How to meet a woman’s special needs with supplements?

And what about women? At various stages of their reproductive lives, they, too, benefit from supplements-as-insurance:

• Before menopause: Women, who lose iron each month through menstrual bleeding, rarely get sufficient amounts of iron from a typical American diet providing fewer than 2,000 calories a day. For them, and for women who are often on a diet to lose weight, iron supplements may be the only practical answer. Iron is a mineral element, so it may be called “iron” or “elemental iron” on the label. Iron pills contain a compound of elemental iron (“ferrous” or “ferric,” from ferrum, the Latin word for iron), plus an ingredient such as a sulfur derivative or lactic acid to enable your body to use the iron. On the label, the combination reads “ferrous sulfate” or “ferrous lactate.” Different iron compounds dissolve at different rates in your stomach, yielding different amounts of elemental iron, so supplement labels usually list the iron this way: Ferrous sulfate 325 mg/Elemental iron 65 mg. Translation? This pill has 325 milligrams of ferrous sulfate, yielding 65 milligrams plain old iron. Sometimes the label omits the first part and simply says: Iron 65 mg. If your doctor says, “Take one 325-milligram pill a day,” she means 325 milligrams iron compound, not plain elemental iron.
• During pregnancy and lactation: Women who are pregnant or nursing often need supplements to provide the nutrients they need to build new maternal and fetal tissue or to produce nutritious breast milk. In addition, supplements of the B vitamin folate now are known to decrease a woman’s risk of giving birth to a child with a neural tube defect (a defect of the spinal cord and column). Never self-prescribe supplements while you’re pregnant. Large amounts of some nutrients may actually be hazardous for your baby. For example, taking megadoses of vitamin A while you’re pregnant can increase the risk of birth defects.
• Through adulthood: True, women older than 19 can get the calcium they require (1,000 milligrams/day) from four 8-ounce glasses of nonfat skim milk a day, three 8-ounce containers of yogurt made with nonfat milk, 22 ounces of canned salmon (with the soft edible bones; no, you definitely should not eat the hard bones in fresh salmon!), or any combination of the above. However, expecting women to do this nutritional balancing act every single day may be unrealistic. The simple alternative is calcium supplements.

Using supplements as insurance

Healthy people who eat a nutritious diet still may want to use supplements to make sure they’re getting adequate nutrition. Plenty of recent research supports their choice.

Protecting against disease
Taking supplements may reduce the likelihood of some types of cancer and other diseases. After analyzing data from a survey of 871 men and women, epidemiologists at Seattle’s Fred Hutchinson Cancer Center found that people taking a daily multivitamin for more than ten years were 50 percent less likely to develop colon cancer. In addition, selenium supplements seem to reduce the risk of prostate cancer, and vitamin C seems to lower the risk of cataracts.

Supplementing aging appetites
As you grow older, your appetite may decline and your sense of taste and smell may falter. If food no longer tastes as good as it once did, if you have to eat alone all the time and don’t enjoy cooking for one, or if dentures make chewing difficult, you may not be taking in all the foods that you need to get the nutrients you require. Dietary supplements to the rescue! If you’re so rushed that you literally never get to eat a full, balanced meal, you may benefit from supplements regardless of your age.

When food isn’t enough

Illness, age, diet preferences, and some gender-related conditions may put you in a spot where you can’t get all the nutrients you need from food alone.

Digestive illnesses, unfriendly drugs, injury, and chronic illness
Certain metabolic disorders and diseases of the digestive organs (liver, gallbladder, pancreas, and intestines) interfere with the normal digestion of food and the absorption of nutrients. Some medicines may also interfere with normal digestion, meaning you need supplements to make up the difference. People who suffer from certain chronic diseases, who have suffered a major injury (such as a serious burn), or who have just been through surgery may need more nutrients than they can get from food. In these cases, a doctor may prescribe supplements to provide the hard-to-get vitamins, minerals, and other nutrients.
Checking with your doctor or pharmacist before opting for a supplement you hope will have medical effects (make you stronger, smooth your skin, ease your anxiety) is a smart idea. The bad old days when doctors were total ignoramuses about nutrition may not be gone forever, but they’re fading fast. Besides, your doctor is the person most familiar with your health, knows what medications you’re taking, and can warn you of potential side effects.

