflammatory Bowel Disease (IBD): In a study of people with ulcerative colitis, a type of inflammatory bowel disorder, psyllium seeds were as effective as the prescription drug mesalamine in decreasing recurrences of the disease. In addition, a physician may recommend the use of psyllium as a bulking agent for mild to moderate cases of diarrhea from either ulcerative colitis.
Sources: Psyllium.com, Wikipedia, National Institute of Health.
Monday, July 20, 2009
Wednesday, July 8, 2009
11. Glucosamine and Chondroitin - 7/8/09
I personally take Glucosamine/Chondroitin, 1500mg twice a day (total 3000mg). For me, along with exercise, it eliminates taking Aleve (NSAIDS) altogether (read below about side effects of NSAIDS), and limits my use of Hydrocodone for ohhhhh geeeeeez or back pain, which is about twice a month unless I overdo.
Why do I take it? I had daily joint pain, daily joint stiffness, creaky noises (which are now gone), and Glucosamine/Chondroitin allows me more flexibility, relieves the joint stiffness considerably so that at this point in time, I can walk up to 3 miles a day (with a walking partner, one mile alone w/ cell phone), and the joint pain is manageable with 500 mg Tylenol once or twice a week. When I work two or three days a month at the hospital, I have noticed more flexibility and may have to take a Hydrocodone once or twice a month for back pain.
People with osteoarthritis use glucosamine and chondroitin to relieve joint pain.
Glucosamine and chondroitin, taken alone or together, have not always been shown to relieve pain of osteoarthritis in all people. But glucosamine and chondroitin taken together may help reduce pain in some people with moderate-to-severe knee pain. Some studies show that chondroitin alone may relieve pain and improve function.
There are also some studies that indicate glucosamine may help as much as ibuprofen in relieving symptoms of osteoarthritis, particularly in the knee, with fewer side effects.
Research indicates that glucosamine and chondroitin can help restore cartilage.I strongly recommend that you try a month at 1500mg twice a day before you resort to prescription medication, which can carry a whole list of side effects and may require you to take more pills for the side effects. You can buy it at any drug store, GNC or mail order house. I use mail order because they have the best prices. Puritan's Pride is the one I use because I can take advantage of their Buy 2 Get 3 Free (or Buy 1 Get 2 Free) deals, which are very money-saving. I get six bottles of 120 capsules (4 capsules a day) for $80.00. Each bottle is a month's supply for me. Click here for all deals.
Okay, so what is it?
Glucosamine is sugar protein that is used in the formation and repair of cartilage and believed to help develop and renew cartilage (the hard connective tissue mainly located on bones near joints in the body), and keep it lubricated for better joint movement and flexibility.
Chondroitin is believed to help the body maintain fluid and flexibility in the joints.
The combination of chondroitin and glucosamine is widely used to aid in maintaining healthy joints. It is also used as a nutritional supplement in people with osteoarthritis or other inflammatory disorders. I have a friend who has "knee clicking" and he had been hitting the Hydrocodone two or three times a day. He started taking 1500 mg twice a day and after a month, saw good results. He rarely takes anything more than Tylenol every so often.
Treatment with these joint supplements is based on the theory that oral consumption of glucosamine and chondroitin may increase the rate of formation of new cartilage by providing more of the necessary building blocks.
What is the most important information you should know about chondroitin and glucosamine?
Here's what you need to know:
Do not take chondroitin and glucosamine without the advice of a healthcare provider if you are using insulin, or a blood thinner such as anisindione (Miradon) or warfarin (Coumadin). Avoid taking chitosan (usually marketed as a weight-loss product) while you are taking chondroitin and glucosamine. Chitosan can make it harder for your body to absorb chondroitin.
What should your tell my healthcare provider before taking chondroitin and glucosamine? Here's what you need to know:
Before using chondroitin and glucosamine, talk to your doctor, pharmacist, herbalist, or other healthcare provider. If you are allergic to shellfish, do not take glucosamine unless you have discussed it with your doctor. Glucosamine is made from shellfish covering. Always tell your doctor if you are using a dietary supplement or if you are thinking about combining a dietary supplement with your conventional medical treatment. It may not be safe to forgo your conventional medical treatment and rely only on a dietary supplement. You may not be able to use chondroitin and glucosamine if you have:
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diabetes;
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a bleeding or blood clotting disorder such as hemophilia;
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if you have allergies to certain drugs;
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if you are overweight; or
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if you are on a low-salt diet.
Studies
There have been numerous studies to examine the treatment effects of glucosamine and chondroitin over short periods of time. Most of these studies last only one to two months; however, a 2008 National Institute of Health study has indicated that patients experienced more pain reduction when taking glucosamine and chondroitin than patients receiving a placebo. The improvement experienced by these patients was similar to improvements experienced by patients taking nonsteroidal anti-inflammatory medications (NSAIDs) that have been a mainstay of non-operative arthritis treatment. The difference is that NSAIDs carry an increased risk of side effects including gastrointestinal complaints and bleeding.
Both glucosamine and chondroitin sulfate have been used in Europe for several years, with few reported side effects. Both supplements also have some anti-inflammatory effects that may account for the pain relief. But there is no proof that either substance, taken singly or in combination, will actually slow the degenerative process or restore cartilage in arthritic joints. All studies done to date have been short and focused on pain relief.
****
Of course there are studies that say when used for arthritis and joint pain, glucosamine and chondroitin sulfate, do not seem to work any better than placebo to slow the loss of knee cartilage in osteoarthritis...continue reading here.
A 2006 study showed these conflicting results.
A September 2008 study showed these results.
I welcome your comments about your experiences with this supplement.
Sources: National Institute of Health, Reuters News Service, Web MD, Arthritis Foundation, Puritan's Pride.
Friday, July 3, 2009
10. Inositol Hexaphosphate (IP-6) - 7/3/09
Inositol Hexaphosphate (IP-6) is the ultimate antioxidant. It is associated with dietary fiber and part of the B vitamin family.
We naturally can increase our intake of IP6 by consuming the outer layer of grains (rice, wheat, rye), but soybean seed is the best source with its whole seed (bean) containing up to 26% of IP6.
Research has shown that IP6 can help prevent kidney stone formation, complications of diabetes(i.e. cataracts, renal damage), lung fibrosis, fatty liver disease, sickle cell anemia, heart disease, high cholesterol and high triglycerides. It is calcium binding, thus preventing formation of the most common type of kidney stone (calcium oxibate). Its antioxidant and iron building properties inhibit the progression of lung fibrosis in asbestosis.
Although used primarily by the community of Alternative Medical Doctors and some open-minded orthodox oncologists (medical cancer doctors) because it suppresses almost all types of cancer, it has some other fantastic benefits for longevity.
Independently, IP6 regulates the oxygen capacity of our red blood cells; it reduces both cholesterol and trigylcerides, as well as preventing heart damage during a heart attack.
In diabetes cases, it not only improves insulin sensitivity, but also decreases complications.
In preliminary studies, IP6 prevents depression and may work adjunctively in schizophrenia. The all-important function of enhancing of our immune system, by increasing the activity of our natural killer (NK) cells, may make IP6 the 'aspirin' of the future.
Inositol Hexaphosphate supports natural cell defense and is a powerful anti-cancer agent. Many oncologists offer IP-6 to their cancer patients in megadoses in order to help them maintain antioxidants in their bloodstream because many times, they can't eat the foods required. Inositol Hexaphosphate is among the most powerful cancer prevention substances known, even more so than Green Tea.
It has so many benefits that you can virtually eliminate a few supplements from your daily regimen and still get all the nutrients your body needs. It is also known as phytic acid or B-8.
I take 1000 mg Inositol Hexaphosphate as part of my daily intake for these reasons:
1. I can't eat beans, legumes, wheat bran, rye, citrus fruits or soybeans.
2. I do not get enough dietary fiber from my diet.
3. It helps lower my cholesterol and triglycerides without taking statin drugs.
4. It helps my body process insulin better, so that I do not have to shoot as much insulin into my body (many days NONE at all).
5. It helps with my peripheral neuropathy in hands and feet, thus cutting down my use of Neurotin to 300mg twice a day.
6. I believe it helps my depression symptoms and enhances my level of energy.
7. It supports the immune system by boosting "natural killer" cell activity
8. My diet does not supply the RDA 1000 mg needed per day.
Some formulas come with calcium and magnesium added, but I choose to take plain IP-6 because the amount of calcium and magnesium in most formulas is far less than what is my normal intake.
Here's what you need to know
Inositol hexaphosphate (IP-6, phytic acid or phytate) is a natural carbohydrate found in cereal grains, beans, brown rice, corn, sesame seeds, wheat bran, cantaloupe, citrus fruits, and other high fiber foods. Inositol is not known to be an essential nutrient. However, these foods supply a substance called phytic acid (inositol hexaphosphate, or IP6), which releases inositol when acted on by bacteria in the digestive tract. The typical American diet provides an estimated 1,000 mg daily.
It aids in the metabolism of insulin and calcium, hair growth, bone marrow cell metabolism, eye membrane development, and helps the liver transfer fat to other parts of the body. Now if I could only TELL it to go to certain parts of my body, I could re-distribute the fat cells.
IP-6 in the diet may even help reduce the risk for kidney stones. Many researchers believe that some of the health benefits may be due to the antioxidant, immune enhancing, and cardiovascular supporting activities of IP-6. In-vitro and animal research has shown IP-6 to have significant protective and growth regulating effects on various cells and tissues including those of the colon, breast, and prostate.
We naturally can increase our intake of IP6 by consuming the outer layer of grains (rice, wheat, rye), but soybean seed is the best source with its whole seed (bean) containing up to 26% of IP6.
Research has shown that IP6 can help prevent kidney stone formation, complications of diabetes(i.e. cataracts, renal damage), lung fibrosis, fatty liver disease, sickle cell anemia, heart disease, high cholesterol and high triglycerides. It is calcium binding, thus preventing formation of the most common type of kidney stone (calcium oxibate). Its antioxidant and iron building properties inhibit the progression of lung fibrosis in asbestosis.
Although used primarily by the community of Alternative Medical Doctors and some open-minded orthodox oncologists (medical cancer doctors) because it suppresses almost all types of cancer, it has some other fantastic benefits for longevity.
Independently, IP6 regulates the oxygen capacity of our red blood cells; it reduces both cholesterol and trigylcerides, as well as preventing heart damage during a heart attack.
In diabetes cases, it not only improves insulin sensitivity, but also decreases complications.
In preliminary studies, IP6 prevents depression and may work adjunctively in schizophrenia. The all-important function of enhancing of our immune system, by increasing the activity of our natural killer (NK) cells, may make IP6 the 'aspirin' of the future.
Inositol Hexaphosphate supports natural cell defense and is a powerful anti-cancer agent. Many oncologists offer IP-6 to their cancer patients in megadoses in order to help them maintain antioxidants in their bloodstream because many times, they can't eat the foods required. Inositol Hexaphosphate is among the most powerful cancer prevention substances known, even more so than Green Tea.
It has so many benefits that you can virtually eliminate a few supplements from your daily regimen and still get all the nutrients your body needs. It is also known as phytic acid or B-8.
I take 1000 mg Inositol Hexaphosphate as part of my daily intake for these reasons:
1. I can't eat beans, legumes, wheat bran, rye, citrus fruits or soybeans.
2. I do not get enough dietary fiber from my diet.
3. It helps lower my cholesterol and triglycerides without taking statin drugs.
4. It helps my body process insulin better, so that I do not have to shoot as much insulin into my body (many days NONE at all).
5. It helps with my peripheral neuropathy in hands and feet, thus cutting down my use of Neurotin to 300mg twice a day.
6. I believe it helps my depression symptoms and enhances my level of energy.
7. It supports the immune system by boosting "natural killer" cell activity
8. My diet does not supply the RDA 1000 mg needed per day.
Some formulas come with calcium and magnesium added, but I choose to take plain IP-6 because the amount of calcium and magnesium in most formulas is far less than what is my normal intake.
Here's what you need to know
Inositol hexaphosphate (IP-6, phytic acid or phytate) is a natural carbohydrate found in cereal grains, beans, brown rice, corn, sesame seeds, wheat bran, cantaloupe, citrus fruits, and other high fiber foods. Inositol is not known to be an essential nutrient. However, these foods supply a substance called phytic acid (inositol hexaphosphate, or IP6), which releases inositol when acted on by bacteria in the digestive tract. The typical American diet provides an estimated 1,000 mg daily.
It aids in the metabolism of insulin and calcium, hair growth, bone marrow cell metabolism, eye membrane development, and helps the liver transfer fat to other parts of the body. Now if I could only TELL it to go to certain parts of my body, I could re-distribute the fat cells.
IP-6 in the diet may even help reduce the risk for kidney stones. Many researchers believe that some of the health benefits may be due to the antioxidant, immune enhancing, and cardiovascular supporting activities of IP-6. In-vitro and animal research has shown IP-6 to have significant protective and growth regulating effects on various cells and tissues including those of the colon, breast, and prostate.
Inositol, unofficially referred to as "vitamin B 8," is present in all animal tissues, with the highest levels in the heart and brain. It is part of the membranes (outer coverings) of all cells, and plays a role in helping the liver process fats as well as contributing to the function of muscles and nerves.
Depression
Inositol may also be involved in depression. People who are depressed may have lower than normal levels of inositol in their spinal fluid. In addition, inositol participates in the action of serotonin, a neurotransmitter known to be a factor in depression. (Neurotransmitters are chemicals that transmit messages between nerve cells.) For these two reasons, inositol has been proposed as a treatment for depression, and preliminary evidence suggests that it may be helpful.
Inositol has also been tried for other psychological and nerve-related conditions.
Other diseases/disorders
Inositol has also been studied for bipolar disorder, panic disorder, bulimia, and obsessive-compulsive disorder, but the evidence remains far from conclusive. Other potential uses include Alzheimer's disease and attention deficit disorder.
According to two double-blind studies enrolling a total of almost 400 people, inositol may help improve various symptoms of polycystic ovary syndrome, including infertility and weight gain.
Another very small double-blind study found that inositol supplements could help reduce symptoms of psoriasis triggered or made worse by use of the drug lithium.
A small double-blind study failed to find inositol helpful for premenstrual dysphoric disorder, a severe form of premenstrual syndrome (PMS).
Inositol is sometimes proposed as a treatment for diabetic neuropathy, but there have been no double-blind, placebo-controlled studies on this subject, and two uncontrolled studies had mixed results.
Inositol has also been investigated for potential cancer-preventive properties.
People with panic disorder frequently develop panic attacks, often with no warning. The racing heartbeat, chest pressure, sweating, and other physical symptoms can be so intense that they are mistaken for a heart attack. A small double-blind study (21 participants) found that people given 12 g of inositol daily had fewer and less severe panic attacks as compared to the placebo group.
A double-blind, crossover study of 20 individuals compared inositol to the antidepressant drug fluvoxamine (Luvox), a medication related to Prozac. The results over 4 weeks of treatment showed that the supplement was at least as effective as the drug.
Polycystic ovary syndrome (PCOS) is a chronic endocrine disorder in women that leads to infertility, weight gain, and many other problems. In a double-blind, placebo-controlled trial, 136 women with PCOS were given inositol at a dose of 100 mg twice daily, while 147 were given placebo.
Over the study period of 14 weeks, participants given inositol showed improvement in ovulation frequency as compared to those given placebo. Benefits were also seen in terms of weight loss and levels of HDL ("good") cholesterol. A subsequent study of 94 people found similar results. However, both of the studies were performed by the same research group. Independent confirmation will be necessary before inositol could be considered an effective treatment for PCOS.
No serious ill effects have been reported for inositol, even with a therapeutic dosage that equals about 18 times the average dietary intake. However, no long-term safety studies have been performed.
Although inositol has sometimes been recommended for bipolar disorder, there is evidence to suggest inositol may trigger manic episodes in people with this condition. If you have bipolar disorder, you should not take inositol unless under a doctor's supervision.
Nature’s most effective iron-chelating molecule is IP6, and is a selective agent against cancer cells. It is believed to work against cancer, because cancer cells have a high iron content, and IP6 selectively removes iron from tumour cells, thus depriving them of their primary growth factor. IP6 does not remove iron from red blood cells, which are tightly bound to haemoglobin.
Inositol hexaphosphate does not kill cancer cells – it tames them and makes them behave like normal cells.
There have been numerous laboratory and animal studies that conclusively prove IP6 is an effective and non-toxic anticancer molecule, and the following results have been obtained:
a) Inhibits growth,and induces G1 arrest and apoptotic death of prostate carcinoma
b) Decreases proliferation of cancer cells and causes them to differentiate, often reverting to the size, shape and structure of normal cells
c) Activates natural killer cells, promotes differentiation, supports p53 activity, and normalizes the cell cycle by modifying signal transduction pathways.
This technology enables the addition of inositol hexaphosphate (IHP) into red blood cells to enhance oxygen delivery in cardiorespiratory diseases.
Research on human liver cancer cells that were treated with inositol hexaphosphate and transplanted into mice. They found that inositol hexaphosphate slowed or stopped the growth of liver cancer cells and shrank existing tumors three- to four-fold.
Here's what you need to know
Inositol hexaphosphate may help to fortify the immune system, prevent kidney stones, lower cholesterol and triglyceride levels, fight infection, and reduce risks of heart disease
Protected both human skin cells and a skin cancer-prone mouse from exposure to ultraviolet B (UVB) radiation, the damaging radiation found in sunlight.
The combination of compounds produced from rice bran, Inositol and its derivative Inositol Hexaphosphate (IP6), work synergistically to support the immune system by boosting natural killer cell activity and maintaining DNA integrity.
IP6 enhances the anti-cancer effects of Adriamycin and Tamoxifen, two commonly used cancer drugs but continues to be largely ignored by mainstream medicine.
In 2001 Food and Drug Administration researchers reported that 8 out of 12 chelating agents tested caused gene mutations. Among the four non-toxic chelators was IP6.
Safety has not been established in young children, women who are pregnant or nursing, and those with severe liver and kidney disease. As with all supplements used in very large doses, it is important to purchase a reputable product, because a contaminant present even in small percentages could add up to a real problem.
Here's what you need to know:
I order my IP-6 from Puritan's Pride company. I buy it in 510mg capsules and take two per day. It says to take it on an empty stomach, between or after meals, but I take it along with the other handful of stuff I take every day. Usually it is about two hours after my morning meal. The filler used is rice powder, gelatin, and vegetable magnesium stearate. I have never had a problem with IP-6 when ordering from this company.
Recommended daily dosage for healthy adults is 1000mg (that's milligrams NOT grams). Oncologists and Alternative Medical Doctors will recommend dosages from 2 Grams to as much as 15 Grams per day for various diseases/disorders. Do not attempt to take megadoses of any supplement without doctor supervision.
Make sure if you are food sensitive that your label reads:
No wheat, no gluten, no soybeans, no dairy, no egg, no fish/shellfish, no peanuts/tree nuts.
Studies, Conclusions & Findings
In each of the following references, these are studies that have been done or are in progress. In each reference, read the last two or three lines for the conclusion or findings.
You can read more about studies being done with IP-6, how we cook out the nutrients from our foods and the effect of traditional, microwave and industrial cooking on inositol phosphate content in beans, chickpeas and lentils here.
You can read more about studies being done with IP-6 and radiation protection here
You can read more about studies being done with IP-6 and bone density and osteoporosis here
You can read more about studies being done with IP-6 and tumor growth here
You can read more about studies being done with IP-6 and pancreatic cancer here
You can read more about studies being done with IP-6 and prostate cancer here
You can read more about stuides being done with IP-6 and protection against cancer here
You can read more about studies being done with IP-6 and breast cancer here and here
You can read more about studies being done with IP-6 and reducing cancer tumor growth here
You can read more about reducing risk of cardiovascular disease with IP-6 here
You can read more about lowering cholesterol studies and IP-6 here
I hope you found some information here of value to you in your quest for good health using supplements. Thank you for stopping by.
Sources: iHerb.com; Puritan's Pride; biopsychiatry.com; articlealley.com; Science Daily; National Institute of Health.
Tuesday, June 30, 2009
9. Vitamin C - Ascorbic Acid - 6/30/09
Vitamin C - also known as Ascorbic Acid, Antioxidant AND Oxidant
Ascorbic acid is used to prevent and treat scurvy, a disease caused by a lack of vitamin C in the body. This medication is sometimes prescribed for other uses.
Ascorbic acid comes in extended-release (long-acting) capsules and tablets, lozenges, syrup, chewable tablets, and liquid drops to be given by mouth. It usually is taken once a day. Follow the directions on the package or on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take ascorbic acid exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
Both tests reveal information about a person’s risk of heart disease - the number one killer of Americans. Standard tests of assessing risk of heart disease are mainly limited to a cholesterol and triglyceride test. While it is known that cholesterol and triglycerides potentially affect heart and cardiovascular health, it is hardly the entire story.
Over the past ten years, a mountain of research has emerged pointing to other factors besides cholesterol and triglyercide levels that play heavily into cardiovascular risk. It is now believed that inflammation plays almost as an important of a role in heart disease as does elevated cholesterol. A recent study using Zetia in people with NORMAL cholesterol was found to be very effective at lowering inflammation in the blood vessels, which may be as important as lowering cholesterol. Many researchers have suggested that the ability of statin drugs to reduce risk of heart attack can be solely attributed to their anti-inflammatory effect, and not by their ability to lower cholesterol.
Zetia lowers cholesterol by reducing the amount that is normally absorbed in your intestines from the food you eat. The study found that although it was effective at lowering cholesterol levels, it was not effective at slowing the development of plaque formation and heart disease. Only statin medications, the ones that lower inflammation, have been shown to lower the risk of heart disease.
We have learned that cholesterol is not the biggest evil when it comes to the progression of heart disease. The inflammation component is proving to be just as significant or maybe even more significant. So why aren’t doctors monitoring inflammation levels like they monitor cholesterol levels?
A very simple, affordable test exists that very accurately can assess the amount of inflammation present in blood vessels. That test is called c-reactive protein.
C-reactive protein is a marker for inflammation everywhere in the body. To avoid getting information related to the inflammation in your bad knee, you have to ask your doctor for a cardiac specific c-reactive protein test often referred to as hs (highly sensitive) c-reactive protein.
Every person should have this test done at least once a year in combination with their annual cholesterol check. Having elevated levels of c-reactive protein can quadruple your risk of developing heart stopping plaques.
If you have elevated levels of c-reactive protein, your doctor will try to convince you that the only way to reduce it is to use the statin medication called Crestor that was highlighted for its ability to lower c-reactive protein. Clearly, this is exactly what the pharmaceutical companies want. A side note: This “groundbreaking study,” which now justifies the use of statin medications in people with normal cholesterol levels, was funded by AstraZenica, the company that makes Crestor.
However, the idea that you must use statins to lower c-reactive protein couldn’t be further from the truth. Statin medications are dangerous and come with the risk of serious side effects. The statin medication Lipitor ranked number five on the list of the top fifteen drugs that cause severe adverse reactions resulting in permanent injury or disability.
Crestor is considered more potent than Lipitor and is associated with a higher risk of side effects. The press forgot to mention that the participants taking Crestor were more likely to develop diabetes. Additionally, although it did lower the overall rate of heart attack better than a placebo, participants taking Crestor were more likely to suffer a fatal heart attack.
There are some very effective natural therapies to lower cardiac specific c-reactive protein and lower your risk of cardiovascular disease. Food intake can play a significant role in how much inflammation is present in your body. Some foods like red meat, sugar, alcohol and trans fats directly increase inflammatory markers and put you at a greater risk for elevated levels of c-reactive protein.
It will not surprise you to learn what types of foods reduce inflammation and have been documented to lower c-reactive protein levels. Higher intakes of fruits and vegetables, particularly ones rich in certain compounds can reduce c-reactive protein levels.
In a recent study evaluating the data from 8,334 individuals, it was found that those who consumed the highest amount of flavonoids from fruits and vegetables had the lowest circulating levels of c-reactive protein. Flavonoids are naturally occurring plant compounds that have been correlated to numerous beneficial effects on health ranging from antioxidant to immune boosting.
Green and brightly colored vegetables typically have the highest flavonoid concentration. In this particular study, the only fruit correlated with lower c-reactive protein levels was apples, but I suspect that other fruits high in flavonoids and antioxidants, such as blueberries, blackberries, goji berry, pomegranate, acai and noni, would all have similar effects. They probably were not consumed in high enough quantities to be reported by the participants in this particular study.
Another diet-centered study evaluated the effectiveness of carotenoid-rich fruits and vegetables and their ability to lower circulating levels of c-reactive protein. In this randomized four-week intervention trial, three groups were asked to consume different amounts of carotenoid-rich fruits and vegetables daily. Group 1 consumed only two servings per day, group 2 consumed five servings per day and group 3 consumed eight servings per day. After the four weeks, the group that consumed eight servings per day had significantly reduced levels of c-reactive protein compared to the low fruit and vegetable intake group.
High carotenoid vegetables used in the study included carrots, green beans, peas, broccoli, zucchini, tomatoes, kohlrabi, Brussels sprouts, red cabbage, cauliflower, spinach and radishes. Selected fruits included apples, pears, kiwis, bananas, peaches, nectarines, cherries, strawberries and red currants.
Although other vitamins and supplements could be mentioned here, this post is dedicated to Vitamin C only.
Perhaps one of the most exciting new studies to be published on c-reactive protein involves the use of vitamin C. 396 healthy nonsmokers were evaluated to see if supplementation with 1,000 mg of vitamin C for two months could significantly lower c-reactive protein in those individuals who had elevated levels at baseline.
The results were quite dramatic. Vitamin C was associated with 25.3% drop in c-reactive protein. Just as a comparison, Crestor in the above study reduced c-reactive protein by 37%. It would be interesting to see how higher levels of vitamin C supplementation might affect c-reactive protein levels.
More Americans die from heart disease than from any other cause, and research has that inflammation plays almost as an important of a role in the development of heart disease as does high cholesterol. If you are 35 or older, have your doctor perform a c-reactive protein test regularly so that you can be aware of and take steps to control inflammation before it leads to heart disease.
Daily requirements - Here's what you need to know:
FROM MEDLINE
- Vitamin C (ascorbic acid) is a water-soluble vitamin, which is necessary in the body to form collagen in bones, cartilage, muscle, and blood vessels and aids in the absorption of iron. Dietary sources of vitamin C include fruits and vegetables, particularly citrus fruits such as oranges.
- Severe deficiency of vitamin C causes scurvy and are treated with Vitamin C. Although rare, scurvy includes potentially severe consequences, and can cause sudden death.
- Many uses for vitamin C have been proposed, but few have been found to be beneficial in scientific studies. In particular, research in asthma, cancer, and diabetes remains inconclusive, and no benefits have been found in the prevention of cataracts or heart disease.
The use of vitamin C in the prevention/treatment of the common cold and respiratory infections remains controversial, with ongoing research. For cold prevention , more than 30 clinical trials including over 10,000 participants have examined the effects of taking daily vitamin C. Overall, no significant reduction in the risk of developing colds has been observed. In people who developed colds while taking vitamin C, no difference in severity of symptoms has been seen overall, although a very small significant reduction in the duration of colds has been reported (approximately 10% in adults and 15% in children). Notably, a subset of studies in people living in extreme circumstances, including soldiers in sub-arctic exercises, skiers, and marathon runners, have found a significant reduction in the risk of developing a cold by approximately 50%. This area merits additional study and may be of particular interest to elite athletes or military personnel. For cold treatment , numerous studies have examined the effects of starting vitamin C after the onset of cold symptoms. So far, no significant benefits have been observed.
Disease Prevention
The amount of vitamin C required to prevent chronic disease appears to be more than that required for prevention of scurvy. Much of the information regarding vitamin C and the prevention of chronic disease is based on prospective studies, in which vitamin C intake is assessed in large numbers of people who are followed over time to determine whether they develop specific chronic diseases.
Cardiovascular Disease
Coronary Heart Disease - CHD
Until recently, the results of most prospective studies indicated that low or deficient intakes of vitamin C were associated with an increased risk of cardiovascular diseases and that modest dietary intakes of about 100 mg/day were sufficient for maximum reduction of cardiovascular disease risk among nonsmoking men and women. The First National Health and Nutrition Examination Study (NHANES I) Epidemiologic Follow-up Study found that the risk of death from cardiovascular diseases was 42% lower in men and 25% lower in women who consumed more than 50 mg/day of dietary vitamin C and who regularly took vitamin C supplements, corresponding to a total vitamin C intake of about 300 mg/day.
Results from the Nurses’ Health Study, based on the follow-up of more than 85,000 women over 16 years, also suggest that higher vitamin C intakes may be cardioprotective. In this study, vitamin C intakes of more than 359 mg/day from diet plus supplements or supplement use itself were associated with a 27-28% reduction in CHD risk. However, in those women who did not take vitamin C supplements, dietary vitamin C intake was not significantly associated with CHD risk.
More recently, a pooled analysis of 9 prospective cohort studies, including more than 290,000 adults who were free of CHD at baseline and followed for an average of 10 years, found that those who took more than 700 mg/day of supplemental vitamin C had a 25% lower risk of CHD than those who did not take vitamin C supplements.
Data from the National Institutes of Health (NIH) indicate that plasma and circulating cells in healthy, young subjects became fully saturated with vitamin C at a dose of about 400 mg/day. The results of the pooled analysis of prospective cohort studies suggest that maximum reduction of CHD risk may require vitamin C intakes high enough to saturate plasma and circulating cells, and thus the vitamin C body pool.
Stroke - CVA
With respect to vitamin C and cerebrovascular disease, a prospective study that followed more than 2,000 residents of a rural Japanese community for 20 years found that the risk of stroke in those with the highest serum levels of vitamin C was 29% lower than in those with the lowest serum levels of vitamin C. Additionally, the risk of stroke in those who consumed vegetables 6-7 days of the week was 54% lower than in those who consumed vegetables 0-2 days of the week.
In this population, serum levels of vitamin C were highly correlated with fruit and vegetable intake. Therefore, as in many studies of vitamin C intake and cardiovascular disease risk, it is difficult to separate the effects of vitamin C on stroke risk from the effects of other components of fruits and vegetables, emphasizing the benefits of a diet rich in fruits and vegetables. In fact, plasma vitamin C levels may be a good biomarker for fruit and vegetable intake and other lifestyle factors that may contribute to a reduced risk of stroke. A recent 10-year prospective study in 20,649 adults found that those in the top quartile of plasma vitamin C concentrations experienced a 42% lower risk of stroke compared to those in the lowest quartile.
Cancer
A large number of studies have shown that increased consumption of fresh fruits and vegetables is associated with a reduced risk for most types of cancer. Such studies are the basis for dietary guidelines endorsed by the U.S. Department of Agriculture and the National Cancer Institute, which recommend at least 5 servings of fruits and vegetables per day.
A number of case-control studies have investigated the role of vitamin C in cancer prevention. Most have shown that higher intakes of vitamin C are associated with decreased incidence of cancers of the mouth, throat and vocal chords, esophagus, stomach, colon-rectum, and lung.
