May 21, 2002 (Morning Star - Wilmington, N.C.) - Health-conscious
consumers might be more familiar with the slogans and catch phrases
of the industry selling "essential vitamins and minerals" than they
are with information on how to choose one.
They may know these components are needed for "strong bones" and
a "healthy immune system" or that they may "protect against cancer,"
but that doesn't necessarily help when it's time to select the best
bottle from the rows of them available at the neighborhood drug
store.
Research and hype about vitamins and herbal remedies has brought
more products to the market. Now, in addition to single vitamins,
multivitamins and formulas specialized for seniors, women, men and
children, there are supplements labeled "active formula" and those
laced with herbal remedies such as ginseng, ginkgo and saw palmetto.
Consumers are bombarded with news of the latest studies that tout
the benefits of everything from vitamin A to zinc, making it
difficult for people to keep the facts straight.
Quality control
Vitamins are big business. Three out of every five American
consumers take dietary supplements regularly, according to the
Dietary Supplement Information Bureau. And vitamins, the best-
selling of these, account for almost $6 billion in sales annually.
An estimated 59 percent of these consumers take multivitamins.
But the products may not deliver what they promise, according to
recent testing of multivitamins by ConsumerLabs.com, which provides
independent test results to help evaluate health and nutrition
products. After a product review is completed, the company posts
names of the brands that passes their tests on its Web site, which
is accessed through a subscription.
"We found that about 40 percent of multiples weren't up to
snuff," said Dr. Tod Cooperman, president of ConsumerLabs.com.
The company tested 27 multivitamins. Only 14 achieved the lab's
approved quality status.
There were problems with the supplements that included less than
the claimed amount of ingredients, inability to disintegrate (which
means they may not be absorbed by the body) and some ingredients
exceeding the upper limit, or UL, which is the most that should be
taken.
There is no agency responsible for routinely testing dietary
supplements for their contents or quality, according to
ConsumerLabs.com. So the responsibility for choosing the best
vitamin falls to the consumer. But there are some considerations to
keep in mind.
"The first step is to determine if you really need it at all, "
Dr. Cooperman said.
Needs vary
A person's need for vitamins and minerals varies according to
age, gender and conditions such as pregnancy or menopause.
In general, vitamin and mineral supplements are recommended for
people age 65 or older, for postmenopausal woman (because it can be
difficult to obtain the recommended amounts of calcium and vitamin
D) and those who are pregnant or are trying to become so, according
to Mayo Clinic Health Information.
You should consider a dietary supplement if you require a special
diet or have an illness that affects the way your body absorbs
nutrients, such as disease of the liver or intestine, or if you've
had surgery on your digestive tract.
Vitamins are recommended if you smoke cigarettes, drink
excessively or don't eat well.
Not eating right is probably why most Americans reach for a
multivitamin. After all, they've been reminded, repeatedly, that
they're not getting the recommended five servings a day of fruits
and vegetables - those foods most rich with the essential nutrients.
"Absorption from real food is always better," said Dr. Melody
Kyzer, nutritionist and assistant professor in health education at
the University of North Carolina at Wilmington. "And there are
healthy things in real food that they just can't replicate in a
vitamin."
But because of unhealthy eating habits, some in the health
community began pushing the idea of a daily multivitamin in the
1970s, said Dr. Jose Antonio, who works in sports and nutrition and
is co-author of Sports Supplement Encyclopedia.
"Most Americans eat poorly, if they take a multivitamin, at least
they can say they're getting the daily recommended amounts," he
said.
Dr. Kyzer refers to taking a multivitamin as "dietary insurance" -
a way to make up for those days when you don't eat as you should.
But, she said, people shouldn't rely only on vitamins to get their
nutrients.
Navigating labels
Manufacturers want people to choose their particular version of
the vitamin. And the labeling information is designed to persuade
consumers that the bottle they're holding in their hand is the best
choice.
To know if this is really the case, it helps to be familiar with
vitamin lingo and understand what Recommended Daily Allowances are
and how they are explained on labels.
RDAs are the average amount of each vitamin and mineral needed
each day to meet the needs of most people. They're determined by the
Food and Nutrition Board of the Institute of Medicine, part of the
National Academy of Sciences. There are different allowances, if
necessary, to account for differences in sex, age and physical
condition.
Generally, labels include the amount of the RDA that one serving
supplies for a healthy adult. This amount is listed as the percent
of the Daily Value, or percent DV. For example, a label may read
that one pill provided 60 percent of the DV, which means another 40
percent is needed through diet to meet the recommended goal.
In 2001, the Institute of Medicine updated the national
guidelines on how much of every vitamin and mineral Americans should
consume. For the first time, the IOM also compiled a list of the
upper limits for some nutrients.
The Food and Drug Administration, which sets the rules for
labeling on vitamins, however, has not announced when, or if, it
will require vitamin manufacturers to base their labeling on these
latest findings. The FDA also does not require labels to list the
safe upper doses.
Today's food labels are based on RDAs set in 1968.
The industry is reluctant to change to using RDAs because they'd
no longer be able to include the "100 percent" on the label that
consumers look for, he said. They also are reluctant because some
have too much in them.
The FDA also bases DVs on a 2,000-calorie-a-day diet. Many women
and older adults may need only about 1,600 calories a day. And
active women and most men need more calories than the average diet.
Your DVs for various nutrients generally rise or fall accordingly,
according to the Mayo Clinic.
Megadoses
All of this can be a problem when it comes to overdosing on
vitamins and minerals.
"There are cases when it's too much of a good thing," Dr.
Cooperman said. "They are not benign. Not a lot of people know that
there can be side effects."
This is where the UL, or the upper tolerable limit, is a concern.
