Homework No. 11:
Popular Supplements – Vitamins and Minerals
Homework 11: Popular Supplements – Vitamins and Minerals
11.1 Vitamins and Minerals and Safety of Vitamin Mineral Supplements (15 pts.)
11.1.1 In the Vitamins and Minerals paper, what point do the authors make by going through all the types of definitions?
Scientific, regulatory or marketplace standard definitions are still non-existent for MVMMs with widely different ingredients and characteristics (Yetley, 2007, p. 269S).
11.1.2 What are bio-availability and bio-equivalence and what is the importance of these in considering vitamins and minerals? What factors affect bio-availability and why are these important?
Bio-availability and bio-equivalence refer to product characteristics and are important in evaluating the quality of published scientific research (Yetley, 2007, p. 269S). The factors that affect these are: a) homeostatic mechanisms that control absorption or excretion; b) age, sex and physiologic state; and c) ingested size or volume (p. 272S). These factors are important due to concerns on intended use and dosage (p. 272S).
11.1.3 What do the authors say about interactions of vitamins and minerals and drugs? Give 2 examples.
Product dissolution or release may affect bio-availability while the rate of release can be affected by formulations, fillers, coatings, exipients and surfactants (Yetley, 2007, p. 274S). One, is the interaction of Vitamin C with inorganic iron which enhances the bio-availability of iron (p. 274S). Another, is the decreased volumes of magnesium and calcium which also enhances the bio-availability of iron (p. 274S).
11.1.4 What is a dose response curve and why is it important?
The dose response curve graphically shows that the deficiency of certain substances as well as increased volumes affect health (Mulholland & Benford, 2007, p. 318S). It is important in illustrating and measuring nutrient deficiencies and toxicity due to increased nutrient volumes (p. 318S). For instance, Vitamin C deficiency results to scurvy while excessive intakes of it can result to gastrointestinal problems (p. 318S). Hence, the dose response curve is important in setting standards for safe intake and acceptable intake of MVMMs (p. 318S).
11.1.5 Explain the significance of Figure 1.
Figure 1 defines the safe range of dosage for MVMMs to help determine deficiency or excessive intakes (Mulholland & Benford, 2007, p. 319S). This is important for standards- setting, regulation and monitoring of MVMM products.
11.1.6 Explain figure 2 and then choose several examples given by the author and place them at the level of severity that you think is appropriate. Explain why.
Figure 2 illustrates and defines the escalating levels of adverse effects with regards to bio-chemicals and recovery of the human body from such adverse effects (Mulholland & Benford, 2007, p. 320S). One example is the intake of large doses of iron that results to constipation, nausea, vomiting and stomach pain (p. 319S). Its level of severity is no. 4 because the person can recover from these by lowering intake or taking the supplement with food (p. 319S). Another example is the intake of isotretinoin during pregnancy that causes children to have birth defects such as small ears, cleft palate, microcephaly, etc (p. 319S). Its level of severity is no. 7 due to irreversible organ damage (p. 319S). A third example is the intake of Vitamin A that results to decreased bone mineral density and increased fracture risk (p. 320S). Its level of severity is no. 5 in case of decreased bone mineral density or no. 6 in case of fracture risk (p. 320S).
11.2 Nutritional Supplements in Pregnancy (6 pts.) The answers under this heading are based or derived from Glenville (2006).
11.2.1 (1 point) What background does the author present in the introduction? What is the purpose of her paper that resulted from her background search?
Glenville showed that sufficient nutrients and good health are related and this is very important during pregnancy (p. 642). Her paper aimed to examine the role of nutritional supplements in the health of the mother during pregnancy, the result of the pregnancy, and the health of the baby (p. 642).
11.2.2 (5 points) Go through the categories presented by the author (e.g. pre-eclampsia, preterm, birth, etc) and summarize the evidence for whether vitamin mineral supplements have led to better outcomes. What do you conclude in terms of need for vitamin mineral supplements in pregnancy?
Preeclampsia. Vitamin E plus C reduced the incidence of preeclampsia (p. 643). In another study, anti-oxidant intake reduced the risk of preeclampsia although it increased the risk of preterm birth (p. 643). A significant study that included pregnant women with diabtes, previous preeclampsia, chronic hypertension, renal disease and multiple births showed results that Vitamin E and C treatment did not reduce preeclampsia. The researcher explained that this might be due to the reactions of specific disease drug treatments with the vitamin E and C treatments.
Preterm births. Vitamin C intake significantly reduced the incidence of premature rapture of the chorioam niotic membrane or PROM (p. 644). A combined intake of vitamin C and vitamin E also prolonged birthing periods (p. 644). Likewise, fish oil supplements positively resulted in longer gestation period and increased weight among new born babies (p. 644).
Birth size and weight. Fish oil supplements among pregnant women increased birth weight (p. 644). Deficiencies in Vitamin D, zinc, folic acid, Vitamin B6 and B12 have also been found to negatively affect the birth size and weight of babies (p. 645).
Gestational diabetes. There is an ongoing study in the prevention of Type 1 Diabetes (p. 645). The result of the study is not yet available (p. 645).
Oral clefts. Folic acid has been found to reduce neural tube defects, decrease the incidence of oral clefts, and possibly decrease the risk of congenital heart disease (p. 645).