A prospective study of 870 men over a period of 25 years found that those who consumed more than 83 mg of vitamin C daily had a striking 64% reduction in lung cancer compared with those who consumed less than 63 mg per day.
Although most large prospective studies found no association between breast cancer and vitamin C intake, two recent studies found dietary vitamin C intake to be inversely associated with breast cancer risk in certain subgroups. In the Nurses' Health Study, premenopausal women with a family history of breast cancer who consumed an average of 205 mg/day of vitamin C from foods had a 63% lower risk of breast cancer than those who consumed an average of 70 mg/day (19).
In the Swedish Mammography Cohort, women who were overweight and consumed an average of 110 mg/day of vitamin C had a 39% lower risk of breast cancer compared to overweight women who consumed an average of 31 mg/day.
A number of observational studies have found increased dietary vitamin C intake to be associated with decreased risk of stomach cancer, and laboratory experiments indicate that vitamin C inhibits the formation of carcinogenic compounds in the stomach.
Infection with the bacteria, helicobacter pylori (H. pylori) is known to increase the risk of stomach cancer and also appears to lower the vitamin C content of stomach secretions. Although two intervention studies did not find a decrease in the occurrence of stomach cancer with vitamin C supplementation, more recent research suggests that vitamin C supplementation may be a useful addition to standard H. pylori eradication therapy in reducing the risk of gastric cancer.
Cataracts
Cataracts are a leading cause of visual impairment throughout the world. In the U.S., cataract-related expenditure is estimated to exceed 3 billion dollars annually. Cataracts occur more frequently and become more severe as people age. Decreased vitamin C levels in the lens of the eye have been associated with increased severity of cataracts in humans. Some, but not all, studies have observed increased dietary vitamin C intake and increased blood levels of vitamin C to be associated with decreased risk of cataracts. Those studies that have found a relationship suggest that vitamin C intake may have to be higher than 300 mg/day for a number of years before a protective effect can be detected.
Recently, a 7-year controlled intervention trial of a daily antioxidant supplement containing 500 mg of vitamin C, 400 IU of vitamin E, and 15 mg of beta-carotene in 4,629 men and women found no difference between the antioxidant combination and a placebo on the development and progression of age-related cataracts. Therefore, the relationship between vitamin C intake and the development of cataracts requires further clarification before specific recommendations can be made.
Lead toxicity
Although the use of lead paint and leaded gasoline has been discontinued in the U.S., lead toxicity continues to be a significant health problem, especially in children living in urban areas. Abnormal growth and development has been observed in infants of women exposed to lead during pregnancy, while children who are chronically exposed to lead are more likely to develop learning disabilities, behavioral problems, and to have low IQs.
In adults, lead toxicity may result in kidney damage and high blood pressure. In a study of 747 older men, blood lead levels were significantly higher in those who reported total dietary vitamin C intakes averaging less than 109 mg/day compared to men who reported higher vitamin C intakes.
A much larger study of 19,578 people, including 4,214 children from 6 to 16 years of age, found higher serum vitamin C levels to be associated with significantly lower blood lead level. An intervention trial that examined the effects of vitamin C supplementation on blood lead levels in 75 adult male smokers found that 1,000 mg/day of vitamin C resulted in significantly lower blood lead levels over a 4-week treatment period compared to placebo. A lower dose of 200 mg/day did not significantly affect blood lead levels, despite the finding that serum vitamin C levels were not different than those of the group that took 1,000 mg/day. The mechanism for the relationship between vitamin C intake and blood lead levels is not known, although it has been postulated that vitamin C may inhibit intestinal absorption or enhance urinary excretion of lead.
Disease Treatment
Cardiovascular Disease
Vasodilation
The ability of blood vessels to relax or dilate is compromised in individuals with atherosclerosis. The damage to the heart muscle caused by a heart attack and damage to the brain caused by a stroke is related, in part, to the inability of blood vessels to dilate enough to allow blood flow to the affected areas. The pain of angina pectoris is also related to insufficient dilation of the coronary arteries.
Treatment with vitamin C has consistently resulted in improved dilation of blood vessels in individuals with atherosclerosis as well as those with angina pectoris, congestive heart failure, high cholesterol, and high blood pressure. Improved blood vessel dilation has been demonstrated at a dose of 500 mg of vitamin C daily.
Hypertension
Individuals with high blood pressure (hypertension) are at increased risk of developing cardiovascular diseases. Several studies have demonstrated a blood pressure lowering effect of vitamin C supplementation. One recent study of individuals with high blood pressure found that a daily supplement of 500 mg of vitamin C resulted in an average drop in systolic blood pressure of 9% after 4 weeks. It should be noted that those participants who were taking antihypertensive medication continued taking it throughout the 4-week study.
Because the findings regarding vitamin C and high blood pressure have not yet been replicated in larger studies it is important for individuals with significantly high blood pressure to continue current therapy (medication, lifestyle changes, etc.) in consultation with their health care provider.
Cancer
Studies in the 1970's and 1980's conducted by Linus Pauling and colleagues suggested that very large doses of vitamin C (10 grams/day intravenously for 10 days followed by at least 10 grams/day orally indefinitely) were helpful in increasing the survival time and improving the quality of life of terminal cancer patients.
However, two randomized placebo-controlled studies conducted at the Mayo clinic found no differences in outcome between terminal cancer patients receiving 10 grams of vitamin C/day orally or placebo. There were significant methodological differences between the Mayo Clinic and Pauling's studies, and recently, two researchers from the NIH suggested that the route of administration (intravenous versus oral) may have been the key to the discrepant results.
Intravenous (IV) administration can result in much higher blood levels of vitamin C than oral administration, and levels that are toxic to certain types of cancer cells in culture can be achieved with intravenous but not oral administration of vitamin C. Thus, it appears reasonable to reevaluate the use of high-dose vitamin C as cancer therapy.
Currently, there are no results from controlled clinical trials indicating that vitamin C would adversely affect the survival of cancer patients. However, vitamin C should not be used in place of therapy that has been demonstrated effective in the treatment of a particular type of cancer, for example, chemotherapy or radiation therapy.
If an individual with cancer chooses to take vitamin supplements, it is important that the clinician coordinating his or her treatment is aware of the type and dose of each supplement. While research is underway to determine whether combinations of antioxidant vitamins might be beneficial as an adjunct to conventional cancer therapy, definitive conclusions are not yet possible.
Diabetes Mellitus
Cardiovascular diseases (heart disease and stroke) are the leading cause of death in individuals with diabetes. Evidence that diabetes is a condition of increased oxidative stress led to the hypothesis that higher intakes of antioxidant nutrients could help decrease cardiovascular disease risk in diabetic individuals.
In support of this hypothesis, a 16-year study of 85,000 women, 2% of whom were diabetic, found that vitamin C supplement use (400 mg/day or more) was associated with significant reductions in the risk of fatal and nonfatal coronary heart disease in the entire cohort as well as those with diabetes.
In contrast, a 15-year study of postmenopausal women found that diabetic women who reported taking at least 300 mg/day of vitamin C from supplements when the study began were at significantly higher risk of death from coronary heart disease and stroke than those who did not take vitamin C supplements.
Vitamin C supplement use was not associated with a significant increase in cardiovascular disease mortality in the cohort as a whole. Although a number of observational studies have found that higher dietary intakes of vitamin C are associated with lower cardiovascular disease risk, randomized controlled trials have not found antioxidant supplementation that included vitamin C to reduce the risk of cardiovascular disease in diabetic or other high-risk individuals.
Common cold
The work of Linus Pauling stimulated public interest in the use of large doses (greater than 1 gram/day) of vitamin C to prevent the common cold. In the past 30 years, numerous placebo-controlled trials have examined the effect of vitamin C supplementation on the prevention and treatment of colds.
A meta-analysis of 30 placebo-controlled prevention trials found that vitamin C supplementation in doses up to 2 g/day did not decrease the incidence of colds. However, in a subgroup of marathon runners, skiers and soldiers training in the Arctic, doses ranging from 250 mg/day to 1 g/day decreased the incidence of colds by 50%.
Overall, the preventive use of vitamin C supplementation reduced the duration of colds by about 8% in adults and 14% in children. Most of the prevention trials used a dose of 1 g/day. When treatment was started at the onset of symptoms, vitamin C supplementation did not shorten the duration of colds in 7 placebo-controlled trials at doses ranging from 1-4 g/day.
If you are interested in autism, you may read about Vitamin C and autism here.
If you are interested in diabetes, you may read about Vitamin C and diabetes here
If you think taking Vitamin C is a waste of money, because you pee it out, you can read about Linus Pauling's answers here.
If you want to read more about the benefits of Vitamin C and various diseases, click here.
If you want to read about Vitamin C as an alternative therapy for cancer, click here.
If you want to know about skin wrinkling and Vitamin C benefits, click here.
If you only want to take WEBMD's word about Vitamin C and the common cold, click here.
If you want to read more indepth about gout and Vitamin C, click here.
Sources: Linus Pauling Institute; Medline; Wikipedia; NIH (National Institute of Health); Kevin Passero, Naturopathic Physician;
Ascorbic acid is used to prevent and treat scurvy, a disease caused by a lack of vitamin C in the body. This medication is sometimes prescribed for other uses.
Ascorbic acid comes in extended-release (long-acting) capsules and tablets, lozenges, syrup, chewable tablets, and liquid drops to be given by mouth. It usually is taken once a day. Follow the directions on the package or on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take ascorbic acid exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
Some tablets should be chewed; other tablets and capsules should be swallowed with a full glass of water. It may take up to 3 weeks for symptoms of scurvy to improve.
Vitamin C is water soluble. See additional links at end of post.
How Does Vitamin C Function With Other Nutrients?
As an antioxidant, vitamin C can rejuvenate vitamin E, making it an indirect contributor to the fight against free radical damage in the lipids. It's not surprising, then, that these two nutrients can be effective partners in reducing the destructive process of lipid peroxidation. In human and animal studies, this reduction took place in subjects with diabetes, cerebral arteriosclerosis or a heart disorder.Together, vitamins C and E can help to prevent the blood from clotting, a condition that contributes to the risk of stroke. This combination may offer protection against cataracts as well.
The combination of vitamins C and E may be further enhanced by the addition of vitamin A. In one study of 30 elderly long-stay patients, for example, this trio was effective in improving certain aspects of cell-mediated immunity, such as the number of T cells, T4 subsets and the ratio of T4 to T8 cells.
In another study, a complex of vitamins A, E and C significantly enhanced the "characteristics of enzymatic and non-enzymatic antioxidant protection of the liver" in mice. Finally, a classic antioxidant combination - vitamins C and E, beta carotene and selenium - helped to alleviate pancreatitis, or an inflammation of the pancreas, in a study of 28 patients.
A Blood Test That Could Save Your Life: C-Reactive Protein - Here's what you need to know:
There are two very important blood tests that all people over the age of 35 should have done regularly. You would think that after years of research has demonstrated their importance, all doctors would routinely run these tests. Unfortunately, this is not the case. Very few doctors make it standard practice to order these tests despite extensive research supporting their importance.Both tests reveal information about a person’s risk of heart disease - the number one killer of Americans. Standard tests of assessing risk of heart disease are mainly limited to a cholesterol and triglyceride test. While it is known that cholesterol and triglycerides potentially affect heart and cardiovascular health, it is hardly the entire story.
Over the past ten years, a mountain of research has emerged pointing to other factors besides cholesterol and triglyercide levels that play heavily into cardiovascular risk. It is now believed that inflammation plays almost as an important of a role in heart disease as does elevated cholesterol. A recent study using Zetia in people with NORMAL cholesterol was found to be very effective at lowering inflammation in the blood vessels, which may be as important as lowering cholesterol. Many researchers have suggested that the ability of statin drugs to reduce risk of heart attack can be solely attributed to their anti-inflammatory effect, and not by their ability to lower cholesterol.
Zetia lowers cholesterol by reducing the amount that is normally absorbed in your intestines from the food you eat. The study found that although it was effective at lowering cholesterol levels, it was not effective at slowing the development of plaque formation and heart disease. Only statin medications, the ones that lower inflammation, have been shown to lower the risk of heart disease.
We have learned that cholesterol is not the biggest evil when it comes to the progression of heart disease. The inflammation component is proving to be just as significant or maybe even more significant. So why aren’t doctors monitoring inflammation levels like they monitor cholesterol levels?
A very simple, affordable test exists that very accurately can assess the amount of inflammation present in blood vessels. That test is called c-reactive protein.
C-reactive protein is a marker for inflammation everywhere in the body. To avoid getting information related to the inflammation in your bad knee, you have to ask your doctor for a cardiac specific c-reactive protein test often referred to as hs (highly sensitive) c-reactive protein.
Every person should have this test done at least once a year in combination with their annual cholesterol check. Having elevated levels of c-reactive protein can quadruple your risk of developing heart stopping plaques.
If you have elevated levels of c-reactive protein, your doctor will try to convince you that the only way to reduce it is to use the statin medication called Crestor that was highlighted for its ability to lower c-reactive protein. Clearly, this is exactly what the pharmaceutical companies want. A side note: This “groundbreaking study,” which now justifies the use of statin medications in people with normal cholesterol levels, was funded by AstraZenica, the company that makes Crestor.
However, the idea that you must use statins to lower c-reactive protein couldn’t be further from the truth. Statin medications are dangerous and come with the risk of serious side effects. The statin medication Lipitor ranked number five on the list of the top fifteen drugs that cause severe adverse reactions resulting in permanent injury or disability.
Crestor is considered more potent than Lipitor and is associated with a higher risk of side effects. The press forgot to mention that the participants taking Crestor were more likely to develop diabetes. Additionally, although it did lower the overall rate of heart attack better than a placebo, participants taking Crestor were more likely to suffer a fatal heart attack.
There are some very effective natural therapies to lower cardiac specific c-reactive protein and lower your risk of cardiovascular disease. Food intake can play a significant role in how much inflammation is present in your body. Some foods like red meat, sugar, alcohol and trans fats directly increase inflammatory markers and put you at a greater risk for elevated levels of c-reactive protein.
It will not surprise you to learn what types of foods reduce inflammation and have been documented to lower c-reactive protein levels. Higher intakes of fruits and vegetables, particularly ones rich in certain compounds can reduce c-reactive protein levels.
In a recent study evaluating the data from 8,334 individuals, it was found that those who consumed the highest amount of flavonoids from fruits and vegetables had the lowest circulating levels of c-reactive protein. Flavonoids are naturally occurring plant compounds that have been correlated to numerous beneficial effects on health ranging from antioxidant to immune boosting.
Green and brightly colored vegetables typically have the highest flavonoid concentration. In this particular study, the only fruit correlated with lower c-reactive protein levels was apples, but I suspect that other fruits high in flavonoids and antioxidants, such as blueberries, blackberries, goji berry, pomegranate, acai and noni, would all have similar effects. They probably were not consumed in high enough quantities to be reported by the participants in this particular study.
Another diet-centered study evaluated the effectiveness of carotenoid-rich fruits and vegetables and their ability to lower circulating levels of c-reactive protein. In this randomized four-week intervention trial, three groups were asked to consume different amounts of carotenoid-rich fruits and vegetables daily. Group 1 consumed only two servings per day, group 2 consumed five servings per day and group 3 consumed eight servings per day. After the four weeks, the group that consumed eight servings per day had significantly reduced levels of c-reactive protein compared to the low fruit and vegetable intake group.
High carotenoid vegetables used in the study included carrots, green beans, peas, broccoli, zucchini, tomatoes, kohlrabi, Brussels sprouts, red cabbage, cauliflower, spinach and radishes. Selected fruits included apples, pears, kiwis, bananas, peaches, nectarines, cherries, strawberries and red currants.
Although other vitamins and supplements could be mentioned here, this post is dedicated to Vitamin C only.
Perhaps one of the most exciting new studies to be published on c-reactive protein involves the use of vitamin C. 396 healthy nonsmokers were evaluated to see if supplementation with 1,000 mg of vitamin C for two months could significantly lower c-reactive protein in those individuals who had elevated levels at baseline.
The results were quite dramatic. Vitamin C was associated with 25.3% drop in c-reactive protein. Just as a comparison, Crestor in the above study reduced c-reactive protein by 37%. It would be interesting to see how higher levels of vitamin C supplementation might affect c-reactive protein levels.
More Americans die from heart disease than from any other cause, and research has that inflammation plays almost as an important of a role in the development of heart disease as does high cholesterol. If you are 35 or older, have your doctor perform a c-reactive protein test regularly so that you can be aware of and take steps to control inflammation before it leads to heart disease.
Daily requirements - Here's what you need to know:
The North American Dietary Reference Intake recommends 90 milligrams per day and no more than 2 grams per day (2000 milligrams per day) for humans. There is continuing debate within the scientific community over the best dose schedule (the amount and frequency of intake) of vitamin C for maintaining optimal health in humans. It is generally agreed that a balanced diet without supplementation contains enough vitamin C to prevent scurvy in an average healthy adult, while those who are pregnant, smoke tobacco, or are under stress require slightly more.
High doses (thousands of milligrams) may result in diarrhea in healthy adults.
Government recommended intakes
Recommendations for vitamin C intake have been set by various national agencies:
- 60 milligrams per day: the United Kingdom's Food Standards Agency
- 45 milligrams per day: the World Health Organization
- 60 mg/day: Health Canada 2007
- 60–95 milligrams per day: United States' National Academy of Sciences
The United States defined Tolerable Upper Intake Level for a 25-year-old male is 2,000 milligrams per day.
Alternative recommendations on intakes
Some independent researchers have calculated the amount needed for an adult human to achieve similar blood serum levels as vitamin C synthesising mammals as follows:
- 400 milligrams per day: the Linus Pauling Institute
- 500 milligrams per 12 hours: Professor Roc Ordman, from research into biological free radicals
- 3,000 milligrams per day (or up to 30,000 mg during illness): the Vitamin C Foundation.
- 6,000–12,000 milligrams per day: Thomas E. Levy, Colorado Integrative Medical Centre.
- 6,000–18,000 milligrams per day: Linus Pauling's personal use.
Therapeutic uses
Vitamin C is necessary for the treatment and prevention of scurvy which is commonly comorbid with other diseases of malnutrition; sufficient vitamin C to prevent scurvy occurs in most diets in industrialized nations.
Vitamin C functions as an antioxidant. Adequate intake is necessary for health, but supplementation is probably not necessary in most cases.
Based on animal and epidemiological models, high doses of vitamin C may have "protective effects" on lead-induced nerve and muscle abnormalities, especially in smokers.
Dehydroascorbic acid, the main form of oxidized vitamin C in the body, may reduce neurological deficits and mortality following stroke due to its ability to cross the blood-brain barrier, while "the antioxidant ascorbic acid (AA) or vitamin C does not penetrate the blood-brain barrier".
Vitamin C's effect on the common cold has been extensively researched. Evidence however does not support its use.
What health conditions require special emphasis on vitamin C?
Most forms of cardiovascular disease, joint disease, cancer, eye disease, thyroid disease, liver disease, and lung disease require special emphasis on vitamin C intake. The process of aging itself requires special attention to vitamin C. In addition to these broader categories, several specific health conditions also require special emphasis on vitamin C. These specific health conditions include:
- Acne
- Alcoholism
- Alzheimer's disease
- Asthma
- Autism
- Depression
- Diabetes
- Irritable bowel disease
- Parkinson's disease
Vitamin C toxicity is very rare, because the body cannot store the vitamin. However, amounts greater than 2,000 mg/day are not recommended because such high doses can lead to stomach upset and diarrhea.
Too little vitamin C can lead to signs and symptoms of deficiency, including:
- Dry and splitting hair
- Gingivitis (inflammation of the gums)
- Bleeding gums
- Rough, dry, scaly skin
- Decreased wound-healing rate
- Easy bruising
- Nosebleeds
- Weakened tooth enamel
- Swollen and painful joints
- Anemia
- Decreased ability to fight infection
- Possible weight gain because of slowed metabolism
A severe form of vitamin C deficiency is known as scurvy, - including bleeding gums and skin discoloration due to ruptured blood vessels - which mainly affects older, malnourished adults.
The best way to get the daily requirement of essential vitamins, including vitamin C, is to eat a balanced diet that contains a variety of foods from the food guide pyramid.
Vitamin C should be consumed every day because it is not fat-soluble and, therefore, cannot be stored for later use.
Vitamin C megadosage
Higher vitamin C intake reduces serum uric acid levels, and is associated with lower incidence of gout. Vitamin C has also been promoted as efficacious against a vast array of diseases and syndromes. Variously, adequate dietary intake, oral megadose, or intravenous injection may be required for the purported benefits.
These disorders include: the common cold, pneumonia, bird flu, SARS, heart disease, AIDS, autism, low sperm count, age-related macular degeneration, altitude sickness, pre-eclampsia, amyotrophic lateral sclerosis (ALS), asthma, tetanus, and cancer. These uses are poorly supported by the evidence, and sometimes contraindicated.
Common side-effects
Relatively large doses of vitamin C may cause indigestion, particularly when taken on an empty stomach.
When taken in large doses, vitamin C causes diarrhea in healthy subjects. In one trial, doses up to 6 grams of ascorbic acid were given to 29 infants, 93 children of preschool and school age, and 20 adults for more than 1400 days. With the higher doses, toxic manifestations were observed in five adults and four infants. The signs and symptoms in adults were nausea, vomiting, diarrhea, flushing of the face, headache, fatigue and disturbed sleep. The main toxic reactions in the infants were skin rashes.
Possible side-effects
As vitamin C enhances iron absorption, iron poisoning can become an issue to people with rare iron overload disorders, such as haemochromatosis or Addison's Disease. A genetic condition that results in inadequate levels of the enzyme G6PD can cause sufferers to develop hemolytic anemia after ingesting specific oxidizing substances, such as very large dosages of vitamin C.
There is a longstanding belief among the mainstream medical community that vitamin C causes kidney stones, which is based on little science. Although recent studies have found a relationship, a clear link between excess Vitamin C (ascorbic acid) intake and kidney stone formation has not been generally established.
Recent rat and human studies suggest that adding Vitamin C supplements to an exercise training program can cause a decrease in mitochondria production, hampering endurance capacity.
Food preparation
Vitamin C chemically decomposes under certain conditions, many of which may occur during the cooking of food. Normally, boiling water at 100°C is not hot enough to cause any significant destruction of the nutrient, which only decomposes at 190°C, despite popular opinion. However, pressure cooking, roasting, frying and grilling food is more likely to reach the decomposition temperature of vitamin C. Longer cooking times also add to this effect, as will copper food vessels, which catalyse the decomposition.
Another cause of vitamin C being lost from food is LEACHING, where the water-soluble vitamin dissolves into the cooking water, which is later poured away and not consumed. However, vitamin C doesn't leach in all vegetables at the same rate; research shows BROCCOLI seems to retain more than any other. Research has also shown that fresh-cut fruits don't lose significant nutrients when stored in the refrigerator for a few days.
Adverse Reactions
Common: Nausea, diarrhea, stomach cramps and possible hypoglycemia and hypotension with doses greater than 1 gram. Reported (oral): In patients with a history of kidney stones, increased oxalate kidney stone formation occurs with possible nephrolithiasis, acute renal failure, or renal insufficiency. In patients with G6PDH deficiency, hemolytic anemia may occur at high doses . Reported (oral): Severe cyanide poisoning following ingestion of 3 grams of amygdalin with concurrent use of 4800 mg of vitamin C per day. Toxicity: Excessive use of chewable tablets may break down tooth enamel, increasing the risk of dental caries. Drug and Herb Interactions Iron: Ascorbic acid increases iron absorption and modulates transport and storage in the body. Significant in patients with hematochromatosis. High dose ascorbic acid supplementation may alter results of urine glucose testing strips, and may cause a false negative guaiac (occult blood) test . |
Natural and artificial dietary sources
Vitamin C is absorbed by the intestines using a sodium-ion dependent channel. It is transported through the intestine via both glucose-sensitive and glucose-insensitive mechanisms. The presence of large quantities of sugar either in the intestines or in the blood can slow absorption.
The richest natural sources are fruits and vegetables and of those, the Kakadu plum and the camu camu fruit fruit contain the highest concentration of the vitamin. It is also present in some cuts of meat, especially liver. Vitamin C is the most widely taken nutritional supplement an is available in a variety of forms, including tablets, drink mixes, crystals in capsules or naked crystals.
But does it prevent or cure the common cold?
Recent research has indicated that the intake of antioxidants can prevent or counteract cell damage due to aging and exposure to free radicals. However, studies have yet to prove that vitamin C's effectiveness at the cell level translates to the prevention of or cure for chronic diseases.
Vitamin C has not been shown to prevent the common cold. High doses of vitamin C at the beginning of a cold has only been shown in some cases to reduce the severity of the symptoms to a modest degree, due to a mild antihistaminic effect. Similar high doses of vitamin C used for the treatment of cancer patients have not been found to be beneficial. For example, research done at the Mayo clinic in a double blind trial (neither the doctors or the patients knew who was given the high doses of vitamin C) revealed that those who received the vitamin C in the high doses actually did worse than those who got a placebo.
Some people believe that because vitamin C is water-soluble, it is safe to take in high doses. While it is best to not exceed the recommended upper intake level of 2,000 mg a day, the most serious possible consequence of an intake above this dosage is diarrhea.
Vitamin C is an important part of a healthy diet. It is not a miracle drug, and may cause harm if taken in extreme excess. A well-balanced, varied diet will ensure that you receive more than enough vitamin C to prevent scurvy and other potential health problems.
Plant sources
While plants are generally a good source of vitamin C, the amount in foods of plant origin depends on: the precise variety of the plant, the soil condition, the climate in which it grew, the length of time since it was picked, the storage conditions, and the method of preparation.
The following table is approximate and shows the relative abundance in different raw plant sources. As some plants were analyzed fresh while others were dried, the data are subject to potential variation and difficulties for comparison. The amount is given in milligrams per 100 grams of fruit or vegetable and is a rounded average from multiple authoritative sources:
| Plant source | Amount (mg / 100g) |
|---|---|
| Kakadu plum | 3100 |
| Camu Camu | 2800 |
| Rose hip | 2000 |
| Acerola | 1600 |
| Seabuckthorn | 695 |
| Jujube | 500 |
| Indian gooseberry | 445 |
| Baobab | 400 |
| Blackcurrant | 200 |
| Red pepper | 190 |
| Parsley | 130 |
| Guava | 100 |
| Kiwifruit | 90 |
| Broccoli | 90 |
| Loganberry | 80 |
| Redcurrant | 80 |
| Brussels sprouts | 80 |
| Wolfberry (Goji) | 73 † |
| Lychee | 70 |
| Cloudberry | 60 |
| Elderberry | 60 |
| Persimmon | 60 |
† average of 3 sources; dried
| Plant source | Amount (mg / 100g) |
|---|---|
| Papaya | 60 |
| Strawberry | 60 |
| Orange | 50 |
| Lemon | 40 |
| Melon, cantaloupe | 40 |
| Cauliflower | 40 |
| Garlic | 31 |
| Grapefruit | 30 |
| Raspberry | 30 |
| Tangerine | 30 |
| Mandarin orange | 30 |
| Passion fruit | 30 |
| Spinach | 30 |
| Cabbage raw green | 30 |
| Lime | 30 |
| Mango | 28 |
| Blackberry | 21 |
| Potato | 20 |
| Melon, honeydew | 20 |
| Cranberry | 13 |
| Tomato | 10 |
| Blueberry | 10 |
| Pineapple | 10 |
| Pawpaw | 10 |
| Plant source | Amount (mg / 100g) |
|---|---|
| Grape | 10 |
| Apricot | 10 |
| Plum | 10 |
| Watermelon | 10 |
| Banana | 9 |
| Carrot | 9 |
| Avocado | 8 |
| Crabapple | 8 |
| Persimmon - fresh | 7 |
| Cherry | 7 |
| Peach | 7 |
| Apple | 6 |
| Asparagus | 6 |
| Beetroot | 5 |
| Chokecherry | 5 |
| Pear | 4 |
| Lettuce | 4 |
| Cucumber | 3 |
| Eggplant | 2 |
| Raisin | 2 |
| Fig | 2 |
| Bilberry | 1 |
| Horned melon | 0.5 |
| Medlar | 0.3 |
Animal sources
The overwhelming majority of species of animals and plants synthesise their own vitamin C, making some, but not all, animal products, sources of dietary vitamin C.
Vitamin C is most present in the liver meat and least present in the muscle meat. Since muscle provides the majority of meat consumed in the western human diet, animal products are not a reliable source of the vitamin. Vitamin C is present in mother's milk and, in lower amounts, in raw cow's milk, with pasteurized milk containing only trace amounts. All excess vitamin C is disposed of through the urinary system.
The following table shows the relative abundance of vitamin C in various foods of animal origin, given in milligram of vitamin C per 100 grams of food:
| Animal Source | Amount (mg / 100g) |
|---|---|
| Calf liver (raw) | 36 |
| Beef liver (raw) | 31 |
| Oysters (raw) | 30 |
| Cod roe (fried) | 26 |
| Pork liver (raw) | 23 |
| Lamb brain (boiled) | 17 |
| Chicken liver (fried) | 13 |
| Animal Source | Amount (mg / 100g) |
|---|---|
| Lamb liver (fried) | 12 |
| Calf adrenals (raw) | 11 [137] |
| Lamb heart (roast) | 11 |
| Lamb tongue (stewed) | 6 |
| Human milk (fresh) | 4 |
| Goat milk (fresh) | 2 |
| Cow milk (fresh) | 2 |
FROM MEDLINE
The use of vitamin C in the prevention/treatment of the common cold and respiratory infections remains controversial, with ongoing research. For cold prevention , more than 30 clinical trials including over 10,000 participants have examined the effects of taking daily vitamin C. Overall, no significant reduction in the risk of developing colds has been observed. In people who developed colds while taking vitamin C, no difference in severity of symptoms has been seen overall, although a very small significant reduction in the duration of colds has been reported (approximately 10% in adults and 15% in children). Notably, a subset of studies in people living in extreme circumstances, including soldiers in sub-arctic exercises, skiers, and marathon runners, have found a significant reduction in the risk of developing a cold by approximately 50%. This area merits additional study and may be of particular interest to elite athletes or military personnel. For cold treatment , numerous studies have examined the effects of starting vitamin C after the onset of cold symptoms. So far, no significant benefits have been observed.
Evidence
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
| Uses based on scientific evidence | Grade* |
|---|---|
| Vitamin C deficiency (scurvy) | A |
| Common cold prevention (extreme environments) | B |
| Iron absorption enhancement | B |
| Urinary tract infection (during pregnancy) | B |
| Asthma | C |
| Bleeding stomach ulcers caused by aspirin | C |
| Cancer prevention | C |
| Cancer treatment | C |
| Complex regional pain syndrome | C |
| Helicobacter pylori infection | C |
| Ischemic heart disease | C |
| Metabolic abnormalities (alkaptonuria) | C |
| Plaque/ calculus on teeth | C |
| Pneumonia (prevention) | C |
| Pregnancy | C |
| Prostate cancer | C |
| Skin damage caused by the sun (UVA-induced) | C |
| Skin pigmentation disorders (perifollicular pigmentation) | C |
| Stroke prevention | C |
| Vaginitis | C |
| Cataracts (prevention/progression) | D |
| Common cold prevention (general) | D |
| Common cold treatment | D |
| Heart disease prevention | D |
| Premature infants | D |
*Key to grades
A: Strong scientific evidence for this use;
B: Good scientific evidence for this use;
C: Unclear scientific evidence for this use;
D: Fair scientific evidence against this use;
F: Strong scientific evidence against this use.
