Vitamin Supplements: What are the Benefits and Risks?

I need some one to answer these that I will post below. Please, You must write 400-500 words.1. What are the arguments in favor of taking supplements? Who really need them?2. What are the arguments against taking supplements? Who are at risk of toxicities, and related problems?3. When choosing a supplement, is comparing the labels of two supplements at the grocery store an effective way to choose a supplement? Why or why not?4. Application: do you or, someone close to you take supplements? What is your experience or, the experience of someone you know with taking supplements? Do they help? Please share with the group the experience, or, your own opinion after reading the content of this controversy.
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Chapter 7: The Vitamins: 7-11d Controversy 7 Vitamin Supplements: What are the Benefits and Risks?
Book Title: Nutrition: Concepts and Controversies
Printed By: Mohanad Al Nahdi (almo1403@stcloudstate.edu)
© 2017 Cengage Learning, Cengage Learning
7-11d Controversy 7 Vitamin Supplements: What are the Benefits and Risks?
LO 7.12
Debate for and against taking vitamin supplements.
More than half of the U.S. population takes dietary supplements, spending $32.5 billion
each year to do so.
Most take a daily multivitamin and mineral pill, hoping to make up
for dietary shortfalls; others take single nutrient supplements to ward off diseases; and many
do both. Do people need all these supplements? If people do need supplements, which
ones are best? What about health risks from supplements? This Controversy examines
evidence surrounding these questions and concludes with some advice on choosing a
supplement with the most benefit and least risk.
Dietary supplements were defined in Chapter 1.
Arguments in Favor of Taking Supplements
By far, most people can meet their nutrient needs from their diet alone. Indisputably,
however, the people listed in Table C7-1 need supplements. For them, nutrient supplements
can prevent or reverse illnesses. Because supplements are not risk-free, these people
should consult a health-care provider who is alert to potential adverse effects and nutrientdrug interactions.
Table C7-1
Some Valid Reasons for Taking Supplements
These people may need supplements:
People with nutrient deficiencies.
Women who are capable of becoming
pregnant (supplemental or enrichment sources
of folic acid are recommended to reduce risk
of neural tube defects in infants).
Pregnant or lactating women (they may need
iron and folate).
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Newborns (they are routinely given a vitamin K
dose).
Infants (they may need various supplements;
see Chapter 13).
People who undergo weight-loss surgery (this
creates nutrient malabsorption).
Those who are lactose intolerant (they need
calcium to forestall osteoporosis).
Habitual dieters (they may eat insufficient
food).
Elderly people often benefit from some of the
vitamins and minerals in a balanced
supplement (they may choose poor diets, have
trouble chewing, or absorb or metabolize
nutrients less efficiently; see Chapter 14).
People living with HIV or other wasting
illnesses (they lose nutrients faster than foods
can supply them).
Those addicted to drugs or alcohol (they
absorb fewer and excrete more nutrients;
nutrients cannot undo damage from drugs or
alcohol).
Those recovering from surgery, burns, injury,
or illness (they need extra nutrients to help
regenerate tissues).
Strict vegetarians (vegans may need vitamin
, vitamin D, iron, and zinc).
People taking medications that interfere with
the body’s use of nutrients.
People with Deficiencies
In the United States, few adults suffer nutrient-deficiency diseases such as scurvy, pellagra,
and beriberi. When deficiency diseases do appear, prescribed supplements of the missing
nutrients quickly stop or reverse most of the damage (exceptions include vitamin Aâ??
deficiency blindness, some vitamin
â??deficiency nerve damage, and birth defects caused
by folate deficiency in pregnant women).
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Subtle subclinical deficiencies that do not cause classic symptoms are easily overlooked or
misdiagnosedâ??and they often occur. People who diet habitually or elderly people with
diminished appetite may eat so little nutritious food that they teeter on the edge of
deficiency, with no reserve to handle any increase in demand. Similarly, people who omit
entire food groups without proper diet planning or who are too busy or lack knowledge or
lack money are likely to lack nutrients. For them, until they correct their diets, a low-dose,
complete vitamin-mineral supplement may help them avoid deficiency diseases.
Life Stages with Increased Nutrient Needs
During certain stages of life, many people find it difficult or impossible to meet nutrient
needs without supplements. For example, women who lose a lot of blood and therefore a lot
of iron during menstruation each month often need an iron supplement. Similarly, pregnant
and breastfeeding women have exceptionally high nutrient needs and routinely take special
supplements to help meet them. Newborns require a dose of vitamin K at birth, as the
preceding chapter pointed out.
