Vitamin and Mineral Therapy

Nutritional Weapons against Disease

As far back as Cleopatra's day, people realized that they could prevent and treat different health problems by eating certain foods. The ancient Egyptians, for instance, ate liver to ward off night blindness. Fifth-century Chinese sailors grew potted ginger aboard their ships and nibbled on the shoots to steer clear of scurvy, a disease marked by loose teeth and bleeding gums.

It wasn't until the early twentieth century, though, that researchers discovered special substances in foods that prevent and cure the likes of scurvy. That potentially fatal disease turned out to be the result of too little vitamin C, a nutrient plentiful in ginger shoots. And night blindness? A nasty consequence of insufficient vitamin A, a nutrient abundant in liver.

Over time, scientists put together everything they knew about the vitamins and minerals women, men and children need to ward off severe deficiency. In 1943, the Food and Nutrition Board of the National Academy of Sciences established a dietary standard known as the Recommended Dietary Allowances (RDAs).

WHY "AVERAGE" ISN'T GOOD ENOUGH

Glance at any cereal box--or just about any packaged food--and you'll notice that the vitamin and mineral contents are listed as percentages of Daily Values (DVs), not RDAs. Daily Values are essentially the recommended amounts needed by the general population, ages four and up, to ensure adequate nutrition. Daily Values are easier to use when referring to people in general, not individuals. They're less precise than the RDAs.

Take, for example, your need for calcium, a mineral essential for healthy bones. The Daily Value for calcium, for the population as a whole, is 1,000 milligrams a day. The RDA for women over the age of 25 is lower--800 milligrams of calcium a day. For pregnant or nursing women, it's considerably more--1,200 milligrams a day. So for women, the RDAs are more meaningful than Daily Values.

THE CASE FOR MORE

The RDAs serve as benchmarks--guides to assessing the nutritional value of foods in terms of what men, women and children need to avoid nutritional deficiency. As new information evolves, the board periodically revises their recommendations.

As a tool for combating nutritional deficiency, the RDAs are adequate, says Shari Lieberman, Ph.D., clinical nutritionist and certified nutrition specialist in New York City and co-author of The Real Vitamin and Mineral Book. "But a growing number of studies suggest that to stay truly healthy, we need doses of most vitamins and minerals that are higher than the RDAs. The RDAs won't ensure optimal health for women," she adds emphatically.

Like-minded nutritionists, physicians and researchers agree. The RDAs are high enough to prevent the kind of extreme deficiency that can lead, in a relatively short time, to diseases like scurvy.

But many of the allowances aren't high enough to prevent less pronounced deficiencies that can slowly and surreptitiously trigger the physiological changes that lead to cancer and degenerative disorders such as heart disease, they warn.

Doses that are higher than the RDA can help prevent and also help treat a wide range of common health problems, says Michael Janson, M.D., director of the Center for Preventive Medicine in Barnstable, Massachusetts, and author of The Vitamin Revolution in Health Care.

Evidence suggests that beyond-RDA doses of certain vitamins and minerals can prevent and treat fatigue, depression, diabetes, asthma, infections, allergies, osteoporosis and arthritis, Dr. Janson says. Minerals for which there is no RDA, like chromium, may help prevent or treat diabetes.

Evidence also suggests that, in addition to vitamins and minerals, other protective nutrients may help a number of health problems unique to women, such as premenstrual syndrome, menstrual cramps and menopausal symptoms, among others. For example, the Food and Nutrition Board has yet to establish RDAs for bioflavonoids--plant compounds found in fruits and vegetables--but studies show that bioflavonoids can help to cool menopausal hot flashes, guard against heart disease and prevent breast cancer, says Dr. Janson.

ANTIOXIDANTS TO THE RESCUE

The best documented benefits of vitamin and mineral therapy are reduced risks of heart disease and cancer. Numerous studies suggest that higher doses of carotenes (some of which your body converts into vitamin A), vitamins C and E, the mineral selenium and other assorted plant compounds can help protect you from both. Collectively, these protective nutrients are known as antioxidants.

Antioxidants come to the rescue by disarming toxic molecules called free radicals, Dr. Janson explains. Free radicals are the unstable by-products of all sorts of chemical reactions. Industrial manufacturing often produces free radical­generating molecules. So do normal physiological and metabolic processes that take place inside our bodies.