Uses based on tradition or theory A: Strong scientific evidence for this use;
B: Good scientific evidence for this use;
C: Unclear scientific evidence for this use;
D: Fair scientific evidence against this use;
F: Strong scientific evidence against this use.
The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
Immune system functions. Vitamin C can enhance the body's resistance to an assortment of diseases, including infectious disorders and many types of cancer. It strengthens and protects the immune system by stimulating the activity of antibodies and immune system cells such as phagocytes and neutrophils.
Studies suggest that vitamin C's antioxidant mechanisms may help to prevent cancer in several ways. It combats the peroxidation of lipids, for example, which has been linked to the aging process and degeneration. One study of elderly people found that 400 mg of vitamin C per day (for a one-year period) reduced serum lipid peroxide levels. Vitamin C can also work inside the cells to protect DNA from the damage caused by free radicals. In several studies, vitamin C reduced the level of potentially destructive genetic alterations or chromosome aberrations.
Many of the pollutants that now pervade our environment can cause toxic, carcinogenic or mutagenic effects. Vitamin C may be able to arrest these harmful effects, in part by stimulating detoxifying enzymes in the liver.
Vitamin C can help to optimize the immune system, which does the all important job of surveying the body for the presence of cancer cells. According to Richard A. Passwater, Ph.D., it also enhances an intracellular material called ground substance that holds tissues together. When this substance is strong, cancer cells have a harder time infiltrating cells.
Finally, vitamin C can reduce the development of nitrosamines from nitrates, chemicals that are commonly used in processed foods. Once formed, nitrosamine can become a carcinogen. But in several human studies, in which the subjects consumed a nitrosamine precursor, the urinary levels of nitrosamines were significantly reduced by vitamin C. Three animal studies also support the preventive effects of ascorbic acid on nitrate-induced cancer. In all three cases, the formation of tumors was inhibited, suppressed or reduced in frequency in the animals treated with vitamin C.
As far back as the late 1940s, researchers began to note a connection between the incidence of cancer and a dietary deficiency of vitamin C or low blood levels in the body. Studies conducted in the past decade have confirmed that link. According to two studies from the early 1980s, 2 to 5 grams of vitamin C per day can correct these low serum levels and, in some patients, improve the immune system defenses.
FROM LINUS PAULING INSTITUTE
Disease Prevention
The amount of vitamin C required to prevent chronic disease appears to be more than that required for prevention of scurvy. Much of the information regarding vitamin C and the prevention of chronic disease is based on prospective studies, in which vitamin C intake is assessed in large numbers of people who are followed over time to determine whether they develop specific chronic diseases.
Cardiovascular Disease
Coronary Heart Disease - CHD
Until recently, the results of most prospective studies indicated that low or deficient intakes of vitamin C were associated with an increased risk of cardiovascular diseases and that modest dietary intakes of about 100 mg/day were sufficient for maximum reduction of cardiovascular disease risk among nonsmoking men and women. The First National Health and Nutrition Examination Study (NHANES I) Epidemiologic Follow-up Study found that the risk of death from cardiovascular diseases was 42% lower in men and 25% lower in women who consumed more than 50 mg/day of dietary vitamin C and who regularly took vitamin C supplements, corresponding to a total vitamin C intake of about 300 mg/day.
Results from the Nurses’ Health Study, based on the follow-up of more than 85,000 women over 16 years, also suggest that higher vitamin C intakes may be cardioprotective. In this study, vitamin C intakes of more than 359 mg/day from diet plus supplements or supplement use itself were associated with a 27-28% reduction in CHD risk. However, in those women who did not take vitamin C supplements, dietary vitamin C intake was not significantly associated with CHD risk.
More recently, a pooled analysis of 9 prospective cohort studies, including more than 290,000 adults who were free of CHD at baseline and followed for an average of 10 years, found that those who took more than 700 mg/day of supplemental vitamin C had a 25% lower risk of CHD than those who did not take vitamin C supplements.
Data from the National Institutes of Health (NIH) indicate that plasma and circulating cells in healthy, young subjects became fully saturated with vitamin C at a dose of about 400 mg/day. The results of the pooled analysis of prospective cohort studies suggest that maximum reduction of CHD risk may require vitamin C intakes high enough to saturate plasma and circulating cells, and thus the vitamin C body pool.
Stroke - CVA
With respect to vitamin C and cerebrovascular disease, a prospective study that followed more than 2,000 residents of a rural Japanese community for 20 years found that the risk of stroke in those with the highest serum levels of vitamin C was 29% lower than in those with the lowest serum levels of vitamin C. Additionally, the risk of stroke in those who consumed vegetables 6-7 days of the week was 54% lower than in those who consumed vegetables 0-2 days of the week.
In this population, serum levels of vitamin C were highly correlated with fruit and vegetable intake. Therefore, as in many studies of vitamin C intake and cardiovascular disease risk, it is difficult to separate the effects of vitamin C on stroke risk from the effects of other components of fruits and vegetables, emphasizing the benefits of a diet rich in fruits and vegetables. In fact, plasma vitamin C levels may be a good biomarker for fruit and vegetable intake and other lifestyle factors that may contribute to a reduced risk of stroke. A recent 10-year prospective study in 20,649 adults found that those in the top quartile of plasma vitamin C concentrations experienced a 42% lower risk of stroke compared to those in the lowest quartile.
Cancer
A large number of studies have shown that increased consumption of fresh fruits and vegetables is associated with a reduced risk for most types of cancer. Such studies are the basis for dietary guidelines endorsed by the U.S. Department of Agriculture and the National Cancer Institute, which recommend at least 5 servings of fruits and vegetables per day.
A number of case-control studies have investigated the role of vitamin C in cancer prevention. Most have shown that higher intakes of vitamin C are associated with decreased incidence of cancers of the mouth, throat and vocal chords, esophagus, stomach, colon-rectum, and lung.
A prospective study of 870 men over a period of 25 years found that those who consumed more than 83 mg of vitamin C daily had a striking 64% reduction in lung cancer compared with those who consumed less than 63 mg per day.
Although most large prospective studies found no association between breast cancer and vitamin C intake, two recent studies found dietary vitamin C intake to be inversely associated with breast cancer risk in certain subgroups. In the Nurses' Health Study, premenopausal women with a family history of breast cancer who consumed an average of 205 mg/day of vitamin C from foods had a 63% lower risk of breast cancer than those who consumed an average of 70 mg/day (19).
In the Swedish Mammography Cohort, women who were overweight and consumed an average of 110 mg/day of vitamin C had a 39% lower risk of breast cancer compared to overweight women who consumed an average of 31 mg/day.
A number of observational studies have found increased dietary vitamin C intake to be associated with decreased risk of stomach cancer, and laboratory experiments indicate that vitamin C inhibits the formation of carcinogenic compounds in the stomach.
Infection with the bacteria, helicobacter pylori (H. pylori) is known to increase the risk of stomach cancer and also appears to lower the vitamin C content of stomach secretions. Although two intervention studies did not find a decrease in the occurrence of stomach cancer with vitamin C supplementation, more recent research suggests that vitamin C supplementation may be a useful addition to standard H. pylori eradication therapy in reducing the risk of gastric cancer.
Cataracts
Cataracts are a leading cause of visual impairment throughout the world. In the U.S., cataract-related expenditure is estimated to exceed 3 billion dollars annually. Cataracts occur more frequently and become more severe as people age. Decreased vitamin C levels in the lens of the eye have been associated with increased severity of cataracts in humans. Some, but not all, studies have observed increased dietary vitamin C intake and increased blood levels of vitamin C to be associated with decreased risk of cataracts. Those studies that have found a relationship suggest that vitamin C intake may have to be higher than 300 mg/day for a number of years before a protective effect can be detected.
Recently, a 7-year controlled intervention trial of a daily antioxidant supplement containing 500 mg of vitamin C, 400 IU of vitamin E, and 15 mg of beta-carotene in 4,629 men and women found no difference between the antioxidant combination and a placebo on the development and progression of age-related cataracts. Therefore, the relationship between vitamin C intake and the development of cataracts requires further clarification before specific recommendations can be made.
Lead toxicity
Although the use of lead paint and leaded gasoline has been discontinued in the U.S., lead toxicity continues to be a significant health problem, especially in children living in urban areas. Abnormal growth and development has been observed in infants of women exposed to lead during pregnancy, while children who are chronically exposed to lead are more likely to develop learning disabilities, behavioral problems, and to have low IQs.
In adults, lead toxicity may result in kidney damage and high blood pressure. In a study of 747 older men, blood lead levels were significantly higher in those who reported total dietary vitamin C intakes averaging less than 109 mg/day compared to men who reported higher vitamin C intakes.
A much larger study of 19,578 people, including 4,214 children from 6 to 16 years of age, found higher serum vitamin C levels to be associated with significantly lower blood lead level. An intervention trial that examined the effects of vitamin C supplementation on blood lead levels in 75 adult male smokers found that 1,000 mg/day of vitamin C resulted in significantly lower blood lead levels over a 4-week treatment period compared to placebo. A lower dose of 200 mg/day did not significantly affect blood lead levels, despite the finding that serum vitamin C levels were not different than those of the group that took 1,000 mg/day. The mechanism for the relationship between vitamin C intake and blood lead levels is not known, although it has been postulated that vitamin C may inhibit intestinal absorption or enhance urinary excretion of lead.
Disease Treatment
Cardiovascular Disease
Vasodilation
The ability of blood vessels to relax or dilate is compromised in individuals with atherosclerosis. The damage to the heart muscle caused by a heart attack and damage to the brain caused by a stroke is related, in part, to the inability of blood vessels to dilate enough to allow blood flow to the affected areas. The pain of angina pectoris is also related to insufficient dilation of the coronary arteries.
Treatment with vitamin C has consistently resulted in improved dilation of blood vessels in individuals with atherosclerosis as well as those with angina pectoris, congestive heart failure, high cholesterol, and high blood pressure. Improved blood vessel dilation has been demonstrated at a dose of 500 mg of vitamin C daily.
Hypertension
Individuals with high blood pressure (hypertension) are at increased risk of developing cardiovascular diseases. Several studies have demonstrated a blood pressure lowering effect of vitamin C supplementation. One recent study of individuals with high blood pressure found that a daily supplement of 500 mg of vitamin C resulted in an average drop in systolic blood pressure of 9% after 4 weeks. It should be noted that those participants who were taking antihypertensive medication continued taking it throughout the 4-week study.
Because the findings regarding vitamin C and high blood pressure have not yet been replicated in larger studies it is important for individuals with significantly high blood pressure to continue current therapy (medication, lifestyle changes, etc.) in consultation with their health care provider.
Cancer
Studies in the 1970's and 1980's conducted by Linus Pauling and colleagues suggested that very large doses of vitamin C (10 grams/day intravenously for 10 days followed by at least 10 grams/day orally indefinitely) were helpful in increasing the survival time and improving the quality of life of terminal cancer patients.
However, two randomized placebo-controlled studies conducted at the Mayo clinic found no differences in outcome between terminal cancer patients receiving 10 grams of vitamin C/day orally or placebo. There were significant methodological differences between the Mayo Clinic and Pauling's studies, and recently, two researchers from the NIH suggested that the route of administration (intravenous versus oral) may have been the key to the discrepant results.
Intravenous (IV) administration can result in much higher blood levels of vitamin C than oral administration, and levels that are toxic to certain types of cancer cells in culture can be achieved with intravenous but not oral administration of vitamin C. Thus, it appears reasonable to reevaluate the use of high-dose vitamin C as cancer therapy.
Currently, there are no results from controlled clinical trials indicating that vitamin C would adversely affect the survival of cancer patients. However, vitamin C should not be used in place of therapy that has been demonstrated effective in the treatment of a particular type of cancer, for example, chemotherapy or radiation therapy.
If an individual with cancer chooses to take vitamin supplements, it is important that the clinician coordinating his or her treatment is aware of the type and dose of each supplement. While research is underway to determine whether combinations of antioxidant vitamins might be beneficial as an adjunct to conventional cancer therapy, definitive conclusions are not yet possible.
Diabetes Mellitus
Cardiovascular diseases (heart disease and stroke) are the leading cause of death in individuals with diabetes. Evidence that diabetes is a condition of increased oxidative stress led to the hypothesis that higher intakes of antioxidant nutrients could help decrease cardiovascular disease risk in diabetic individuals.
In support of this hypothesis, a 16-year study of 85,000 women, 2% of whom were diabetic, found that vitamin C supplement use (400 mg/day or more) was associated with significant reductions in the risk of fatal and nonfatal coronary heart disease in the entire cohort as well as those with diabetes.
In contrast, a 15-year study of postmenopausal women found that diabetic women who reported taking at least 300 mg/day of vitamin C from supplements when the study began were at significantly higher risk of death from coronary heart disease and stroke than those who did not take vitamin C supplements.
Vitamin C supplement use was not associated with a significant increase in cardiovascular disease mortality in the cohort as a whole. Although a number of observational studies have found that higher dietary intakes of vitamin C are associated with lower cardiovascular disease risk, randomized controlled trials have not found antioxidant supplementation that included vitamin C to reduce the risk of cardiovascular disease in diabetic or other high-risk individuals.
Common cold
The work of Linus Pauling stimulated public interest in the use of large doses (greater than 1 gram/day) of vitamin C to prevent the common cold. In the past 30 years, numerous placebo-controlled trials have examined the effect of vitamin C supplementation on the prevention and treatment of colds.
A meta-analysis of 30 placebo-controlled prevention trials found that vitamin C supplementation in doses up to 2 g/day did not decrease the incidence of colds. However, in a subgroup of marathon runners, skiers and soldiers training in the Arctic, doses ranging from 250 mg/day to 1 g/day decreased the incidence of colds by 50%.
Overall, the preventive use of vitamin C supplementation reduced the duration of colds by about 8% in adults and 14% in children. Most of the prevention trials used a dose of 1 g/day. When treatment was started at the onset of symptoms, vitamin C supplementation did not shorten the duration of colds in 7 placebo-controlled trials at doses ranging from 1-4 g/day.
Food Sources
As shown in the table below different fruits and vegetables vary in their vitamin C content, but five servings (2½ cups) of fruits and vegetables should average out to at least 200 mg of vitamin C. If you wish to check foods you eat frequently for their nutrient content, search the USDA food composition database.
| Food | Serving | Vitamin C (mg) |
| Orange juice | ¾ cup (6 ounces) | 75 |
| Grapefruit juice | ¾ cup (6 ounces) | 60 |
| Orange | 1 medium | 70 |
| Grapefruit | ½ medium | 44 |
| Strawberries | 1 cup, whole | 82 |
| Tomato | 1 medium | 23 |
| Sweet red pepper | ½ cup, raw chopped | 141 |
| Broccoli | ½ cup, cooked | 58 |
| Potato | 1 medium, baked | 26 |
Vitamin C (L-ascorbic acid) is available in many forms, but there is little scientific evidence that any one form is better absorbed or more effective than another.
Natural vs. synthetic vitamin C
Natural and synthetic L-ascorbic acid are chemically identical and there are no known differences in their biological activities or bioavailability.
Mineral ascorbates
Mineral salts of ascorbic acid are buffered and therefore, less acidic than ascorbic acid. Some people find them less irritating to the gastrointestinal tract than ascorbic acid. Sodium ascorbate and calcium ascorbate are the most common forms, although a number of other mineral ascorbates are available. Sodium ascorbate generally provides 131 mg of sodium per 1,000 mg of ascorbic acid, and pure calcium ascorbate provides 114 mg of calcium per 1,000 mg of ascorbic acid.
Vitamin C with bioflavonoids
Bioflavonoids are a class of water-soluble plant pigments that are often found in vitamin C-rich fruits and vegetables, especially citrus fruits. Although many bioflavonoids are thought to function as antioxidants, there is little evidence that the bioflavonoids in most commercial preparations increase the bioavailability or efficacy of vitamin C.
Ascorbate and vitamin C metabolites
One such supplement (Ester-C®) contains mainly calcium ascorbate, but also contains small amounts of the vitamin C metabolites dehydroascorbate (oxidized ascorbic acid), calcium threonate, and trace levels of xylonate and lyxonate. Although the metabolites are supposed to increase the bioavailability of vitamin C, the only published study in humans found no difference between Ester-C® and commercially available ascorbic acid tablets with respect to the absorption and urinary excretion of vitamin C. Ester-C® should not be confused with ascorbyl palmitate, which is also marketed as "vitamin C ester" (see below).
Ascorbyl palmitate
Ascorbyl palmitate is actually a vitamin C ester (vitamin C that has been esterified to a fatty acid). In this case, vitamin C is esterified to the saturated fatty acid, palmitic acid, resulting in a fat-soluble form of vitamin C. Ascorbyl palmitate has been added to a number of skin creams due to interest in its antioxidant properties as well as the important role of vitamin C in collagen synthesis. Although ascorbyl palmitate is also available as an oral supplement, it is likely that most of it is hydrolyzed (broken apart) to ascorbic acid and palmitic acid in the digestive tract before it is absorbed. Ascorbyl palmitate is also marketed as, "vitamin C ester," which should not be confused with Ester-C® (see above).
Kidney StonesBecause oxalate is a metabolite of vitamin C, there is some concern that high vitamin C intake could increase the risk of oxalate kidney stones. Some but not all studies have reported that supplemental vitamin C increases urinary oxalate levels. Whether any increase in oxalate levels would translate to an elevation in risk for kidney stones has been examined in epidemiological studies.
Two large studies, one following 45,251 men for six years and the other following 85,557 women for 14 years, reported that consumption of ≥ 1,500 mg of vitamin C daily did not increase the risk of kidney stone formation compared to those consuming <>
However, a more recent prospective study that followed 45,619 men for 14 years found that those who consumed ≥ 1,000 mg/day of vitamin C had a 41% higher risk of kidney stones compared to men consuming < style="font-weight: bold;">generally benefit health, were also associated with a significantly elevated risk. Supplemental vitamin C intake was only weakly associated with increased risk of kidney stones in this study. Despite conflicting results, it may be prudent for individuals predisposed to oxalate kidney stone formation to avoid high-dose vitamin C supplementation.
Drug Interactions
A number of drugs are known to lower vitamin C levels, requiring an increase in its intake.
Estrogen-containing contraceptives (birth control pills) are known to lower vitamin C levels in plasma and white blood cells.
Aspirin can lower vitamin C levels if taken frequently. For example, taking two aspirin tablets every six hours for a week has been reported to lower vitamin C levels in white blood cells by 50%, primarily by increasing urinary excretion of vitamin C.
There is some evidence, though controversial, that vitamin C interacts with anticoagulant medications (blood thinners) like warfarin (Coumadin). Large doses of vitamin C may block the action of warfarin, requiring an increase in dose to maintain its effectiveness. Individuals on anticoagulants should limit their vitamin C intake to 1 gram/day and have their prothrombin time monitored by the clinician following their anticoagulant therapy.
Because high doses of vitamin C have also been found to interfere with the interpretation of certain laboratory tests (e.g., serum bilirubin, serum creatinine, and the guaiac assay for occult blood) it is important to inform one's health care provider of any recent supplement use.
Antioxidant Supplements and HMG-CoA Reductase Inhibitors (Statins)
A 3-year randomized controlled trial in 160 patients with documented coronary heart disease (CHD) and low HDL levels found that a combination of simvastatin (Zocor) and niacin increased HDL2 levels, inhibited the progression of coronary artery stenosis (narrowing), and decreased the frequency of cardiovascular events, such as myocardial infarction (heart attack) and stroke.
Surprisingly, when an antioxidant combination (1,000 mg vitamin C, 800 IU alpha-tocopherol, 100 mcg selenium, and 25 mg beta-carotene daily) was taken with the simvastatin-niacin combination, the protective effects were diminished. Since the antioxidants were taken together in this trial, the individual contribution of vitamin C cannot be determined.
In contrast, a much larger randomized controlled trial of simvastatin and an antioxidant combination (600 mg vitamin E, 250 mg vitamin C, and 20 mg beta-carotene daily) in more than 20,000 men and women with coronary artery disease or diabetes found that the antioxidant combination did not diminish the cardioprotective effects of simvastatin therapy over a 5-year period. These contradictory findings indicate that further research is needed on potential interactions between antioxidant supplements and cholesterol-lowering agents, such as HMG-CoA reductase inhibitors (statins).
RDA - The Linus Pauling Institute recommends a vitamin C intake of at least 400 mg daily—the amount that has been found to fully saturate plasma and circulating cells with vitamin C in young, healthy nonsmokers. Consuming at least five servings (2½ cups) of fruits and vegetables daily may provide about 200 mg of vitamin C. Most multivitamin supplements provide 60 mg of vitamin C.
Older adults (65 years and older)
Although it is not yet known with certainty whether older adults have higher requirements for vitamin C than younger people, some older populations have been found to have vitamin C intakes considerably below the RDA of 75 and 90 mg/day for women and men, respectively. A vitamin C intake of at least 400 mg daily may be particularly important for older adults who are at higher risk for chronic diseases.
If you are interested in autism, you may read about Vitamin C and autism here.
If you are interested in diabetes, you may read about Vitamin C and diabetes here
If you think taking Vitamin C is a waste of money, because you pee it out, you can read about Linus Pauling's answers here.
If you want to read more about the benefits of Vitamin C and various diseases, click here.
If you want to read about Vitamin C as an alternative therapy for cancer, click here.
If you want to know about skin wrinkling and Vitamin C benefits, click here.
If you only want to take WEBMD's word about Vitamin C and the common cold, click here.
If you want to read more indepth about gout and Vitamin C, click here.
Sources: Linus Pauling Institute; Medline; Wikipedia; NIH (National Institute of Health); Kevin Passero, Naturopathic Physician;
Monday, June 29, 2009
8. Magnesium - 6/29/09
Magnesium aids in cell formation, helps promote healthy bones and absolutely (!) helps with muscle cramps in your legs. Magnesium is the fourth most abundant mineral in the body and is essential to good health. Approximately 50% of total body magnesium is found in bone. The other half is found predominantly inside cells of body tissues and organs. Only 1% of magnesium is found in blood, but the body works very hard to keep blood levels of magnesium constant. I take it with my Calcium for leg cramps and because it helps the Calcium digest better, making the body less gaseous.
Magnesium is needed for more than 300 biochemical reactions in the body. It helps maintain normal muscle and nerve function, keeps heart rhythm steady, supports a healthy immune system, and keeps bones strong. Magnesium also helps regulate blood sugar levels, promotes normal blood pressure, and is known to be involved in energy metabolism and protein synthesis. There is an increased interest in the role of magnesium in preventing and managing disorders such as hypertension, cardiovascular disease, and diabetes. Dietary magnesium is absorbed in the small intestines. Magnesium is excreted through the kidneys... you pee out what your body doesn't need. ***** I no longer take blood pressure medication because I am managed with magnesium, bananas, green vegetables, yogurt and baked potatoes. Because I also have Crohn's Disease, my body is constantly depleted of magnesium, so I supplement as well as add to my diet. Because I also have Multiple Sclerosis and Rhematoid Arthritis, magnesium is essential for the immune system.
Kinds of Magnesium:
1. Magnesium Gluconate is used to treat low blood magnesium. Low blood magnesium is caused by gastrointestinal disorders, prolonged vomiting or diarrhea, kidney disease, or certain other conditions. Certain drugs lower magnesium levels as well. This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information. A balanced diet usually provides enough magnesium. Sometimes supplements are necessary because of illness or medication use. Magnesium is found in a variety of foods, including green leafy vegetables, nuts, peas, beans, and cereal grains with the outer layers intact. A high-fat diet may decrease the amount of magnesium you absorb from your diet. Over-cooking food also may decrease the amount of magnesium you absorb from your food. Magnesium gluconate comes as a tablet and liquid to take by mouth. It usually is taken two to four times a day, depending on your condition. To prevent side effects, magnesium gluconate should be taken with meals. If you are taking an extended-release (long-acting) product, do not chew or crush the tablet. There are some tablets that can be crushed and mixed with food.
2. Magnesium Hydroxide is used on a short-term basis to treat constipation and is sometimes prescribed for other uses. Magnesium hydroxide come as a tablet and liquid to take by mouth. It usually is taken as needed for constipation. Shake the liquid well before each use. Example: Milk of Magnesia.
3. Magnesium oxide is an element your body needs to function normally. Magnesium oxide may be used for different reasons. Some people use it as an antacid to relieve heartburn, sour stomach, or acid indigestion. Magnesium oxide also may be used as a laxative for short-term, rapid emptying of the bowel (before surgery, for example). It should not be used repeatedly. Magnesium oxide also is used as a dietary supplement when the amount of magnesium in the diet is not enough. Magnesium oxide is available without a prescription.
4. Magnesium Gluconate is used to treat low blood magnesium. Low blood magnesium is caused by gastrointestinal disorders, prolonged vomiting or diarrhea, kidney disease, or certain other conditions. Certain drugs lower magnesium levels as well. Magnesium gluconate comes as a tablet and liquid to take by mouth. It usually is taken two to four times a day, depending on your condition. Magnesium may cause side effects. To avoid unpleasant taste, take the tablet with citrus fruit juice. Tell your doctor if either of these symptoms are severe or do not go away:
Here's what you need to know:
Table 1: Recommended Dietary Allowances for magnesium for children and adults
Data from the 1999-2000 National Health and Nutrition Examination Survey suggest that substantial numbers of adults in the United States (US) fail to get recommended amounts of magnesium in their diets. Among adult men and women, the diets of Caucasians have significantly more magnesium than do those of African-Americans. Magnesium intake is lower among older adults in every racial and ethnic group. Among African-American men and Caucasian men and women who take dietary supplements, the intake of magnesium is significantly higher than in those who do not.
Refined grains are generally low in magnesium. When white flour is refined and processed, the magnesium-rich germ and bran are removed. Bread made from whole grain wheat flour provides more magnesium than bread made from white refined flour. Tap water can be a source of magnesium, but the amount varies according to the water supply. Water that naturally contains more minerals is described as "hard". "Hard" water contains more magnesium than "soft" water.
Eating a wide variety of legumes, nuts, whole grains, and vegetables will help you meet your daily dietary need for magnesium. Selected food sources of magnesium are listed in Table 1.
Table 2: Selected food sources of magnesium
*DV = Daily Value. DVs are reference numbers developed by the Food and Drug Administration (FDA) to help consumers determine if a food contains a lot or a little of a specific nutrient. The DV for magnesium is 400 milligrams (mg). Most food labels do not list a food's magnesium content. The percent DV (%DV) listed on the table above indicates the percentage of the DV provided in one serving. A food providing 5% of the DV or less per serving is a low source while a food that provides 10-19% of the DV is a good source.
A food that provides 20% or more of the DV is high in that nutrient. It is important to remember that foods that provide lower percentages of the DV also contribute to a healthful diet.
The health status of the digestive system and the kidneys significantly influence magnesium status. Magnesium is absorbed in the intestines and then transported through the blood to cells and tissues. Approximately one-third to one-half of dietary magnesium is absorbed into the body. Gastrointestinal disorders that impair absorption such as Crohn's disease can limit the body's ability to absorb magnesium. These disorders can deplete the body's stores of magnesium and in extreme cases may result in magnesium deficiency. Chronic or excessive vomiting and diarrhea may also result in magnesium depletion.
Healthy kidneys are able to limit urinary excretion of magnesium to make up for low dietary intake. However, excessive loss of magnesium in urine can be a side effect of some medications and can also occur in cases of poorly-controlled diabetes and alcohol abuse.
Early signs of magnesium deficiency include loss of appetite, nausea, vomiting, fatigue, and weakness. As magnesium deficiency worsens, numbness, tingling, muscle contractions and cramps, seizures (sudden changes in behaviors caused by excessive electrical activity in the brain), personality changes, abnormal heart rhythms, and coronary spasms can occur. Severe magnesium deficiency can result in low levels of calcium in the blood (hypocalcemia). Magnesium deficiency is also associated with low levels of potassium in the blood (hypokalemia).
Many of these symptoms are general and can result from a variety of medical conditions other than magnesium deficiency. It is important to have a physician evaluate health complaints and problems so that appropriate care can be given.
Table 3 describes some important interactions between certain drugs and magnesium. These interactions may result in higher or lower levels of magnesium, or may influence absorption of the medication. Here's what you need to know:
Table 3: Common and important magnesium/drug interactions
What is the best way to get extra magnesium? Here's what you need to know:
Eating a variety of whole grains, legumes, and vegetables (especially dark-green, leafy vegetables) every day will help provide recommended intakes of magnesium and maintain normal storage levels of this mineral. Increasing dietary intake of magnesium can often restore mildly depleted magnesium levels. However, increasing dietary intake of magnesium may not be enough to restore very low magnesium levels to normal.
When blood levels of magnesium are very low, intravenous (i.e. by IV) magnesium replacement is usually recommended. Magnesium tablets also may be prescribed, although some forms can cause diarrhea. It is important to have the cause, severity, and consequences of low blood levels of magnesium evaluated by a physician, who can recommend the best way to restore magnesium levels to normal. Because people with kidney disease may not be able to excrete excess amounts of magnesium, they should not take magnesium supplements unless prescribed by a physician.
Oral magnesium supplements combine magnesium with another substance such as a salt. Examples of magnesium supplements include magnesium oxide, magnesium sulfate, and magnesium carbonate. Elemental magnesium refers to the amount of magnesium in each compound. Bioavailability refers to the amount of magnesium in food, medications, and supplements that is absorbed in the intestines and ultimately available for biological activity in your cells and tissues. Enteric coating (the outer layer of a tablet or capsule that allows it to pass through the stomach and be dissolved in the small intestine) of a magnesium compound can decrease bioavailability.
What are some current issues and controversies about magnesium? Here's what you need to know:
Magnesium and blood pressure
"Epidemiologic evidence suggests that magnesium may play an important role in regulating blood pressure." Diets that provide plenty of fruits and vegetables, which are good sources of potassium and magnesium, are consistently associated with lower blood pressure. The DASH study (Dietary Approaches to Stop Hypertension), a human clinical trial, suggested that high blood pressure could be significantly lowered by a diet that emphasizes fruits, vegetables, and low fat dairy foods. Such a diet will be high in magnesium, potassium, and calcium, and low in sodium and fat.