Appetite and Physical Stress
Any interference with a person’s appetite, ability to eat, or ability to absorb or use nutrients
will impair nutrient status. Prolonged illnesses, extensive injuries or burns, weight-loss or
other surgery, and addictions to alcohol or other drugs all have these effects, and such
stressors increase nutrient requirements of the tissues. In addition, medications used to
treat such conditions often increase nutrient needs. In all these cases, appropriate nutrient
supplements can avert further decline.
Arguments against Taking Supplements
In study after study, well-nourished people are the ones found to be taking supplements,
adding excess nutrients to already sufficient intakes.
Ironically, people with low nutrient
intakes from food generally do not take supplements. As for risks, the most likely hazard to
the supplement taker is to the walletâ??as an old saying goes, â??If you take supplements of
the water-soluble vitamins, you’ll have the most expensive urine in town.â? Occasionally,
though, supplement intake is both costly and harmful to health.
Toxicity
Foods rarely cause nutrient imbalances or toxicities, but supplements easily canâ??and the
higher the dose, the greater the risk. Supplement users are more likely to have excessive
intakes of certain nutrientsâ??notably iron, zinc, vitamin A, and niacin.
People’s tolerances for high doses of nutrients vary, just as their risks of deficiencies do,
and amounts tolerable for some may be harmful for others. The DRI Tolerable Upper Intake
Levels define the highest intakes that appear safe for most healthy people. A few sensitive
people may experience toxicities at lower doses, however. Table C7-2 compares Tolerable
Upper Intake Levels with typical nutrient doses in supplements.
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Table C7-2
Intake Guidelines (Adults) and Supplement Doses
Typical
Average Single-
MultivitaminNutrient
Tolerable Upper
Mineral
Intake Level
Supplement
Nutrient
Supplement
Vitamins
Vitamin A
3,000 μg (10,000 IU)
5,000 IU
8,000 to 10,000
IU
Vitamin D
100 μg (4,000 IU)
400 IU
400 to 50,000 IU
Vitamin E
1,000 mg (1,500 to
30 IU
100 to 1,000 IU
2,200 IU)
Vitamin K
â??
40 μg
â??
Thiamin
â??
1.5 mg
50 mg
Riboflavin
â??
1.7 mg
25 mg
Niacin (as
35 mg
20 mg
100 to 500 mg
2 mg
100 to 200 mg
1,000 μg
400 μg
400 μg
Vitamin
â??
6 μg
100 to 1,000 μg
Pantothenic acid
â??
10 mg
100 to 500 mg
Biotin
â??
30 μg
300 to 600 μg
niacinamide)
Vitamin
Folate
100 mg
Vitamin C
2,000 mg
10 mg
500 to 2,000 mg
Choline
3,500 mg
10 mg
250 mg
2,000 to 3,000 mg
160 mg
250 to 600 mg
4,000 mg
110 mg
Minerals
Calcium
Phosphorus
Magnesium
Iron
350 mg
45 mg
â??
100 mg
250 mg
18 mg
18 to 30 mg
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Typical
Average Single-
MultivitaminNutrient
Zinc
Tolerable Upper
Mineral
Intake Level
Supplement
Nutrient
Supplement
40 mg
15 mg
1,100 μg
150 μg
Selenium
400 μg
10 μg
Fluoride
10 mg
â??
â??
Copper
10 mg
0.5 mg
â??
Manganese
11 mg
5 mg
â??
Chromium
â??
25 μg
Iodine
Molybdenum
2,000 μg
25 μg
10 to 100 mg
â??
50 to 200 μg
200 to 400 μg
â??
The true extent of supplement toxicity in this country is unknown, but many adverse events
are reported each year from vitamins, minerals, essential oils, herbs, and other
supplements.
Only an alert health-care professional knowledgeable in nutrition can
reliably recognize nutrient toxicity and report it to the FDA. Many chronic, subclinical
toxicities go unrecognized and unreported.
Supplement Contamination and Safety
The FDA recently identified over 330 â??dietary supplementsâ? sold on the U.S. market that
were contaminated with pharmaceutical drugs, such as steroid hormones and stimulants.
Such products are often sold as â??naturalâ? alternatives to FDA-approved drugs, but their use
has caused positive results on tests for banned drugs in athletes. In addition, a range of
symptoms, including stroke, injury to the liver, kidney failure, and death, has been
documented in consumers of these supplements.