Miscarriage. A trial involving women with three or more miscarriages provided treatment with omega-3 fatty acids. All women became pregnant after treatment, babies delivered weighed more than 2500 grams, and no longer suffered any miscarriages (p. 645).
Postpartum depression. Randomized doses of omega-3 fatty acids over an eight-week period lowered postpartum depression scores from the average (p. 646).
Future health of the baby. Mothers who consumed omega-3 fatty acids and breastfed their babies had children who have higher I.Q.s at the age of four (p. 646).
Based on Glenville’s finding, vitamin and mineral supplements are necessary during pregnancy to reduce a number of health risks. However, the intake of such supplements should be carefully considered when combined with drugs taken for the treatment of certain diseases as the reaction of these drugs with the supplements can have adverse effects.
11.3 Choice of Vitamin/ Mineral Products (9 pts.) The answers for this heading were based or derived from BodyBuilding.com (n.d.).
11.3.1 (9 points) Find at least 3 vitamin/mineral products…e.g. Centrum, One a Day, Flintstones, etc. They must be comparable products, i.e. do not choose one multi, one iron supplement, etc, but all multi vitamin/mineral supplements. Given what we read for the first question, how do your products compare in terms of % of RDA for various vitamins and minerals? What criteria would you personally set up to evaluate if one is the best buy? What are the “selling points” that supposedly make one a better deal than another (e.g. does one have a USP label or some other quality standard)? Why would you choose one over the other? Here you need to use your criteria from above—the criteria are critical to explain and you have the reading from the first question to help you think about this. Given what you write, how would you make a decision as to which to buy?
In terms of % RDA for various vitamins and minerals, the MVMM selection in Table 1 shows many differences in the presence or absence of certain ingredients, volume or content of particular ingredients, and form of the ingredient.
Safety will be a sound criterion. Too many combinations of certain compounds will likely have adverse effects, so the best buy would be the product that has: a) few unknown ingredients; b) complete RDA percentages for well-known vitamins and minerals, including compounds; and c) produced by a reputable company.
Yummi Bears’ selling point is: “All-In-One Formula Contains The Right Amount of Vitamins and Minerals. Child-Vites selling point is: “Affordable and Tastes So Good.” Children’s Chewables selling point is: “Provides Essential Nutrients to Help Build Healthy Bodies.”
Yummi Bears would be a good choice due to the following reasons: a) it does not contain too many unknown compounds or trace minerals that might not be necessary or could have adverse effects on health when accumulated over time; b) its selling point indicates that the manufacturer is aware of the possible adverse effects of too many ingredients that can possibly have chemical reactions; and c) the shape and form of the supplement is attractive to children.
Finally, a table comparing the ingredients of each MVMM product like Table 1 can help provide the right information that is crucial to the decision process in buying and using a particular MVMM product.
Table 1. Comparison of Three Children’s Multivitamins and Multimineral Products
Vitamin A Palmitate
2500 IU 100%
Beta-carotene 5000IU 80%
2,500 IU 100%
30 mg 75%
Ascorbic Acid 120mg
30 mg 75%
200 IU 50%
200 IU 50%
d-Alpha Tocopheryl Succinate
15 IU 150%
d-Alpha Tocopheryl Succinate
d-Alpha Tocopheryl Succinate
15 IU 150%
10 mg 100%
10 mg 111%
0.75 mg 107%
0.85 mg 106%
1 mg 150%
1 mg 143%
200 mcg 100%
200 mcg 100%
3 mcg 100%
3 mcg 100%
150 mcg 100%
5 mg 100%
Pantothenic Acid 15mg
9.2 mg 1%
Calcium Carbonate 30mg
Calcium Phosphate 20.5 mg 3%
75 mcg 110%
8 mg 4%
Magnesium Oxide 83% and Amino Acid Chelate 17% 24mg
3 mg 2%
7.5 mg 100%
Amino Acid Chelate 5mg
1 mg 13%
Choline Bitartrate 10mg
Ferrochel Iron Bisglycinate
9 mg 90%
Amino Acid Chelate 10mcg
Amino Acid Chelate 200mcg
Amino Acid Chelate 1.0mg
Amino Acid Chelate/ Chelavite
Sodium Molybdate 15mcg
15.5 mg 2%
Bodybuilding.com. (n.d.). “Children’s Chewable.” Bodybuilding.com. Retrieved July 15, 2007, from http://www.bodybuilding.com/store/schiff/child.html.
Bodybuilding.com. (n.d.). “Child-Vites.” Bodybuilding.com. Retrieved July 15, 2007, from http://www.bodybuilding.com/store/ns/childvites.html.
Bodybuilding.com. (n.d.). “Yummi Bears Multi.” Bodybuilding.com. Retrieved July 15, 2007, from http://www.bodybuilding.com/store/hero/multi.html.
Glenville, M. (2006). “Nutritional supplements in pregnancy: commercial push or evidence based?” Current Opinion in Obstetrics and Gynecology 18. Lippincott Williams & Wilkins.
Mulholland, C.A. and Benford, D.J. (2007). “What is known about the safety of multivitamin-multimineral supplements for the generally healthy population? Theoretical basis for harm.” The American Journal of Clinical Nutrition 85. American Society for Nutrition.
Yetley, E.A. (2007). “Multivitamin and multimineral dietary supplements: definitions, characterization, bioavailability, and drug interactions.” The American Journal of Clinical Nutrition 85. American Society for Nutrition.