An observational study examined the effect of various nutritional factors on incidence of high blood pressure in over 30,000 US male health professionals. After four years of follow-up, it was found that a lower risk of hypertension was associated with dietary patterns that provided more magnesium, potassium, and dietary fiber. For 6 years, the Atherosclerosis Risk in Communities (ARIC) Study followed approximately 8,000 men and women who were initially free of hypertension. In this study, the risk of developing hypertension decreased as dietary magnesium intake increased in women, but not in men.
Foods high in magnesium are frequently high in potassium and dietary fiber. This makes it difficult to evaluate the independent effect of magnesium on blood pressure. However, newer scientific evidence from DASH clinical trials is strong enough that the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure states that diets that provide plenty of magnesium are positive lifestyle modifications for individuals with hypertension. This group recommends the DASH diet as a beneficial eating plan for people with hypertension and for those with "prehypertension" who desire to prevent high blood pressure.
Magnesium and diabetes
Diabetes is a disease resulting in insufficient production and/or inefficient use of insulin. Insulin is a hormone made by the pancreas. Insulin helps convert sugar and starches in food into energy to sustain life. There are two types of diabetes: type 1 and type 2. Type 1 diabetes is most often diagnosed in children and adolescents, and results from the body's inability to make insulin. Type 2 diabetes, which is sometimes referred to as adult-onset diabetes, is the most common form of diabetes. It is usually seen in adults and is most often associated with an inability to use the insulin made by the pancreas. Obesity is a risk factor for developing type 2 diabetes. In recent years, rates of type 2 diabetes have increased along with the rising rates of obesity.
Magnesium plays an important role in carbohydrate metabolism. It may influence the release and activity of insulin, the hormone that helps control blood glucose (sugar) levels. Low blood levels of magnesium (hypomagnesemia) are frequently seen in individuals with type 2 diabetes. Hypomagnesemia may worsen insulin resistance, a condition that often precedes diabetes, or may be a consequence of insulin resistance.
Individuals with insulin resistance do not use insulin efficiently and require greater amounts of insulin to maintain blood sugar within normal levels. The kidneys possibly lose their ability to retain magnesium during periods of severe hyperglycemia (significantly elevated blood glucose). The increased loss of magnesium in urine may then result in lower blood levels of magnesium. In older adults, correcting magnesium depletion may improve insulin response and action.
The Nurses' Health Study (NHS) and the Health Professionals' Follow-up Study (HFS) follow more than 170,000 health professionals through questionnaires the participants complete every 2 years.
Diet was first evaluated in 1980 in the NHS and in 1986 in the HFS, and dietary assessments have been completed every 2 to 4 years since. Information on the use of dietary supplements, including multivitamins, is also collected. As part of these studies, over 127,000 participants (85,060 women and 42,872 men) with no history of diabetes, cardiovascular disease, or cancer at baseline were followed to examine risk factors for developing type 2 diabetes.
Women were followed for 18 years; men were followed for 12 years. Over time, the risk for developing type 2 diabetes was greater in men and women with a lower magnesium intake. This study supports the dietary recommendation to increase consumption of major food sources of magnesium, such as whole grains, nuts, and green leafy vegetables.
The Iowa Women's Health Study has followed a group of older women since 1986. Researchers from this study examined the association between women's risk of developing type 2 diabetes and intake of carbohydrates, dietary fiber, and dietary magnesium. Dietary intake was estimated by a food frequency questionnaire, and incidence of diabetes throughout 6 years of follow-up was determined by asking participants if they had been diagnosed by a doctor as having diabetes. Based on baseline dietary intake assessment only, researchers' findings suggested that a greater intake of whole grains, dietary fiber, and magnesium decreased the risk of developing diabetes in older women.
The Women's Health Study was originally designed to evaluate the benefits versus risks of low-dose aspirin and vitamin E supplementation in the primary prevention of cardiovascular disease and cancer in women 45 years of age and older. In an examination of almost 40,000 women participating in this study, researchers also examined the association between magnesium intake and incidence of type 2 diabetes over an average of 6 years.
Among women who were overweight, the risk of developing type 2 diabetes was significantly greater among those with lower magnesium intake. This study also supports the dietary recommendation to increase consumption of major food sources of magnesium, such as whole grains, nuts, and green leafy vegetables.
On the other hand, the Atherosclerosis Risk in Communities (ARIC) study did not find any association between dietary magnesium intake and the risk for type 2 diabetes. During 6 years of follow-up, ARIC researchers examined the risk for type 2 diabetes in over 12,000 middle-aged adults without diabetes at baseline examination. In this study, there was no association between dietary magnesium intake and incidence of type 2 diabetes in either black or white participants.
It can be confusing to read about studies that examine the same issue but have different results. Before reaching a conclusion on a health issue, scientists conduct and evaluate many studies. Over time, they determine when results are consistent enough to suggest a conclusion. They want to be sure they are providing correct recommendations to the public.
Several clinical studies have examined the potential benefit of supplemental magnesium on control of type 2 diabetes. In one such study, 63 subjects with below normal serum magnesium levels received either 2.5 grams of oral magnesium chloride daily "in liquid form" (providing 300 mg elemental magnesium per day) or a placebo. At the end of the 16-week study period, those who received the magnesium supplement had higher blood levels of magnesium and improved control of diabetes, as suggested by lower hemoglobin A1C levels, than those who received a placebo. Hemoglobin A1C is a test that measures overall control of blood glucose over the previous 2 to 3 months, and is considered by many doctors to be the single most important blood test for diabetics.
In another study, 128 patients with poorly controlled type 2 diabetes were randomized to receive a placebo or a supplement with either 500 mg or 1000 mg of magnesium oxide (MgO) for 30 days. All patients were also treated with diet or diet plus oral medication to control blood glucose levels. Magnesium levels increased in the group receiving 1000 mg magnesium oxide per day (equal to 600 mg elemental magnesium per day) but did not significantly change in the placebo group or the group receiving 500 mg of magnesium oxide per day (equal to 300 mg elemental magnesium per day). However, neither level of magnesium supplementation significantly improved blood glucose control.
These studies provide intriguing results but also suggest that additional research is needed to better explain the association between blood magnesium levels, dietary magnesium intake, and type 2 diabetes. In 1999, the American Diabetes Association (ADA) issued nutrition recommendations for diabetics stating that "routine evaluation of blood magnesium level is recommended only in patients at high risk for magnesium deficiency. Levels of magnesium should be replaced only if hypomagnesemia can be demonstrated".
Magnesium and cardiovascular disease
Magnesium metabolism is very important to insulin sensitivity and blood pressure regulation, and magnesium deficiency is common in individuals with diabetes. The observed associations between magnesium metabolism, diabetes, and high blood pressure increase the likelihood that magnesium metabolism may influence cardiovascular disease.
Some observational surveys have associated higher blood levels of magnesium with lower risk of coronary heart disease. In addition, some dietary surveys have suggested that a higher magnesium intake may reduce the risk of having a stroke. There is also evidence that low body stores of magnesium increase the risk of abnormal heart rhythms, which may increase the risk of complications after a heart attack. These studies suggest that consuming recommended amounts of magnesium may be beneficial to the cardiovascular system. They have also prompted interest in clinical trials to determine the effect of magnesium supplements on cardiovascular disease.
Several small studies suggest that magnesium supplementation may improve clinical outcomes in individuals with coronary disease. In one of these studies, the effect of magnesium supplementation on exercise tolerance (the ability to walk on a treadmill or ride a bicycle), chest pain caused by exercise, and quality of life was examined in 187 patients. Patients received either a placebo or a supplement providing 365 milligrams of magnesium citrate twice daily for 6 months. At the end of the study period researchers found that magnesium therapy significantly increased magnesium levels. Patients receiving magnesium had a 14 percent improvement in exercise duration as compared to no change in the placebo group. Those receiving magnesium were also less likely to experience chest pain caused by exercise.
In another study, 50 men and women with stable coronary disease were randomized to receive either a placebo or a magnesium supplement that provided 342 mg magnesium oxide twice daily. After 6 months, those who received the oral magnesium supplement were found to have improved exercise tolerance.
In a third study, researchers examined whether magnesium supplementation would add to the anti-thrombotic (anti-clotting) effects of aspirin in 42 coronary patients. For three months, each patient received either a placebo or a supplement with 400 mg of magnesium oxide two to three times daily. After a four-week break without any treatment, treatment groups were reversed so that each person in the study then received the alternate treatment for three months. Researchers found that supplemental magnesium did provide an additional anti-thrombotic effect.
These studies are encouraging, but involved small numbers. Additional studies are needed to better understand the complex relationships between magnesium intake, indicators of magnesium status, and heart disease. Doctors can evaluate magnesium status when above-mentioned medical problems occur, and determine the need for magnesium supplementation.
Magnesium and osteoporosis
Bone health is supported by many factors, most notably calcium and vitamin D. However, some evidence suggests that magnesium deficiency may be an additional risk factor for postmenopausal osteoporosis. This may be due to the fact that magnesium deficiency alters calcium metabolism and the hormones that regulate calcium.
Several human studies have suggested that magnesium supplementation may improve bone mineral density. In a study of older adults, a greater magnesium intake maintained bone mineral density to a greater degree than a lower magnesium intake. Diets that provide recommended levels of magnesium are beneficial for bone health, but further investigation on the role of magnesium in bone metabolism and osteoporosis is needed.
What is the health risk of too much magnesium (toxicity)? Here's what you need to know:
Dietary magnesium does not pose a health risk, however pharmacologic doses of magnesium in supplements can promote adverse effects such as diarrhea and abdominal cramping. Risk of magnesium toxicity increases with kidney failure, when the kidney loses the ability to remove excess magnesium. Very large doses of magnesium-containing laxatives and antacids also have been associated with magnesium toxicity.
For example, a case of hypermagnesemia after unsupervised intake of aluminum magnesia oral suspension occurred after a 16 year old girl decided to take the antacid every two hours rather than four times per day, as prescribed. Three days later, she became unresponsive and demonstrated loss of deep tendon reflex. Doctors were unable to determine her exact magnesium intake, but the young lady presented with blood levels of magnesium five times higher than normal. Therefore, it is important for medical professionals to be aware of the use of any magnesium-containing laxatives or antacids. Signs of excess magnesium can be similar to magnesium deficiency and include changes in mental status, nausea, diarrhea, appetite loss, muscle weakness, difficulty breathing, extremely low blood pressure, and irregular heartbeat.
Sources: Institute of Medicine of the National Academy of Sciences, National Institute of Health, Office of Dietary Supplements
Magnesium is needed for more than 300 biochemical reactions in the body. It helps maintain normal muscle and nerve function, keeps heart rhythm steady, supports a healthy immune system, and keeps bones strong. Magnesium also helps regulate blood sugar levels, promotes normal blood pressure, and is known to be involved in energy metabolism and protein synthesis. There is an increased interest in the role of magnesium in preventing and managing disorders such as hypertension, cardiovascular disease, and diabetes. Dietary magnesium is absorbed in the small intestines. Magnesium is excreted through the kidneys... you pee out what your body doesn't need. ***** I no longer take blood pressure medication because I am managed with magnesium, bananas, green vegetables, yogurt and baked potatoes. Because I also have Crohn's Disease, my body is constantly depleted of magnesium, so I supplement as well as add to my diet. Because I also have Multiple Sclerosis and Rhematoid Arthritis, magnesium is essential for the immune system.
Kinds of Magnesium:
1. Magnesium Gluconate is used to treat low blood magnesium. Low blood magnesium is caused by gastrointestinal disorders, prolonged vomiting or diarrhea, kidney disease, or certain other conditions. Certain drugs lower magnesium levels as well. This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information. A balanced diet usually provides enough magnesium. Sometimes supplements are necessary because of illness or medication use. Magnesium is found in a variety of foods, including green leafy vegetables, nuts, peas, beans, and cereal grains with the outer layers intact. A high-fat diet may decrease the amount of magnesium you absorb from your diet. Over-cooking food also may decrease the amount of magnesium you absorb from your food. Magnesium gluconate comes as a tablet and liquid to take by mouth. It usually is taken two to four times a day, depending on your condition. To prevent side effects, magnesium gluconate should be taken with meals. If you are taking an extended-release (long-acting) product, do not chew or crush the tablet. There are some tablets that can be crushed and mixed with food.
2. Magnesium Hydroxide is used on a short-term basis to treat constipation and is sometimes prescribed for other uses. Magnesium hydroxide come as a tablet and liquid to take by mouth. It usually is taken as needed for constipation. Shake the liquid well before each use. Example: Milk of Magnesia.
3. Magnesium oxide is an element your body needs to function normally. Magnesium oxide may be used for different reasons. Some people use it as an antacid to relieve heartburn, sour stomach, or acid indigestion. Magnesium oxide also may be used as a laxative for short-term, rapid emptying of the bowel (before surgery, for example). It should not be used repeatedly. Magnesium oxide also is used as a dietary supplement when the amount of magnesium in the diet is not enough. Magnesium oxide is available without a prescription.
4. Magnesium Gluconate is used to treat low blood magnesium. Low blood magnesium is caused by gastrointestinal disorders, prolonged vomiting or diarrhea, kidney disease, or certain other conditions. Certain drugs lower magnesium levels as well. Magnesium gluconate comes as a tablet and liquid to take by mouth. It usually is taken two to four times a day, depending on your condition. Magnesium may cause side effects. To avoid unpleasant taste, take the tablet with citrus fruit juice. Tell your doctor if either of these symptoms are severe or do not go away:
- cramping
- diarrhea
If you experience any of the following symptoms, call your doctor immediately:
- rash or hives
- itching
- dizziness or lightheadedness
- skin flushing
- mood or mental changes
- unusual tiredness
- weakness
- nausea
- vomiting
What are the Dietary Reference Intakes for magnesium?
Recommendations for magnesium are provided in the Dietary Reference Intakes (DRIs) developed by the Institute of Medicine of the National Academy of Sciences. Dietary Reference Intakes is the general term for a set of reference values used for planning and assessing nutrient intake for healthy people. The RDA recommends the average daily intake that is sufficient to meet the nutrient requirements of nearly all (97%-98%) healthy people.Here's what you need to know:
Table 1: Recommended Dietary Allowances for magnesium for children and adults
| Age (years) | Male (mg/day) | Female (mg/day) | Pregnancy (mg/day) | Lactation (mg/day) |
|---|---|---|---|---|
| 1-3 | 80 | 80 | N/A | N/A |
| 4-8 | 130 | 130 | N/A | N/A |
| 9-13 | 240 | 240 | N/A | N/A |
| 14-18 | 410 | 360 | 400 | 360 |
| 19-30 | 400 | 310 | 350 | 310 |
| 31+ | 420 | 320 | 360 | 320 |
Data from the 1999-2000 National Health and Nutrition Examination Survey suggest that substantial numbers of adults in the United States (US) fail to get recommended amounts of magnesium in their diets. Among adult men and women, the diets of Caucasians have significantly more magnesium than do those of African-Americans. Magnesium intake is lower among older adults in every racial and ethnic group. Among African-American men and Caucasian men and women who take dietary supplements, the intake of magnesium is significantly higher than in those who do not.
What foods provide magnesium?
Green vegetables such as spinach are good sources of magnesium because the center of the chlorophyll molecule (which gives green vegetables their color) contains magnesium. Some legumes (beans and peas), nuts and seeds, and whole, unrefined grains are also good sources of magnesium.Refined grains are generally low in magnesium. When white flour is refined and processed, the magnesium-rich germ and bran are removed. Bread made from whole grain wheat flour provides more magnesium than bread made from white refined flour. Tap water can be a source of magnesium, but the amount varies according to the water supply. Water that naturally contains more minerals is described as "hard". "Hard" water contains more magnesium than "soft" water.
Eating a wide variety of legumes, nuts, whole grains, and vegetables will help you meet your daily dietary need for magnesium. Selected food sources of magnesium are listed in Table 1.
Table 2: Selected food sources of magnesium
| FOOD | Milligrams (mg) | %DV* |
|---|---|---|
| Halibut, cooked, 3 ounces | 90 | 20 |
| Almonds, dry roasted, 1 ounce | 80 | 20 |
| Cashews, dry roasted, 1 ounce | 75 | 20 |
| Soybeans, mature, cooked, ? cup | 75 | 20 |
| Spinach, frozen, cooked, ? cup | 75 | 20 |
| Nuts, mixed, dry roasted, 1 ounce | 65 | 15 |
| Cereal, shredded wheat, 2 rectangular biscuits | 55 | 15 |
| Oatmeal, instant, fortified, prepared w/ water, 1 cup | 55 | 15 |
| Potato, baked w/ skin, 1 medium | 50 | 15 |
| Peanuts, dry roasted, 1 ounce | 50 | 15 |
| Peanut butter, smooth, 2 Tablespoons | 50 | 15 |
| Wheat Bran, crude, 2 Tablespoons | 45 | 10 |
| Blackeyed Peas, cooked, ? cup | 45 | 10 |
| Yogurt, plain, skim milk, 8 fluid ounces | 45 | 10 |
| Bran Flakes, ? cup | 40 | 10 |
| Vegetarian Baked Beans, ? cup | 40 | 10 |
| Rice, brown, long-grained, cooked, ? cup | 40 | 10 |
| Lentils, mature seeds, cooked, ? cup | 35 | 8 |
| Avocado, California, ? cup pureed | 35 | 8 |
| Kidney Beans, canned, ? cup | 35 | 8 |
| Pinto Beans, cooked, ? cup | 35 | 8 |
| Wheat Germ, crude, 2 Tablespoons | 35 | 8 |
| Chocolate milk, 1 cup | 33 | 8 |
| Banana, raw, 1 medium | 30 | 8 |
| Milk Chocolate candy bar, 1.5 ounce bar | 28 | 8 |
| Milk, reduced fat (2%) or fat free, 1 cup | 27 | 8 |
| Bread, whole wheat, commercially prepared, 1 slice | 25 | 6 |
| Raisins, seedless, ? cup packed | 25 | 6 |
| Whole Milk, 1 cup | 24 | 6 |
| Chocolate Pudding, 4 ounce ready-to-eat portion | 24 | 6 |
*DV = Daily Value. DVs are reference numbers developed by the Food and Drug Administration (FDA) to help consumers determine if a food contains a lot or a little of a specific nutrient. The DV for magnesium is 400 milligrams (mg). Most food labels do not list a food's magnesium content. The percent DV (%DV) listed on the table above indicates the percentage of the DV provided in one serving. A food providing 5% of the DV or less per serving is a low source while a food that provides 10-19% of the DV is a good source.
A food that provides 20% or more of the DV is high in that nutrient. It is important to remember that foods that provide lower percentages of the DV also contribute to a healthful diet.
When can magnesium deficiency occur?
Even though dietary surveys suggest that many Americans do not get recommended amounts of magnesium, symptoms of magnesium deficiency are rarely seen in the US. However, there is concern that many people may not have enough body stores of magnesium because dietary intake may not be high enough. Having enough body stores of magnesium may be protective against disorders such as cardiovascular disease and immune dysfunction.The health status of the digestive system and the kidneys significantly influence magnesium status. Magnesium is absorbed in the intestines and then transported through the blood to cells and tissues. Approximately one-third to one-half of dietary magnesium is absorbed into the body. Gastrointestinal disorders that impair absorption such as Crohn's disease can limit the body's ability to absorb magnesium. These disorders can deplete the body's stores of magnesium and in extreme cases may result in magnesium deficiency. Chronic or excessive vomiting and diarrhea may also result in magnesium depletion.
Healthy kidneys are able to limit urinary excretion of magnesium to make up for low dietary intake. However, excessive loss of magnesium in urine can be a side effect of some medications and can also occur in cases of poorly-controlled diabetes and alcohol abuse.
Early signs of magnesium deficiency include loss of appetite, nausea, vomiting, fatigue, and weakness. As magnesium deficiency worsens, numbness, tingling, muscle contractions and cramps, seizures (sudden changes in behaviors caused by excessive electrical activity in the brain), personality changes, abnormal heart rhythms, and coronary spasms can occur. Severe magnesium deficiency can result in low levels of calcium in the blood (hypocalcemia). Magnesium deficiency is also associated with low levels of potassium in the blood (hypokalemia).
Many of these symptoms are general and can result from a variety of medical conditions other than magnesium deficiency. It is important to have a physician evaluate health complaints and problems so that appropriate care can be given.
Who may need extra magnesium?
Magnesium supplementation may be indicated when a specific health problem or condition causes an excessive loss of magnesium or limits magnesium absorption.- Some medicines may result in magnesium deficiency, including certain diuretics, antibiotics, and medications used to treat cancer (anti-neoplastic medication). Examples of these medications are:
- Diuretics: Lasix, Bumex, Edecrin, and hydrochlorothiazide
- Antibiotics: Gentamicin, and Amphotericin
- Anti-neoplastic medication: Cisplatin
- Individuals with poorly-controlled diabetes may benefit from magnesium supplements because of increased magnesium loss in urine associated with hyperglycemia.
- Magnesium supplementation may be indicated for persons with alcoholism. Low blood levels of magnesium occur in 30% to 60% of alcoholics, and in nearly 90% of patients experiencing alcohol withdrawal. Anyone who substitutes alcohol for food will usually have significantly lower magnesium intakes.
- Individuals with chronic malabsorptive problems such as Crohn's disease, gluten sensitive enteropathy, regional enteritis, and intestinal surgery may lose magnesium through diarrhea and fat malabsorption. Individuals with these conditions may need supplemental magnesium.
- Individuals with chronically low blood levels of potassium and calcium may have an underlying problem with magnesium deficiency. Magnesium supplements may help correct the potassium and calcium deficiencies.
- Older adults are at increased risk for magnesium deficiency. The 1999-2000 and 1998-94 National Health and Nutrition Examination Surveys suggest that older adults have lower dietary intakes of magnesium than younger adults. In addition, magnesium absorption decreases and renal excretion of magnesium increases in older adults. Seniors are also more likely to be taking drugs that interact with magnesium. This combination of factors places older adults at risk for magnesium deficiency. It is very important for older adults to get recommended amounts of dietary magnesium.
Table 3 describes some important interactions between certain drugs and magnesium. These interactions may result in higher or lower levels of magnesium, or may influence absorption of the medication. Here's what you need to know:
Table 3: Common and important magnesium/drug interactions
| Drug | Potential Interaction |
|---|---|
| These drugs may increase the loss of magnesium in urine. Thus, taking these medications for long periods of time may contribute to magnesium depletion. | |
| Magnesium binds tetracycline in the gut and decreases the absorption of tetracycline. | |
| Many antacids and laxatives contain magnesium. When frequently taken in large doses, these drugs can inadvertently lead to excessive magnesium consumption and hypermagnesemia, which refers to elevated levels of magnesium in blood. |
What is the best way to get extra magnesium? Here's what you need to know:
Eating a variety of whole grains, legumes, and vegetables (especially dark-green, leafy vegetables) every day will help provide recommended intakes of magnesium and maintain normal storage levels of this mineral. Increasing dietary intake of magnesium can often restore mildly depleted magnesium levels. However, increasing dietary intake of magnesium may not be enough to restore very low magnesium levels to normal.When blood levels of magnesium are very low, intravenous (i.e. by IV) magnesium replacement is usually recommended. Magnesium tablets also may be prescribed, although some forms can cause diarrhea. It is important to have the cause, severity, and consequences of low blood levels of magnesium evaluated by a physician, who can recommend the best way to restore magnesium levels to normal. Because people with kidney disease may not be able to excrete excess amounts of magnesium, they should not take magnesium supplements unless prescribed by a physician.
Oral magnesium supplements combine magnesium with another substance such as a salt. Examples of magnesium supplements include magnesium oxide, magnesium sulfate, and magnesium carbonate. Elemental magnesium refers to the amount of magnesium in each compound. Bioavailability refers to the amount of magnesium in food, medications, and supplements that is absorbed in the intestines and ultimately available for biological activity in your cells and tissues. Enteric coating (the outer layer of a tablet or capsule that allows it to pass through the stomach and be dissolved in the small intestine) of a magnesium compound can decrease bioavailability.
What are some current issues and controversies about magnesium? Here's what you need to know:
Magnesium and blood pressure"Epidemiologic evidence suggests that magnesium may play an important role in regulating blood pressure." Diets that provide plenty of fruits and vegetables, which are good sources of potassium and magnesium, are consistently associated with lower blood pressure. The DASH study (Dietary Approaches to Stop Hypertension), a human clinical trial, suggested that high blood pressure could be significantly lowered by a diet that emphasizes fruits, vegetables, and low fat dairy foods. Such a diet will be high in magnesium, potassium, and calcium, and low in sodium and fat.
An observational study examined the effect of various nutritional factors on incidence of high blood pressure in over 30,000 US male health professionals. After four years of follow-up, it was found that a lower risk of hypertension was associated with dietary patterns that provided more magnesium, potassium, and dietary fiber. For 6 years, the Atherosclerosis Risk in Communities (ARIC) Study followed approximately 8,000 men and women who were initially free of hypertension. In this study, the risk of developing hypertension decreased as dietary magnesium intake increased in women, but not in men.
Foods high in magnesium are frequently high in potassium and dietary fiber. This makes it difficult to evaluate the independent effect of magnesium on blood pressure. However, newer scientific evidence from DASH clinical trials is strong enough that the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure states that diets that provide plenty of magnesium are positive lifestyle modifications for individuals with hypertension. This group recommends the DASH diet as a beneficial eating plan for people with hypertension and for those with "prehypertension" who desire to prevent high blood pressure.
Magnesium and diabetes
Diabetes is a disease resulting in insufficient production and/or inefficient use of insulin. Insulin is a hormone made by the pancreas. Insulin helps convert sugar and starches in food into energy to sustain life. There are two types of diabetes: type 1 and type 2. Type 1 diabetes is most often diagnosed in children and adolescents, and results from the body's inability to make insulin. Type 2 diabetes, which is sometimes referred to as adult-onset diabetes, is the most common form of diabetes. It is usually seen in adults and is most often associated with an inability to use the insulin made by the pancreas. Obesity is a risk factor for developing type 2 diabetes. In recent years, rates of type 2 diabetes have increased along with the rising rates of obesity.
Magnesium plays an important role in carbohydrate metabolism. It may influence the release and activity of insulin, the hormone that helps control blood glucose (sugar) levels. Low blood levels of magnesium (hypomagnesemia) are frequently seen in individuals with type 2 diabetes. Hypomagnesemia may worsen insulin resistance, a condition that often precedes diabetes, or may be a consequence of insulin resistance.
Individuals with insulin resistance do not use insulin efficiently and require greater amounts of insulin to maintain blood sugar within normal levels. The kidneys possibly lose their ability to retain magnesium during periods of severe hyperglycemia (significantly elevated blood glucose). The increased loss of magnesium in urine may then result in lower blood levels of magnesium. In older adults, correcting magnesium depletion may improve insulin response and action.
The Nurses' Health Study (NHS) and the Health Professionals' Follow-up Study (HFS) follow more than 170,000 health professionals through questionnaires the participants complete every 2 years.
Diet was first evaluated in 1980 in the NHS and in 1986 in the HFS, and dietary assessments have been completed every 2 to 4 years since. Information on the use of dietary supplements, including multivitamins, is also collected. As part of these studies, over 127,000 participants (85,060 women and 42,872 men) with no history of diabetes, cardiovascular disease, or cancer at baseline were followed to examine risk factors for developing type 2 diabetes.
Women were followed for 18 years; men were followed for 12 years. Over time, the risk for developing type 2 diabetes was greater in men and women with a lower magnesium intake. This study supports the dietary recommendation to increase consumption of major food sources of magnesium, such as whole grains, nuts, and green leafy vegetables.
The Iowa Women's Health Study has followed a group of older women since 1986. Researchers from this study examined the association between women's risk of developing type 2 diabetes and intake of carbohydrates, dietary fiber, and dietary magnesium. Dietary intake was estimated by a food frequency questionnaire, and incidence of diabetes throughout 6 years of follow-up was determined by asking participants if they had been diagnosed by a doctor as having diabetes. Based on baseline dietary intake assessment only, researchers' findings suggested that a greater intake of whole grains, dietary fiber, and magnesium decreased the risk of developing diabetes in older women.
The Women's Health Study was originally designed to evaluate the benefits versus risks of low-dose aspirin and vitamin E supplementation in the primary prevention of cardiovascular disease and cancer in women 45 years of age and older. In an examination of almost 40,000 women participating in this study, researchers also examined the association between magnesium intake and incidence of type 2 diabetes over an average of 6 years.
Among women who were overweight, the risk of developing type 2 diabetes was significantly greater among those with lower magnesium intake. This study also supports the dietary recommendation to increase consumption of major food sources of magnesium, such as whole grains, nuts, and green leafy vegetables.
On the other hand, the Atherosclerosis Risk in Communities (ARIC) study did not find any association between dietary magnesium intake and the risk for type 2 diabetes. During 6 years of follow-up, ARIC researchers examined the risk for type 2 diabetes in over 12,000 middle-aged adults without diabetes at baseline examination. In this study, there was no association between dietary magnesium intake and incidence of type 2 diabetes in either black or white participants.
It can be confusing to read about studies that examine the same issue but have different results. Before reaching a conclusion on a health issue, scientists conduct and evaluate many studies. Over time, they determine when results are consistent enough to suggest a conclusion. They want to be sure they are providing correct recommendations to the public.
Several clinical studies have examined the potential benefit of supplemental magnesium on control of type 2 diabetes. In one such study, 63 subjects with below normal serum magnesium levels received either 2.5 grams of oral magnesium chloride daily "in liquid form" (providing 300 mg elemental magnesium per day) or a placebo. At the end of the 16-week study period, those who received the magnesium supplement had higher blood levels of magnesium and improved control of diabetes, as suggested by lower hemoglobin A1C levels, than those who received a placebo. Hemoglobin A1C is a test that measures overall control of blood glucose over the previous 2 to 3 months, and is considered by many doctors to be the single most important blood test for diabetics.
In another study, 128 patients with poorly controlled type 2 diabetes were randomized to receive a placebo or a supplement with either 500 mg or 1000 mg of magnesium oxide (MgO) for 30 days. All patients were also treated with diet or diet plus oral medication to control blood glucose levels. Magnesium levels increased in the group receiving 1000 mg magnesium oxide per day (equal to 600 mg elemental magnesium per day) but did not significantly change in the placebo group or the group receiving 500 mg of magnesium oxide per day (equal to 300 mg elemental magnesium per day). However, neither level of magnesium supplementation significantly improved blood glucose control.
These studies provide intriguing results but also suggest that additional research is needed to better explain the association between blood magnesium levels, dietary magnesium intake, and type 2 diabetes. In 1999, the American Diabetes Association (ADA) issued nutrition recommendations for diabetics stating that "routine evaluation of blood magnesium level is recommended only in patients at high risk for magnesium deficiency. Levels of magnesium should be replaced only if hypomagnesemia can be demonstrated".
Magnesium and cardiovascular disease
Magnesium metabolism is very important to insulin sensitivity and blood pressure regulation, and magnesium deficiency is common in individuals with diabetes. The observed associations between magnesium metabolism, diabetes, and high blood pressure increase the likelihood that magnesium metabolism may influence cardiovascular disease.