Toxic plant material, toxic heavy
metals, bacteria, and other contaminants have also shown up in dietary supplements.
Plain multivitamin and mineral supplements from reputable sources, without herbs or addons, generally test free from contamination, although their contents may vary from those
stated on the label. Over twice the label amount of vitamin A was found in a popular
multivitamin, and several other brands contained more than the Tolerable Upper Intake
Levels of niacin and magnesium.
A prenatal multivitamin contained more than 140
percent of the chromium listed on the label.
Many consumers wrongly believe that government scientistsâ??in particular, those of the
FDAâ??test each new dietary supplement to ensure its safety and effectiveness before
allowing it to be sold. They do not. In fact, under the current Dietary Supplement Health and
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Education Act, the FDA has little control over supplement sales.
tainted products from store shelves, however, and does so often.
It can act to remove
Most Americans express support for greater regulation of dietary supplements, and most
health professionals emphatically agree. Meanwhile, consumers can report adverse
reactions to supplements directly to the FDA via its hotline or website.
Life-Threatening Misinformation
Another problem arises when people who are ill come to believe that self-prescribed high
doses of vitamins or minerals can be therapeutic. On experiencing a warning symptom of a
disease, a person might postpone seeking a diagnosis, thinking, â??I probably just need a
supplement to make this go away.� Such self-diagnosis postpones medical care and gives
the disease a chance to worsen. Improper dosing can also be a problem. For example, a
man who suffered from mental illness arrived at an emergency room with dangerously low
blood pressure. He had ingested 11 grams of niacin on the advice of an Internet website
that falsely touted niacin as an effective therapy for schizophrenia. The Tolerable Upper
Intake Level for niacin is 35 milligrams.
Supplements are almost never effective for purposes other than those already listed in Table
C7-1. This doesn’t stop marketers from making enticing structure-function claims in
materials of all kindsâ??in print, on labels, and on television or the Internet. Such sales
pitches often fall far short of the FDA standard that claims should be â??truthful and not
misleading.�
False Sense of Security
Lulled into a false sense of security, a person might eat irresponsibly, thinking, â??My
supplement will cover my needs.� However, no one knows exactly how to formulate the
â??idealâ? supplement, and no standards exist for formulations. What nutrients should be
included? How much of each? On whose needs should the choices be based? Which, if
any, of the phytochemicals should be added?
Whole Foods Are Best for Nutrients
In general, the body assimilates nutrients best from foods that dilute and disperse them
among other substances that facilitate their absorption and use by the body.
Taken in
pure, concentrated form, nutrients are likely to interfere with one another’s absorption or
with the absorption of other nutrients from foods eaten at the same time. Such effects are
particularly well known among the minerals. For example, zinc hinders copper and calcium
absorption, iron hinders zinc absorption, and calcium hinders magnesium and iron
absorption. Among vitamins, vitamin C supplements enhance iron absorption, making iron
overload likely in susceptible people. High doses of vitamin E interfere with vitamin K
functions, delaying blood clotting and possibly raising the risk of brain hemorrhage (a form
of stroke). These and other interactions present drawbacks to supplement use.
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Can Supplements Prevent Chronic Diseases?
Many people take supplements in the belief that they can prevent heart disease and cancer.
Can taking a supplement prevent these killers?
Vitamin D and Cancer
Reports that vitamin D supplements might prevent cancers, particularly of the breast, colon,
and prostate, have boosted sales. True, low vitamin D intakes have been associated with
increased cancer risk in some studies, and patients with higher serum vitamin D levels at
the time of colorectal cancer diagnosis have better survival rates, but overall the connection
has proved insignificant.
The committee on DRI, along with others, concludes that
insufficient evidence exists to support an association between vitamin D intakes and cancer
risk.
The U.S. Preventive Services Task Force, a group that offers unbiased advice
concerning medical treatments, has recommended against taking vitamin D for cancer
prevention.
Antioxidant Supplements
Central to the idea that antioxidant nutrients might fight diseases is the theory of oxidative
stress (damage inflicted on living systems by free radicals.) (terms are defined in Table C73). The chapter explained that normal activities of body cells produce free radicals (highly
unstable molecules of oxygen) that can damage cell structures. Oxidative stress results
when free-radical activity in the body exceeds its antioxidant defenses. When such damage
accumulates, it triggers inflammation, which may lead to heart disease and cancer, among
other conditions. Antioxidant nutrients (vitamins and minerals that oppose the effects of
oxidants on human physical functions. The antioxidant vitamins are vitamin E, vitamin C,
and betacarotene. The mineral selenium also participates in antioxidant activities.) help to
quench these free radicals, rendering them harmless to cellular structures and stopping the
chain of events.
