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Micronutrient Dose Rationale
- Bill D. Misner (10 May 2003)
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Let's not issue any more guessing about vitamins; do the proper study
- Sandra J. Reines, M.D. (11 May 2003)
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Dangerously misleading information !
- Michael Stur (26 May 2003)
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Bill D. Misner, Director R & D E-CAPS INC.
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Greetings Editors, I disagree with the hypothesis that implies a balanced diet satisfies micronutrient requirements. In the past 6 years, I performed over 60 computerized dietary analysis of the foods consumed by endurance athletes, all (100%) of which were found deficient. RDA-level showed deficiency range from 11-28 conditionally essential micronutrients in all of (100%)these athletes. Incidently, I was one of the 60+ subjects. My "balanced diet" was determined by 10 years of careful preliminary practical research applied to a caloric-sufficient dietary protocol that fell well short of meeting RDA-standards for specific micronutrients. Had I not been supplementing these nutrients, each of my 11 deficencies would have proceded unmet, which might have contributed to dietary deficiency disease or immune system compromise from regular aerobic exercise (running or cycling) over 15 hours per week, 52 weeks per annum. Strenuous prolonged exertion and heavy training are associated with depressed immune function. Furthermore, improper nutrition can compound the negative influence of heavy exertion on immunocompetence. Dietary deficiencies of protein and specific micronutrients have long been associated with immune dysfunction. An adequate intake of iron, zinc, and vitamins A, E, B6 and B12 is particularly important but excess intakes can also impair immune function. Deficiencies or excesses of various dietary components can have a substantial impact on immune function and may further exacerbate the immunosuppression associated with heavy training loads. A balanced diet fails to adequately replenish micronutrients for 4 reasons: (A) Consumer's poor food choices
Person's handicapped with nutritionally related disease, older adults, heavy exercising athletes, and/or stress-challenged do require micronutrient supplementation. A multivitamin and mineral supplement taken for 1 year reduced the incidence of participant-reported infection and related absenteeism in a sample of participants with type 2 diabetes mellitus and a high prevalence of subclinical micronutrient deficiency [1]. Supplementation with a multivitamin formulated at about 100% Daily Value can decrease the prevalence of suboptimal vitamin status in older adults and improve their micronutrient status to levels associated with reduced risk for several chronic diseases [2]. A multivitamin-mineral combination was tested has been reported well tolerated and can be used as part of a treatment program for stress-related symptoms at the recommended dose [3]. Preparation of foods by cooking reduces the original water soluble micronutrients remarkably. Vitamin C (ascorbic acid) loss of three vegetable samples (carrots, peas and potatoes) was measured at various points during exposure to a hospital cook-chill system. Substantial losses for all vegetables were identified at the cooking and regeneration stages. The ascorbic acid levels of the selected vegetables when raw ranged from 6 to 10 mg/100 g sample. At the end of the food service cycle the vitamin C (ascorbic acid) content of the vegetables was reduced to 1.7-5.8 mg/100 g sample. The largest percentage loss of ascorbic acid, i.e. 76%, was found in mashed potatoes. Peas incurred the least percentage loss, i.e. 42%. This progressive deterioration during the cook-chill plated catering system causes an insubstantial presence of ascorbic acid in the food served to hospitalized patients [4]. Even when Broccoli was film-wrapped and stored for 7 days at 1 degrees C to simulate a maximum period of commercial transport and distribution, significant loss of micronutrients were reported. Results showed major losses at the end of both periods, in comparison with broccoli at harvest. Thus, the respective losses, at the end of cold storage and retail periods, were 71-80% of total glucosinolates, 62-59% of total flavonoids, 51-44% of sinapic acid derivatives, and 73-74% caffeoyl-quinic acid derivatives [5]. The recommended dietary intake (RDA) for vitamin C was recently increased to 75 mg per day for adult women and 90 mg per day for men. A study published in April 