Some observational surveys have associated higher blood levels of magnesium with lower risk of coronary heart disease. In addition, some dietary surveys have suggested that a higher magnesium intake may reduce the risk of having a stroke. There is also evidence that low body stores of magnesium increase the risk of abnormal heart rhythms, which may increase the risk of complications after a heart attack. These studies suggest that consuming recommended amounts of magnesium may be beneficial to the cardiovascular system. They have also prompted interest in clinical trials to determine the effect of magnesium supplements on cardiovascular disease.
Several small studies suggest that magnesium supplementation may improve clinical outcomes in individuals with coronary disease. In one of these studies, the effect of magnesium supplementation on exercise tolerance (the ability to walk on a treadmill or ride a bicycle), chest pain caused by exercise, and quality of life was examined in 187 patients. Patients received either a placebo or a supplement providing 365 milligrams of magnesium citrate twice daily for 6 months. At the end of the study period researchers found that magnesium therapy significantly increased magnesium levels. Patients receiving magnesium had a 14 percent improvement in exercise duration as compared to no change in the placebo group. Those receiving magnesium were also less likely to experience chest pain caused by exercise.
In another study, 50 men and women with stable coronary disease were randomized to receive either a placebo or a magnesium supplement that provided 342 mg magnesium oxide twice daily. After 6 months, those who received the oral magnesium supplement were found to have improved exercise tolerance.
In a third study, researchers examined whether magnesium supplementation would add to the anti-thrombotic (anti-clotting) effects of aspirin in 42 coronary patients. For three months, each patient received either a placebo or a supplement with 400 mg of magnesium oxide two to three times daily. After a four-week break without any treatment, treatment groups were reversed so that each person in the study then received the alternate treatment for three months. Researchers found that supplemental magnesium did provide an additional anti-thrombotic effect.
These studies are encouraging, but involved small numbers. Additional studies are needed to better understand the complex relationships between magnesium intake, indicators of magnesium status, and heart disease. Doctors can evaluate magnesium status when above-mentioned medical problems occur, and determine the need for magnesium supplementation.
Magnesium and osteoporosis
Bone health is supported by many factors, most notably calcium and vitamin D. However, some evidence suggests that magnesium deficiency may be an additional risk factor for postmenopausal osteoporosis. This may be due to the fact that magnesium deficiency alters calcium metabolism and the hormones that regulate calcium.
Several human studies have suggested that magnesium supplementation may improve bone mineral density. In a study of older adults, a greater magnesium intake maintained bone mineral density to a greater degree than a lower magnesium intake. Diets that provide recommended levels of magnesium are beneficial for bone health, but further investigation on the role of magnesium in bone metabolism and osteoporosis is needed.
What is the health risk of too much magnesium (toxicity)? Here's what you need to know:
Dietary magnesium does not pose a health risk, however pharmacologic doses of magnesium in supplements can promote adverse effects such as diarrhea and abdominal cramping. Risk of magnesium toxicity increases with kidney failure, when the kidney loses the ability to remove excess magnesium. Very large doses of magnesium-containing laxatives and antacids also have been associated with magnesium toxicity.For example, a case of hypermagnesemia after unsupervised intake of aluminum magnesia oral suspension occurred after a 16 year old girl decided to take the antacid every two hours rather than four times per day, as prescribed. Three days later, she became unresponsive and demonstrated loss of deep tendon reflex. Doctors were unable to determine her exact magnesium intake, but the young lady presented with blood levels of magnesium five times higher than normal. Therefore, it is important for medical professionals to be aware of the use of any magnesium-containing laxatives or antacids. Signs of excess magnesium can be similar to magnesium deficiency and include changes in mental status, nausea, diarrhea, appetite loss, muscle weakness, difficulty breathing, extremely low blood pressure, and irregular heartbeat.
Sources: Institute of Medicine of the National Academy of Sciences, National Institute of Health, Office of Dietary Supplements
Sunday, June 28, 2009
7. Vitamin D and D3-- 6/28/09
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Vitamin D
Vitamin D is considered the Sunny Supplement because of the body's ability to store it after being exposed to sunlight. Food sources of Vitamin D are limited, which is a major reason why supplementing is very important.
Another important reason to take a Vitamin D supplement is that a lack of exposure to sunlight may reduce Vitamin D levels in the body, especially in winter months. Have your Vitamin D levels checked every time you go to your doctor for bloodwork. Also ask for Vitamin D circulating test, D3 and magnesium levels.
Daily intake from food alone is inadequate to meet your body's needs unless you are exposed to large amounts of sunlight in summer months. Vitamin D is fat-soluble vitamin that is naturally present in very few foods, added to others and used mostly as a dietary supplement.
Vitamin D helps to maintain a healthy immune system. When I read that I can take that two ways. It maintains an ALREADY healthy immune system OR it can help maintain your immune system on its way to healthy. Hmmm.
Vitamin D works with calcium to maintain healthy bones and teeth and helps to increase calcium absorption.
Vitamin D is essential for promoting calcium absorption in the gut and maintaining adequate serum calcium and phosphate concentrations to enable normal mineralization of bone. It is also needed for bone growth and bone. Without sufficient vitamin D, bones can become thin, brittle, or misshapen. Vitamin D sufficiency prevents rickets in children and osteomalacia in adults. Together with calcium, vitamin D also helps protect older adults from osteoporosis.
Vitamin D has other roles in human health, including modulation of neuromuscular and immune function and reduction of inflammation. Many genes encoding proteins that regulate cell proliferation, differentiation, and apoptosis are modulated in part by vitamin D.
Serum concentration of 25(OH)D is the best indicator of vitamin D status. It reflects vitamin D produced cutaneously and that obtained from food and supplements and has a fairly long circulating half-life of 15 days. However, serum 25(OH)D levels do not indicate the amount of vitamin D stored in other body tissues. Circulating 1,25(OH)2D is generally not a good indicator of vitamin D status because it has a short half-life of 15 hours and serum concentrations are closely regulated by parathyroid hormone, calcium, and phosphate . Levels of 1,25(OH)2D do not typically decrease until vitamin D deficiency is severe.
So HERE 'S WHAT YOU NEED TO KNOW about bloodwork and the results when your doctor calls you with results or when you are presented with the result printout: < = less than; > = more than
Table 1: Serum 25-Hydroxyvitamin D [25(OH)D] Concentrations and Health*
* Serum concentrations of 25(OH)D are reported in both nanograms per milliliter (ng/mL) and nanomoles per liter (nmol/L).
** 1 ng/mL = 2.5 nmol/L.
Table 2: Adequate Intakes (AIs) for Vitamin D
In 2008, the American Academy of Pediatrics (AAP) issued recommended intakes for vitamin D, based on evidence from more recent clinical trials and the history of safe use of 400 IU/day of vitamin D in pediatric and adolescent populations. Exclusively and partially breastfed infants should receive supplements of 400 IU/day of vitamin D shortly after birth and continue to receive these supplements until they are weaned and consume ≥1,000 mL/day of vitamin D-fortified formula or whole milk.
Food
Very few foods in nature contain vitamin D. The flesh of fish (such as salmon, tuna, and mackerel) and fish liver oils are among the best sources. Small amounts of vitamin D are found in beef liver, cheese, and egg yolks. Vitamin D in these foods is primarily in the form of vitamin D3 (cholecalciferol) and its metabolite 25(OH)D3. Some mushrooms provide vitamin D2 (ergocalciferol) in variable amounts.
Fortified foods provide most of the vitamin D in the American diet. For example, almost all of the U.S. milk supply is fortified with 100 IU/cup of vitamin D (25% of the Daily Value or 50% of the AI level for ages 14-50 years). READ YOUR LABELS!
In the 1930s, a milk fortification program was implemented in the United States to combat rickets, then a major public health problem. This program virtually eliminated the disorder at that time. Other dairy products made from milk, such as cheese and ice cream, are generally not fortified. Ready-to-eat breakfast cereals often contain added vitamin D, as do some brands of orange juice, yogurt, and margarine.
In the United States, foods allowed to be fortified with vitamin D include cereal flours and related products, milk and products made from milk, and calcium-fortified fruit juices and drinks. Maximum levels of added vitamin D are specified by law.
Several food sources of vitamin D are listed in Table 3.
Table 3: Selected Food Sources of Vitamin D
*IUs = International Units.
**DV = Daily Value. DVs were developed by the U.S. Food and Drug Administration to help consumers compare the nutrient contents of products within the context of a total diet. The DV for vitamin D is 400 IU for adults and children age 4 and older. Food labels, however, are not required to list vitamin D content unless a food has been fortified with this nutrient. Foods providing 20% or more of the DV are considered to be high sources of a nutrient.
Sun exposure
Most people meet their vitamin D needs through exposure to sunlight. Ultraviolet (UV) B radiation with a wavelength of 290-315 nanometers penetrates uncovered skin and converts cutaneous 7-dehydrocholesterol to previtamin D3, which in turn becomes vitamin D3.
Season, geographic latitude, time of day, cloud cover, smog, skin melanin content, and sunscreen are among the factors that affect UV radiation exposure and vitamin D synthesis. The UV energy above 42 degrees north latitude (a line approximately between the northern border of California and Boston) is insufficient for cutaneous vitamin D synthesis from November through February; in far northern latitudes, this reduced intensity lasts for up to 6 months. Latitudes below 34 degrees north (a line between Los Angeles and Columbia, South Carolina) allow for cutaneous production of vitamin D throughout the year.
Complete cloud cover reduces UV energy by 50%; shade (including that produced by severe pollution) reduces it by 60%.
UVB radiation does not penetrate glass, so exposure to sunshine indoors through a window does not produce vitamin D.
Sunscreens with a sun protection factor of 8 or more appear to block vitamin D-producing UV rays, although in practice people generally do not apply sufficient amounts, cover all sun-exposed skin, or reapply sunscreen regularly.
Skin likely synthesizes some vitamin D even when it is protected by sunscreen as typically applied.
The amount of sun exposure needed to maintain adequate vitamin D levels make it difficult to provide general guidelines. It has been suggested by some vitamin D researchers, for example, that approximately 5-30 minutes of sun exposure between 10 AM and 3 PM at least twice a week to the face, arms, legs, or back without sunscreen usually lead to sufficient vitamin D synthesis and that the moderate use of commercial tanning beds that emit 2-6% UVB radiation is also effective.
Individuals with limited sun exposure need to include good sources of vitamin D in their diet or take a supplement.
Despite the importance of the sun to vitamin D synthesis, it is prudent to limit exposure of skin to sunlight. UV radiation is a carcinogen responsible for most of the estimated 1.5 million skin cancers and the 8,000 deaths due to metastatic melanoma that occur annually in the United States. Lifetime cumulative UV damage to skin is also largely responsible for some age-associated dryness and other cosmetic changes.
It is not known whether a desirable level of regular sun exposure exists that imposes no (or minimal) risk of skin cancer over time. The American Academy of Dermatology advises that photoprotective measures be taken, including the use of sunscreen, whenever one is exposed to the sun.
Dietary supplements
In supplements and fortified foods, vitamin D is available in two forms, D2 (ergocalciferol) and D3
(cholecalciferol).Vitamin D2 is manufactured by the UV irradiation of ergosterol in yeast, and vitamin D3 is manufactured by the irradiation of 7-dehydrocholesterol from lanolin and the chemical conversion of cholesterol.
The two forms have traditionally been regarded as equivalent based on their ability to cure rickets, but evidence has been offered that they are metabolized differently.
Vitamin D3 could be more than three times as effective as vitamin D2 in raising serum 25(OH)D concentrations and maintaining those levels for a longer time, and its metabolites have superior affinity for vitamin D-binding proteins in plasma.
Many supplements are being reformulated to contain vitamin D3 instead of vitamin D2. Both forms (as well as vitamin D in foods and from cutaneous synthesis) effectively raise serum 25(OH)D levels.
The prevalence of serum concentrations of 25(OH)D ≤15 ng/mL (≤37.5 nmol/L) was 10 times greater for the African American women (42.2%) than for the white women (4.2%).
The 2000-2004 NHANES provided the most recent data on the vitamin D nutritional status of the U.S. population. Generally, younger people had higher serum 25(OH)D levels than older people; males had higher levels than females; and non-Hispanic whites had higher levels than Mexican Americans, who in turn had higher levels than non-Hispanic blacks.
Among adults in the United Kingdom, nationally representative data collected between 1992 and 2001 show that 5-20% in most age groups on average had serum 25(OH)D levels <10>65 years of age in residential care homes and among women >85 years. Among all adults, 20-60% had levels ≤20 ng/ml (≤50 nmol/L) and 90% had levels ≤32 ng/ml (≤80 nmol/L).
Rickets and osteomalacia are the classical vitamin D deficiency diseases. In children, vitamin D deficiency causes rickets, a disease characterized by a failure of bone tissue to properly mineralize, resulting in soft bones and skeletal deformities.
Rickets was first described in the mid-17th century by British researchers. In the late 19th and early 20th centuries, German physicians noted that consuming 1-3 teaspoons of cod liver oil per day could reverse rickets.
In the 1920s and prior to identification of the structure of vitamin D and its metabolites, biochemist Harry Steenbock patented a process to impart antirachitic activity to foods. The process involved the addition of what turned out to be precursor forms of vitamin D followed by exposure to UV radiation. The fortification of milk with vitamin D has made rickets a rare disease in the United States. However, rickets is still reported periodically, particularly among African American infants and children. A 2003 report from Memphis, for example, described 21 cases of rickets among infants, 20 of whom were African American.
Prolonged exclusive breastfeeding without recommended vitamin D supplementation is a significant cause of rickets, particularly in dark-skinned infants breastfed by mothers who are not vitamin D replete.
Additional causes of rickets include extensive use of sunscreens and placement of children in daycare programs, where they often have less outdoor activity and sun exposure. Rickets is also more prevalent among immigrants from Asia, Africa, and the Middle East, possibly because of genetic differences in vitamin D metabolism and behavioral differences that lead to less sun exposure.
In adults, vitamin D deficiency can lead to osteomalacia, resulting in weak muscles and bones. Osteomalacia term for the softening of the bones due to defective bone minteralization. Symptoms of bone pain and muscle weakness can indicate inadequate vitamin D levels, but such symptoms can be subtle and go undetected in the initial stages.
Breastfed infants
Vitamin D requirements cannot be met by human milk alone, which provides only about 25 IU/L. A recent review of reports of nutritional rickets found that a majority of cases occurred among young, breastfed African Americans. The sun is a potential source of vitamin D, but AAP advises keeping infants out of direct sunlight and having them wear protective clothing and sunscreen. As noted earlier, AAP recommends that exclusively and partially breastfed infants be supplemented with 400 IU of vitamin D per day.
Older adults
Americans aged 50 and older are at increased risk of developing vitamin D insufficiency. As people age, skin cannot synthesize vitamin D as efficiently and the kidney is less able to convert vitamin D to its active hormone form. As many as half of older adults in the United States with hip fractures could have serum 25(OH)D levels <12>People with limited sun exposure
Homebound individuals, people living in northern latitudes (such as New England and Alaska), women who wear long robes and head coverings for religious reasons, and people with occupations that prevent sun exposure are unlikely to obtain adequate vitamin D from sunlight.
People with dark skin
Greater amounts of the pigment melanin result in darker skin and reduce the skin's ability to produce vitamin D from exposure to sunlight. Some studies suggest that older adults, especially women, with darker skin are at high risk of developing vitamin D insufficiency. However, one group with dark skin, African Americans, generally has lower levels of 25(OH)D yet develops fewer osteoporotic fractures than Caucasians (see section below on osteoporosis).
People with fat malabsorption
As a fat-soluble vitamin, vitamin D requires some dietary fat in the gut for absorption. Individuals who have a reduced ability to absorb dietary fat might require vitamin D supplements. Fat malabsorption is associated with a variety of medical conditions including pancreatic enzyme deficiency, Crohn's disease, GERDS, cystic fibrosis, celiac disease, surgical removal of part of the stomach or intestines, and some forms of liver disease.
People who are obese
Individuals with a body mass index (BMI) more than 30 typically have a low plasma concentration of 25(OH)D; this level decreases as obesity and body fat increase. Obesity does not affect skin's capacity to synthesize vitamin D, but greater amounts of subcutaneous fat sequester more of the vitamin and alter its release into the circulation. Even with orally administered vitamin D, BMI is inversely correlated with peak serum concentrations, probably because some vitamin D is sequestered in the larger pools of body fat.
In March 2007, a group of vitamin D and nutrition researchers published a controversial and provocative editorial that supplemental intakes of 400 IU/day of vitamin D increase 25(OH)D concentrations by only 2.8-4.8 ng/mL (7-12 nmol/L) and that daily intakes of approximately 1,700 IU are needed to raise these concentrations from 20 to 32 ng/mL (50 to 80 nmol/L).
Osteoporosis
More than 25 million adults in the United States have or are at risk of developing osteoporosis, a disease characterized by fragile bones that significantly increases the risk of bone fractures. Osteoporosis is most often associated with inadequate calcium intakes (generally less than 1,000-1,200 mg/day), but insufficient vitamin D contributes to osteoporosis by reducing calcium absorption.
Although rickets and osteomalacia are extreme examples of the effects of vitamin D deficiency, osteoporosis is an example of a long-term effect of calcium and vitamin D insufficiency. Adequate storage levels of vitamin D maintain bone strength and might help prevent osteoporosis in older adults, nonambulatory individuals who have difficulty exercising, postmenopausal women, and individuals on chronic steroid therapy.
Normal bone is constantly being remodeled. During menopause, the balance between these processes changes, resulting in more bone being resorbed than rebuilt. Hormone therapy with estrogen and progesterone might be able to delay the onset of osteoporosis. However, some medical groups and professional societies recommend that postmenopausal women consider using other agents to slow or stop bone resorption because of the potential adverse health effects of hormone therapy.
Most supplementation trials of the effects of vitamin D on bone health also include calcium, so it is not possible to isolate the effects of each nutrient. The authors of a recent evidence-based review of research concluded that supplements of both vitamin D3 (at 700-800 IU/day) and calcium (500-1,200 mg/day) decreased the risk of falls, fractures, and bone loss in elderly individuals aged 62-85 years.
The decreased risk of fractures occurred primarily in elderly women aged 85 years, on average, and living in a nursing home. Women should consult their healthcare providers about their needs for vitamin D (and calcium) as part of an overall plan to prevent or treat osteoporosis.
African Americans have lower levels of 25(OH)D than Caucasians, yet they develop fewer osteoporotic fractures. This suggests that factors other than vitamin D provide protection. African Americans have an advantage in bone density from early childhood, a function of their more efficient calcium economy, and have a lower risk of fracture even when they have the same bone density as Caucasians.
They also have a higher prevalence of obesity, and the resulting higher estrogen levels in obese women might protect them from bone loss. Further reducing the risk of osteoporosis in African Americans are their lower levels of bone-turnover markers, shorter hip-axis length, and superior renal calcium conservation. However, despite this advantage in bone density, osteoporosis is a significant health problem among African Americans as they age.
Cancer
Laboratory and animal evidence as well as epidemiologic data suggest that vitamin D status could affect cancer risk. Strong biological and mechanistic bases indicate that vitamin D plays a role in the prevention of colon, prostate, and breast cancers.
Emerging epidemiologic data suggest that vitamin D has a protective effect against colon cancer, but the data are not as strong for a protective effect against prostate and breast cancer, and are variable for cancers at other sites. Studies do not consistently show a protective effect or no effect, however.
One study of Finnish smokers, for example, found that subjects in the highest quintile of baseline vitamin D status have a three-fold higher risk of developing pancreatic cancer.
Vitamin D emerged as a protective factor in a prospective, cross-sectional study of 3,121 adults aged ≥50 years (96% men) who underwent a colonoscopy. The study found that 10% had at least one advanced cancerous lesion. Those with the highest vitamin D intakes (>645 IU/day) had a significantly lower risk of these lesions.
However, the Women's Health Initiative, in which 36,282 postmenopausal women of various races and ethnicities were randomly assigned to receive 400 IU vitamin D plus 1,000 mg calcium daily or a placebo, found no significant differences between the groups in the incidence of colorectal cancers over 7 years.
More recently, a clinical trial focused on bone health in 1,179 postmenopausal women residing in rural Nebraska found that subjects supplemented daily with calcium (1,400-1,500 mg) and vitamin D3 (1,100 IU) had a significantly lower incidence of cancer over 4 years compared to women taking a placebo.
The small number of cancers reported (50) precludes generalizing about a protective effect from either or both nutrients or for cancers at different sites. This caution is supported by an analysis of 16,618 participants in NHANES III, where total cancer mortality was found to be unrelated to baseline vitamin D status.
However, colorectal cancer mortality was inversely related to serum 25(OH)D concentrations; levels >80 nmol/L were associated with a 72% risk reduction than those <50 style="font-weight: bold;">Other conditions
A growing body of research suggests that vitamin D might play some role in the prevention and treatment of type 1 and type 2 diabetes, hypertension, glucose intolerance, multiple sclerosis, and other medical conditions.
However, most evidence for these roles comes from in vitro, animal, and epidemiological studies, not the randomized clinical trials considered to be more definitive. Until such trials are conducted, the implications of the available evidence for public health and patient care will be debated.
The subjects in these trials were primarily healthy, middle aged or elderly, and at high risk of fractures; they took 300-2,000 IU/day of vitamin D supplements.
Symptoms and Health Risks from Excessive Vitamin D
Vitamin D toxicity (too much) can cause nonspecific symptoms such as nausea, vomiting, poor appetite, constipation, weakness, and weight loss. More seriously, it can also raise blood levels of calcium, causing mental status changes such as confusion and heart rhythm abnormalities. The use of supplements of both calcium (1,000 mg/day) and vitamin D (400 IU/day) by postmenopausal women was associated with a 17% increase in the risk of kidney stones over 7 years in the Women's Health Initiative. Deposition of calcium and phosphate in the kidneys and other soft tissues can also be caused by excessive vitamin D levels. A serum 25(OH)D concentration consistently >200 ng/mL (>500 nmol/L) is considered to be potentially toxic. In an animal model, concentrations ≤400 ng/mL (≤1,000 nmol/L) were not associated with harm.
Excessive sun exposure does not result in vitamin D toxicity because the sustained heat on the skin is thought to photodegrade previtamin D3 and vitamin D3 as it is formed. High intakes of dietary vitamin D are very unlikely to result in toxicity unless large amounts of cod liver oil are consumed.
Long-term intakes above the UL increase the risk of adverse health effects (Table 4). Substantially larger doses administered for a short time or periodically (e.g., 50,000 IU/week for 8 weeks) do not cause toxicity. Rather, the excess is stored and used as needed to maintain normal serum 25(OH)D concentrations when vitamin D intakes or sun exposure are limited.
Table 4: Tolerable Upper Intake Levels (ULs) for Vitamin D [5]
Steroids
Corticosteroid medications such as prednisone, often prescribed to reduce inflammation, can reduce calcium absorption and impair vitamin D metabolism. These effects can further contribute to the loss of bone and the development of osteoporosis associated with their long-term use.
Other medications
Both the weight-loss drug orlistat (brand names Xenical® and alli™) and the cholesterol-lowering drug cholestyramine (brand names Questran®, LoCholest®, and Prevalite®) can reduce the absorption of vitamin D and other fat-soluble vitamins. Both phenobarbital and phenytoin (brand name Dilantin®), used to prevent and control epileptic seizures, increase the hepatic (liver) metabolism of vitamin D to inactive compounds and reduce calcium absorption.
The Dietary Guidelines for Americans describes a healthy diet as one that
Vitamin D
Vitamin D is considered the Sunny Supplement because of the body's ability to store it after being exposed to sunlight. Food sources of Vitamin D are limited, which is a major reason why supplementing is very important.
Another important reason to take a Vitamin D supplement is that a lack of exposure to sunlight may reduce Vitamin D levels in the body, especially in winter months. Have your Vitamin D levels checked every time you go to your doctor for bloodwork. Also ask for Vitamin D circulating test, D3 and magnesium levels.
Daily intake from food alone is inadequate to meet your body's needs unless you are exposed to large amounts of sunlight in summer months. Vitamin D is fat-soluble vitamin that is naturally present in very few foods, added to others and used mostly as a dietary supplement.
Vitamin D helps to maintain a healthy immune system. When I read that I can take that two ways. It maintains an ALREADY healthy immune system OR it can help maintain your immune system on its way to healthy. Hmmm.
Vitamin D works with calcium to maintain healthy bones and teeth and helps to increase calcium absorption.
Vitamin D is essential for promoting calcium absorption in the gut and maintaining adequate serum calcium and phosphate concentrations to enable normal mineralization of bone. It is also needed for bone growth and bone. Without sufficient vitamin D, bones can become thin, brittle, or misshapen. Vitamin D sufficiency prevents rickets in children and osteomalacia in adults. Together with calcium, vitamin D also helps protect older adults from osteoporosis.
Vitamin D has other roles in human health, including modulation of neuromuscular and immune function and reduction of inflammation. Many genes encoding proteins that regulate cell proliferation, differentiation, and apoptosis are modulated in part by vitamin D.
Serum concentration of 25(OH)D is the best indicator of vitamin D status. It reflects vitamin D produced cutaneously and that obtained from food and supplements and has a fairly long circulating half-life of 15 days. However, serum 25(OH)D levels do not indicate the amount of vitamin D stored in other body tissues. Circulating 1,25(OH)2D is generally not a good indicator of vitamin D status because it has a short half-life of 15 hours and serum concentrations are closely regulated by parathyroid hormone, calcium, and phosphate . Levels of 1,25(OH)2D do not typically decrease until vitamin D deficiency is severe.
So HERE 'S WHAT YOU NEED TO KNOW about bloodwork and the results when your doctor calls you with results or when you are presented with the result printout: < = less than; > = more than
Table 1: Serum 25-Hydroxyvitamin D [25(OH)D] Concentrations and Health*
| ng/mL** | nmol/L** | Health status |
|---|---|---|
| less than 11 | <27.5 | Associated with vitamin D deficiency and rickets in infants and young children. |
| less than 10-15 | <25-37.5 | Generally considered inadequate for bone and overall health in healthy individuals. |
| more than 30 | >75 | Proposed by some as desirable for overall health and disease prevention, although a recent government-sponsored expert panel concluded that insufficient data are available to support these higher levels. |
| Consistently >200 | Consistently >500 | Considered potentially toxic, leading to hypercalcemia and hyperphosphatemia, although human data are limited. In an animal model, concentrations ≤400 ng/mL (≤1,000 nmol/L) demonstrated no toxicity. |
* Serum concentrations of 25(OH)D are reported in both nanograms per milliliter (ng/mL) and nanomoles per liter (nmol/L).
** 1 ng/mL = 2.5 nmol/L.
Reference Intakes
Intake reference values for vitamin D and other nutrients are provided in the Dietary Reference Intakes. These values, which vary by age and gender, include:- Recommended Dietary Allowance (RDA): average daily level of intake sufficient to meet the nutrient requirements of nearly all (97-98%) healthy people.
- Adequate Intake (AI): established when evidence is insufficient to develop an RDA and is set at a level assumed to ensure nutritional adequacy.
- Tolerable Upper Intake Level (UL): maximum daily intake unlikely to cause adverse health effects.
Table 2: Adequate Intakes (AIs) for Vitamin D
| Age | Children | Men | Women | Pregnancy | Lactation |
|---|---|---|---|---|---|
| Birth to 13 years | 5 mcg (200 IU) | ||||
| 14-18 years | 5 mcg (200 IU) | 5 mcg (200 IU) | 5 mcg (200 IU) | 5 mcg (200 IU) | |
| 19-50 years | 5 mcg (200 IU) | 5 mcg (200 IU) | 5 mcg (200 IU) | 5 mcg (200 IU) | |
| 51-70 years | 10 mcg (400 IU) | 10 mcg (400 IU) | |||
| 71+ years | 15 mcg (600 IU) | 15 mcg (600 IU) |
In 2008, the American Academy of Pediatrics (AAP) issued recommended intakes for vitamin D, based on evidence from more recent clinical trials and the history of safe use of 400 IU/day of vitamin D in pediatric and adolescent populations. Exclusively and partially breastfed infants should receive supplements of 400 IU/day of vitamin D shortly after birth and continue to receive these supplements until they are weaned and consume ≥1,000 mL/day of vitamin D-fortified formula or whole milk.
Sources of Vitamin D
Food
Very few foods in nature contain vitamin D. The flesh of fish (such as salmon, tuna, and mackerel) and fish liver oils are among the best sources. Small amounts of vitamin D are found in beef liver, cheese, and egg yolks. Vitamin D in these foods is primarily in the form of vitamin D3 (cholecalciferol) and its metabolite 25(OH)D3. Some mushrooms provide vitamin D2 (ergocalciferol) in variable amounts.
Fortified foods provide most of the vitamin D in the American diet. For example, almost all of the U.S. milk supply is fortified with 100 IU/cup of vitamin D (25% of the Daily Value or 50% of the AI level for ages 14-50 years). READ YOUR LABELS!
In the 1930s, a milk fortification program was implemented in the United States to combat rickets, then a major public health problem. This program virtually eliminated the disorder at that time. Other dairy products made from milk, such as cheese and ice cream, are generally not fortified. Ready-to-eat breakfast cereals often contain added vitamin D, as do some brands of orange juice, yogurt, and margarine.
In the United States, foods allowed to be fortified with vitamin D include cereal flours and related products, milk and products made from milk, and calcium-fortified fruit juices and drinks. Maximum levels of added vitamin D are specified by law.
Several food sources of vitamin D are listed in Table 3.
Table 3: Selected Food Sources of Vitamin D
| Food | IUs per serving* | Percent DV** |
|---|---|---|
| Cod liver oil, 1 tablespoon | 1,360 | 340 |
| Salmon, cooked, 3.5 ounces | 360 | 90 |
| Mackerel, cooked, 3.5 ounces | 345 | 90 |
| Tuna fish, canned in oil, 3 ounces | 200 | 50 |
| Sardines, canned in oil, drained, 1.75 ounces | 250 | 70 |
| Milk, nonfat, reduced fat, and whole, vitamin D-fortified, 1 cup | 98 | 25 |
| Margarine, fortified, 1 tablespoon | 60 | 15 |
| Ready-to-eat cereal, fortified with 10% of the DV for vitamin D, 0.75-1 cup (more heavily fortified cereals might provide more of the DV) | 40 | 10 |
| Egg, 1 whole (vitamin D is found in yolk) | 20 | 6 |
| Liver, beef, cooked, 3.5 ounces | 15 | 4 |
| Cheese, Swiss, 1 ounce | 12 | 4 |
*IUs = International Units.
**DV = Daily Value. DVs were developed by the U.S. Food and Drug Administration to help consumers compare the nutrient contents of products within the context of a total diet. The DV for vitamin D is 400 IU for adults and children age 4 and older. Food labels, however, are not required to list vitamin D content unless a food has been fortified with this nutrient. Foods providing 20% or more of the DV are considered to be high sources of a nutrient.