Like the proverbial bull in a china shop, unstable free radicals damage any cells that they come in contact with. Widespread damage can accelerate aging at the cellular level, promote the buildup of plaque that clogs the arteries to our hearts, damage cell membranes and DNA and lead to cancer.

At levels higher than the RDA, antioxidants seem to protect cells from free radical damage. For example, the RDA for women for vitamin C is 60 milligrams. For vitamin E, the RDA for women is 12 international units. And there is no RDA for beta-carotene. But consider: A study conducted in the United States suggests that beyond-the-RDA doses of vitamin E can protect women against heart disease. The Nurses Health Study, an ongoing study of 87,000 women, found that women who'd been taking 100 international units of vitamin E daily--eight times the RDA--were 34 percent less likely to have heart attacks than women who didn't take supplements.

As for the role of antioxidants in cancer protection, the evidence is equally promising.

* Several population studies have found that women who average 300 milligrams of vitamin C daily--five times the RDA--reduce their risk of breast cancer by 30 percent.

* In a Latin American study, women who consumed more than 300 milligrams of vitamin C daily ran a 31 percent lower risk of cer- vical cancer than women with intakes of less than 153 milligrams.

* In an Iowa study, women who averaged 66 international units of vi- tamin E daily had one-third the risk of colon cancer of women who averaged 36 international units.

Over-the-RDA doses of antioxidants have been shown to ease and prevent debilitating health problems, such as osteoarthritis, as well. A Boston University Medical Center study found that high vitamin C intake can slow the progression of osteoarthritis by helping prevent the loss of cartilage in joints. Moderate to high doses of vitamin C ranging from 141 to 2,319 milligrams also appear to reduce knee pain. But proceed with caution: Doses of vitamin C higher than 1,200 milligrams can cause diarrhea in some people.

Research suggests that antioxidants can also help treat adult-onset diabetes. If you have diabetes, your cells have trouble using glucose, the simple sugar that serves as your body's primary fuel. There are two types of diabetes. With Type I, which usually appears in childhood, your body produces little or no insulin, the hormone that ushers glucose from your bloodstream into your cells where it can be used. With Type II, which usually appears in adulthood, your body produces insulin, but your cells refuse to accept insulin or the accompanying glucose. Shut out of your cells, glucose builds up in your bloodstream. Glucose buildup can damage your blood vessels, nerves, kidneys and eyes, leading to kidney failure, loss of vision and other problems.

Vitamin E may help women with diabetes, however. In an Italian study, men and women with Type II diabetes who took 900 milligrams of vitamin E daily (112 times the RDA) were able to use glucose more efficiently. After four months of supplementation, tests showed that their cells were more receptive to insulin and allowed more glucose inside. Talk to your doctor before taking high amounts of Vitamin E.

Chromium, an essential mineral for which there's no RDA, also appears to improve glucose tolerance in women with diabetes and lower levels of artery-clogging cholesterol, says Dr. Lieberman. She recommends 200 to 400 micrograms of chromium daily if you have high cholesterol, and sometimes more if you have diabetes. It's a good idea, however, to first consult your doctor about this approach, if you'd like to explore it. If she consents to giving it a try, she may need to adjust any medication that you've been prescribed.

B VITAMINS GET HIGH MARKS

Ranking with antioxidants in the benefits department are folic acid and vitamin B₆. In a Canadian study, people who had high intake of vitamin B₆ or folic acid had lower risks of heart disease and heart attack. Studies suggest that a high daily dose of the B vitamin folic acid can also help prevent cervical dysplasia, abnormal changes in the cells in the opening to your uterus. These changes may lead to cervical cancer.

Folate seems to boost resistance to the human papillomavirus, the most common cause of cervical dysplasia. In a University of Alabama study, women with low levels of folate who were infected with the virus, which is sexually transmitted, were five times more likely to develop dysplasia than women who had plenty of folate in their bloodstream. The RDA for folic acid is 400 micrograms for expectant mothers (it helps prevent birth defects) and 180 micrograms for everyone else.

If you suffer from migraines, riboflavin--another B vitamin--may help, says Alan Gaby, M.D., professor of therapeutic nutrition at Bastyr University in Seattle and author of Every Woman's Essential Guide to Preventing and Reversing Osteoporosis. The RDA for riboflavin is 1.3 milligrams. In one study, migraine sufferers who took 400 milligrams of riboflavin a day experienced two-thirds fewer debilitating headaches.