Table C7-3
Antioxidant Terms
antioxidant nutrients vitamins and minerals
that oppose the effects of oxidants on human
physical functions. The antioxidant vitamins
are vitamin E, vitamin C, and beta-carotene.
The mineral selenium also participates in
antioxidant activities.
oxidants compounds (such as oxygen itself)
that oxidize other compounds. Compounds
that prevent oxidation are called antioxidants,
whereas those that promote it are called
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prooxidants (anti means â??againstâ?; pro means
â??forâ?).
oxidative stress damage inflicted on living
systems by free radicals.
Taking antioxidant pills instead of making needed lifestyle changes may sound appealing,
but evidence does not support a role for supplements against chronic diseases.
In some
cases, supplements may even be harmful.
For example, taking high doses of vitamin C,
an antioxidant nutrient, may lower blood pressure somewhat, a small but potentially
beneficial effect. The same doses also increase markers of oxidation in the blood and
elevate the risk of vision-impairing cataracts in the eyes, however.
Researchers are
investigating links between high doses of vitamin C and cataracts.
Vitamin E and Chronic Disease
Hopeful early studies reported that taking vitamin E supplements reduced the rate of death
from heart disease.
It made sense because in the laboratory vitamin E opposes blood
clotting, tissue inflammation, arterial injury, and lipid oxidationâ??all factors in heart disease
development. After years of follow-up human studies, however, little protective effect is
evident.
In fact, pooled results revealed a slight but alarming increased risk for death
among people taking vitamin E supplements. Neither help nor harm is consistently observed
with vitamin E supplementation.
Studies reporting negative findings have been criticized for testing too low a dose, testing
only the alpha-tocopherol form of vitamin E, failing to establish previous vitamin E status, or
other reasons.
For now, the results are disappointing, but research continues.
Currently, some preliminary evidence links certain forms of vitamin E with cancer protection.
However, much more research is needed to clarify these connections before
conclusions can be drawn, and vitamin E supplements, taken for any reason, carry risks.
The Story of Beta-Caroteneâ??A Case in Point
Again and again, population studies confirm that people who eat plenty of fruits and
vegetables, particularly those rich in beta-carotene, have low rates of certain cancers. Years
ago, researchers focused on beta-carotene, while supplement makers touted it as a
powerful anticancer substance. Consumers eagerly bought and took beta-carotene
supplements in response.
Then, in a sudden reversal, support for beta-carotene supplements crumbled overnight.
Trials around the world were abruptly stopped when scientists noted no benefits but
observed a 28 percent increase in lung cancer among smokers taking beta-carotene
compared with a placebo. Today, beta-carotene supplements are not recommended.
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Such reversals might shock and frustrate the unscientific mind, but scientists expect them
as research unfolds. In this case, a long-known and basic nutrition principle was reaffirmed:
low disease risk accompanies a diet of nutritious whole foods, foods that present a balance
of nutrients and other beneficial constituents. Whereas a sweet potato and a pill may both
contain beta-carotene, the sweet potato presents a balanced array of nutrients,
phytochemicals, and fiber that modulate beta-carotene’s effects. The pill provides only betacarotene, a lone chemical.
For most people, taking an ordinary daily multivitamin and mineral supplement is generally
safe when they choose an appropriate product and follow dosing directions. And for those
who need them, nutrient supplements constitute a modern-day miracle. Table C7-4 reviews
the arguments for and against taking supplements.
Table C7-4
Taking Dietary Supplements: Point, Counterpoint
Many people take dietary supplements either to counterbalance an unhealthy diet or
to improve on their already abundant intake of nutrients. This table considers some
arguments for and against doing so.
Arguments in Support of Dietary
Arguments in Opposition to Dietary
Supplements
Supplements
1. Prevent or correct deficiencies.
1. Cause toxicities. Dietary supplements
Supplements are important for people
provide no benefits to well-nourished people.
suffering from nutrient deficiencies, and in
High nutrient doses from single-nutrient
most cases, they can correct the problems
supplements pose a thr …
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