Sun exposure
Most people meet their vitamin D needs through exposure to sunlight. Ultraviolet (UV) B radiation with a wavelength of 290-315 nanometers penetrates uncovered skin and converts cutaneous 7-dehydrocholesterol to previtamin D3, which in turn becomes vitamin D3.
Season, geographic latitude, time of day, cloud cover, smog, skin melanin content, and sunscreen are among the factors that affect UV radiation exposure and vitamin D synthesis. The UV energy above 42 degrees north latitude (a line approximately between the northern border of California and Boston) is insufficient for cutaneous vitamin D synthesis from November through February; in far northern latitudes, this reduced intensity lasts for up to 6 months. Latitudes below 34 degrees north (a line between Los Angeles and Columbia, South Carolina) allow for cutaneous production of vitamin D throughout the year.
Complete cloud cover reduces UV energy by 50%; shade (including that produced by severe pollution) reduces it by 60%.
UVB radiation does not penetrate glass, so exposure to sunshine indoors through a window does not produce vitamin D.
Sunscreens with a sun protection factor of 8 or more appear to block vitamin D-producing UV rays, although in practice people generally do not apply sufficient amounts, cover all sun-exposed skin, or reapply sunscreen regularly.
Skin likely synthesizes some vitamin D even when it is protected by sunscreen as typically applied.
The amount of sun exposure needed to maintain adequate vitamin D levels make it difficult to provide general guidelines. It has been suggested by some vitamin D researchers, for example, that approximately 5-30 minutes of sun exposure between 10 AM and 3 PM at least twice a week to the face, arms, legs, or back without sunscreen usually lead to sufficient vitamin D synthesis and that the moderate use of commercial tanning beds that emit 2-6% UVB radiation is also effective.
Individuals with limited sun exposure need to include good sources of vitamin D in their diet or take a supplement.
Despite the importance of the sun to vitamin D synthesis, it is prudent to limit exposure of skin to sunlight. UV radiation is a carcinogen responsible for most of the estimated 1.5 million skin cancers and the 8,000 deaths due to metastatic melanoma that occur annually in the United States. Lifetime cumulative UV damage to skin is also largely responsible for some age-associated dryness and other cosmetic changes.
It is not known whether a desirable level of regular sun exposure exists that imposes no (or minimal) risk of skin cancer over time. The American Academy of Dermatology advises that photoprotective measures be taken, including the use of sunscreen, whenever one is exposed to the sun.
Dietary supplements
In supplements and fortified foods, vitamin D is available in two forms, D2 (ergocalciferol) and D3
(cholecalciferol).Vitamin D2 is manufactured by the UV irradiation of ergosterol in yeast, and vitamin D3 is manufactured by the irradiation of 7-dehydrocholesterol from lanolin and the chemical conversion of cholesterol.
The two forms have traditionally been regarded as equivalent based on their ability to cure rickets, but evidence has been offered that they are metabolized differently.
Vitamin D3 could be more than three times as effective as vitamin D2 in raising serum 25(OH)D concentrations and maintaining those levels for a longer time, and its metabolites have superior affinity for vitamin D-binding proteins in plasma.
Many supplements are being reformulated to contain vitamin D3 instead of vitamin D2. Both forms (as well as vitamin D in foods and from cutaneous synthesis) effectively raise serum 25(OH)D levels.
Vitamin D Intakes and Status
In 1988-1994, as part of the third National Health and Nutrition Examination Survey (NHANES III), the frequency of use of some vitamin D-containing foods and supplements was examined in 1,546 non-Hispanic African American women and 1,426 non-Hispanic white women of reproductive age (15-49 years). In both groups, 25(OH)D levels were higher in the fall (after a summer of sun exposure) and when milk or fortified cereals were consumed more than three times per week.The prevalence of serum concentrations of 25(OH)D ≤15 ng/mL (≤37.5 nmol/L) was 10 times greater for the African American women (42.2%) than for the white women (4.2%).
The 2000-2004 NHANES provided the most recent data on the vitamin D nutritional status of the U.S. population. Generally, younger people had higher serum 25(OH)D levels than older people; males had higher levels than females; and non-Hispanic whites had higher levels than Mexican Americans, who in turn had higher levels than non-Hispanic blacks.
Among adults in the United Kingdom, nationally representative data collected between 1992 and 2001 show that 5-20% in most age groups on average had serum 25(OH)D levels <10>65 years of age in residential care homes and among women >85 years. Among all adults, 20-60% had levels ≤20 ng/ml (≤50 nmol/L) and 90% had levels ≤32 ng/ml (≤80 nmol/L).
Vitamin D Deficiency
Nutrient deficiencies are usually the result of dietary inadequacy, impaired absorption and use, increased requirement, or increased excretion. A vitamin D deficiency can occur when usual intake is lower than recommended levels over time, exposure to sunlight is limited, the kidneys cannot convert vitamin D to its active form, or absorption of vitamin D from the digestive tract is inadequate. Vitamin D-deficient diets are associated with milk allergy, lactose intolerance, and strict vegetarianism.Rickets and osteomalacia are the classical vitamin D deficiency diseases. In children, vitamin D deficiency causes rickets, a disease characterized by a failure of bone tissue to properly mineralize, resulting in soft bones and skeletal deformities.
Rickets was first described in the mid-17th century by British researchers. In the late 19th and early 20th centuries, German physicians noted that consuming 1-3 teaspoons of cod liver oil per day could reverse rickets.
In the 1920s and prior to identification of the structure of vitamin D and its metabolites, biochemist Harry Steenbock patented a process to impart antirachitic activity to foods. The process involved the addition of what turned out to be precursor forms of vitamin D followed by exposure to UV radiation. The fortification of milk with vitamin D has made rickets a rare disease in the United States. However, rickets is still reported periodically, particularly among African American infants and children. A 2003 report from Memphis, for example, described 21 cases of rickets among infants, 20 of whom were African American.
Prolonged exclusive breastfeeding without recommended vitamin D supplementation is a significant cause of rickets, particularly in dark-skinned infants breastfed by mothers who are not vitamin D replete.
Additional causes of rickets include extensive use of sunscreens and placement of children in daycare programs, where they often have less outdoor activity and sun exposure. Rickets is also more prevalent among immigrants from Asia, Africa, and the Middle East, possibly because of genetic differences in vitamin D metabolism and behavioral differences that lead to less sun exposure.
In adults, vitamin D deficiency can lead to osteomalacia, resulting in weak muscles and bones. Osteomalacia term for the softening of the bones due to defective bone minteralization. Symptoms of bone pain and muscle weakness can indicate inadequate vitamin D levels, but such symptoms can be subtle and go undetected in the initial stages.
Groups at Risk of Vitamin D Inadequacy
Obtaining sufficient vitamin D from natural food sources alone can be difficult. For many people, consuming vitamin D-fortified foods and being exposed to sunlight are essential for maintaining a healthy vitamin D status. In some groups, dietary supplements might be required to meet the daily need for vitamin D.Breastfed infants
Vitamin D requirements cannot be met by human milk alone, which provides only about 25 IU/L. A recent review of reports of nutritional rickets found that a majority of cases occurred among young, breastfed African Americans. The sun is a potential source of vitamin D, but AAP advises keeping infants out of direct sunlight and having them wear protective clothing and sunscreen. As noted earlier, AAP recommends that exclusively and partially breastfed infants be supplemented with 400 IU of vitamin D per day.
Older adults
Americans aged 50 and older are at increased risk of developing vitamin D insufficiency. As people age, skin cannot synthesize vitamin D as efficiently and the kidney is less able to convert vitamin D to its active hormone form. As many as half of older adults in the United States with hip fractures could have serum 25(OH)D levels <12>People with limited sun exposure
Homebound individuals, people living in northern latitudes (such as New England and Alaska), women who wear long robes and head coverings for religious reasons, and people with occupations that prevent sun exposure are unlikely to obtain adequate vitamin D from sunlight.
People with dark skin
Greater amounts of the pigment melanin result in darker skin and reduce the skin's ability to produce vitamin D from exposure to sunlight. Some studies suggest that older adults, especially women, with darker skin are at high risk of developing vitamin D insufficiency. However, one group with dark skin, African Americans, generally has lower levels of 25(OH)D yet develops fewer osteoporotic fractures than Caucasians (see section below on osteoporosis).
People with fat malabsorption
As a fat-soluble vitamin, vitamin D requires some dietary fat in the gut for absorption. Individuals who have a reduced ability to absorb dietary fat might require vitamin D supplements. Fat malabsorption is associated with a variety of medical conditions including pancreatic enzyme deficiency, Crohn's disease, GERDS, cystic fibrosis, celiac disease, surgical removal of part of the stomach or intestines, and some forms of liver disease.
People who are obese
Individuals with a body mass index (BMI) more than 30 typically have a low plasma concentration of 25(OH)D; this level decreases as obesity and body fat increase. Obesity does not affect skin's capacity to synthesize vitamin D, but greater amounts of subcutaneous fat sequester more of the vitamin and alter its release into the circulation. Even with orally administered vitamin D, BMI is inversely correlated with peak serum concentrations, probably because some vitamin D is sequestered in the larger pools of body fat.
Vitamin D and Health
Optimal serum concentrations of 25(OH)D for bone and general health throughout life have not been established and are likely to vary at each stage of life, depending on the physiological measures selected.In March 2007, a group of vitamin D and nutrition researchers published a controversial and provocative editorial that supplemental intakes of 400 IU/day of vitamin D increase 25(OH)D concentrations by only 2.8-4.8 ng/mL (7-12 nmol/L) and that daily intakes of approximately 1,700 IU are needed to raise these concentrations from 20 to 32 ng/mL (50 to 80 nmol/L).
Osteoporosis
More than 25 million adults in the United States have or are at risk of developing osteoporosis, a disease characterized by fragile bones that significantly increases the risk of bone fractures. Osteoporosis is most often associated with inadequate calcium intakes (generally less than 1,000-1,200 mg/day), but insufficient vitamin D contributes to osteoporosis by reducing calcium absorption.
Although rickets and osteomalacia are extreme examples of the effects of vitamin D deficiency, osteoporosis is an example of a long-term effect of calcium and vitamin D insufficiency. Adequate storage levels of vitamin D maintain bone strength and might help prevent osteoporosis in older adults, nonambulatory individuals who have difficulty exercising, postmenopausal women, and individuals on chronic steroid therapy.
Normal bone is constantly being remodeled. During menopause, the balance between these processes changes, resulting in more bone being resorbed than rebuilt. Hormone therapy with estrogen and progesterone might be able to delay the onset of osteoporosis. However, some medical groups and professional societies recommend that postmenopausal women consider using other agents to slow or stop bone resorption because of the potential adverse health effects of hormone therapy.
Most supplementation trials of the effects of vitamin D on bone health also include calcium, so it is not possible to isolate the effects of each nutrient. The authors of a recent evidence-based review of research concluded that supplements of both vitamin D3 (at 700-800 IU/day) and calcium (500-1,200 mg/day) decreased the risk of falls, fractures, and bone loss in elderly individuals aged 62-85 years.
The decreased risk of fractures occurred primarily in elderly women aged 85 years, on average, and living in a nursing home. Women should consult their healthcare providers about their needs for vitamin D (and calcium) as part of an overall plan to prevent or treat osteoporosis.
African Americans have lower levels of 25(OH)D than Caucasians, yet they develop fewer osteoporotic fractures. This suggests that factors other than vitamin D provide protection. African Americans have an advantage in bone density from early childhood, a function of their more efficient calcium economy, and have a lower risk of fracture even when they have the same bone density as Caucasians.
They also have a higher prevalence of obesity, and the resulting higher estrogen levels in obese women might protect them from bone loss. Further reducing the risk of osteoporosis in African Americans are their lower levels of bone-turnover markers, shorter hip-axis length, and superior renal calcium conservation. However, despite this advantage in bone density, osteoporosis is a significant health problem among African Americans as they age.
Cancer
Laboratory and animal evidence as well as epidemiologic data suggest that vitamin D status could affect cancer risk. Strong biological and mechanistic bases indicate that vitamin D plays a role in the prevention of colon, prostate, and breast cancers.
Emerging epidemiologic data suggest that vitamin D has a protective effect against colon cancer, but the data are not as strong for a protective effect against prostate and breast cancer, and are variable for cancers at other sites. Studies do not consistently show a protective effect or no effect, however.
One study of Finnish smokers, for example, found that subjects in the highest quintile of baseline vitamin D status have a three-fold higher risk of developing pancreatic cancer.
Vitamin D emerged as a protective factor in a prospective, cross-sectional study of 3,121 adults aged ≥50 years (96% men) who underwent a colonoscopy. The study found that 10% had at least one advanced cancerous lesion. Those with the highest vitamin D intakes (>645 IU/day) had a significantly lower risk of these lesions.
However, the Women's Health Initiative, in which 36,282 postmenopausal women of various races and ethnicities were randomly assigned to receive 400 IU vitamin D plus 1,000 mg calcium daily or a placebo, found no significant differences between the groups in the incidence of colorectal cancers over 7 years.
More recently, a clinical trial focused on bone health in 1,179 postmenopausal women residing in rural Nebraska found that subjects supplemented daily with calcium (1,400-1,500 mg) and vitamin D3 (1,100 IU) had a significantly lower incidence of cancer over 4 years compared to women taking a placebo.
The small number of cancers reported (50) precludes generalizing about a protective effect from either or both nutrients or for cancers at different sites. This caution is supported by an analysis of 16,618 participants in NHANES III, where total cancer mortality was found to be unrelated to baseline vitamin D status.
However, colorectal cancer mortality was inversely related to serum 25(OH)D concentrations; levels >80 nmol/L were associated with a 72% risk reduction than those <50 style="font-weight: bold;">Other conditions
A growing body of research suggests that vitamin D might play some role in the prevention and treatment of type 1 and type 2 diabetes, hypertension, glucose intolerance, multiple sclerosis, and other medical conditions.
However, most evidence for these roles comes from in vitro, animal, and epidemiological studies, not the randomized clinical trials considered to be more definitive. Until such trials are conducted, the implications of the available evidence for public health and patient care will be debated.
The subjects in these trials were primarily healthy, middle aged or elderly, and at high risk of fractures; they took 300-2,000 IU/day of vitamin D supplements.
Symptoms and Health Risks from Excessive Vitamin D
Vitamin D toxicity (too much) can cause nonspecific symptoms such as nausea, vomiting, poor appetite, constipation, weakness, and weight loss. More seriously, it can also raise blood levels of calcium, causing mental status changes such as confusion and heart rhythm abnormalities. The use of supplements of both calcium (1,000 mg/day) and vitamin D (400 IU/day) by postmenopausal women was associated with a 17% increase in the risk of kidney stones over 7 years in the Women's Health Initiative. Deposition of calcium and phosphate in the kidneys and other soft tissues can also be caused by excessive vitamin D levels. A serum 25(OH)D concentration consistently >200 ng/mL (>500 nmol/L) is considered to be potentially toxic. In an animal model, concentrations ≤400 ng/mL (≤1,000 nmol/L) were not associated with harm.Excessive sun exposure does not result in vitamin D toxicity because the sustained heat on the skin is thought to photodegrade previtamin D3 and vitamin D3 as it is formed. High intakes of dietary vitamin D are very unlikely to result in toxicity unless large amounts of cod liver oil are consumed.
Long-term intakes above the UL increase the risk of adverse health effects (Table 4). Substantially larger doses administered for a short time or periodically (e.g., 50,000 IU/week for 8 weeks) do not cause toxicity. Rather, the excess is stored and used as needed to maintain normal serum 25(OH)D concentrations when vitamin D intakes or sun exposure are limited.
Table 4: Tolerable Upper Intake Levels (ULs) for Vitamin D [5]
| Age | Children | Men | Women | Pregnancy | Lactation |
|---|---|---|---|---|---|
| Birth to 12 months | 25 mcg (1,000 IU) | ||||
| 1-13 years | 50 mcg (2,000 IU) | ||||
| 14+ years | 50 mcg (2,000 IU) | 50 mcg (2,000 IU) | 50 mcg (2,000 IU) | 50 mcg (2,000 IU) |
Interactions with Medications
Vitamin D supplements have the potential to interact with several types of medications. A few examples are provided below. Individuals taking these medications on a regular basis should discuss vitamin D intakes with their healthcare providers.Steroids
Corticosteroid medications such as prednisone, often prescribed to reduce inflammation, can reduce calcium absorption and impair vitamin D metabolism. These effects can further contribute to the loss of bone and the development of osteoporosis associated with their long-term use.
Other medications
Both the weight-loss drug orlistat (brand names Xenical® and alli™) and the cholesterol-lowering drug cholestyramine (brand names Questran®, LoCholest®, and Prevalite®) can reduce the absorption of vitamin D and other fat-soluble vitamins. Both phenobarbital and phenytoin (brand name Dilantin®), used to prevent and control epileptic seizures, increase the hepatic (liver) metabolism of vitamin D to inactive compounds and reduce calcium absorption.
Vitamin D and Healthful Diets
According to the 2005 Dietary Guidelines for Americans, "nutrient needs should be met primarily through consuming foods. Foods provide an array of nutrients and other compounds that may have beneficial effects on health. In certain cases, fortified foods and dietary supplements may be useful sources of one or more nutrients that otherwise might be consumed in less than recommended amounts. However, dietary supplements, while recommended in some cases, cannot replace a healthful diet."The Dietary Guidelines for Americans describes a healthy diet as one that
- Emphasizes a variety of fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products.
- Milk is fortified with vitamin D, as are many ready-to-eat cereals and a few brands of yogurt and orange juice. Cheese naturally contains small amounts of vitamin D.
- Includes lean meats, poultry, fish, beans, eggs, and nuts.
- Fish such as salmon, tuna, and mackerel are very good sources of vitamin D. Small amounts of vitamin D are also found in beef liver and egg yolks.
- Is low in saturated fats, trans fats, cholesterol, salt (sodium), and added sugars.
- Vitamin D is added to some margarines.
- Stays within your daily calorie needs.
Friday, June 19, 2009
6. Calcium 06/18/09
Calcium is a major mineral responsible for strong bones, proper nutrition, strong teeth, and bone well-being.
We have about three pounds of calcium in our bodies, mostly in bones and teeth. As we lose bone mass with age, regular exercise and adequate intake of calcium and Vitamin D helps to maintain good bone health and may reduce the risk of osteoporosis. Caucasian women of northern European and Asian ancestry in teens and young adult years have a higher risk of developing osteoporosis.
Calcium is also needed for nerves and muscles to work properly, and in chemical reactions in the cells. The body controls the amount of calcium in the blood. However, the amount of protein in the blood can affect calcium test results. Abnormal calcium levels can indicate digestive problems.
500 milligram calcium supplements made from calcium carbonate
We have about three pounds of calcium in our bodies, mostly in bones and teeth. As we lose bone mass with age, regular exercise and adequate intake of calcium and Vitamin D helps to maintain good bone health and may reduce the risk of osteoporosis. Caucasian women of northern European and Asian ancestry in teens and young adult years have a higher risk of developing osteoporosis.
Calcium is also needed for nerves and muscles to work properly, and in chemical reactions in the cells. The body controls the amount of calcium in the blood. However, the amount of protein in the blood can affect calcium test results. Abnormal calcium levels can indicate digestive problems.
Phosphorus, like calcium, is a major component of bones. Low levels of phosphorus for a long period of time can cause damage to bones, nerves and muscles. High phosphate levels are most often due to kidney failure.
Each commercial laboratory has its own set of “normal” values, called “Normal Range” or “Reference Range” on your lab report. These values depend on the equipment or method used. Compare your results to the range shown on your lab report. Results that are “out of range” may not represent a problem. Your test results can be affected by several factors, including your age or gender, if you are pregnant, the time of day when the sample was taken, active infectons, and food (some test samples need to be taken after you have fasted - not eaten anything - for several hours). Where normal values for men and women are different, they are indicated as W for women and M for men. Discuss “out of range” results with your health care provider.
The table below compares the units used in the United States with the "Système International d'Unités (SI units), a metric system used in many parts of the world. The last column, "To Convert US to SI Units," is the factor to multiply US lab values to convert them to SI units. To convert SI units to US units, divide the SI value by the conversion factor.
Here's what you need to know:
| Laboratory Test | Normal Range in US Units | Normal Range in SI Units | To Convert US to SI Units |
| ALT (Alanine aminotransferase) | W 7-30 units/liter M 10-55 units/liter | W 0.12-0.50 µkat/liter M 0.17-0.92 µkat/liter | x 0.01667 |
| Albumin | 3.1 - 4.3 g/dl | 31 - 43 g/liter | x 10 |
| Alkaline Phosphatase | W 30-100 units/liter M 45-115 units/liter | W 0.5-1.67 µkat/liter W 0.75-1.92 µkat/liter | x 0.01667 |
| Amylase (serum) | 53-123 units/liter | 0.88-2.05 nkat/liter | x 0.01667 |
| AST (Aspartate aminotransferase) | W 9-25 units/liter M 10-40 units/liter | W 0.15-0.42 µkat/liter M 0.17-0.67 µkat/liter | x 0.01667 |
| Basophils | 0-3% of lymphocytes | 0.0-0.3 fraction of white blood cells | x 0.01 |
| Bilirubin - Direct | 0.0-0.4 mg/dl | 0-7 µmol/liter | x 17.1 |
| Bilirubin - Total | 0.0-1.0 mg/dl | 0-17 µmol/liter | x 17.1 |
| Blood pressure | Normal: 120/70 to 120/80 millimeters of mercury (mmHg). The top number is systolic pressure, when the heart is pumping. Bottom number is diastolic pressure then the heart is at rest. Blood pressure can be too low (hypotension) or too high (hypertension). | No conversion | |
| C peptide | 0.5-2.0 ng/ml | 0.17-0.66 nmol/liter | x 0.33 |
| Calcium, serum | 8.5 -10.5 mg/dl | 2.1-2.6 mmol/liter | x 0.25 |
| Calcium, urine | 0-300 mg/24h | 0.0-7.5 mmol/24h | x 0.025 |
| Cholesterol, total |
| x 0.01129 | |
| Urea, plasma (BUN) | 8-25 mg/dl | 2.9-8.9 mmol/liter | x 0.357 |
| Urinalysis: pH Specific gravity | 5.0-9.0 1.001-1.035 | 5.0-9.0 1.001-1.035 | No conversion |
| WBC (White blood cells, leucocytes) | 4.5-11.0x103/mm3 | 4.5-11.0x109/liter | No conversion |
UNITS:
gram: common measurement of weight. Used in this table: pg (picograms), g (grams), mg (milligrams), etc. per liter
katal (kat): a unit of catalytic activity, used especially in the chemistry of enzymes. Used in this table: µkat (microkatals), nkat (nanokatals) per liter
micrometer (µm): a unit of length. Mean Corpuscular Volume is expressed in cubic micrometers
mole: also “gram molecular weight,” a quantity based on the atomic weight of the substance. Many test results in the Système Internationale are expressed as the number of moles per liter. In US units, these measurements are usually in grams per liter. Used in this table: mmol (millimoles), µmol, (micromoles), nmol (nanomoles), pmol (picomoles) per liter
Some units of measurement include the following fractions and multipliers:
mega (M): 106 or x1,000,000 | milli (m): 10-3 or ÷1,000 |
| kilo (k): 103 or x1,000 | micro (µ): 10-6 or ÷1,000,000 |
| deca or deka: 101 or x10 | nano (n): 10-9 or ÷1,000,000,000 |
| deci (d): 10-1 or ÷10 | pico (p): 10-12 or ÷1,000,000,000,000 |
Nutrition
| Age | Calcium (mg/day) |
|---|---|
| 0–6 months | 210 |
| 7–12 months | 270 |
| 1–3 years | 500 |
| 4–8 years | 800 |
| 9–18 years | 1300 |
| 19–50 years | 1000 |
| 51+ years | 1200 |
Calcium is an important component of a healthy diet and a mineral necessary for life. The National Osteoporosis Foundation says, "Calcium plays an important role in building stronger, denser bones early in life and keeping bones strong and healthy later in life." Approximately ninety-nine percent of the body's calcium is stored in the bones and teeth.[6] The rest of the calcium in the body has other important uses, such as some exocytosis, especially neurotransmitter release, and muscle contraction. Long-term calcium deficiency can lead to rickets and poor blood clotting and in case of a menopausal woman, it can lead to osteoporosis, in which the bone deteriorates and there is an increased risk of fractures. While a lifelong deficit can affect bone and tooth formation, over-retention can cause hypercalcemia (elevated levels of calcium in the blood), impaired kidney function and decreased absorption of other minerals. High calcium intakes or high calcium absorption were previously thought to contribute to the development of kidney stones. However, a high calcium intake has been associated with a lower risk for kidney stones in more recent research. Vitamin D is needed to absorb calcium.
Dairy products, such as milk and cheese, are a well-known source of calcium. However, some individuals are allergic to dairy products and even more people, particularly those of non Indo-European descent, are lactose-intolerant, leaving them unable to consume non-fermented dairy products in quantities larger than about half a liter per serving. Others, such as vegans, avoid dairy products for ethical and health reasons. Fortunately, many good sources of calcium exist. These include seaweeds such as kelp, wakame and hijiki; nuts and seeds (like almonds and sesame); blackstrap molasses; beans; oranges; figs; quinoa; amaranth; collard greens; okra; rutabaga; broccoli; dandelion leaves; kale; and fortified products such as orange juice and soy milk. (However, calcium fortified orange juice often contains vitamin D3 derived from lanolin, and is thus unacceptable for vegans. An overlooked source of calcium is eggshell, which can be ground into a powder and mixed into food or a glass of waterCultivated vegetables generally have less calcium than wild plants.
The calcium content of most foods can be found in the USDA National Nutrient Database.
How much to take: Here's what you need to know:
Dietary calcium supplements
Calcium supplements are used to prevent and to treat calcium deficiencies. Most experts recommend that supplements be taken with food and that no more than 600 mg should be taken at a time because the percent of calcium absorbed decreases as the amount of calcium in the supplement increases. It is recommended to spread doses throughout the day. Recommended daily calcium intake for adults ranges from 1000 to 1500 mg. It is recommended to take supplements with food to aid in absorption.
Vitamin D is added to some calcium supplements. Proper vitamin D status is important because vitamin D is converted to a hormone in the body which then induces the synthesis of intestinal proteins responsible for calcium absorption.
- The absorption of calcium from most food and commonly-used dietary supplements is very similar. This is contrary to what many calcium supplement manufacturers claim in their promotional materials.
- Milk is an excellent source of dietary calcium because it has a high concentration of calcium and the calcium in milk is excellently absorbed.
- Calcium carbonate is the most common and least expensive calcium supplement. It should be taken with food. It depends on low pH levels for proper absorption in the intestine. Some studies suggests that the absorption of calcium from calcium carbonate is similar to the absorption of calcium from milk.[20][21] While most people digest calcium carbonate very well, some might develop gastrointestinal discomfort or gas. Taking magnesium with it can help to avoid constipation. Calcium carbonate is 40% elemental calcium. 1000 mg will provide 400 mg of calcium. However, supplement labels will usually indicate how much calcium is present in each serving, not how much calcium carbonate is present.
- Antacids, such as Tums, frequently contain calcium carbonate, and are a very commonly-used, inexpensive calcium supplement.
- Coral Calcium is a salt of calcium derived from fossilized coral reefs. Coral calcium is composed of calcium carbonate and trace minerals.
- Calcium citrate can be taken without food and is the supplement of choice for individuals with achlorhydria or who are taking histamine-2 blockers or proton-pump inhibitors. It is more easily digested and absorbed than calcium carbonate if taken on empty stomach and less likely to cause constipation and gas than calcium carbonate. It also has a lower risk of contributing to the formation of kidney stones. Calcium citrate is about 21% elemental calcium. 1000 mg will provide 210 mg of calcium. It is more expensive than calcium carbonate and more of it must be taken to get the same amount of calcium.
- Calcium phosphate costs more than calcium carbonate, but less than calcium citrate. It is easily absorbed and is less likely to cause constipation and gas than either.
- Calcium lactate has similar absorption as calcium carbonate, but is more expensive. Calcium lactate and calcium gluconate are less concentrated forms of calcium and are not practical oral supplements.
- Calcium chelates are synthetic calcium compounds, with calcium bound to an organic molecule, such as malate, aspartate, or fumarate. These forms of calcium may be better absorbed on an empty stomach. However, in general they are absorbed similarly to calcium carbonate and other common calcium supplements when taken with food.The 'chelate' mimics the action that natural food performs by keeping the calcium soluble in the intestine. Thus, on an empty stomach, in some individuals, chelates might theoretically be absorbed better.
- Microcrystalline hydroxyapatite (MH) is marketed as a calcium supplement, and has in some randomized trials been found to be more effective than calcium carbonate.
- Orange juice with calcium added is a good dietary source for persons who have lactose intolerance.
In July 2006, a report citing research from Fred Hutchinson Cancer Research Center in Seattle, Washington claimed that women in their 50s gained 5 pounds less in a period of 10 years by taking more than 500 mg of calcium supplements than those who did not. However, the doctor in charge of the study, Dr. Alejandro J. Gonzalez also noted it would be "going out on a limb" to suggest calcium supplements as a weight-limiting aid.
Prevention of fractures due to osteoporosis
Such studies often do not test calcium alone, but rather combinations of calcium and vitamin D. Randomized controlled trials found both positive and negative effects. The different results may be explained by doses of calcium and underlying rates of calcium supplementation in the control groups. However, it is clear that increasing the intake of calcium promotes deposition of calcium in the bones, where it is of more benefit in preventing the compression fractures resulting from the osteoporotic thinning of the dendritic web of the bodies of the vertebrae, than it is at preventing the more serious cortical bone fractures which happen at hip and wrist.
Possible cancer prevention
A meta-analysis by the international Cochrane Collaboration of two randomized controlled trials found that calcium "might contribute to a moderate degree to the prevention of adenomatous colonic polyps".
More recent studies were conflicting, and one which was positive for effect (Lappe, et al.) did control for a possible anti-carcinogenic effect of vitamin D, which was found to be an independent positive influence from calcium-alone on cancer risk (see second study below) .
- A randomized controlled trial found that 1000 mg of elemental calcium and 400 IU of vitamin D3 had no effect on colorectal cancer
- A randomized controlled trial found that 1400–1500 mg supplemental calcium and 1100 IU vitamin D3 reduced aggregated cancers with a relative risk of 0.402.
- An observational cohort study found that high calcium and vitamin D intake was associated with "lower risk of developing premenopausal breast cancer."
Overdose
Exceeding the recommended daily calcium intake for an extended period of time can result in hypercalcemia and calcium metabolism disorder.
Sources: USDA National Nutrient Database, Linus Pauling (General Chemistry), National Library of Medicine
Wednesday, June 17, 2009
5. Vitamin E 06/17/09
If you wonder if you need Vitamin E, just remember that E is for Everybody!
Lots of information here, make several visits to be able to get the benefit of this article. Forgive any repeats within article as I have used several different sources to compile. Use labels for faster searches.