BEYOND THE RDAs

Considering the evidence, Dr. Lieberman, Dr. Janson and others say that to get truly protective amounts of vitamins, minerals and other nutrients, you need to take supplements.

Getting even the generally accepted requirement of certain vitamins and minerals from food alone can be difficult, even for people who choose their foods carefully, says Dr. Janson. Consuming protective amounts is harder still.

To consume enough vitamin E to protect yourself from heart disease--400 international units, according to some studies--you'd have to finish off 40 cups of almonds, a rich source of vitamin E, Dr. Janson says. So supplements of vitamins and minerals in pill form are a convenient way to bridge the gap.

A STARTER PLAN FOR PREVENTION

That said, it's hard to say precisely how much higher than the RDA you should go. Some studies, for example, suggest that 100 international units of vitamin E will help keep heart attacks at bay. Others suggest that 800 international units is appropriate.

Why the discrepancy? In part, what's considered ideal for one woman isn't necessarily the ideal dose for another, says Dr. Gaby. Differences in genetic makeup, health status and lifestyle create different needs. Women with diabetes, for instance, seem to need more vitamin E to protect their hearts than do women who don't have diabetes, explains Dr. Lieberman.

The differences don't end there. Research suggests that if you take birth control pills, you'll need more folic acid than women who don't take the Pill. And if you're pregnant, Dr. Gaby says, you'll need more vitamin B₆, along with up to 1,000 extra milligrams of calcium and up to 500 extra milligrams of magnesium. "Evidence suggests that those nutrients, in higher amounts, help prevent pregnancy-induced high blood pressure," he says. (If you have heart or kidney problems, check with your doctor before taking magnesium supplements.)

You also need to consider your environment. If you live in midtown Manhattan, you'll need more of vitamins E and C than women living in the country, says Dr. Lieberman. "Research shows that people who live in polluted environments need more antioxidants," she points out.

To design your basic vitamin and mineral regimen, follow these guidelines.

Take three-or-more-a-day multis. You can meet most of your needs easily and conveniently with a good multivitamin/mineral supplement, says Dr. Gaby. Look for a multi that gives you 10 to 20 times the RDA of the B vitamins, 500 to 1,000 milligrams of vitamin C, 200 to 400 international units of vitamin E and at least 500 milligrams of calcium and 300 milligrams of magnesium, he says.

Standard one-a-day multis are too small to give you everything that you need, says Dr. Gaby. You'll have to choose a multiple-dose multivitamin/mineral supplement--one that you take three to six times a day. You can find them in health food stores.

Supplement your supplement. Even the best multiple-dose multi won't give you everything that you need. Unless your doctor advises you otherwise, shoot for at least 600 to 1,200 milligrams of calcium and 300 to 600 milligrams of magnesium daily, Dr. Gaby says. If your multi gives you 600 milligrams of each, make up the difference with individual supplements plus calcium- and magnesium-rich foods such as leafy greens, yogurt and almonds. The RDA for women for magnesium is 280 milligrams--less than half that for calcium. But research suggests that unless otherwise indicated by your doctor, you're better off taking just as much magnesium as calcium, he explains.

Dr. Lieberman agrees. "Taking a lot of calcium every day without sufficient magnesium can induce a magnesium deficiency, which may raise your risk of osteoporosis and heart disease, too."

Consider natural supplements. Some evidence indicates that your body can more easily absorb and use naturally occurring vitamin E than synthetic vitamin E. Dr. Lieberman recommends natural brands primarily because they're less likely to contain artificial dyes and additives.

Check the expiration date on the bottle. Supplements lose their potency over time. Most supplements keep for three years unopened and for one year once they are opened. To keep vitamins and minerals from deteriorating, store supplements in a cool, dry, dark place, Dr. Lieberman says.

Take your supplements with food. Supplements are best absorbed and less likely to upset your stomach when taken with food, says Dr. Janson. He suggests that you take a third of your vitamins and minerals with breakfast, a third with lunch and a third with dinner.

Don't substitute pills for food. Advocates of vitamin and mineral therapy say that even if you take supplements, you need to pay attention to your diet. They emphasize that you should include at least five servings of vegetables and fruits daily. Besides vitamins and minerals, nutritious food supplies other critical nutrients--protein, carbohydrates and essential fatty acids--best supplied by food, not pills.

