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Iron deficiency anemia remains a global public health problem typically associated with poverty and is more common in women and children. However, iron also acts as a pro-oxidant inducing free radical damage, and an excessive iron intake may promote lipid oxidation, damaging mitochondria and DNA. Furthermore, a substantial proportion of the population has genetic traits for hemachromatosis and tends to accumulate toxic levels of iron in the liver Bothwell, ; Lynch, Cellbased theories on how iron overload promotes hepatic, cardiac, and pancreatic disease have been reviewed by Britton et al.

Do I Need a Multivitamin on Intermittent Fasting?

Opposition to widespread iron fortification of foods to prevent anemia in women and children may reduce the number of iron fortified products available, creating a need for these sensitive populations to rely on supplements. Men and post-menopausal women have lower iron needs and thus do not require iron supplementation in most cases. FDA requires child-resistant closures on prenatal iron supplements to prevent accidental poisoning of young children, for whom the lethal dose is about 3 g NRC, Commercial calcium supplements, notably dolomite and bonemeal, may be contaminated with lead at levels exceeding FDA tolerable daily intake limits Bourgoin et al.

However, mineral, as well as most vitamin supplements are generally manufactured according to United States Pharmacopeia USP guidelines prohibiting such contamination. The USP is a nongovernmental, voluntary organization that establishes guidelines for vitamin and mineral supplement strength, purity, and quality.

A balanced diet provides the nine essential amino acids that humans cannot synthesize; hence, protein deficiency is rare in the United States. Although solutions of free amino acids may be appropriate for total parenteral nutrition of critically ill patients, there is no evidence that amino acid supplements are beneficial for healthy persons.

Unlike vitamins and minerals, there are no Dietary Reference Intakes DRIs , dietary reference values for the intake of nutrients and food components by Americans and Canadians, for amino acids. Excess amino acids must be deaminated before being used as an energy source, and high intakes may be injurious to persons with impaired kidney function. The excessive consumption of protein or amino acids may lower calcium stores by increasing the excretion of urinary calcium, which is needed to buffer the excreted protein waste. Although there is no clear association between high protein intake and the risk for osteoporosis, susceptible individuals should refrain from consuming a highprotein diet or taking amino acid supplements NRC, Supplements of L-tryptophan, a precursor of the brain neurotransmitter serotonin, became popular as a natural sleep aid in the late s.

However, a large epidemic of eosinophilia-myalgia syndrome EMS , a rare and sometimes fatal systemic illness characterized by elevations of certain white blood cells and severe muscle pain, was associated with the use of tryptophan supplements. Therefore, FDA requested that manufacturers recall supplements containing synthetic tryptophan Glickstein et al. It is not clear if the adverse effects were due to the amino acid, a contaminant, or to their interaction.

A contaminating dimer of tryptophan was found in supplements produced by one manufacturer that supplied most of the tryptophan used in the United States, so most of the EMS cases were related to this source. However, this contaminant may not be the sole cause of EMS Roufs, Furthermore, cases of EMS possibly related to mixtures of amino acids have been reported since the original outbreak, which involved supplements containing only L-tryptophan. The finding in of impurities in some dietary supplement products containing 5-hydroxy-L-tryptophan, which is synthesized from L-tryptophan in the body, suggests that continued caution may be warranted with the use of tryptophan supplements FDA, This category of dietary supplements is controversial because many botanical supplement ingredients are not derived from plants normally used for food, and safety and efficacy often have not been established with randomized, placebo-controlled clinical experiments.

Plant products and their extracts are sources of traditional nutrients as well as biologically-active non-nutrient phytochemicals.

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For example, the large family of phenolic compounds, which includes anthocyanins and other flavonoids, function as antioxidants and thus may protect cells from free radical damage. The concentration and distribution of phytochemicals in medicinal vascular plants varies in the roots, stems, leaves, flowers, and fruits, and also fluctuates during the growth cycle or season.

Moreover, plants or related species similar in appearance may have vastly different chemical compositions. For example, the composition of ginseng grown in Korea Panax ginseng C. Mey is different from that of the native American plant Panax quinquefolius L. This may create difficulties in formulating botanical supplements with consistent ingredients and potencies and presents challenges for inexperienced plant collectors.