At present, the vitamin E content of foods and dietary supplements is listed on labels in international units (IUs), a measure of biological activity rather than quantity. Naturally sourced vitamin E is called d-alpha-tocopherol; the synthetically produced form is dl-alpha-tocopherol. Conversion rules are:
Here's what you need to know:
Supplements of vitamin E typically provide only alpha-tocopherol, although "mixed" products containing other tocopherols and even tocotrienols are available. Naturally occurring alpha-tocopherol exists in one stereoisomeric form. In contrast, synthetically produced alpha-tocopherol contains equal amounts of its eight possible stereoisomers; serum and tissues maintain only four of these stereoisomers. A given amount of synthetic alpha-tocopherol (listed on labels as "DL" or "d") is therefore only half as active as the same amount (by weight in mg) of the natural form (labeled as "D" or "d"). People need approximately 50% more IU of synthetic alpha tocopherol from dietary supplements and fortified foods to obtain the same amount of the nutrient as from the natural form.
Most vitamin-E-only supplements provide ≥100 IU of the nutrient. These amounts are substantially higher than the RDAs. The 1999-2000 National Health and Nutrition Examination Survey (NHANES) found that 11.3% of adults took vitamin E supplements containing at least 400 IU.
Alpha-tocopherol in dietary supplements and fortified foods is often esterified to prolong its shelf life while protecting its antioxidant properties. The body hydrolyzes and absorbs these esters (alpha-tocopheryl acetate and succinate) as efficiently as alpha-tocopherol.
The Dietary Guidelines for Americans describes a healthy diet as one that:
Some people with abetalipoproteinemia, a rare inherited disorder resulting in poor absorption of dietary fat, require enormous doses of supplemental vitamin E (approximately 100 mg/kg or 5-10 g/day). Vitamin E deficiency secondary to abetalipoproteinemia causes such problems as poor transmission of nerve impulses, muscle weakness, and retinal degeneration that leads to blindness. Ataxia and vitamin E deficiency (AVED) is another rare, inherited disorder in which the liver’s alpha-tocopherol transfer protein is defective or absent. People with AVED have such severe vitamin E deficiency that they develop nerve damage and lose the ability to walk unless they take large doses of supplemental vitamin E.
Age-related macular degeneration (AMD) and cataracts are among the most common causes of significant vision loss in older people. Their etiologies are usually unknown, but the cumulative effects of oxidative stress have been postulated to play a role. If so, nutrients with antioxidant functions, such as vitamin E, could be used to prevent or treat these conditions.
Prospective cohort studies have found that people with relatively high dietary intakes of vitamin E (e.g., 30 IU/day) have an approximately 20% lower risk of developing AMD than people with low intakes (e.g., <15 style="font-weight: bold;">d-alpha-tocopherol in one study and 111 IU/day dl-alpha-tocopheryl acetate combined with 20 mg/day beta-carotene in the other or a placebo failed to show a protective effect for vitamin E on AMD. The Age-Related Eye Disease Study (AREDS), a large randomized clinical trial, revealed that participants with early-stage AMD could slow the progression of their disease by taking a daily supplement of vitamin E (400 IU dl-alpha-tocopheryl acetate), vitamin C (500 mg), beta-carotene (15 mg), zinc (80 mg), and copper (2 mg) for an average of 6.3 years compared to participants taking a placebo.
Several observational studies have revealed a potential relationship between vitamin E supplements and the risk of cataract formation. One prospective cohort study found that lens clarity was superior in participants who took vitamin E supplements and those with higher blood levels of the vitamin. In another study, long-term use of vitamin E supplements was associated with slower progression of age-related lens opacification. However, in the randomized AREDS study, the use of the vitamin E-containing supplement package had no apparent effect on the development or progression of cataracts over 7 years.
Overall, the available evidence is inconsistent with respect to whether vitamin E supplements, taken alone or in combination with other antioxidants, can reduce the risk of developing AMD or cataracts. However, the formulation of vitamin E, other antioxidants, zinc, and copper used in AREDS holds promise for slowing the progression of AMD in people with early-stage disease. Additional information about the dietary supplements used in AREDS is available at http://www.nei.nih.gov/amd. AREDS 2, a followup study, will determine whether a modified combination of dietary supplements can further slow the progression of vision loss from AMD; further information is available at http://www.nei.nih.gov/areds2.
Cognitive decline
The brain has a high oxygen consumption rate and abundant polyunsaturated fatty acids in the neuronal cell membranes. Researchers hypothesize that if cumulative free-radical damage to neurons over time contributes to cognitive decline and neurodegenerative diseases, such as Alzheimer's disease, then ingestion of sufficient or supplemental antioxidants (such as vitamin E) might provide some protection. This hypothesis was supported by the results of a clinical trial in 341 patients with Alzheimer's disease of moderate severity who were randomly assigned to receive a placebo, vitamin E (2,000 IU/day dl-alpha-tocopherol), a monoamine oxidase inhibitor (selegiline), or vitamin E and selegiline. Over 2 years, treatment with vitamin E and selegiline, separately or together, significantly delayed functional deterioration and the need for institutionalization compared to placebo. However, participants taking vitamin E experienced significantly more falls.
Vitamin E consumption from foods or supplements was associated with less cognitive decline over 3 years in a prospective cohort study of elderly, free-living individuals aged 65-102 years. However, a clinical trial in primarily healthy older women who were randomly assigned to receive 600 IU d-alpha-tocopherol every other day or a placebo for ≤4 years found that the supplements provided no apparent cognitive benefits. Another trial in which 769 men and women with mild cognitive impairment were randomly assigned to receive 2,000 IU/day vitamin E (type not specified), a cholinesterase inhibitor (donepezil), or placebo found no significant differences in the progression rate of Alzheimer’s disease between the vitamin E and placebo groups.
In summary, most research results do not support the use of vitamin E supplements by healthy or mildly impaired individuals to maintain cognitive performance or slow its decline with normal aging. More research is needed to identify the role of vitamin E, if any, in the management of cognitive impairment.
The FNB has established ULs for vitamin E based on the potential for hemorrhagic effects (see Table 3). The ULs apply to all forms of supplemental alpha-tocopherol, including the eight stereoisomers present in synthetic vitamin E. Doses of up to 1,000 mg/day (1,500 IU/day of the natural form or 1,100 IU/day of the synthetic form) in adults appear to be safe, although the data are limited and based on small groups of people taking at least 2,000 IU for a few weeks or months. Long-term intakes above the UL increase the risk of adverse health effects. Vitamin E ULs for infants have not been established.
Table 3: Tolerable Upper Intake Levels (ULs) for Vitamin E
Note: I, myself, do not exceed 400 IU per day. This chart was provided as an informational source, not a recommendation.
Vitamin E supplements have the potential to interact with several types of medications. A few examples are provided below. People taking these and other medications on a regular basis should discuss their vitamin E intakes with their healthcare providers.
Anticoagulant and antiplatelet medications
Vitamin E can inhibit platelet aggregation and antagonize vitamin K-dependent clotting factors. As a result, taking large doses with anticoagulant or antiplatelet medications, such as warfarin (Coumadin®), can increase the risk of bleeding, especially in conjunction with low vitamin K intake. The amounts of supplemental vitamin E needed to produce clinically significant effects are unknown but probably exceed 400 IU/day.
Simvastatin and niacin
Some people take vitamin E supplements with other antioxidants, such as vitamin C, selenium, and beta-carotene. This collection of antioxidant ingredients stunted the rise in high-density lipoprotein (HDL) cholesterol levels, especially levels of HDL2, the most cardioprotective HDL component, among people treated with a combination of simvastatin (brand name Zocor®) and niacin.
Chemotherapy and radiotherapy
Oncologists generally advise against the use of antioxidant supplements during cancer chemotherapy or radiotherapy because they might reduce the effectiveness of these therapies by inhibiting cellular oxidative damage in cancerous cells. Although a systematic review of randomized controlled trials has called this concern into question, further research is needed to evaluate the potential risks and benefits of concurrent antioxidant supplementation with conventional therapies for cancer.
Sources: Institute of Medicine, Food and Nutrition Board; Office of Dietary Supplements, Dept of Human Nutrition at Ohio State University; http://www.nei.nih.gov/amd; and various medical journals.
Lots of information here, make several visits to be able to get the benefit of this article. Forgive any repeats within article as I have used several different sources to compile. Use labels for faster searches.
Why do we need vitamin E?
Vitamin E, the most effective fat-soluble vitamin, is an antioxidant vitamin involved in the metabolism of all cells. It protects vitamin A and essential fatty acids from oxidation in the body cells and prevents breakdown of body tissues.Vitamin E helps maintain a healthy immune system, supports prostate health, promotes circulatory and metabolic function, and nutritionally supports cardiovascular health and healthy blood vessels.
At present, the vitamin E content of foods and dietary supplements is listed on labels in international units (IUs), a measure of biological activity rather than quantity. Naturally sourced vitamin E is called d-alpha-tocopherol; the synthetically produced form is dl-alpha-tocopherol. Conversion rules are:
- To convert from mg to IU: 1 mg of alpha-tocopherol is equivalent to 1.49 IU of the natural form or 2.22 IU of the synthetic form.
- To convert from IU to mg: 1 IU of alpha-tocopherol is equivalent to 0.67 mg of the natural form or 0.45 mg of the synthetic form.
Do we get enough vitamin E?
According to recent surveys of the U.S. Department of Agriculture (USDA), the intake of vitamin E by women 19-50 years of age averages less than 90 percent of the RDA. Americans consume roughly 7-9 milligrams compared to the recommended 15 milligrams. Generally Americans consume two-thirds of their vitamin E intake from salad oils, shortenings, and margarines. Eleven percent is from fruits and vegetables and the other 7 percent is from grains and grain products.
How can we get enough vitamin E?
Eating a variety of foods that contain vitamin E is the best way to get an adequate amount. Healthy individuals who eat a balanced diet rarely need supplements. My diet is rarely balanced, so I supplement as my choice. Since vitamin E is a fat-soluble vitamin, people on low-fat diets can have trouble getting enough of the vitamin. Therefore, dietary fat should be monitored and not reach below safe limits.
How to prepare foods to retain vitamin E.
Vitamin E can be lost from foods during preparation, cooking, or storage. To retain vitamin E:
- Use whole-grain flours.
- Store foods in airtight containers and avoid exposing them to light.
What about fortified foods?
Most ready-to-eat cereals are fortified with vitamin E. Fortified ready-to-eat cereals usually contain at least 40% of the U.S. RDA for vitamin E.
What is a serving?
The amount of a nutrient in a serving depends on the weight of the serving. For example, 1/2 cup canned fruit contains more vitamin E than 1/2 cup of the same fruit served raw, because a serving of the canned fruit weighs more. Therefore, the canned fruit may appear on the list while the raw form does not. The raw fruit provides the nutrient --but just not enough in a 1/2-cup serving to be considered a good source.
The benefits of vitamin e for the overall good health of individuals are substantial. In particular, vitamin e is very important in healthy and proper skin care.
Benefits of Vitamin E for Skin
In terms of skin health and skin care, vitamin E benefits are numerous. In fact, skin care products that contain vitamin E have become an essential part of healthy skin care.
Antioxidant
First of all, because of its antioxidant activity, vitamin E is vital in protecting skin cells from ultra violet light, pollution, drugs, and other elements that produce cell damaging free radicals. It is believed that vitamin E is most effective in its natural form rather than its acetate form where it is a less effective antioxidant. Watch for this in the labelling of skin care products.
Regulator for Vitamin A
The benefits of vitamin E for healthy skin care also include its ability to regulate vitamin A in the body, which itself is important for healthy skin.
Anti-Aging Benefits of Vitamin E
Vitamin E added to lotions, creams, and other skin care products, as well as taken orally, plays a role in the anti-aging of skin. It helps skin look younger by reducing the appearance of fine lines and wrinkles. Also, free radicals are believed to play an important role in skin aging and therefore the antioxidant activity is quite valuable for this skin problem.
Sun Protection and Sun Burn Treatment
Vitamin E lotions provide some benefit in preventing and treating sunburns. These lotions protect the epidermis layer of the skin from early stages of ultra violet light damage. Vitamin E preparations also increase the effectiveness of sunscreens. Such lotions do not work immediately. They must be applied about 20 minutes before sun exposure in order to allow the vitamin E to be absorbed deep into the epidermis layer.
Treatment of Skin Diseases
Vitamin E can aid in the treatment of various skin diseases or skin conditions. Topical applications such as those used to treat psoriasis is one of the benefits of Vitamin E. Orally ingested vitamin E can help treat erythema (a skin inflammation that results in reddish, painful, and tender lumps).
Treatment of Scars
This is one of the more controversial benefits of vitamin E. Initially, it was thought that vitamin E was very beneficial in the prevention and treatment of scarring (acne scars or surgical scars) and healing of skin from various forms of damage such as burns. Some recent research has questioned this benefit of vitamin E. In fact some studies have indicated that vitamin E creams do not help prevent surgical scarring and may actually make the scar look worse. This is in opposition to the experience of a number of individuals that claim vitamin E creams help soften the appearance of scars.
Skin Cancer
One of the most important benefits of vitamin E is the prevention of skin cancer. This occurs because of its sun protection quality and of course its powerful antioxidant properties, which help reduce or prevent sun damage.
There are a variety of other benefits of vitamin E for skin care:
- vitamin E products help reduce the appearance of stretch marks
- vitamin E can help prevent the appearance of age spots
- it helps maintain the skin’s oil balance during the cleansing process
- it reduces transepidermal water loss from skin and strengthens the skin’s barrier function
Overall for skin care, more benefit is obtained from topical application of vitamin E through creams or lotions rather than taking vitamin E orally. Skin is able to absorb natural vitamin E effectively. However, taking vitamin E orally is important for the good health of other areas of the body.
The recommended skin lotions and creams by many experts are those that contain the alcohol form of vitamin E (alpha-tocopherol) instead of the acetate form (alpha-tocopherol acetate). The acetate form does not penetrate the skin’s surface well and provides less of the benefits of vitamin E such as antioxidant activity for the skin.
Why is vitamin E important for good health?
Here's what you need to know.
There are several benefits of vitamin E for your body. Some preliminary studies involving intakes of vitamin E higher than the daily-recommended requirement have shown that vitamin E may be useful in treating or possibly preventing:
- menstrual pain - I swore by Vitamin E for this.
- low sperm count
- inflammation of eye tissues
- cataracts
- restless leg syndrome or relief from muscle cramping - one of the reasons I take it.
- Alzheimer’s disease
- Parkinson’s disease
- rheumatoid arthritis - one of the reasons I take it.
- asthma
- various diabetes related complications and maybe helpful in treating and preventing diabetes itself
- cardiovascular disease
- prostate cancer and breast cancer
Benefits of vitamin E also include helping the body increase and regulate the levels of vitamin E in the body and as a general immune system booster, especially in older adults. Topical vitamin E might also promote good blood circulation and prevent the formation of blood clots, especially in people with diabetes.
The problem is that although it is agreed that vitamin E is a very useful and essential vitamin for humans (especially for its antioxidant activity), many of the stated benefits of vitamin E are anecdotal. There are few in depth studies available to verify some of the benefits of vitamin E claims that are being made. However, there are numerous informal reports of individuals insisting significant health benefits with increased levels of vitamin E. Further scientific study will help to target specifically whether vitamin E truly does play a role in treating or preventing the conditions mentioned above.
Natural (alpha-tocopherol) vs. Synthetic (DL or d alpha-tocopherol)Vitamin EHere's what you need to know:
Supplements of vitamin E typically provide only alpha-tocopherol, although "mixed" products containing other tocopherols and even tocotrienols are available. Naturally occurring alpha-tocopherol exists in one stereoisomeric form. In contrast, synthetically produced alpha-tocopherol contains equal amounts of its eight possible stereoisomers; serum and tissues maintain only four of these stereoisomers. A given amount of synthetic alpha-tocopherol (listed on labels as "DL" or "d") is therefore only half as active as the same amount (by weight in mg) of the natural form (labeled as "D" or "d"). People need approximately 50% more IU of synthetic alpha tocopherol from dietary supplements and fortified foods to obtain the same amount of the nutrient as from the natural form.
Most vitamin-E-only supplements provide ≥100 IU of the nutrient. These amounts are substantially higher than the RDAs. The 1999-2000 National Health and Nutrition Examination Survey (NHANES) found that 11.3% of adults took vitamin E supplements containing at least 400 IU.
Alpha-tocopherol in dietary supplements and fortified foods is often esterified to prolong its shelf life while protecting its antioxidant properties. The body hydrolyzes and absorbs these esters (alpha-tocopheryl acetate and succinate) as efficiently as alpha-tocopherol.
Vitamin E and Healthful Diets
According to the 2005 Dietary Guidelines for Americans, "nutrient needs should be met primarily through consuming foods. Foods provide an array of nutrients and other compounds that may have beneficial effects on health. In certain cases, fortified foods and dietary supplements may be useful sources of one or more nutrients that otherwise might be consumed in less than recommended amounts. However, dietary supplements, while recommended in some cases, cannot replace a healthful diet."The Dietary Guidelines for Americans describes a healthy diet as one that:
- Emphasizes a variety of fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products.
- Vitamin E is found in green leafy vegetables, whole grains, and fortified cereals.
- Includes lean meats, poultry, fish, beans, eggs, and nuts.
- Nuts are good sources of vitamin E.
- Is low in saturated fats, trans fats, cholesterol, salt (sodium), and added sugars.
- Vitamin E is commonly found in vegetable oils.
- Stays within your daily calorie needs.
Vitamin E Deficiency
Frankly, vitamin E deficiency is rare and overt deficiency symptoms have not been found in healthy people who obtain little vitamin E from their diets. Premature babies of very low birth weight (<1,500 style="font-weight: bold;">requires fat to absorb vitamin E, people with fat-malabsorption disorders are more likely to become deficient than people without such disorders. Deficiency symptoms include peripheral neuropathy, ataxia, skeletal myopathy, retinopathy, and impairment of the immune response. People with Crohn’s disease, cystic fibrosis, or an inability to secrete bile from the liver into the digestive tract, for example, often pass greasy stools or have chronic diarrhea; as a result, they sometimes require water-soluble forms of vitamin E, such as tocopheryl polyethylene glycol-1000 succinate.Some people with abetalipoproteinemia, a rare inherited disorder resulting in poor absorption of dietary fat, require enormous doses of supplemental vitamin E (approximately 100 mg/kg or 5-10 g/day). Vitamin E deficiency secondary to abetalipoproteinemia causes such problems as poor transmission of nerve impulses, muscle weakness, and retinal degeneration that leads to blindness. Ataxia and vitamin E deficiency (AVED) is another rare, inherited disorder in which the liver’s alpha-tocopherol transfer protein is defective or absent. People with AVED have such severe vitamin E deficiency that they develop nerve damage and lose the ability to walk unless they take large doses of supplemental vitamin E.
Vitamin E and Health
Many claims have been made about vitamin E’s potential to promote health and prevent and treat disease. Vitamin E is an antioxidant and has roles in anti-inflammatory processes, inhibition of platelet aggregation, and immune enhancement.Age-related macular degeneration (AMD) and cataracts are among the most common causes of significant vision loss in older people. Their etiologies are usually unknown, but the cumulative effects of oxidative stress have been postulated to play a role. If so, nutrients with antioxidant functions, such as vitamin E, could be used to prevent or treat these conditions.
Prospective cohort studies have found that people with relatively high dietary intakes of vitamin E (e.g., 30 IU/day) have an approximately 20% lower risk of developing AMD than people with low intakes (e.g., <15 style="font-weight: bold;">d-alpha-tocopherol in one study and 111 IU/day dl-alpha-tocopheryl acetate combined with 20 mg/day beta-carotene in the other or a placebo failed to show a protective effect for vitamin E on AMD. The Age-Related Eye Disease Study (AREDS), a large randomized clinical trial, revealed that participants with early-stage AMD could slow the progression of their disease by taking a daily supplement of vitamin E (400 IU dl-alpha-tocopheryl acetate), vitamin C (500 mg), beta-carotene (15 mg), zinc (80 mg), and copper (2 mg) for an average of 6.3 years compared to participants taking a placebo.
Several observational studies have revealed a potential relationship between vitamin E supplements and the risk of cataract formation. One prospective cohort study found that lens clarity was superior in participants who took vitamin E supplements and those with higher blood levels of the vitamin. In another study, long-term use of vitamin E supplements was associated with slower progression of age-related lens opacification. However, in the randomized AREDS study, the use of the vitamin E-containing supplement package had no apparent effect on the development or progression of cataracts over 7 years.
Overall, the available evidence is inconsistent with respect to whether vitamin E supplements, taken alone or in combination with other antioxidants, can reduce the risk of developing AMD or cataracts. However, the formulation of vitamin E, other antioxidants, zinc, and copper used in AREDS holds promise for slowing the progression of AMD in people with early-stage disease. Additional information about the dietary supplements used in AREDS is available at http://www.nei.nih.gov/amd. AREDS 2, a followup study, will determine whether a modified combination of dietary supplements can further slow the progression of vision loss from AMD; further information is available at http://www.nei.nih.gov/areds2.
Cognitive decline
The brain has a high oxygen consumption rate and abundant polyunsaturated fatty acids in the neuronal cell membranes. Researchers hypothesize that if cumulative free-radical damage to neurons over time contributes to cognitive decline and neurodegenerative diseases, such as Alzheimer's disease, then ingestion of sufficient or supplemental antioxidants (such as vitamin E) might provide some protection. This hypothesis was supported by the results of a clinical trial in 341 patients with Alzheimer's disease of moderate severity who were randomly assigned to receive a placebo, vitamin E (2,000 IU/day dl-alpha-tocopherol), a monoamine oxidase inhibitor (selegiline), or vitamin E and selegiline. Over 2 years, treatment with vitamin E and selegiline, separately or together, significantly delayed functional deterioration and the need for institutionalization compared to placebo. However, participants taking vitamin E experienced significantly more falls.
Vitamin E consumption from foods or supplements was associated with less cognitive decline over 3 years in a prospective cohort study of elderly, free-living individuals aged 65-102 years. However, a clinical trial in primarily healthy older women who were randomly assigned to receive 600 IU d-alpha-tocopherol every other day or a placebo for ≤4 years found that the supplements provided no apparent cognitive benefits. Another trial in which 769 men and women with mild cognitive impairment were randomly assigned to receive 2,000 IU/day vitamin E (type not specified), a cholinesterase inhibitor (donepezil), or placebo found no significant differences in the progression rate of Alzheimer’s disease between the vitamin E and placebo groups.
In summary, most research results do not support the use of vitamin E supplements by healthy or mildly impaired individuals to maintain cognitive performance or slow its decline with normal aging. More research is needed to identify the role of vitamin E, if any, in the management of cognitive impairment.
Health Risks from Excessive Vitamin E
Research has not found any adverse effects from consuming vitamin E in food. However, high doses of alpha-tocopherol supplements can cause hemorrhage and interrupt blood coagulation in animals, and in vitro data suggest that high doses inhibit platelet aggregation. Two clinical trials have found an increased risk of hemorrhagic stroke in participants taking alpha-tocopherol; one trial included Finnish male smokers who consumed 50 mg/day for an average of 6 years and the other trial involved a large group of male physicians in the United States who consumed 400 IU every other day for 8 years. Because the majority of physicians in the latter study were also taking aspirin, this finding could indicate that vitamin E has a tendency to cause bleeding.The FNB has established ULs for vitamin E based on the potential for hemorrhagic effects (see Table 3). The ULs apply to all forms of supplemental alpha-tocopherol, including the eight stereoisomers present in synthetic vitamin E. Doses of up to 1,000 mg/day (1,500 IU/day of the natural form or 1,100 IU/day of the synthetic form) in adults appear to be safe, although the data are limited and based on small groups of people taking at least 2,000 IU for a few weeks or months. Long-term intakes above the UL increase the risk of adverse health effects. Vitamin E ULs for infants have not been established.
Table 3: Tolerable Upper Intake Levels (ULs) for Vitamin E
| Age | Male | Female | Pregnancy | Lactation |
|---|---|---|---|---|
| 1-3 years | 200 mg (300 IU) | 200 mg (300 IU) | ||
| 4-8 years | 300 mg (450 IU) | 300 mg (450 IU) | ||
| 9-13 years | 600 mg (900 IU) | 600 mg (900 IU) | ||
| 14-18 years | 800 mg (1,200 IU) | 800 mg (1,200 IU) | 800 mg (1,200 IU) | 800 mg (1,200 IU) |
| 19+ years | 1,000 mg (1,500 IU) | 1,000 mg (1,500 IU) | 1,000 mg (1,500 IU) | 1,000 mg (1,500 IU) |
Note: I, myself, do not exceed 400 IU per day. This chart was provided as an informational source, not a recommendation.
Interactions with Medications: Important Info
Here's what you need to know:Vitamin E supplements have the potential to interact with several types of medications. A few examples are provided below. People taking these and other medications on a regular basis should discuss their vitamin E intakes with their healthcare providers.
Anticoagulant and antiplatelet medications
Vitamin E can inhibit platelet aggregation and antagonize vitamin K-dependent clotting factors. As a result, taking large doses with anticoagulant or antiplatelet medications, such as warfarin (Coumadin®), can increase the risk of bleeding, especially in conjunction with low vitamin K intake. The amounts of supplemental vitamin E needed to produce clinically significant effects are unknown but probably exceed 400 IU/day.
Simvastatin and niacin
Some people take vitamin E supplements with other antioxidants, such as vitamin C, selenium, and beta-carotene. This collection of antioxidant ingredients stunted the rise in high-density lipoprotein (HDL) cholesterol levels, especially levels of HDL2, the most cardioprotective HDL component, among people treated with a combination of simvastatin (brand name Zocor®) and niacin.
Chemotherapy and radiotherapy
Oncologists generally advise against the use of antioxidant supplements during cancer chemotherapy or radiotherapy because they might reduce the effectiveness of these therapies by inhibiting cellular oxidative damage in cancerous cells. Although a systematic review of randomized controlled trials has called this concern into question, further research is needed to evaluate the potential risks and benefits of concurrent antioxidant supplementation with conventional therapies for cancer.
Sources: Institute of Medicine, Food and Nutrition Board; Office of Dietary Supplements, Dept of Human Nutrition at Ohio State University; http://www.nei.nih.gov/amd; and various medical journals.
Tuesday, June 16, 2009
4. Alpha Lipoic Acid (ALA) 06/16/09
Alpha-Lipoic Acid (ALA) is known as the Universal Antioxidant. It is the antioxidant with metabolic function and fights against cell-damaging free radicals. ALA serves a variety of important functions in the body, including helping to metabolize sugar, especially in muscles where it promotes energy.
ALA is a free radical scavenger and has been shown to be a recycler of antioxidants in the body. Antioxidants, in general, are important for the support of health throughout the body, including immune, nerve, and heart health. Alpha lipoic acid is a fatty acid found naturally inside every cell in the body. It's needed by the body to produce the energy for our body's normal functions. Alpha lipoic acid converts glucose (blood sugar) into energy.
What are free radicals? Use as a dietary supplement: Here's what you need to know:
ALA is a free radical scavenger and has been shown to be a recycler of antioxidants in the body. Antioxidants, in general, are important for the support of health throughout the body, including immune, nerve, and heart health. Alpha lipoic acid is a fatty acid found naturally inside every cell in the body. It's needed by the body to produce the energy for our body's normal functions. Alpha lipoic acid converts glucose (blood sugar) into energy.
What are free radicals?
Free radicals are organic molecules responsible for aging tissue damage, and possibly some diseases. These molecules are very unstable, therefore they look to bond with other molecules, destroying their vigor and perpetuating the detrimental process. Antioxidants, present in many foods, are molecules that prevent free radicals from harming healthy tissue.
Free radicals are "free" because they float around until they stabilize, and "radical" in the sense that there are a wide variety of molecules from which they can take an electron. However, the damage doesn't stop there, as the new molecule, say a piece of a cell wall, is now also missing an electron and has become another free radical. This snowball effect can wreak havoc on healthy tissue.
Antidotes to the voracious electron appetite of free radicals are antioxidants. Antioxidants are found in fresh foods like vegetables and fruits, particularly in Vitamin A, Vitamin E, and beta-carotene. These amazing molecules act like a giant boulder in the path of the snowball, stopping free radicals from causing untold damage. It's better to get antioxidants from a balanced diet, rather than vitamin supplements because our body can more easily absorb them.
Some processes brought about by free radicals are inevitable, such as aging, but others can be prevented, like destruction of DNA or clogging of arteries. Free radicals are creation by environmental pollution, cigarette smoking, and poisons like cleaners and pesticides. Their role in certain types of cancer, strokes, and heart disease is still being investigated. Preliminarily, low concentrations of free radicals have been associated with a reduced risk for heart disease and stroke, but more studies are needed to understand their relationship.
Since the early 1990s lipoic acid has been consumed as a dietary supplement, typical RDA doses are 100–200 mg/day. A chronic/carcinogenicity study in rats reported that racemic lipoic acid was found to be non-carcinogenic and did not show any evidence of target organ toxicity.
As an Antioxidant
Lipoic acid was first postulated to be an effective antioxidant when it was found it prevented the symptoms of Vitamin C and Vitamin E deficiency. Dihydrolipoic acid (DHA) is able to regenerate (reduce) antioxidants, such as glutathione, vitamin C and vitamin E. In cells, lipoic acid can theoretically be reduced to DHA, though significant quantities of DHA derived from orally-ingested lipoic acid have never been demonstrated. Recent findings suggest that lipoic acid's curative effects are due to modulation of regulation in eukaryotes. This likely occurs due to lipoic acid acting as an oxidant, not a reductant.
Disease Treatment
Lipoic acid has been shown in cell culture experiments to increase cellular uptake of glucose by suggesting its use in diabetes, although these findings are controversial as lipoic acid worsened the condition of type 1 diabetes induced rats. Studies of rat aging have suggested that the use of Acetyl-L-carnitine and lipoic acid results in improved memory performance and delayed structural mitrochondrial decay. As a result, it may be helpful for people with Alzheimer's disease or Parkinson's disease. In 2009 a study found that it reduced triglycerides in mice.
Alpha lipoic acid is a powerful antioxidant that may help with peripheral neuropathy, memory, and mental problems.
ALA has been used for the treatment of various cancers for which no effective treatments exist.
Monday, June 15, 2009
3. Vitamins, Minerals, Supplements, Diet - Oh My!! 6/15/09
WHY ARE VITAMINS AND MINERALS IMPORTANT?
Vitamins and minerals are sometimes called micronutrients. Our bodies need them, in small amounts, to support the chemical reactions our cells need to live. Different nutrients affect digestion, the nervous system, thinking, and other body processes.
Micronutrients can be found in many foods. Healthy people might be able to get enough vitamins and minerals from their food. People with immune diseases and other illnesses need more micronutrients to help repair and heal cells. Also, many medications can create shortages of different nutrients.
Some molecules in the body are in a form called oxidized. These molecules are also called free radicals. They react very easily with other molecules, and can damage cells. High levels of free radicals cause a lot of the damage associated with aging.