A diet that includes fruits and vegetables also supplies hundreds of other plant compounds, known as phytochemicals, that researchers believe may be as crucial to health as the vitamins and minerals listed on your cereal box. (One family of protective nutrients, the carotenoids, includes 500 members.) While a handful of these protective nutrients are available in supplement form, others are still available only in plant foods like fruits, vegetables and grains. Also, new phytochemicals are discovered every year, so you'll be ahead of the game if you rely on plant compounds for these nutrients.

CUSTOMIZING YOUR SUPPLEMENT PROGRAM

Depending on your family medical history, your personal health status and your lifestyle, you may want to take extra amounts of certain vitamins or minerals, Dr. Lieberman says. Talk to a nutritionist or your doctor for advice on how vitamins and minerals best fit into your life.

Consider antioxidants. Dr. Janson recommends extra antioxidants for most women. He suggests 25,000 international units of mixed carotenoids and 2,000 milligrams of mixed bioflavonoids.

Don't go overboard. Excessively high doses of certain vitamins and minerals can be toxic. For example, doses of vitamin B₆ higher than 62 times the RDA of 1.6 milligrams can cause unstable gait and numb feet. Doses of vitamin A higher than 10,000 international units are not advised for pregnant women. Excessive amounts have caused birth defects.

Consult a professional. "I don't think people should run off and pop the latest pill they've read about," says Dr. Gaby. "Instead, consult a professional."

Not all doctors are convinced that all women need to take supplements or higher-than-RDA doses of vitamins and minerals. But the number of converts is growing. At one gathering of cardiologists, says Dr. Gaby, a good 70 percent of the doctors raised their hands when asked if they took vitamin E. At one time, he says, they would have laughed at the notion.

Not only are M.D.'s taking supplements, and particularly antioxidants, they're also recommending them for their patients, Dr. Lieberman says. "More than 90 percent of my clients are referred to me by physicians."

Know your medical history. Evidence suggests that vitamin or mineral therapy can benefit a growing list of health conditions. But determining the right dosage requires an accurate diagnosis and sometimes a blood test.

A case in point is iron, a mineral needed to form hemoglobin, the substance that helps your red blood cells transport oxygen from your lungs to the rest of your body. Women who have iron-deficiency anemia may need extra iron before menopause because we lose some when we menstruate. Women also need extra iron while they're pregnant, to nourish the developing fetus. After menopause, though, our iron needs drop, says Dr. Janson. In fact, several studies suggest that excess iron may contribute to heart disease before and after menopause.

The RDAs for iron take these changes into account and will meet most women's needs, says Dr. Janson. So you shouldn't take more than the RDA unless your doctor tells you to, he advises.

Folic acid is another example. In one study, 47 women with cervical dysplasia saw significant improvement after taking 10,000 micrograms a day for three months, notes Dr. Gaby. So he recommends up to 10,000 micrograms of folic acid a day if you have, or are at risk of, dysplasia. But high doses of folic acid can hide symptoms of a form of anemia that can lead to permanent nerve damage. So you shouldn't take doses higher than 400 micrograms without medical supervision.

If you have kidney stones, ask your doctor before taking extra vitamin C, since high doses of the vitamin can aggravate the condition, says Chris Meletis, doctor of naturopathy and clinic director, chief medical officer and medicinary director at the National College of Naturopathic Medicine in Portland, Oregon.

Also, in some people, high doses of vitamin C can cause diarrhea. If that happens to you, lower your dose, says Adriane Fugh-Berman, M.D., former head of field investigations for the Office of Alternative Medicine at the National Institutes of Health in Bethesda, Maryland. If you have diarrhea, it means that you're taking too much, she says.

Use caution with medications. With some medications there may be a limit on the amount of a vitamin or mineral you should take. For example, taking 100 international units or more of vitamin E thins the blood, says Dr. Fugh-Berman. So if you're taking blood-thinning drugs, you need to limit your intake of vitamin E. Also, people on blood thinners must be sure not to overdo it with too much vitamin K or any other fat-soluble vitamins.

Separate supplements and prescription drugs. Iron supplements will interact with certain prescription drugs in ways that may prevent their absorption. Iron supplements will keep your body from properly absorbing thyroid drugs, for instance, says Jacob Teitelbaum, M.D., clinician and researcher on the treatment of chronic fatigue syndrome at Anne Arundel Medical Center in Annapolis, Maryland, and author of From Fatigued to Fantastic! If you take your medications in the morning and at night, take iron supplements around lunchtime, he suggests.