Conventional medical journals have begun to publish more controlled clinical studies using botanicals. A review of 18 randomized controlled trials concluded that saw palmetto Serenoa repens [Bartr.

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Although Chinese herbal medicine improved the symptoms of patients with irritable bowel syndrome compared with those given placebos, only those patients who had received individualized herb therapy maintained improvement 14 weeks after cessation of therapy Bensoussan et al. The five most popular botanicals in the United States are listed in Table 5. These materials are sold singly and in combination with other dietary supplement ingredients.

These herbs are also added to some products such as juices and water. Tyler considers these particular botanicals to be safe and effective in healthy individuals. Many botanical supplements are consumed with no adverse effects, yet some products with known hazards are present in the marketplace Tables 3 and 4. The most serious problems have resulted from ingesting the herb ephedra Ephedra sp.

Ephedrine and related alkaloids in this product are potent central nervous system stimulants. Dietary supplements containing ephedra are promoted for increasing energy and aiding in weight loss, but may be accompanied by such adverse effects as anxiety, heart attack, stroke, and seizures, sometimes resulting in death. A number of deaths caused by cardiac arrest have been attributed to ephedra. Herbal teas are popular among consumers trying to avoid caffeine, but herbal tea supplements may contain guarana Paullinia cupana H.

Since caffeine disclosure is not required for dietary supplements, consumers who take certain herbal supplements may inadvertantly be exposed to undesirable or high levels of caffeine. Commercial herbal tea products may also contain potentially dangerous compounds such as hepatotoxic pyrrolizidine alkaloids and various tannins, allergens, and psychoactive compounds Manteiga et al. Dehydroepiandrosterone DHEA is an anabolic steroid that is promoted for enhancing physical strength and immunity, which diminish during aging.

Another steroidal hormone, androstenedione, became popular in amid publicity that it was used by baseball slugger Mark McGwire Schrof, However, a recent study indicated that oral supplements of androstenedione did not enhance muscle strength in men and was associated with adverse effects including a reduction of serum HDL-cholesterol and an elevation of serum estradiol levels King et al. Oral creatine supplementation is popular among athletes, but many studies have failed to show an ergogenic benefit. Furthermore, numerous side effects including renal abnormalities have been reported for creatine Pritchard and Kaira, , and there is growing concern about potential longterm adverse effects on various organ systems Juhn, Some of the products contain 1,4 butanediol, which is converted to GHB when ingested.

Public health measures such as the fortification of breads and cereals with iron and some B vitamins, the widespread use of iodized salt, and the fortification of milk with vitamin D have markedly reduced the incidence of deficiency diseases that were once common. Furthermore, the year-round availability of fruits and vegetables, and the diversity and affordability of the food supply in general, have helped eliminate nutrient deficiencies.

Today, nutrition-related diseases in the United States are typically chronic in nature and are more likely associated with an excessive intake of fats, sweets, and calories from all sources, rather than from dietary inadequacies. Certain segments of the population, however, are susceptible to nutritional deficiencies because of elevated requirements arising from medical or environmental conditions or inborn errors of metabolism NRC, For example, a thiamin deficiency may exist in renal patients undergoing chronic dialysis or in patients on long term intravenous feeding.

Smokers may require more vitamin C than nonsmokers to counteract the increased metabolic turnover of the vitamin associated with smoking. A vitamin E deficiency is sometimes seen in premature, low birth weight babies, or in individuals with abnormal fat absorption. Persons with other malabsorption conditions such as atrophic gastritis, or those suffering from cancer or other serious illnesses, also may have increased requirements for certain nutrients. It is more common for Americans to report consuming dietary intakes that fall below the RDA for certain nutrients than to exhibit overt deficiency symptoms.

According to the U. Failure to meet the RDA intakes does not necessarily mean that an individual is not meeting nutrient requirements, since RDAs represent population averages with margins of safety that account for presumed variability in requirements among individuals. Also, dietary intake data do not correlate precisely with disease risk.