Vegetarianism
Vitamin B12 is found only in food from animals, such as meat, milk, and eggs. (Some seaweed does have B12, but the suspicion is that the vitamin comes from microorganisms living in the plant.) Without these foods, vegans —vegetarians who don’t eat any foods of animal origin — almost certainly have to get their vitamin B12 from supplements or fortified foods.

Why People Use Dietary Supplements?

In a country where food is plentiful and affordable, you have to wonder why so many people opt to scarf down pills instead of just plain food. Many people consider vitamin and mineral supplements a quick and easy way to get nutrients without so much shopping and kitchen time and without all the pesky fat and sugars in food. Others take supplements as nutritional insurance. And some even use supplements as substitutes for medical drugs. In general, nutrition experts, including the American Dietetic Association, the National Academy of Sciences, and the National Research Council, prefer that you invest your time and money whipping up meals and snacks that supply the nutrients you need in a balanced, tasty diet. Nonetheless, every expert worth his or her vitamin C admits that in certain circumstances, supplements can be a definite plus.

In 2002, the American Medical Association (AMA), which for decades had turned thumbs down on vitamin supplements, changed its collective mind after a review of 26 years’ worth of scientific studies relating vitamin levels to the risk of chronic illness. Robert H. Fletcher and Kathleen M. Fairfield, the Harvard-based authors of the study, which was published in the Journal of the American Medical Association (JAMA), said, yes, true vitamin-deficiency diseases such as scurvy and beriberi are rare in Western countries. But suboptimal vitamin levels — sciencespeak for slightly less than you need — are a real problem. If “slightly less than you need” sounds slightly less than important, consider this:

• Suboptimal intake of folate and two other B vitamins (B6 and B12) raises your risk of heart disease, colon cancer, breast cancer, and birth defects.
  
• Suboptimal vitamin D intake means a higher risk of rickets and osteoporosis.
• Suboptimal levels of antioxidant vitamins A, E, and C are linked to a particular form of heart disease and some forms of cancer.

Hence the new AMA rule: “It’s prudent for all adults to take vitamin supplements.”
But just as that bit of info was settling in, a new study said, “Hold it! There’s too much Vitamin A in that pill!” That was followed by more new research on too much vitamin E. As you read this, vitamin manufacturers are tumbling over each other in the race to get new, lower formulations to market.

Introducing Dietary Supplements

The vitamin pill you may pop each morning is a dietary supplement. So are the calcium antacids many American women consider standard nutrition. Echinacea, the herb reputed to short-circuit your winter cold, is, and so is the vanilla-flavored meal-in-a-can liquid your granny chug-a-lugs every afternoon just before setting off on her daily mile power walk. The FDA classifies each of these as a dietary supplement because they meet the agency’s definition: any pill, tablet, capsule, powder, or liquid you take by mouth that contains a dietary ingredient.
Of course, that raises another question: What’s a dietary ingredient?

Answer:

• Vitamins
• Minerals
• Herbs
• Organ tissue, such as desiccated (dried) liver
• Some hormones, such as melatonin, which is promoted as a sleep aid
• Metabolites (substances produced when nutrients are digested)
• Extracts

Dietary supplements may be single-ingredient products, such as vitamin E capsules, or they may be combination products, such as the nutrient-packed protein powders favored by some athletes.

Understanding terms used to describe nutrient recommendations

Nutrient listings use the metric system. RDAs for protein are listed in grams. The RDA and AIs for vitamins and minerals are shown in milligrams (mg) and micrograms (mcg). A milligram is 1⁄1000 of a gram; a microgram is 1⁄1000 of a milligram. Vitamin A, vitamin D, and vitamin E are special cases.