1996 suggests that 200 mg of Vitamin C per day is probably optimal for sedentary adults [6]. However, it is untrue that high vitamin C dose will create gastric stress in the majority of the population. However, too much vitamin C, will produce gastric stress in some, not all predisposed subjects, ranging from loose bowels to severe diarrhea. For other subjects no reactive gastric stress may result. Colgan reported that some subjects taking 5 grams vitamin C daily show little excretion while others taking only 1 gram daily show a large excretion rate of the 1 gram ingested [6]. Three major intervention strategies have been suggested for the control of micronutrient malnutrition vulnerable segments of the Indian population: supplementation of the specific micronutrients; fortification of foods with micronutrients; and horticulture intervention to increase production and nutrition education to ensure regular consumption of micronutrient rich foods [7]. Trace metal deficiencies are now a well- documented complication of total parenteral nutrition (TPN). Clinical abnormalities that may develop when deficiencies of trace metals occur during TPN administration [8]. I do agree with Zosia Kmietowicz' statements that smokers should avoid beta carotene supplementation and plausibly we should avoid synthetic chromium picolinate. However, I favor use of the natural niacin- bound chromium polynicotinate version, which has not been implicated in carcinogenic mutations. Sedentary subjects should NOT take excessive doses of fat-soluble vitamins A, D, K, or E. Selenium specifically should not be consumed above 400 micrograms except upon the supervisory advice of the patient's health care provider. Vitamin B-12 and folate should be supplemented in a proportionate balance of 400-800 micrograms Folate to 100-200 micrograms vitamin B-12, especially by vegetarians, patients subject to coronary Artery Disease, or those with genetic homocystinuria. Athletes on the other hand whose exercise stress levels exceed 1 hour per day should consider the Optimum Daily Allowance ODA micronutrient protocols as rationally presented by Shari Lieberman & Nancy Bruning [9]. As a personal case study to report to BMJ, from ages 56-63, I have taken at 2555 ODA doses half strength considerably higher than the RDA recommended dose, with remarkably positive results and NO side effects or dietary defiency signs. Guidelines for authorizing maximal supplement dose formulations are not currently agreed upon by alternative medicine and allopathic practioners. Guidelines for prevention of overdose need to be addressed and very well could be once both sides of the issue micronutrient deficiency versus micronutrient overdose find common grounds. REFERENCES [1] Barringer TA, Kirk JK, Santaniello AC, Foley KL, Michielutte R., Effect of a multivitamin and mineral supplement on infection and quality of life. A randomized, double-blind, placebo-controlled trial. Ann Intern Med. 2003 Mar 4;138(5):365-71. [2] McKay DL, Perrone G, Rasmussen H, Dallal G, Hartman W, Cao G, Prior RL, Roubenoff R, Blumberg JB., The effects of a multivitamin/mineral supplement on micronutrient status, antioxidant capacity and cytokine production in healthy older adults consuming a fortified diet. J Am Coll Nutr. 2000 Oct;19(5):613-21. [3] Schlebusch L, Bosch BA, Polglase G, Kleinschmidt I, Pillay BJ, Cassimjee MH. A double-blind, placebo-controlled, double-centre study of the effects of an oral multivitamin-mineral combination on stress. S Afr Med J. 2000 Dec;90(12):1216-23. [4] McErlain L, Marson H, Ainsworth P, Burnett SA., Ascorbic acid loss in vegetables: adequacy of a hospital cook-chill system. Int J Food Sci Nutr. 2001 May;52(3):205-11. [5] Vallejo F, Tomas-Barberan F, Garcia-Viguera C., Health-Promoting Compounds in Broccoli as Influenced by Refrigerated Transport and Retail Sale Period. J Agric Food Chem. 2003 May 7;51(10):3029-3034. [6] See: Recommended Dietary Allowances (RDAs)@: http://users.rcn.com/jkimball.ma.ultranet/BiologyPages/R/RDAs.html [6] Colgan M, Your Personal Vitamin Profile, New York, Morrow, 1982. [7] Vijayaraghavan K., Strategies for control of micronutrient malnutrition. Indian J Med Res. 1995 Nov;102:216-22. [8] McClain CJ. Trace metal abnormalities in adults during hyperalimentation. JPEN J Parenter Enteral Nutr. 1981 Sep-Oct;5(5):424-9. Review. [9] Lieberman, S., Brunig, N.,THE REAL VITAMIN AND MINERAL BOOK. Avery Publishing, Garden City, NY; 1990. Competing interests: Bill Misner is Director of Research & Product Development for E-CAPS Inc. who manufacture micronutrient supplements specifically for extreme Endurance |
