MedInfo Health Line

Vitamins – The Unknown Frontier

An estimated 100 million Americans spend $6.5 billion a year on vitamin and mineral supplements. But these consumers are buying mostly unregulated substances that may help, may harm or may simply have no effect at all.

In the average grocery store, the vitamin-buying consumer faces a wall of possibilities. To add to the confusion, the labels on these bottles provide few clues that the products can be harmful as well as helpful. They do not mention this possibility because the Food and Drug Administration considers vitamins and minerals as “dietary supplements”. As a result, no testing for safety or efficiency–or even for whether the supplements contain what the bottle says they contain–is required before vitamins are put on the shelves.

Even the experts in nutrition have trouble giving consistent information about vitamins and minerals because there is a lack of good long-term studies on them. The government can provide a bewildering volume of standards which it is in the process of revising. “No rational person can understand this stuff,” says Dr. Marion Nestle, chairman of the department of nutrition and food studies at New York University. “All the different numbers are almost guaranteed to make the situation more confusing rather than less.”

The current boom in the vitamin business began in October, 1994, when Congress passed the Dietary Supplement Health and Education Act, which basically keeps the FDA’s hands off vitamins and mineral supplements unless something goes wrong. Stocks that had dropped in 1994 surged 70 percent in 1995, 57 percent in 1995 and 42 percent in the first half of 1997, wildly outperforming the overall market.

Vitamin suppliers fought hard for this profit margin. The FDA had been planning to apply existing regulations for items like drugs to vitamins, minerals, herbal preparations and other supplements. Those rules would have prevented manufacturers from making health claims of any sort for any supplements without agency approval. The vitamin industry responded with fierce lobbying, aided by a letter-writing campaign by consumers who feared that government rules would limit their access to all kinds of supplements. The 1994 law was a compromise–labels on vitamin and mineral products cannot make claims that a product cures a disease or gives a specific health effect without special FDA approval. However, the law does allow general statements on the label about a vitamin or mineral’s function in the body.

The lack of specific claims has not stopped people from assuming vitamins offer extraordinary healing benefits. Based on meager evidence and word-of-mouth, consumers buy the supplements and hope that a nutrient’s normal role is magnified and the vitamin can work as a miracle cure for terminal diseases such as cancer, or a magic wand tonic to a poor diet. The vitamin industry has profited handsomely by such unproven wishful thinking.

Faced with the growing need for more research, the National Institutes of Health established, at the request of Congress, an Office of Dietary Supplements in November 1995. Their research will take some time. Meanwhile, caveat emptor! (Buyer beware)


Vitamins & Minerals

Experts agree that more research on vitamin supplementation is necessary. But what is known–the finding that comes up again and again–is that when vitamins and minerals are consumed in food, they are just about always good for you. In pill form, however, particularly with high doses, vitamins should be used with caution.

One of the difficulties of pill supplementation is in calculating dosage. How much of any vitamin a person needs varies–age, sex, stage of life, and specific individual needs all factor into correct dosage. There is no single level of any vitamin or mineral that can be considered the optimum intake for everyone.

In addition, despite the possible healing properties of supplemental vitamins (unproven at this point), there are risks when nutrients are taken separately from foods containing them and in doses much greater than the body is designed to process.

Specific vitamin overdoses can cause known problems:

Too much vitamin A can cause headaches from increased brain pressure, liver and bone damage, hair loss, skin disorders, psychiatric symptoms and, when taken in early pregnancy, birth defects. Too much B6 can damage nerves. Too much vitamin C can interfere with tests for blood in the stool. Large amounts of calcium can limit the absorption of iron. Iron supplements can be deadly to small children, and the most common cause of poisoning deaths among children is not from caustics or aspirin–but from iron supplements intended for adult use.

Again, for the average healthy person who consumes a variety of foods, there is scant evidence that vitamin and mineral supplements are beneficial. Even for segments of the population who may need more vitamins–smokers, people who are ill or poorly nourished, the elderly and pregnant women–the long-term benefits are unclear at best. According to a 13-year study of 10,758 Americans, people who took vitamins did not live longer or suffer fewer cancer deaths than those who did not take vitamins.

Americans are heavier than ever, but not necessarily well nourished. However, nutrition experts, even those who believe in vitamin supplements, don’t believe vitamin pills can compensate for dietary deficiencies. They emphasize that there are many health-promoting substances in foods other than vitamins and minerals. Their best advice: eat a balanced and varied diet that is low in fat and high in fruits and vegetables and complex carbohydrates.


Eating Healthy

Americans eat well. As a country, we’re well fed. We eat a lot, and we tend to weigh a lot. But that doesn’t mean we’re healthy. With contemporary eating habits, it’s becoming more and more difficult to follow a good nutritional diet. Americans eat out more, and fast food has become an everyday meal for many. This routine means more saturated fat and less nutritional balance.

Convenience is one of the reasons the vitamin industry has done so well in the last few years–We eat on the run, and we want our health on the run. We dine on hamburgers, french fries and pizza, and only 15% of us eat the recommended five servings of fruits and vegetables a day. But we pop a few vitamin pills and hope this takes up the slack. The problem is, research shows this doesn’t work. Even scientists who believe in vitamin supplementation to aid with specific disorders don’t believe vitamin pills can compensate for careless eating habits.

In January, 1996, The American Dietetic Association, the nation’s largest organization of nutrition professionals, gave this advice: “The best nutritional strategy for promoting optimal health and reducing the risk of chronic disease is to obtain adequate nutrients from a wide variety of foods.”

Good advice! Of course, it takes awareness to find out what foods provide you with the nutrients you need–but if your health is at stake, isn’t it worth it?

Here are a few natural vitamin sources:

For Vitamin A, eat liver, egg yolks, fortified milk and dairy products and fish oil.

For beta carotene, eat carrots, sweet potatoes, spinach and other dark green leafy vegetables, cantaloupes and apricots.

Vitamin C of course is in citrus fruits, but also in melons, berries, peppers, potatoes, cabbage, broccoli and tomatoes.

You can get Vitamin D from egg yolks, fortified milk, eel, herring, salmon and liver.

Vitamin E sources are vegetable oil, nuts, wheat germ, whole grains and green leafy vegetables.

B6 is in bananas, beans and peas, avocados, poultry, fish and pork.

For B12, go to meats, diary products, eggs, liver and fish.

Calcium is in diary foods, but also in such vegetables as broccoli and collards, as well as in tofu.

Magnesium is in all unprocessed foods, highest in nuts, vegetables and grains.

Zinc can be found in meat, liver, eggs and seafood.

For iron eat meat, poultry, fish, eggs, vegetables and tofu.

Eating healthy may take a little work at first, but it has one other great advantage over fast food–it’s cheaper, short-term and long-term.