For instance, one form of vitamin A is preformed vitamin A, a form of the nutrient that your body can use right away. Preformed vitamin A, known as retinol, is found in food from animals —liver, milk, and eggs. Carotenoids (red or yellow pigments in plants) also provide vitamin A. But to get vitamin A from carotenoids, your body has to convert the pigments to chemicals similar to retinol. Because retinol is a ready-made nutrient, the RDA for vitamin A is listed in units called retinol equivalents (RE). One mcg (microgram)

RE is approximately equal to 3.33 international units (IU, the former unit of measurement for vitamin A).
Vitamin D consists of three compounds: vitamin D1, vitamin D2, and vitamin D3. Cholecalciferol, the chemical name for vitamin D3, is the most active of the three, so the RDA for vitamin D is measured in equivalents of cholecalciferol. Your body gets vitamin E from two classes of chemicals in food: tocopherols and tocotrienols. The compound with the greatest vitamin E activity is a tocopherol: alpha-tocopherol. The RDA for vitamin E is measured in milligrams of alphatocopherol equivalents (a-TE).

Understanding DRI: Dietary Reference Intake

In 1993, the Food and Nutrition Board’s Dietary Reference Intakes committee established several panels of experts to review the RDAs and other recommendations for major nutrients (vitamins, minerals, and other food components) in light of new research and nutrition information.
The first order of business was to establish a new standard for nutrient recommendations called the Dietary Reference Intake (DRI). DRI is an umbrella term that embraces several categories of nutritional measurements for vitamins, minerals, and other nutrients. It includes the:

• Estimated Average Requirement (EAR): the amount that meets the nutritional needs of half the people in any one group (such as teenage girls or people older than 70). Nutritionists use the EAR to figure out whether an entire population’s normal diet provides adequate amounts of nutrients.
• Recommended Dietary Allowance (RDA): The RDA, now based on information provided by the EAR, is still a daily average for individuals, the amount of any one nutrient known to protect against deficiency.
• Adequate Intake (AI): The AI is a new measurement, providing recommendations for nutrients for which no RDA is set. (Note: AI replaces ESADDI.)
• Tolerable Upper Intake Level (UL): The UL is the highest amount of a nutrient you can consume each day without risking an adverse effect.

The DRI panel’s first report, listing new recommendations for calcium, phosphorus, magnesium, and fluoride, appeared in 1997. Its most notable change was upping the recommended amount of calcium from 800 mg to 1,000 mg for adults ages 31 to 50 as well as post-menopausal women taking estrogen supplements; for post menopausal women not taking estrogen, the recommendation is 1,500 mg.

The second DRI Panel report appeared in 1998. The report included new recommendations for thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B12, pantothenic acid, biotin, and choline. The most important revision was increasing the folate recommendation to 400 mcg a day based on evidence showing that folate reduces a woman’s risk of giving birth to a baby with spinal cord defects and lowers the risk of heart disease for men and women.

As a result of the 1989 DRI Panel report, the FDA ordered food manufacturers to add folate to flour, rice, and other grain products. (Multivitamin products already contain 400 mcg of folate.) In May 1999, data released by the Framingham Heart Study, which has followed heart health among residents of a Boston suburb for nearly half a century, showed a dramatic increase in blood levels of folate. Before the fortification of foods, 22 percent of the study participants had folate deficiencies; after the fortification, the number fell to 2 percent.

A DRI report with revised recommendations for vitamin C, vitamin E, the mineral selenium, beta-carotene, and other antioxidant vitamins was published in 2000. In 2001, new DRIs were released for vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc. And in 2004, the Institute of Medicine (IOM) released new recommendations for sodium, potassium, chloride, and water, plus a special report on recommendations for two groups of older adults (ages 50 to 70 and 71 and over). Put these findings all together, and they spell out the recommendations.

The complete reports on which this table is based are available online. Go to www.iom.edu/Object.File/Master/21/372/0.pdf. Prefer hard copy? IOM plans to consolidate the reports into one book to be published late in 2006.
Hankering for more details? Notice something missing? Right — no recommended allowances for protein, fat, carbohydrates and, of course, water.