For example, although about 10 million Americans have osteoporosis, it is not possible to attribute the disease solely to a lack of dietary calcium, since genetic predisposition, gender, estrogen, vitamin D intake, and lifestyle factors such as amount of physical activity and exposure to sunlight also are risk factors NIH, When are nutrient supplements warranted for the general population? Iron is routinely given during pregnancy, and folic acid is recommended for all women of child-bearing age. Recent studies suggest that dietary supplements of folic acid, vitamin B6, and vitamin B12 may have broad public health benefits, as these nutrients are associated with lowering blood homocysteine levels, which may reduce the risk of coronary heart disease Welch and Loscalzo, There is concern among some professionals that the American population is consuming an imbalance of polyunsaturated fatty acids, with the ratio of omega- 6 to omega-3 fatty acids being larger than optimal.

Since few commonly consumed foods are good sources of omega- 3 fatty acids, supplements may be more widely recommended in the future. Using relative risk estimates, Bendich et. National nutrition surveys have focused on the use of traditional vitamin and mineral supplements. Individuals taking vitamins had significantly lower fat diets, with more fiber and vitamins calcium for women , suggesting that supplement users have generally healthy lifestyles.

In one survey, elderly Georgia residents who used dietary supplements were more likely to be physically active, and to have more arthritis or stomach problems than their non-user neighbors Houston et al. Calcium, vitamin E, and vitamin C were the most popular supplements used within this group, and the researchers concluded that supplement use was part of a cluster of health behaviors practiced by this group. Of more than 2, Americans questioned in a recent telephone survey of alternative medical practices, Herbs were identified as one of the most commonly used treatments for allergies, insomnia, and digestive disorders; vitamins were used for high blood pressure, but other uses were not explored in the study.

These products were not fully reimbursable by insurance companies. In February , National Public Radio, Kaiser Family Foundation, and Harvard University Kennedy School of Government conducted a telephone survey of American adults, of whom reported using supplements regularly or sometimes. Supplement users were more likely to believe that taking supplements is beneficial and that these products are safe.

Regular supplement users were not different from non-users in their attitudes about government regulation of dietary supplements. The U. Vitamins still dominate the U. These sales figures do not include over-thecounter medications that provide calcium or other minerals.

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Adapted from Anonymous Because the nature of dietary supplements available in the marketplace is diverse, it is difficult to provide general recommendations regarding use. Fortunately, the growing popularity of dietary supplements should spur additional, much-needed research on optimal dosages, interactions with drugs and food components, and the relationships between supplements on health maintenance and chronic disease prevention in persons of different genders and ages. A forthcoming report on the value of vitamin and mineral supplements for improving the nutritional status of low income Americans is expected to be issued late in by the USDA and the Life Sciences Research Office of the American Society for Nutritional Sciences Bethesda, Md.

The passage of DSHEA has created an economic and regulatory environment favorable to the expanded marketing, sales, and distribution of dietary supplements. Opportunities for consumers to purchase dietary supplements in a free market economy are vastly increased, but expectations remain that government agencies provide protection from unsafe or mislabeled products. One of the future challenges with respect to dietary supplements will be to reconcile these apparently opposing forces.

Furthermore, better education of consumers would aid their critical evaluation of advertising and label claims and enable them to reach informed decisions regarding which, if any, dietary supplements to take. Angell, M. Alternative medicine— the risks of untested and unregulated remedies editorial. New Engl.


Nutrition industry braces for a competitive future. Business J. Bendich, A. Potential health economic benefits of vitamin supplementation. Bensoussan, A. Treatment of irritable bowel syndrome with Chinese herbal medicine. Block, G. The data support a role for antioxidants in reducing cancer risk. Bourgoin, B. Lead content in 70 brands of dietary calcium supplements. Public Health Boyd, S. Combined dietary chromium picolinate supplementation and an exercise program leads to a reduction of serum cholesterol and insulin in college- aged subjects. Britton, R. Pathophysiology of iron toxicity.

Commission on Dietary Supplement Labels. Printing Office, Washington D. This book is an essential reference resource for pharmacists and other health professionals. Dietary Supplements. Mason, Pamela Online via MedicinesComplete. Dietary Supplements has the latest findings on safety and efficacy of dietary supplements. Available online A quick-start guide to all the main types of Complementary and Alternative Medicine, providing both The eBook guide to drug interactions and their management, for the busy healthcare professional.

