Vitamin Supplements Discussion Paper

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 The Benefits And Risks Of Taking Vitamin Supplements.

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5/16/2018 Print Preview 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 ([email protected]) © 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). http://ng.cengage.com/static/nb/ui/index.html? The Benefits And Risks Of Taking Vitamin Supplements

nbId=832717&nbNodeId=320594831&deploymentId=55674033379458281858759899&eISBN=9781305671157#!&pare 5/16/2018 Print Preview 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 A– deficiency blindness, some vitamin –deficiency nerve damage, and birth defects caused by folate deficiency in pregnant women). http://ng.cengage.com/static/nb/ui/index.html?nbId=832717&nbNodeId=320594831&deploymentId=55674033379458281858759899&eISBN=9781305671157#!&pare 5/16/2018 Print Preview Subtle subclinical deficiencies that do not cause classic symptoms are easily overlooked or misdiagnosed—and they often occur The Benefits And Risks Of Taking Vitamin Supplements.

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 wallet—as an old saying goes, “If you take supplements of the water-soluble vitamins, you’ll have the most expensive urine in town.” Occasionally, though, supplement intake is both costly and harmful to health. Toxicity Foods rarely cause nutrient imbalances or toxicities, but supplements easily can—and the higher the dose, the greater the risk. Supplement users are more likely to have excessive intakes of certain nutrients—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. http://ng.cengage.com/static/nb/ui/index.html? The Benefits And Risks Of Taking Vitamin Supplements

nbId=832717&nbNodeId=320594831&deploymentId=55674033379458281858759899&eISBN=9781305671157#!&pare 5/16/2018 Print Preview 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 — 40 μg — Thiamin — 1.5 mg 50 mg Riboflavin — 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 — 6 μg 100 to 1,000 μg Pantothenic acid — 10 mg 100 to 500 mg Biotin — 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 — 100 mg 250 mg 18 mg 18 to 30 mg http://ng.cengage.com/static/nb/ui/index.html?nbId=832717&nbNodeId=320594831&deploymentId=55674033379458281858759899&eISBN=9781305671157#!&pare 5/16/2018 Print Preview 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 — — Copper 10 mg 0.5 mg — Manganese 11 mg 5 mg — Chromium — 25 μg Iodine Molybdenum 2,000 μg 25 μg 10 to 100 mg — 50 to 200 μg 200 to 400 μg — 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 “dietary supplements” sold on the U.S. market that were contaminated with pharmaceutical drugs, such as steroid hormones and stimulants. Such products are often sold as “natural” 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 The Benefits And Risks Of Taking Vitamin Supplements.

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 scientists—in particular, those of the FDA—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 http://ng.cengage.com/static/nb/ui/index.html?nbId=832717&nbNodeId=320594831&deploymentId=55674033379458281858759899&eISBN=9781305671157#!&pare 5/16/2018 Print Preview 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, “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 kinds—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 “truthful and not misleading.” False Sense of Security Lulled into a false sense of security, a person might eat irresponsibly, thinking, “My supplement will cover my needs.” However, no one knows exactly how to formulate the “ideal” 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. http://ng.cengage.com/static/nb/ui/index.html?nbId=832717&nbNodeId=320594831&deploymentId=55674033379458281858759899&eISBN=9781305671157#!&pare 5/16/2018 Print Preview 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 http://ng.cengage.com/static/nb/ui/index.html?nbId=832717&nbNodeId=320594831&deploymentId=55674033379458281858759899&eISBN=9781305671157#!&pare 5/16/2018 Print Preview prooxidants (anti means “against”; pro means “for”). 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 Benefits And Risks Of Taking Vitamin Supplements.

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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 oxidation—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-Carotene—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 Vitamin Supplements Discussion Paper