Question

Vitamin and mineral supplementation is a growing unregulated industry that is providing many individuals a variety of treatments. As a healthcare provider you are stuck in the middle of the debate of whether vitamin and mineral supplementation is a supported practice. Please discuss in a well supported argument for or against the use of vitamin and mineral supplementation in the treatment of diseases other than immediate deficiency conditions. Please discuss the use of megadose supplementation therapy in your response. List your reference in APA format.

Answer 1

Vitamins are organic compounds that our bodies use, in very small amounts, for a variety of metabolic processes. It is best to get vitamins and minerals from eating a variety of healthy unprocessed foods.

For decades, we’ve been told that supplemental vitamins and minerals will make us healthier and ward off certain diseases. While taking a general ‘broad-spectrum’ vitamin and mineral supplement ‘just in case’ poses little health risk, and may benefit a person whose diet is restricted and lacks variety, taking vitamin and mineral supplements instead of eating a nutritious diet is not recommended.

Historically, there was good reason to embrace supplemental dietary aids. Lack of vitamin D, for example, was known to cause rickets; lack of niacin caused pellagra (a disorder of the nervous system characterized by a scaly skin rash) while lack of vitamin A resulted in blindness. Pregnant women were warned for decades that lack of folic acid in the diet could mean a crippling spine disease for their unborn child. Vitamin deficiencies could even kill.

But better nutrition and vitamin-fortified foods have resolved many of these problems, say health experts. Today, new evidence is mounting that supplemental vitamins and minerals really don’t do much to improve our overall health. In fact, a number of studies are showing that not only do most people not need them - they can actually be harmful to some. Dietary supplements don’t, for instance, prevent chronic disease or death. To date, it remains a contentious issue and to date, many people are still confident that ingesting a multivitamin each day is beneficial at most and harmless at the least.

According the Food and Drug Administration (FDA), a dietary supplement is a product intended for ingestion that adds further nutritional value to the diet. It can be a vitamin, mineral, herb, fiber, fatty acids or amino acids, taken by way of capsules, gels, tablets, liquids or powders. The most common dietary supplements are multivitamins.

Your body only needs a small amount of vitamins and minerals every day. A varied diet generally provides enough of each vitamin and mineral. However, some people may need supplements to correct deficiencies of particular vitamins or minerals.

People who may benefit from vitamin and mineral supplements include:

• pregnant women
• women who are breastfeeding
• people who drink alcohol above the amount that is recommended for reducing risk of disease (one standard drink a day for non-pregnant women and two for men)
• cigarette smokers
• illegal drug users
• crash dieters or people on chronic low-calorie diets
• the elderly (especially those who are disabled or chronically ill)
• some vegetarians or vegans
• women with excessive bleeding during menstruation
• people with allergies to particular foods
• people with malabsorption problems such as diarrhoea, coeliac disease or pancreatitis.
• Women planning a pregnancy should consider taking folic acid (folate) supplements to reduce the risk of neural tube defects in the baby. Folic acid can also be found in some fortified foods such as some breads. Foods fortified with folic acid have the nutrient added to them during production to boost their nutritional value.

Research findings on dietary supplements
Healthcare experts, researchers, nutritionists and proponents of the dietary supplement industry continue to debate the pros and cons of taking vitamins, minerals and other add-ons to daily diet, evidence leans much more in the direction of not doing so if a well-nourished individual eats a healthy, balanced diet.

These findings revolve around this simplified theory: The body makes its own antioxidants to help neutralize free radicals, which can damage DNA and disrupt cell membranes. Since free radicals are bad, many people take large doses of antioxidants found in supplemental products, including vitamins and minerals to enhance the neutralization.

However, free radicals also kill bacteria and can eliminate new cancer cells. So they are not indiscriminately destructive. Furthermore, when add-on doses of antioxidants are taken through supplements along with a healthy diet that is rich in antioxidants, the theory is that the balance is tipped and the immune system may no longer be able to efficiently kill harmful invaders. Researchers have tagged this “the antioxidant paradox.”

Vitamins and minerals from food
Research indicates that most of the vitamins you get from the food you eat are better than those contained in pills. Even though vitamins in supplements are synthesised to the exact chemical composition of naturally-occurring vitamins, they still don’t seem to work as well.

The main exception to this is folate. The synthetic form (in a supplement or fortified food) is actually better absorbed by the body than folate from food sources.

Food is a complex source of vitamins, minerals and phytochemicals (plant chemicals), which all work together. Supplements tend to work in isolation. Research has shown that a food component that has a particular effect on the body may not have the same effect when it is isolated and taken as a supplement. This could be because the vitamins and minerals in foods are also influenced by other components of the food, not just the ‘active ingredient’.

Phytochemicals are an important component of food and are thought to reduce the incidence of heart disease and some cancers. Supplements do not provide the benefits of phytochemicals and other components found in food. Taking vitamin and mineral supplements is no substitute for a healthy diet.

Using vitamin and mineral pills like medicine

It is commonly believed that taking mega-doses of certain vitamins will act like medicine to cure or prevent certain ailments. For instance, vitamin C is suggested as a cure for the common cold, and vitamin E is widely promoted as a beneficial antioxidant to help prevent heart disease.

After extensive research, however, neither of these claims has been shown to be true. Large-scale studies have consistently shown little benefit in taking mega-doses of supplements. In fact, there is some evidence that taking high-dose supplements to prevent or cure major chronic diseases, such as heart disease and cancer, may be harmful to your health.

Vitamin and mineral supplements can be toxic in high doses
Taking higher than recommended doses of some vitamins may cause problems. For example, the vitamins A, D, E and K are fat soluble, which means they are stored in the body. High doses of these vitamins can be toxic.

High doses of some water soluble vitamins, like vitamin B6, can also become toxic. Large folate intakes can hide vitamin B12 deficiencies. In extreme cases, for example, where people take 100 times the recommended dietary intake (RDI), this can stop the work of anticonvulsant drugs, such as those used in epilepsy.

Excessive doses of some minerals may also cause problems. At just five times the RDI, zinc, iron, chromium and selenium can be raised to toxic levels in the body. For example:

• Large intakes of fluoride (especially in childhood) may stain, and even weaken, the teeth.
• Very large doses of fish oil can lead to decreased blood clotting.
• Iron toxicity is also common. Even a small amount over the RDI can cause gastrointestinal upset, nausea and black bowel actions (poo). Severe toxicity can lead to coma and even death.
• High levels of vitamin B6 have been linked to some types of nerve damage.
• Doses of vitamin C above one gram can cause diarrhoea.
• High doses of vitamin A may cause birth defects, as well as central nervous system, liver, bone and skin disorders.

For a healthy adult, if supplements are used, they should generally be taken at levels close to the RDI. High-dose supplements should not be taken unless recommended under medical advice.

Vitamins and minerals as a short-term measure
Taking vitamin and mineral supplements should be viewed as a short-term measure. The long-term use of some high-dose supplements can lead to symptoms of toxicity. If you feel that you could be lacking in certain vitamins and minerals, it may be better to look at changing your diet and lifestyle rather than reaching for supplements.

Remember
Vitamins are organic compounds used by the body in small amounts for various metabolic processes. Vitamin supplements cannot replace a healthy diet. Those who may need vitamin supplements include women who are pregnant or breastfeeding, people who consume alcohol in amounts over those recommended as safe, drug users, and the elderly.