News PharmPress. Revise for your registration exam with questions online. Find your perfect pharmacy job with Pharmaceutical Journal Jobs. Support for pharmacists and exclusive member benefits. The water-soluble vitamins — biotin, vitamin C, niacin, folic acid, pantothenic acid, and the four B complex vitamins — need to be restored more frequently, but the body can tolerate higher doses.

There are two groups of minerals: macrominerals which the body needs in large doses and trace minerals only a pinch required. RDA : Recommended Dietary Allowances, or RDAs, represent the average daily dietary intake of each vitamin and mineral a person needs to stay healthy and steer clear of deficiencies. The values, which are all backed by scientific data, are broken down by age and gender. AI: For those vitamins for which an RDA has not yet been set usually due to lack of scientific data , an AI, or adequate intake level , is used in place.

UL: The tolerable upper intake level UL is the maximum amount of daily vitamin or mineral dosage that is likely to be safe for the average person. Stay under the UL radar especially when using supplements to keep toxicities at bay. The Measurements: Vitamins or minerals that are needed in larger doses are expressed in units of milligrams mg.

Handbook of Minerals as Nutritional Supplements

Trace minerals and vitamins are expressed in micrograms mcg. There are 1, mcg in one milligram no fancy math here. Biotin a. Vitamin B7 or Vitamin H : Like the rest of the water-soluble B-complex vitamins, biotin plays a huge role in cell growth and food metabolism Biotin. Zempleni, J.

Biofactors, Jan-Feb;35 1 Metabolism is the process by which our bodies covert the food we eat into energy that can then be used to power everything we do, from thinking, to running, to hula-hooping. Peter, J. The British Journal of Nutrition, ;21 4 Calcium : Got milk? Guzzle a glassful to get the daily dose of calcium , a macromineral crucial for the healthy development of bones and teeth. Martinez, S. Annals of Pediatrics, Feb And alongside its sidekick, Vitamin D, calcium helps ward off osteoporosis Vitamin D with or without calcium supplementation for prevention of cancer and fractures: an updated meta-analysis for the U.

Preventive Services Task Force. Chung, M. Annals of Internal Medicine, Dec 20; 12 While getting too much calcium from dietary sources is rare, taking too many calcium supplements may carry some risk for kidney stones formation or heart disease , though the research is inconclusive Associations of dietary calcium intake and calcium supplementation with myocardial infarction and stroke risk and overall cardiovascular mortality in the Heidelberg cohort of the European Prospective Investigation into Cancer and Nutrition study EPIC-Heidelberg.

Li, K. Heart, Jun;98 12 Choline : Choline , another water-soluble B vitamin, is a building block of the neurotransmitter acetylcholine , which is essential for the nerve and brain activities that control memory and muscle movement. Choline also helps turn the food we eat and our stored energy hello, love handles into fuel Choline: an essential nutrient for public health. Zeisel, S. Nutrition Reviews, Nov;67 11 Choline: critical role during fetal development and dietary requirements in adults.

Annual Review of Nutrition, ; Vegetarians, vegans, pregnant women, and endurance athletes are at greater risk for choline deficiency, which is linked to fatty liver disease, atherosclerosis, neurological disorders, and impaired fetal development Choline deprivation: An overview of the major hepatic metabolic response pathways.

Al-Humadi, H. Scandinavian Journal of Gastroenterology, May Chromium : You may have chrome wheels, but do you have chromium -dense meals? Trumbo, P. Journal of the American Diabetic Association, Mar; 3 Though some chromium supplements tout muscle building and weight loss benefits, there is no solid research evidence that backs up the claims A pilot study of chromium picolinate for weight loss.

Yazaki, Y. Journal of Alternative and Complementary Medicine, Mar;16 3 In fact, overconsumption of chromium supplements could cause kidney damage Effects of chromium picolinate on glycemic control and kidney of the obese Zucker rat. Mozaffari, M. So shelf the supplement and try an absperiment instead for rock-hard abs. Frontline in the creation of red blood cells, copper is also important for proper energy metabolism, immunity, and nervous system function Dietary reference intakes: vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc.

Though few and far between, copper deficiencies may manifest as anemia, a low white blood cell count, and bone deterioration The role of copper, molybdenum, selenium, and zinc in nutrition and health. Chan, S.

