Intended for healthcare professionals

Rapid response to:


Food watchdog warns against high doses of vitamins and minerals

BMJ 2003; 326 doi: (Published 10 May 2003) Cite this as: BMJ 2003;326:1001

Rapid Response:

Micronutrient Dose Rationale

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.

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

(A) Consumer's poor food choices

(B) Method of food preparation

(C) Food's micronutrient loss occurs from field to store shelf

(D) Soil mineral depletion translates to mineral-poor foods

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.


[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)@:

[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.

[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

Competing interests: No competing interests

10 May 2003
Bill D. Misner
Director R & D