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Sandra J. Reines, M.D., independent Columbia University Station, PO Box 250687, NY, NY 10025
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Madam: I disagree with this article, which reminds me of articles I used to read in medical school, over thirty years ago. Have we nailed nothing down, since then, in hard science? Instead of learning of progress in our knowledge base, we are still being issued pronouncements in journals which do not sufficiently cite carefully done, recent, conclusive scientific studies. Yes, the abundance of food in the West suggests we ought to be able to ingest the vitamins which we need from the food supply alone. On the other hand, a visiting student from Argentina told me food in the US tastes like wax in comparison to her usual meals at home. Shelf life, methods of transportation, and genetic engineering (are there any new metabolites in genetically engineered foods; could any of them be competing for receptors on carrier proteins, or otherwise impacting on absorption), all are capable of resulting in a vitamin deficiency. As long as patients are warned about the potential for overdosage of the fat-soluble vitamins and iron, I do not see why we should be advising them to err on the side of vitamin deficiency, rather than excess. The water soluble vitamins will be excreted quite quickly, anyway. Meanwhile, I personally am not convinced that undetected vitamin deficiencies in the elderly do not contribute to the earliness of the age at which the findings of senility begin to take effect. Three members of my family, including myself, exhibited extraordinary, sudden vigor, within days of commencing a regimen of vitamins. My young son emerged somewhat from his depression. I suddenly was able to traverse a six flight stair- case, whereas three days earlier, I could not maneuver two flights. My 90 year old mother was suddenly no longer tongue-tied and having to grope around for words. The first time I put her on a course of vitamins, she was soon walking her beach once again, having not done so for in excess of a year. The alteration in her regimen did not involve iron. Sincerely,
Competing interests: None declared |
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Michael Stur, University of Vienna Medical School 1090 Vienna
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Editor, The Food Standards Agency (FSA) report on Vitamins and Mironutrients overpresents data which report possible side effects and overlooks or incorrectly cites important information which does not fit into its small and biased field of view ! For example, the AREDS (age-related eye disease study) trial provided important information (1) on the effect of antioxidants and zinc on the aging eye, including detailed reports on possible side effects. This was a National Institute of Health (USA) supported study which was done without any commercial interest. The FSA just mentiones AREDS when discussing zinc side effects, but even misrepresents the actual information, since the real mean follow-up was 6.3 years, and not only 5 years for 20% of the patients as the FSA cites, and there was also sufficient information on blood samples for each of the four treatment groups. The FSA also missed our paper on zinc substition (2), which provided proof in a placebo controlled trial (112 patients, randomized 1:1 to zinc and placebo) that a daily dose of 200 mg zinc sulfate (= 65 mg of zinc) did not affect red blood count, hemoglobin or serum levels of copper within a 24 months period. The most important AREDS finding is that a substitution with a high dose of antioxidants in combination with a high dose of zinc does significantly reduce the risk of vision loss for the second eye in patients who have already lost vision in the first eye due to advanced age -related macular degeneration (odds ratio 0,52). Currently in the EU we do not have medication providing AREDS-conform doses to our patients. The biased report by the FSA makes it even more difficult to convince our patients to get the only treatment which might postpone loss of vision in their only eye. Congratulations ! Michael Stur, M.D.
References: 1.A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E, beta carotene, and zinc for age- related macular degeneration and vision loss: AREDS report no. 8. Arch Ophthalmol. 2001 Oct;119(10):1417-36 2.Stur M, Tittl M, Reitner A, Meisinger V.:Oral zinc and the second eye in age-related macular degeneration. Invest Ophthalmol Vis Sci. 1996 Jun;37(7):1225-35. Competing interests: None declared |
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