For example, high levels of niacin, one of the B vitamins, can cause
flushing of the skin and a tingling or burning sensation, according
to ConsumerLabs. These problems aren't life threatening, but some of
the multis the lab tested exceeded the UL for the vitamin.
Consumers need to consider not only what is taken into the body
through supplements but also through the diet.
Some people also take what's called megadoses of certain
vitamins, purposely exceeding the UL, Dr. Antonio said. For example,
there's some research that shows that larger doses of vitamin C can
help the body recover from exercise.
Some megadoses can cause serious problems. And a person may be
getting a megadose without realizing it. For example, the IOM
recommends a person consume no more than 3,000 micrograms of vitamin
A, an amount routinely included in multivitamins. Higher levels can
cause liver disease and, in pregnant women, birth defects. If a
person takes that vitamin and consumes a diet high in vitamin A, he
or she may be getting too much. The RDA for vitamin A is 900
micrograms for men and 700 micrograms for women.
There always seems to be new information about vitamins and
minerals. Experts say it's probably best to look at studies more
critically. For example, while many people take vitamin E
supplements, there's been some research that shows it may not make a
significant difference in well-being.
What to do
So how do you know what's right for you? It's best to consider
your individual need and get advice from your doctor if necessary.
Some general guidelines are to be wary of catch phrases and
special formulas, especially for multivitamins, according the
Nutrition Action Newsletter.
There are more than 40 essential vitamins and minerals; make sure
the multi includes a wide variety of these nutrients. Many don't
include enough minerals. These trace elements that include
magnesium, phosphorus, sodium and potassium can be difficult to get
through diet. In fact, the newsletter recommends taking calcium and
selenium supplements separately.
It also doesn't hurt to brush up on the way these nutrients work
in the body and with each other. Some vitamins are needed together
to be effective, such as vitamin D, which is necessary for the
absorption of calcium. Others interfere with medication. Vitamin K,
for example, shouldn't be taken with some blood thinning
prescriptions.
Details
You can access some of this information online at
www.mayoclinic.com. You also can subscribe to ConsumerLab.com. Cost
is $16 a year for the access to the entire site or $5.25 for a
single product review. The company publishes results of its tests
online at www.consumerlab.com, including listings of brands that
have passed testing. Or try www.usp.org. It's the home page for U.S.
Pharmacopeia, a group that has established standards for vitamins,
minerals and botanicals.
How to read multivitamin labels
Vitamin labels list how much aof a nutrient is in a serving,
usually one pill, and what percentage of the Recom-mended Daily
Allowance is in that serving.
Nutrient amounts are in mcg = micrograms, mg = milligrams or IU =
international units.
The percentage of the RDA provided is listed as % Daily Value or
% DV.
Example: Vitamin A - 450 mcg - DV 50 % means you are getting
about half the recommended RDA.
Think that tells you everything you need to know?
* Labels are not required to list the maximum amounts that can be
safely taken. Example: RDA for vitamin A: 900 mcg men, 700 mcg
women. More than 3,000 mcg, however, can result in liver damage and
birth defects.
Studies are still being done on many nutrients to determine what,
if any, upper limits should be recommended.
* Some labels use IUs, which are difficult to convert into mcg
and mg because the formula differs from nutrient to nutrient. For
example, 1 mcg of vitamin A equals 3.33 IU - so a common megadose of
10,000 IU of vitamin A meets the daily safety limit of 3,000 mcg.
* RDAs on labels are often just for healthy adults and do not
take into consideration: age, sex, diet, lifestyle, illness or
medical condition.
* No universal guidelines on RDAs exists, so supplements often
contain different amounts of vitamins claiming to be the right RDA.
For example, one might claim 100 percent of the RDA of a vitamin A,
while another only contains 50 percent, but both contain 900 mcg
How many vitamins should I take?
Here are the Institute of Medicine's RDAs fopr healthy adult men
and women, with upper limits noted for those deemed harmful at high
doses.
VITAMINS
A (Beta Carotene and Acetate) - 900 mcg men, 700 mcg women (not
tro exceed 3,000 mcg)
B-1 (Thiamin) - 1.2 mg men, 1.1 mg women
B-2 (Riboflavin) - 1.3 mg men, 1.1 mg women
B-6 1.3 mg (not to exceed 100mg)
B-9 (Folic Acid) - 400 mcg (not to exceed 1,000 mcg)
B-12 (Cobalamin) - 2.4 mcg
BIOTIN - 30 mcg
C - 90 mg men, 75 mg women, 35 more mcg smokers (not to exceed
2,000)
D - 5 mcg (not to exceed 50 mcg)
E - 15 mg (not to exceed 1,000)
K - 120 mcg men, 90 mcg women
NIACIN - 16 mg men, 14 mg women (not to exceed35 mg)
PANTOTHENIC ACID - 5 mg
CHOLINE - 500 mg men, 425 mg women (not to exceed 3,500 mg)
MINERALS
CALCIUM - 1,000 mg (not to exceed 2,500 mg)
PHOSPHORUS - 700 mg (not to exceed 4,000 mg)
MAGNESIUM - 400 mg men, 320 mg women (not to exceed 350 mg from
supplements)
CHROMIUM - 35 mcg men, 25 mcg women
COPPER - 900 mcg (not to exceed 10,000 mcg),
FLUORIDE - 4 mg men, 3 mg women (not to exceed 10 mg)
IODINE - 150 mcg (not exceed 1,100 mcg)
IRON - 8 mg men, 18 mg women (not to exceed 45 mg),
MANGANESE - 2.3 mg men, 1.8 mg women (not to exceed 11 mg)
MOLYBDENUM - 45 mcg (not to exceed 2,000 mcg)
SELENIUM - 55 mcg (not to exceed 400 mcg)
ZINC - 11 mg men; 8mg women (not to exceed 40 mg),
