Nutrition Supplements Jennifer Click Redlich MS, RD, CSO, LDN - - PowerPoint PPT Presentation
Nutrition Supplements Jennifer Click Redlich MS, RD, CSO, LDN Natural Products are Powerful Even Western Medicine uses natural products to treat illnesses every day Many prescription drugs are created or inspired from nature
Jennifer Click Redlich MS, RD, CSO, LDN
– Heal – Improve our health – Add quality and years to our life
– If you believe something has POWER, you also have to respect that it has power….potential for good AND potential for harm
– No one “only” eats – No one “only takes supplements”
– Prescription drugs are not without side effects or risks, but a MD is in control
– ATBC Study (Alpha-Tocopherol Beta-Carotene Prevention Study)
– 29,133 male smokers in Finland – Supplements increased risk; study stopped early
– CARET study (Beta-Carotene and Retinol Efficacy Trial )
– Tested combination of 30 mg beta-carotene and 25,000 IU retinyl palmitate against placebo in 18,314 men and women at high risk of developing lung cancer – Stopped 21 months early : “clear evidence …no benefit …substantial evidence of possible harm” – 28% more lung cancers and 17% more deaths in the active intervention group
– SELECT study (Selenium and Vitamin E Cancer Prevention Trial) – Double-blind, placebo-controlled 4-arm study,: 35,533 men
– Selenium – Vitamin E (400 IU dl-alpha tocopheryl acetate) – Selenium and vitamin E together – placebo
– Fall 2008- “stop taking”: neither vitamin E nor selenium supplements associated with the prevention of prostate cancer – 2011 analysis: 17% increase in prostate cancer incidence in participants who were
groups (non-significant)
– Milk/dairy lowers risk of colorectal cancer (CRC) – Calcium supplements seem to lower risk for most people – In small % raised risk
– In some genetic populations, calcium supplements may bind too much magnesium, thus increasing risk of CRC – When taking a supplement: how do you know if you (as an individual) are one of those in the smallest % that might have increased risk from supplements? – Go with food when possible. Milk/dairy is protective because it contains BOTH calcium and magnesium…
– Prevention of deficiency through avoidance of toxicity… but how much is optimal?
– Fortification of the food supply has decreased birth defects – Is fortification increasing CRC, breast and other cancers?
– How much is optimal for each person and at what time in their life?
– Folic acid isn’t folate – dl-alpha tocopheryl acetate isn’t mixed tocopherals – Beta carotene isn’t carotenoids – Natural products have both desirable and undesirable properties
– Tea: aluminum – Flaxseed: cadmium
– Bodies tightly regulate absorption, metabolism and excretion
– Vitamin C and cancer treatment: PO vs IV – Turmeric vs curcumin
– Ratios and rates are likely important
– Whole soy vs refined soy products
– Timing matters (prior to puberty through post menopausal…it’s not all the same)
– Eatright.org: “Get vitamins and minerals from food” – DGA committee: “Eat ideal diet and take a vitamin D supplement” – AICR: “Don’t rely on supplements to protect you from cancer…Eat a balanced diet instead” (though some allowances are made) – FDA: “Dietary Supplements can be beneficial to your health — but taking supplements can also involve health risks” – IOM: “Take a multi-vitamin/mineral supplement with the RDA for most vitamins and minerals”
Percent of U.S. Population with Average Intake Below EAR
Scientific Report of the 2015 Dietary Guidelines Advisory Committee, Fig. D1.1 From: What We Eat in America, NHANES 2007-2010
– Physician Health Study II
– Large, randomized, double blind, placebo controlled, long term study – Evaluated use of multivitamin/mineral supplement as primary prevention of
– Cancer – CVD – Age related diseases – Cognitive function
Multivitamins in the Prevention of Cancer in Men: The Physicians' Health Study II Randomized Controlled Trial
Cumulative Incidence Rates of Total Cancer Among 13 329 Men With No Baseline History of Cancer and 1312 Men With a Baseline History of Cancer in the Physicians' Health Study II
– Cancer
– Findings were significant (decreased risk of cancer: not so much for prostate cancer but, especially when prostate cancer wasn’t included in results and even more so for those who had a baseline cancer diagnosis prior to participating in the study)
– Cataracts
– Findings were significant (lowered risk of total cataracts and cataract surgeries)
– Major cardiovascular events
– Neither increased nor decreased risk
– Cognitive decline
– Neither increased nor decreased risk
– Promotes cell differentiation, reduces inflammatory cytokines, inhibits proliferation, induces apoptosis – Low vitamin D appears to be associated with risk factors for inflammation, cancer, heart disease, osteoporosis, autoimmune diseases…..maybe even autism and ADHD
– “Association” does not mean “cause” or “effect”
– Some conflicting study results but are we looking at the whole picture? – You’ll probably need a supplement (but get your labs checked first) – Vitamin D deficiency: Magnesium deficiency in disguise?