Dietary Supplements: Nutritional and Legal Considerations -

Clinics in Laboratory Medicine, Dec;18 4 While copper toxicity from dietary intake is rare, cases of acute copper poisoning which leads to some not-so-nice tummy troubles have occurred due to contaminated water supplies or leaching from copper containers A series of patients in the emergency department diagnosed with copper poisoning: recognition equals treatment. Gunay, N. Fluoride : This non-essential trace mineral helps keep those pearly whites cavity-free and bones less breakable Dietary intake and bioavailability of fluoride. Rao, G.

Before snacking on some toothpaste, know that most tap water in the U. Folic Acid a. Crider, K. Advances in Nutrition, Jan;3 1 Folic acid supplementation for the prevention of neural tube defects: an update of the evidence for the U. Wolff, T. Annals of Internal Medicine, May 5; 9 No baby on board? Folic acid also helps create most all cells in the body and may reduce the risk of heart disease and colon cancer Effect modification by population dietary folate on the association between MTHFR genotype, homocysteine, and stroke risk: a meta-analysis of genetic studies and randomized trials.

Holmes, M. Lancet, Aug 13; What You Need: mcg How to Get It: Look out for fortified grains and cereals mcg per cup , asparagus mcg per 6 spears , spinach mcg per half cup , orange juice 83 mcg per cup , and lentils per half cup. Iodine : Definitely dine with iodine : This essential trace mineral is a crucial component of thyroid hormones, which maintain our basal metabolic rate BMR.

Dunn, J. Lee, K. Nutrition Reviews, Jun;57 6 Now and then, an excess of iodine can cause hyperthyroidism, goiters, and in severe cases, GI discomfort and burning of the mouth, throat, and stomach, though rare. Iron is also important in the production of amino acids, collagen, neurotransmitters, and hormones Dietary reference intakes: vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc.

Intestinal iron absorption. Fuqua, B. Since this mineral is more easily absorbed from red meat and poultry, vegetarians and vegans may want to consider iron supplements, or at least consume more iron-rich fruits and leafy green vegetables Vegetarian diets : nutritional considerations for athletes. Venderley, A. Sports Medicine, ;36 4 Banner, W. Pediatric Clinics of North America, Apr;33 2 Magnesium : Magnetically drawn to calcium, magnesium is a macromineral that partners with calcium to assist with proper muscle contraction, blood clotting, cell signaling, energy metabolism, blood pressure regulation, and building healthy bones and teeth Associations of dietary magnesium intake with mortality from cardiovascular disease: the JACC study.

Zhang, W. Atherosclerosis, Apr; 2 Rest easy because magnesium deficiency is super rare and so are toxicities, unless popping magnesium supplements is your thing. If so, watch out for diarrhea, lethargy, heart rate disturbances, and muscle weakness Suboptimal magnesium status in the United States: are the health consequences underestimated?

Rosanoff, A.

The Vitamin Alphabet: Your Guide to Vitamins, Minerals and Food Supplements

Nutrition Reviews, Mar;70 3 Manganese : Hailing from the Greek word for magic, manganese can be a double-edged sword. Though an essential trace mineral and antioxidant, it is also potentially toxic in excess Invited review: manganese superoxide dismutase in disease. Macmillan-Crow, L. Free Radical Research. Pharmacology, Apr;34 4 Important for energy, bone development, and wound healing, overindulgence of this magic mineral — usually a result of water contamination — may cause a dip in intellectual function Manganese toxicity upon overexposure.

Crossgrove, J. NMR in Biomedicine, Dec;17 8 Manganese in drinking water and intellectual impairment in school-age children. Chen, H. Environmental Health Perspectives, Jun; 6 :A Turnlund, J. Molybdenum deficiency has never been documented in healthy people, and toxicity is similarly rare. What You Need: 45 mcg How to Get It: Grub rich in molybdenum includes legumes like black beans mcg per cup and split peas mcg per cup , and nuts like almonds, chestnuts, and peanuts all about 42 mcg per cup.

Niacin a. Vitamin B3 or Nicotinic Acid : On the lookout for beautiful skin, hair, and red blood cells?