A Guide to Nutritional Supplements

                       
Dr. Morgan

I am of the firm opinion that your diet is the most important source of vitamins, minerals, and antioxidants. However, in spite of a good diet supplementing with various vitamins, minerals, antioxidants, herbs and other nutrients offers a valuable adjunct in our efforts to achieve Total Health. At times I will recommend supplements in therapeutic dosages. When we use foods, herbs, vitamins or other supplements to treat a particular problem that is what I mean by nutraceuticals. This would be the treatment of a specific condition. We can’t rely on our diet to give us everything we need.

There is good evidence that our produce is not as nutritious now as it may have been in the past. Certainly, it is more contaminated with pesticides and chemicals. In addition, our environment is becoming more polluted on a daily basis. Buy organic when possible.  Providing proper nutrients to help in the detoxification process is important. Start with a GOOD quality multivitamin.

In a recent review published in the 3rd edition of the Comparative Guide to Nutritional Supplements, over 1,000 nutritional products were evaluated on a comprehensive 14 quality-selection criteria. The Sage Multivitamin that we carry in the Sage Store was ranked the #1 multiple vitamin and mineral formula in the healthcare practitioner marketplace!

Antioxidant Supplements

The importance of dietary and supplemental antioxidants has been a subject of widespread discussion in recent years. Here are some important, but little-known facts about antioxidant supplements:

Think color when you buy produce. As a rule the various brightly colored vegetables offer valuable nutrients.
It is important to consume a broad spectrum of antioxidants. In the process of quenching some free radicals, many antioxidants produce other free radicals. A broad spectrum of different types of antioxidants will produce a optimal reduction of free radical damage.

It is thought to be important to maintain a good ratio of vitamin C to vitamin E. The best ratio appears to be between about 4 to 1 and 10 to 1 (measured as a ratio of milligrams of vitamin C to international units of vitamin E).

Although beta carotene is the most popular of the family of fat-soluble antioxidants called carotenoids, other carotenoids, such as lycopene, may actually be as or more important. Lycopene is the substance that makes some fruits red: tomatoes, watermelon, red grapefruit, etc. Lycopene supplements are now available. Some fruit and vegetable concentrates containing standard amounts of lycopene are also available.

Two other important carotenoids are lutein and zeaxanthin, which are concentrated in the macula, the central area of the retina of the eye. There is good evidence that lutein and zeaxanthin can help prevent or delay age-related macular degeneration, a very common cause of vision problems in old age. Lutein and zeaxanthin are present in vegetables such as broccoli. Lutein is now available as a supplement.

There is increasing evidence of the importance of getting a mixture of carotenes. It may be wise to try to find a good multi-carotene supplement.

A broad spectrum of the more common antioxidants will improve general health, but will not significantly extend lifespan or slow the basic aging process. A major reason for this is that many antioxidants do not penetrate into the cell’s mitochondria. The mitochondria are the primary energy-producing components of the cell. The mitochondria have their own antioxidant system. The most abundant natural antioxidant in the body is copper-zinc superoxide dismutase (Cu-Zn-SOD). The most abundant antioxidant in the mitochondria is manganese superoxide dismutase (Mn-SOD). This is why a good antioxidant supplement will contain a trace amount of manganese.

Two antioxidants that will penetrate the mitochondria are N-Acetyl-Cysteine and melatonin (considered also as a hormone and well-known for its sleep regulation.

Vitamin E has no apparent toxicity, even in very large doses. There is a report of hypertension associated with high doses of Vitamin E although this is questionable in the eyes of every researcher I have spoken with. Vitamin E, itself, will not have any significant adverse effects on blood clotting. However, a breakdown product of vitamin E, called vitamin E quinone, does substantially inhibit blood clotting. The rate of conversion of vitamin E to vitamin E quinone varies greatly from person to person. In a few individuals, several hundred I.U of vitamin E may cause serious problems with normal clotting. The conversion of vitamin E to vitamin E quinone can be slowed by taking a broad spectrum of antioxidants, including vitamin C.

To make sense about vitamin and mineral supplements I suggest you review articles on the subject in legitimate medical journals. One recent comprehensive review of the subject is: Hathcock, John N., Vitamins and Minerals: Efficacy and Safety, American Journal of Clinical Nutrition 1997;66 pp.427-437.

This comprehensive article includes 152 references. The American Journal of Clinical Nutrition is available at most university or medical libraries. The abstract text of this article is available at the web site of the American Journal of Clinical Nutrition web site.

Another very good source of information makes the case that high dose supplementation is documented in different medical conditions. Bruce Ames is a PhD in the biochemistry department at Berkeley. In a well documented paper he reviews the scientific evidence where high dose supplementation with various vitamins and other nutrients overcomes the expression of about 50 different illnesses. (Remember the nutraceutical discussion in the beginning) This paper is written from the perspective of a scientist and is not an easy read for the lay person but I have given this paper to colleagues with the opinion “if you take vitamins then you just have expensive urine”. It is hard to argue with good science. It is my opinion that those that argue about the value of vitamins in treating many of the medical conditions we’ll discuss on this site are just not well informed.


Here are some guidelines as to how much you should take of each vitamin.