RDA = 600-800 IU UL = 4000 IU* *may need more to
correct a deficiency
– Calcium alone
– Doesn’t improve bone health – Increases cardiovascular risk – Lowers risk of CRC for most
– Ratios of Ca: Mg are important
– Asian usual diet 1.7:1 (Ca:Mg) – USA diet (3:1) – Optimal ratio seems to be 1.7-2:1 – <1.7 and >2.8 = detrimental
– Magnesium
– Found in green plants (chlorophyll), nuts, seeds, milk – Involved in DNA “spell check” – Important for heart health and bone health, making ATP, etc – Leg cramps, migraines, tremor, anxiety, fatigue and others – Serves as a cofactor in vitamin D metabolism pathways
Ca: mg/day RDA = 1000-1300 UL = 2000-3000 Mg: mg/day RDA = 310-420 UL (supp)= 350
– B12 (>50 year old adults, bariatric medicine and those chronically using acid blockers, possible benefits for peripheral neuropathy) – Coenzyme Q10? (possible considerations for older adults and those on statins); may interact with warfarin – Alpha lipoic acid? (Germany, prescription for tx of diabetic neuropathies; studies in MS, neurodegenerative disease, Alzheimer's) – Choline?
– Some genetic polymorphisms may have higher needs – With aging?
– Leafy greens (K, vitamin K, Mg, folate) – Ground flaxseed (breast CA) – Vinegar (diabetics, triglycerides, weight control) – Tea (countless benefits) – Brazil nuts (source of selenium) – Nuts, seeds, oils (vitamin E)* – Herbs and spices (countless benefits)
– Mushrooms – High fat fish (Alaskan salmon, etc) and
– Studies show benefit with CVD, arthritis, MS, DM, depression, bipolar disorder, GI diseases, decreased risk of breast cancer – 1-3 grams/day has been studied – Caution: Fish oil supplements may protect cancer cells during treatment (in general, discourage use of supplemental fish oil in patients getting active treatment- some
exceptions apply)
– Food sources of probiotics and prebiotics – Turmeric – *??? (mixed tocopherols??)
– GRAS (the spice, anyway) – Gene regulation – mTOR inhibition, hedgehog inhibition – Regulates inflammation – Studies have been done on conditions such as: aging, cancers (head/neck, CRC most promising), rheumatoid arthritis, osteoarthritis, gout, ulcerative colitis, Crohn’s, MS and more – Biological availability
– Curcumin – Piperine (P450 enzyme), tea, fat
– Currently under investigation for druggability
– Vitamin C (wound healing; cold and flu season)? – Zinc (wound healing; cold and flu season)? – Melatonin
– Possible benefits: traumatic brain injury, jet lag, circadian rhythm disorder – May help with occasional sleepless nights
– use smallest dosage possible for shortest period of time
– Follow Dietary Guidelines – You don’t have to be vegetarian but do eat plants! – Have a general idea of what you’re eating [ChooseMyPlate.gov (Supertracker.gov)] – Know your labs (Vitamin D) – Make up for shortfalls with diet first, but supplement if needed
– Think “complex” and “natural” (if possible) with supplements too
– Take a multivitamin-mineral supplement
– Look for USP, NSF on label (or subscribe to ConsumerLab.com) – Local resource: CMC Morrocroft Pharmacy ($25 consultation but turns into gift card/spending money to use in the pharmacy)
– PubMed (caution: keep the big picture and your critical thinking skills in tact) – Office of Dietary Supplements; National Institutes of Health – FDA: Office of Dietary Supplements Programs – Institutes of Medicine – American Institute for Cancer Research (AICR) – American Cancer Society – UpToDate (by subscription) – ConsumerLabs.com (by subscription) – Natural Standards Database (by subscription)