Free radicals are produced as part of normal body chemistry. Antioxidants are molecules that can stop free radicals from reacting with other molecules. This limits the damage they do. Several nutrients are antioxidants.
Antioxidants are important for people with immune disorders, because it leads to higher levels of free radicals. Higher levels of antioxidants can slow down the damage of free radicals and help repair some of the damage it does.
You might think that all you have to do to get enough vitamins and minerals is to take a “one-a-day” multivitamin pill. Unfortunately, it’s not that easy. The amounts of micronutrients in many of these pills are based on the Recommended Dietary Allowances (RDAs) set by the US government.
The problem with the RDAs is that they do not list the amounts of micronutrients that are needed. Instead, they are the minimum amounts needed to prevent shortages in healthy people. Immune diseases and many medications can use up some nutrients. A high potency multivitamin is a good way to get basic micronutrients.
WHICH NUTRIENTS ARE IMPORTANT?
There has not been a lot of research on specific nutrients and compromised immune systems. Many nutrients interact with each other. Most nutritionists believe in designing an overall program of supplements.
People with compromised immune systems may benefit from taking supplements of the following vitamins and minerals:
- B Vitamins: Vitamin B-1 (Thiamine), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin B12 (Cobalamin), and Folate (Folic Acid).
- Antioxidants, including beta-carotene (the body breaks down beta-carotene to make Vitamin A), selenium, Vitamin E (Tocopherol), and Vitamin C
- Magnesium and Zinc
WHAT ABOUT OTHER SUPPLEMENTS? Here's what you need to know:
In addition to vitamins and minerals, some nutritionists suggest that people with compromised immune systems take supplements of other nutrients:
- Acidophilus, a bacterium that grows naturally in the intestines, helps with digestion.
- Alpha-lipoic acid is a powerful antioxidant that may help with neuropathy and mental problems.
- Carnitine (also called acetyl-L-carnitine) may help prevent wasting and provide other immunologic and metabolic benefits,
- Coenzyme Q10 may help with immune function.
- Essential fatty acids found in evening primrose oil or flaxseed oil can help with dry skin and scalp.
- N-Acetyl-Cysteine, an antioxidant, can help maintain body levels of glutathione. Glutathione is one of the body’s main antioxidants.
- Omega 3 fatty acids can help decrease triglycerides
- Niacin can help increase good cholesterol and decrease bad cholesterol
Most vitamins and nutrients appear to be safe as supplements, even at levels higher than the Recommended Dietary Allowances (RDAs). However, some can cause problems at higher doses, including Vitamin A, Vitamin D, copper, iron, niacin, selenium, and zinc.
A basic program of vitamin and mineral supplementation should be safe. This would include the following, all taken according to directions on the bottle:
- A multiple vitamin/mineral (without extra iron),
- An antioxidant supplement with several different ingredients, and
- A trace element supplement. There are seven essential trace elements: chromium, copper, cobalt, iodine, iron, selenium, and zinc. Some multivitamins also include trace elements.
Any other program of supplements should be based on discussion with a doctor or nutritionist. Remember that higher price may not mean better quality.
I will be discussing dosages in next postings.
2. Cholesterol and Calories! 6/15/09
I thought it might be of interest to some of you to know what the cholesterol and calorie count is in some of the foods that might be on your diet.
Since I don't eat beef, but maybe you do, I have included it below. Here's what you need to know.....Remember your total intake of cholesterol PER DAY is 300mg and your calorie count should be 2500 calories per day to maintain fitness. (Check out the Fast Food calories below!!! Count up what a normal meal would be for you!)
Beef
3 1/2 oz. pot roast, braised - 101 mg Chol, 231 cal
1 medium hamburger, extra lean, 3 1/2 oz broiled - 84 mg Chol, 256 cal
3 1/2 oz. fried liver - 482 mg Chol, 217 cal
3 1/2 oz. broiled T-Bone Steak - 80 mg Chol, 214 cal
Pork
2 slices lean bacon - 11 mg Chol, 73 cal
3 1/2 oz. boneless smoked ham - 58 mg Chol, 175 cal
3 1/2 oz. lean spare ribs, braised - 121 mg Chol, 398 cal
3 1/2 oz. pork loin, roasted - 91 mg Chol, 240 cal
Chicken
3 1/2 oz. Broilers, fryers, batter dipped w/skin -87 mg, 289 cal
3 1/2 oz. Stewed chicken, breast meat w/skin - 78 mg Chol, 219 cal
1/2 chicken breast, batter dipped - 119 mg Chol, 364 cal
1 drumstick w/skin, fried batter dipped - 62 mg Chol, 193 cal
Turkey
3 1/2 oz. white or dark meat w/skin, roasted - 82 mg Chol, 208 cal
3 1/2 oz. Breast w/skin, roasted - 74 mg Chol, 189 cal
3 1/2 oz. Leg, w/ skin, roasted - 87 mg Chol, 207 cal
Fish
1/2 cup Tuna, chunk light, in water - 37 mg Chol, 100 cal
3 1/2 oz. Shrimp, french fried - 120 mg Chol, 225 cal
3 1/2 oz. canned Salmon, sockeye (red) - 36 mg Chol, 171 cal
3 1/2 oz. canned Shrimp, washed and drained - 150 mg Chol, 80 cal
3 1/2 oz. canned Crab - 86 mg Chol, 86 cal
3 1/2 oz. cooked Lobster - 92 mg Chol, 92 cal
Sandwich meats
2 oz. beef bologna - 33 mg Chol, 176 cal
2 oz. corned beef - 55 mg Chol, 142 cal
2 oz. hard salami - 40 mg Chol, 240 cal
2 oz. turkey breast - 20 mg Chol, 60 cal
2 oz. lean ham - 27 mg Chol, 67 cal
Cheeses
1 oz. mozzarella - 22 mg Chol, 80 cal
1 oz. american - 18 mg Chol, 93 cal
1 oz. swiss - 26 mg Chol, 107 cal
1 oz. cheddar - 30 mg Chol, 114 cal
1 oz. Velveeta - 20 mg Chol, 80 cal
1 tablespoon grated parmesan - 4 mg Chol, 33 cal
Eggs - 1 large
boiled - 274 mg Chol, 79 cal
fried, w/ Pam spray - 246 mg Chol, 83 cal
poached - 273 mg Chol, 79 cal
egg yolk only - 272 mg Chol, 63 cal
egg white only - 0 mg Chol, 16 cal
Milk
1 cup 2% lowfat - 18 mg Chol, 121 cal
1 cup whole milk - 33 mg Chol, 150 cal
1/2 cup half & half - 45 mg Chol, 158 cal
1/2 cup sour cream - 51 mg Chol, 247 cal
1/2 cup heavy whipping cream - 163 mg Chol, 411 cal
Fats & Oils - all 1 tablespoon
butter - 36 mg Chol, 123 cal
margarine - 0 mg Chol, 100 cal - see individual labels
lard - 12 mg Chol, 116 cal
shortening - 0 mg Chol, 106 cal
vegetable oils - 0 mg Chol, 120 cal - see individual labels
Ice Cream - all 1/2 cup - check individual labels
vanilla - 10% fat - 30 mg Chol, 135 cal
ice milk - vanilla - 10 mg Chol, 90 cal
sherbet - orange - 7 mg Chol, 135 cal
Cakes (homemade only) -1/12 slice - see individual labels
angel food - 0 mg Chol, 161 cal
chocolate - 43 mg Chol, 227 cal
sponge cake - 162 mg Chol, 195 cal
yellow cake - 33 mg Chol, 275 cal
Snack Cakes
1 Twinkie - 20 mg Chol, 160 cal
1 Ho-Ho - 13 mg Chol, 120 cal
1 Hostess Chocolate cupcake - 3 mg Chol, 170 cal
Fast Food
1 Whopper - made per menu - 94 mg Chol, 626 cal
2 1/2 oz. regular French Fries - 2.4 mg Chol, 227 cal
1 Big Mac - made per menu - 83 mg Chol, 253 cal
2 slices Domino's Pepperoni pizza - 60 mg Chol, 440 cal
13.5 oz. Banana Split - 30 mg Chol, 540 cal
10.2 oz. Chocolate Milk Shake - 30 mg Chol, 383 cal
Remember - eat heart healthy
Since I don't eat beef, but maybe you do, I have included it below. Here's what you need to know.....Remember your total intake of cholesterol PER DAY is 300mg and your calorie count should be 2500 calories per day to maintain fitness. (Check out the Fast Food calories below!!! Count up what a normal meal would be for you!)
Beef
3 1/2 oz. pot roast, braised - 101 mg Chol, 231 cal
1 medium hamburger, extra lean, 3 1/2 oz broiled - 84 mg Chol, 256 cal
3 1/2 oz. fried liver - 482 mg Chol, 217 cal
3 1/2 oz. broiled T-Bone Steak - 80 mg Chol, 214 cal
Pork
2 slices lean bacon - 11 mg Chol, 73 cal
3 1/2 oz. boneless smoked ham - 58 mg Chol, 175 cal
3 1/2 oz. lean spare ribs, braised - 121 mg Chol, 398 cal
3 1/2 oz. pork loin, roasted - 91 mg Chol, 240 cal
Chicken
3 1/2 oz. Broilers, fryers, batter dipped w/skin -87 mg, 289 cal
3 1/2 oz. Stewed chicken, breast meat w/skin - 78 mg Chol, 219 cal
1/2 chicken breast, batter dipped - 119 mg Chol, 364 cal
1 drumstick w/skin, fried batter dipped - 62 mg Chol, 193 cal
Turkey
3 1/2 oz. white or dark meat w/skin, roasted - 82 mg Chol, 208 cal
3 1/2 oz. Breast w/skin, roasted - 74 mg Chol, 189 cal
3 1/2 oz. Leg, w/ skin, roasted - 87 mg Chol, 207 cal
Fish
1/2 cup Tuna, chunk light, in water - 37 mg Chol, 100 cal
3 1/2 oz. Shrimp, french fried - 120 mg Chol, 225 cal
3 1/2 oz. canned Salmon, sockeye (red) - 36 mg Chol, 171 cal
3 1/2 oz. canned Shrimp, washed and drained - 150 mg Chol, 80 cal
3 1/2 oz. canned Crab - 86 mg Chol, 86 cal
3 1/2 oz. cooked Lobster - 92 mg Chol, 92 cal
Sandwich meats
2 oz. beef bologna - 33 mg Chol, 176 cal
2 oz. corned beef - 55 mg Chol, 142 cal
2 oz. hard salami - 40 mg Chol, 240 cal
2 oz. turkey breast - 20 mg Chol, 60 cal
2 oz. lean ham - 27 mg Chol, 67 cal
Cheeses
1 oz. mozzarella - 22 mg Chol, 80 cal
1 oz. american - 18 mg Chol, 93 cal
1 oz. swiss - 26 mg Chol, 107 cal
1 oz. cheddar - 30 mg Chol, 114 cal
1 oz. Velveeta - 20 mg Chol, 80 cal
1 tablespoon grated parmesan - 4 mg Chol, 33 cal
Eggs - 1 large
boiled - 274 mg Chol, 79 cal
fried, w/ Pam spray - 246 mg Chol, 83 cal
poached - 273 mg Chol, 79 cal
egg yolk only - 272 mg Chol, 63 cal
egg white only - 0 mg Chol, 16 cal
Milk
1 cup 2% lowfat - 18 mg Chol, 121 cal
1 cup whole milk - 33 mg Chol, 150 cal
1/2 cup half & half - 45 mg Chol, 158 cal
1/2 cup sour cream - 51 mg Chol, 247 cal
1/2 cup heavy whipping cream - 163 mg Chol, 411 cal
Fats & Oils - all 1 tablespoon
butter - 36 mg Chol, 123 cal
margarine - 0 mg Chol, 100 cal - see individual labels
lard - 12 mg Chol, 116 cal
shortening - 0 mg Chol, 106 cal
vegetable oils - 0 mg Chol, 120 cal - see individual labels
Ice Cream - all 1/2 cup - check individual labels
vanilla - 10% fat - 30 mg Chol, 135 cal
ice milk - vanilla - 10 mg Chol, 90 cal
sherbet - orange - 7 mg Chol, 135 cal
Cakes (homemade only) -1/12 slice - see individual labels
angel food - 0 mg Chol, 161 cal
chocolate - 43 mg Chol, 227 cal
sponge cake - 162 mg Chol, 195 cal
yellow cake - 33 mg Chol, 275 cal
Snack Cakes
1 Twinkie - 20 mg Chol, 160 cal
1 Ho-Ho - 13 mg Chol, 120 cal
1 Hostess Chocolate cupcake - 3 mg Chol, 170 cal
Fast Food
1 Whopper - made per menu - 94 mg Chol, 626 cal
2 1/2 oz. regular French Fries - 2.4 mg Chol, 227 cal
1 Big Mac - made per menu - 83 mg Chol, 253 cal
2 slices Domino's Pepperoni pizza - 60 mg Chol, 440 cal
13.5 oz. Banana Split - 30 mg Chol, 540 cal
10.2 oz. Chocolate Milk Shake - 30 mg Chol, 383 cal
Remember - eat heart healthy
1.Antioxidant - Selenium 6/15/09
Some bloggers have been wondering what vitamins do what to our bodies and which ones does our body actually need?
Over the next few weeks (posting every 3 days or so), I will be posting on a different supplement in detail. Today, the topic is Selenium. When I insert ***, it is to alert you to an important fact or a personal note.
***I take Selenium as part of my daily regimen because I have Crohn's Disease and Rheumatoid Arthritis . Also, Selenium is essential for anyone with gastrointestinal and/or stomach problems.
Selenium is a trace mineral that is essential to good health but required only in small amounts. Selenium has important antioxidant enzymes, helps prevent cellular damage from free radicals. Free radicals are natural by-products of oxygen metabolism that may contribute to the development of chronic diseases such as cancer and heart disease. ***Selenium also helps regulate thyroid function and plays a role in the immune system.
What foods provide selenium?
Plant foods are the major dietary sources of selenium in most countries throughout the world. The content of selenium in food depends on the selenium content of the soil where plants are grown or animals are raised. ***For example, researchers know that soils in the high plains of northern Nebraska and the Dakotas have very high levels of selenium. People living in those regions generally have the highest selenium intakes in the United States. In the U.S., food distribution patterns across the country help prevent people living in low-selenium geographic areas from having low dietary selenium intakes. ***Soils in some parts of China and Russia have very low amounts of selenium. Selenium deficiency is often reported in those regions because most food in those areas is grown and eaten locally.
***Selenium also can be found in some meats and seafood. Animals that eat grains or plants that were grown in selenium-rich soil have higher levels of selenium in their muscle. In the U.S., meats and bread are common sources of dietary selenium. Some nuts are also sources of selenium.
Selenium content of foods can vary. For example, Brazil nuts may contain as much as 544 micrograms of selenium per ounce. They also may contain far less selenium. It is wise to eat Brazil nuts only occasionally because of their unusually high intake of selenium. Selected food sources of selenium are provided below.
Here's what you need to know:
Recommendations for selenium are provided in the Dietary Reference Intakes developed by the Institute of Medicine. Dietary Reference Intakes (DRIs) is the general term for a set of reference values used for planning and assessing nutrient intake for healthy people.
Table 2: Recommended Dietary Allowances (RDA) for selenium for children and adults
There is insufficient information on selenium to establish a RDA for infants. For adults, 55mcg is the RDA, (the daily value is 70 mcg), although people with certain health issues will increase the dosage for therapeutic reasons.
Selected food sources of selenium
*DV = Daily Value.
DVs are reference numbers developed by the Food and Drug Administration (FDA) to help consumers determine if a food contains a lot or a little of a specific nutrient. The DV for selenium is 70 micrograms (mcg).
Baked Turkey
Most food labels do not list a food's selenium content. The percent DV (%DV) listed on the table indicates the percentage of the DV provided in one serving. A food providing 5% of the DV or less is a low source while a food that provides 10-19% of the DV is a good source. A food that provides 20% or more of the DV is high in that nutrient. It is important to remember that foods that provide lower percentages of the DV also contribute to a healthful diet.
Results of the National Health and Nutrition Examination Survey (1988-94) indicated that diets of most Americans provide recommended amounts of selenium. The INTERMAP study examined nutrient intakes of almost 5,000 middle-aged men and women in four countries in the late 1990s, including the U.S. The primary aim of the study was to evaluate the effect of dietary micronutrients on blood pressure. Each study participant completed four, 24-hour dietary recalls, during which they were asked to record everything consumed (food, beverages, and dietary supplements) over the previous 24 hours. Selenium intake was lowest among residents of China, the country with the highest known rate of selenium deficiency. Mean dietary intake of selenium of U.S. participants was 153 mcg for men and 109 mcg for women. Both values exceed the recommended selenium intake for adults and are further evidence of adequate selenium intakes in the U.S.
Three specific diseases have been associated with selenium deficiency:
Source: National Institute for Health
Over the next few weeks (posting every 3 days or so), I will be posting on a different supplement in detail. Today, the topic is Selenium. When I insert ***, it is to alert you to an important fact or a personal note.
***I take Selenium as part of my daily regimen because I have Crohn's Disease and Rheumatoid Arthritis . Also, Selenium is essential for anyone with gastrointestinal and/or stomach problems.
Selenium is a trace mineral that is essential to good health but required only in small amounts. Selenium has important antioxidant enzymes, helps prevent cellular damage from free radicals. Free radicals are natural by-products of oxygen metabolism that may contribute to the development of chronic diseases such as cancer and heart disease. ***Selenium also helps regulate thyroid function and plays a role in the immune system.
What foods provide selenium?
Plant foods are the major dietary sources of selenium in most countries throughout the world. The content of selenium in food depends on the selenium content of the soil where plants are grown or animals are raised. ***For example, researchers know that soils in the high plains of northern Nebraska and the Dakotas have very high levels of selenium. People living in those regions generally have the highest selenium intakes in the United States. In the U.S., food distribution patterns across the country help prevent people living in low-selenium geographic areas from having low dietary selenium intakes. ***Soils in some parts of China and Russia have very low amounts of selenium. Selenium deficiency is often reported in those regions because most food in those areas is grown and eaten locally.
***Selenium also can be found in some meats and seafood. Animals that eat grains or plants that were grown in selenium-rich soil have higher levels of selenium in their muscle. In the U.S., meats and bread are common sources of dietary selenium. Some nuts are also sources of selenium.
Selenium content of foods can vary. For example, Brazil nuts may contain as much as 544 micrograms of selenium per ounce. They also may contain far less selenium. It is wise to eat Brazil nuts only occasionally because of their unusually high intake of selenium. Selected food sources of selenium are provided below.
What is the recommended dietary intake for selenium?
Here's what you need to know:
Recommendations for selenium are provided in the Dietary Reference Intakes developed by the Institute of Medicine. Dietary Reference Intakes (DRIs) is the general term for a set of reference values used for planning and assessing nutrient intake for healthy people.
Table 2: Recommended Dietary Allowances (RDA) for selenium for children and adults
| Age (years) | Males and Females (mcg/day) | Pregnancy (mcg/day) | Lactation (mcg/day) |
|---|---|---|---|
| 1-3 y | 20 | N/A | N/A |
| 4-8 y | 30 | N/A | N/A |
| 9-13 y | 40 | N/A | N/A |
| 14-18 y | 55 | 60 | 70 |
| 19 y + | 55 | 60 | 70 |
There is insufficient information on selenium to establish a RDA for infants. For adults, 55mcg is the RDA, (the daily value is 70 mcg), although people with certain health issues will increase the dosage for therapeutic reasons.
Selected food sources of selenium
| Food | Micrograms (mcg) | Percent DV* |
|---|---|---|
| Brazil nuts, dried, unblanched, 1 ounce | 544 | 780 |
| Tuna, light, canned in water, drained, 3 ounces | 63 | 95 |
| Beef, cooked, 3½ ounces | 35 | 50 |
| Spaghetti w/ meat sauce, frozen entrée, 1 serving | 34 | 50 |
| Cod, cooked, 3 ounces | 32 | 45 |
| Turkey, light meat, roasted, 3½ ounces | 32 | 45 |
| Beef chuck roast, lean only, roasted, 3 ounces | 23 | 35 |
| Chicken Breast, meat only, roasted, 3½ ounces | 20 | 30 |
| Noodles, enriched, boiled, 1/2 cup | 17 | 25 |
| Macaroni, elbow, enriched, boiled, 1/2 cup | 15 | 20 |
| Egg, whole, 1 medium | 14 | 20 |
| Cottage cheese, low fat 2%, 1/2 cup | 12 | 15 |
| Oatmeal, instant, fortified, cooked, 1 cup | 12 | 15 |
| Rice, white, enriched, long grain, cooked, 1/2 cup | 12 | 15 |
| Rice, brown, long-grained, cooked, 1/2 cup | 10 | 15 |
| Bread, enriched, whole wheat, commercially prepared, 1 slice | 10 | 15 |
| Walnuts, black, dried, 1 ounce | 5 | 8 |
| Bread, enriched, white, commercially prepared, 1 slice | 4 | 6 |
| Cheddar cheese, 1 ounce | 4 | 6 |
*DV = Daily Value.
DVs are reference numbers developed by the Food and Drug Administration (FDA) to help consumers determine if a food contains a lot or a little of a specific nutrient. The DV for selenium is 70 micrograms (mcg).
Baked TurkeyMost food labels do not list a food's selenium content. The percent DV (%DV) listed on the table indicates the percentage of the DV provided in one serving. A food providing 5% of the DV or less is a low source while a food that provides 10-19% of the DV is a good source. A food that provides 20% or more of the DV is high in that nutrient. It is important to remember that foods that provide lower percentages of the DV also contribute to a healthful diet.
Results of the National Health and Nutrition Examination Survey (1988-94) indicated that diets of most Americans provide recommended amounts of selenium. The INTERMAP study examined nutrient intakes of almost 5,000 middle-aged men and women in four countries in the late 1990s, including the U.S. The primary aim of the study was to evaluate the effect of dietary micronutrients on blood pressure. Each study participant completed four, 24-hour dietary recalls, during which they were asked to record everything consumed (food, beverages, and dietary supplements) over the previous 24 hours. Selenium intake was lowest among residents of China, the country with the highest known rate of selenium deficiency. Mean dietary intake of selenium of U.S. participants was 153 mcg for men and 109 mcg for women. Both values exceed the recommended selenium intake for adults and are further evidence of adequate selenium intakes in the U.S.
When can selenium deficiency occur?
Human selenium deficiency is rare in the U.S. but is seen in other countries, most notably China, where soil concentration of selenium is low. There is evidence that selenium deficiency may contribute to development of a form of heart disease, hypothyroidism, and a weakened immune system. There is also evidence that selenium deficiency does not usually cause illness by itself. Rather, it can make the body more susceptible to illnesses caused by other nutritional, biochemical or infectious stresses.Three specific diseases have been associated with selenium deficiency:
Keshan disease was first described in the early 1930s in China, and is still seen in large areas of the Chinese countryside with selenium poor soil. Dietary intake in these areas is less than 19 micrograms per day for men and less than 13 micrograms per day for women, significantly lower than the current RDA for selenium. Researchers believe that selenium deficient people infected with a specific virus are most likely to develop Keshan disease. ***Selenium deficiency has also been seen in people who rely on total parenteral nutrition (TPN) as their sole source of nutrition. Tube feeding or TPN is a method of feeding nutrients through an intravenous (IV) line to people whose digestive systems do not function. Forms of nutrients that do not require digestion are dissolved in liquid and infused through the IV line. It is important for TPN solutions to provide selenium in order to prevent a deficiency. Physicians can monitor the selenium status of individuals receiving TPN to make sure they are receiving adequate amounts. ***Severe gastrointestinal disorders may decrease the absorption of selenium, resulting in selenium depletion or deficiency. Gastrointestinal problems that impair selenium absorption usually affect absorption of other nutrients as well, and require routine monitoring of nutritional status so that appropriate medical and nutritional treatment can be provided. Who may need supplemental selenium?***In the U.S., most cases of selenium depletion or deficiency are associated with severe gastrointestinal problems, such as Crohn's disease, or with surgical removal of part of the stomach. These and other gastrointestinal disorders can impair selenium absorption. ***People with acute severe illness who develop inflammation and widespread infection often have decreased levels of selenium in their blood. Physicians will evaluate individuals who have gastrointestinal disease or severe infection for depleted blood levels of selenium to determine the need for supplementation.***People with iodine deficiency may also benefit from selenium supplementation. Iodine deficiency is rare in the U.S., but is still common in developing countries where access to iodine is limited. Researchers believe that selenium deficiency may worsen the effects of iodine deficiency on thyroid function, and that adequate selenium nutritional status may help protect against some of the neurological effects of iodine deficiency. Researchers involved in the Supplementation en Vitamines et Mineraux AntioXydants (SU.VI.MAX) study in France, which was designed to assess the effect of vitamin and mineral supplements on chronic disease risk, evaluated the relationship between goiter and selenium in a subset of this research population. Their findings suggest that selenium supplements may be protective against goiter, which refers to enlargement of the thyroid gland. As noted above, selenium supplementation during TPN administration is now routine. While specific medical problems such as those described above indicate a need for selenium supplementation, evidence is lacking for recommending selenium supplements for healthy children and adults.  Selenium supplements Selenium occurs in staple foods such as corn, wheat, and soybeans. Selenium is also available in 'high selenium yeasts', which may contain as much as 1,000 to 2,000 micrograms of selenium per gram. Most of the selenium in these yeasts is in the form of selenomethionine. ***This form of selenium was used in the large scale cancer prevention trial in 1983, which demonstrated that taking a daily supplement containing 200 micrograms of selenium per day could lower the risk of developing prostate, lung, and colorectal cancer. However, some yeasts may contain inorganic forms of selenium, which are not utilized as well as selenomethionine. What are some current issues and controversies about selenium?Selenium and cancerObservational studies indicate that death from cancer, including lung, colorectal, and prostate cancers, is lower among people with higher blood levels or intake of selenium. In addition, the incidence of nonmelanoma skin cancer is significantly higher in areas of the United States with low soil selenium content. The effect of selenium supplementation on the recurrence of different types of skin cancers was studied in seven dermatology clinics in the U.S. from 1983 through the early 1990s. Research suggests that selenium affects cancer risk in two ways. As an anti-oxidant, selenium can help protect the body from damaging effects of free radicals. ***Selenium may also prevent or slow tumor growth. Certain breakdown products of selenium are believed to prevent tumor growth by enhancing immune cell activity and suppressing development of blood vessels to the tumor. However, not all studies have shown a relationship between selenium status and cancer. In 1982, over 60,000 participants of the Nurse's Health Study with no history of cancer submitted toenail clippings for selenium analysis. Toenails are thought to reflect selenium status over the previous year. After three and a half years of data collection, researchers compared toenail selenium levels of nurses with and without cancer. Those nurses with higher levels of selenium in their toenails did not have a reduced risk of cancer. ***Two long-term studies, the SU.VI.MAX study in France and the Selenium and Vitamin E Cancer Prevention Trial (SELECT) in the United States and Canada, investigated whether selenium combined with at least one other dietary supplement could reduce the risk of prostate cancer in men. The SU.VI.MAX study examined the effects of a supplement package containing moderate doses of vitamins E and C, beta-carotene, zinc, and selenium (100 mcg/day) versus placebo on the risk of chronic diseases such as cancer and cardiovascular disease. Among the 5,141 men enrolled, those randomized to the supplements who began the study with a normal (<3>35,000 men, was discontinued in October 2008 when an analysis found that the supplements, taken alone or together for an average of 5.5 years, did not prevent prostate cancer. Study staff members will continue to monitor participants' health for an additional 3 years. Selenium and heart disease Some population surveys have suggested an association between lower antioxidant intake and a greater incidence of heart disease. Evidence also suggests that oxidative stress from free radicals, which are natural by-products of oxygen metabolism, may promote heart disease. For example, it is the oxidized form of low-density lipoproteins (LDL, often called "bad" cholesterol) that promotes plaque build-up in coronary arteries. ****Selenium is one of a group of antioxidants that may help limit the oxidation of LDL cholesterol and thereby help to prevent coronary artery disease. Currently there is insufficient evidence available to recommend selenium supplements for the prevention of coronary heart disease. Selenium and arthritis Surveys indicate that individuals with rheumatoid arthritis, a chronic disease that causes pain, stiffness, swelling, and loss of function in joints, have reduced selenium levels in their blood. In addition, some individuals with arthritis have a low selenium intake. The body's immune system naturally makes free radicals that can help destroy invading organisms and damaged tissue, but that can also harm healthy tissue. Selenium, as an antioxidant, may help to relieve symptoms of arthritis by controlling levels of free radicals. Current findings are considered preliminary, and further research is needed before selenium supplements can be recommended for individuals with arthritis. ***Although it is not recommended, many people feel better taking Selenium supplements as part of their daily regimen and believes it does relieve symptoms. Selenium and HIV HIV/AIDS malabsorption can deplete levels of many nutrients, including selenium. Selenium deficiency is associated with decreased immune cell counts, increased disease progression, and high risk of death in the HIV/AIDS population. HIV/AIDS gradually destroys the immune system, and oxidative stress may contribute to further damage of immune cells. ***Antioxidant nutrients such as selenium help protect cells from oxidative stress, thus potentially slowing progression of the disease. Selenium also may be needed for the replication of the HIV virus, which could further deplete levels of selenium. An examination of 125 HIV-positive men and women linked selenium deficiency with a higher rate of death from HIV. In a small study of 24 children with HIV who were observed for five years, those with low selenium levels died at a younger age, which may indicate faster disease progression. ***Results of research studies have led experts to suggest that selenium status may be a significant predictor of survival for those infected with HIV. Researchers continue to investigate the relationship between selenium and HIV/AIDS, including the effect of selenium levels on disease progression and mortality. There is insufficient evidence to routinely recommend selenium supplements for individuals with HIV/AIDS, but physicians may prescribe such supplements as part of an overall treatment plan. ****It is also important for HIV-positive individuals to consume recommended amounts of selenium in their diet. What is the health risk of too much selenium?High blood levels of selenium (greater than 100 mcg/dL) can result in a condition called selenosis. ***Symptoms of selenosis include gastrointestinal upsets, hair loss, white blotchy nails, garlic breath odor, fatigue, irritability, and mild nerve damage.Selenium toxicity is rare in the U.S. The few reported cases have been associated with industrial accidents and a manufacturing error that led to an excessively high dose of selenium in a supplement. The Institute of Medicine of the National Academy of Sciences has set a tolerable upper intake level (UL) for selenium at 400 micrograms per day for adults to prevent the risk of developing selenosis. Table 4 lists ULs for selenium, in micrograms per day, for infants, children, and adults. Here's what you need to know: Table 4: Tolerable Upper Intake Levels (UL) for selenium for infants, children, and adults
Selecting a healthful dietThe 2000 Dietary Guidelines for Americans states, "Different foods contain different nutrients and other healthful substances. No single food can supply all the nutrients in the amounts you need." |
Source: National Institute for Health
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