 

Recommended Doses of Vitamins & Minerals


VITAMINS

  • Vitamin A (Retinol) 5000 IU 1.5 mg (5,000 IU) with high dietary retinol 3.0 mg (10,000 IU) with low dietary retinol
    • Note: these are maintenance doses and are at times adjusted up (sometimes to mega doses) for various ailments
  • Beta Carotene (synthetic or naturally derived) ++ 25 mg for non-smokers 0 mg for smokers
  • Vitamin D (D2 and D3) Ergocalciferol; Cholecalciferol 800 IU 60 meg (2,400 IU) (Note: Vitamin D3 is The preferred form)
  • Vitamin E 30 IU 1073 mg as RRR-alpha-tocopherol (1600 IU)
    • Note: gamma tocopherol is probably a better source
  • Vitamin K 80 mg (Ki and K2) (Phylloquinone, Phytonadione, Menaquinone)10 mg
  • Vitamin C (Ascorbic Acid, Ascorbates) 60 mg
    • Note: many recommendations for this are in the multi-gram range per day


MINERALS

  • Calcium 1000 mg
  • Phosphorus 1000 mg - 1500 mg
  • Magnesium 400 mg
  • Potassium 1500 mg (500 mg up to three times daily with meals.)
    • NOTE: The FDA does not allow more than 100 mg Potassium in a suggested daily dose, even though there is no discernible scientific justification for this arbitrary low threshold.
  • Boron 6 mg
  • Chromium (any form of trivalent Chromium) 120 mg -1000 mg
  • Copper 2 mg (Note: Cupric Oxide is a very poorly bioavailable source of Copper.)
  • Iodine 150 mg - 500 mg
  • Iron 18 mg with food 45 mg on empty stomach
  • Manganese 2 mg -10 mg
  • Molybdenum 75 meg -350 meg
  • Selenium 70 meg -200 meg
  • Zinc 15 mg -30 mg

(Note: Zinc oxide is a poorly bioavailable source of Zinc.)
*ULS (2004)

Council for Responsible Nutrition’s “Upper Level for Supplements”
{Vitamin and Mineral Safety, 2nd Edition, CRN)
No ULS has been determined for Vanadium, Nickel, Silicon


COFACTORS & NUTRACEUTICALS

L-Carnitine No DV
OSL (Observed Safe Level) - 2000 mg/day
“Risk assessment for carnitine” John N. Hathcock, et al
Regulatory Toxicology and Pharmacology (2006)

Creatine M on hydrate No DV
OSL (Observed Safe Level) - 5 grams/day
“Risk assessment for creatine monohydrate” Andrew Shao, et al
Regulatory Toxicology and Pharmacology (2006)

Coenzyme Qm No DV
OSL (Observed Safe Level) -1200 mg/day
“Risk assessment for Coenzyme Q10” John N. Hathcock, et al
Regulatory Toxicology and Pharmacology (2006)
Note: a very important nutrient for the heart. This is involved in energy metabolism in the mitochondria.


Lutein No DV
OSL (Observed Safe Level) - 20 mg/day (equal to 40 mg Lutein Esters/day)
“Risk assessment for the carotenoids lutein and lycopene”
Andrew Shao, et al
Regulatory Toxicology and Pharmacology (2006)

Lycopene No DV
OSL (Observed Safe Level) - 75 mg/day
“Risk assessment for the carotenoids lutein and lycopene”
Andrew Shao, et al
Regulatory Toxicology and Pharmacology (2006)

Choline
UL (Tolerable Upper Limit) - 3500 mg/day
From the Institute of Medicine, National Academy of Sciences USA.
“Dietary Reference Intakes for Folate, Thiamin, Riboflavin, Niacin,
Vitamin B12, Pantothenic Acid, Biotin and Choline”, Vol. 1. Washington,
DC; Natl.Acad.Press.
+Daily Value

Additional NUTRACEUTICALS

Glucosamine No DV
OSL (Observed Safe Level) - 2000 mg/day
(either the Hydrochloride or the Sulfate).
“Risk assessment for Glucosamine and Chondroitin Sulfate”
John N. Hathcock, et al.
Regulatory Toxicology and Pharmacology (2006)

Chondroitin Sulfate No DV
OSL (Observed Safe Level) -1200 mg/day
“Risk assessment for Glucosamine and Chondroitin Sulfate”
John N. Hathcock, et al.
Regulatory Toxicology and Pharmacology (2006)


+ Daily Value
Note: many of these recommendations are constantly questioned. Again I reference the paper by Bruce Ames, PhD:
.Ames BN, Elson-Schwab I, Silver EA. High-dose vitamin therapy stimulate variant enzymes with decreased coenzyme-binding affinity (increased Km): Relevance to genetic disease and polymorphisms. Am. J. Clin. Nutr. 2002;75:616-58.

Dr. Ames has over 450 publications to his credit and is one of the most reference scientists in this field. His current research efforts are focused on aging and he is constantly discovering the benefits to aging lab animals from supplementation with various nutrients.

Stay tuned.

I believe that many of these benefits to aging lab animals will be and are being found to correspond with benefits in humans that are aging. Most, if not all of these supplements and nutraceuticals are quite safe. The only downside that I find is the cost. Much of this supplementation issue is a medicine for the affluent issue. What if…President Obama would look at the value of this and the amelioration of disease and would allocate resources for this and preventive medicine in his planned healthcare reform?

NOTE: OSL and UL levels are for adults unless otherwise indicated.