Stop Getting Sick

Pyramid of Dietary Supplements

Annette Dickinson, Ph.D.
Vice President, 
Scientific & Regulatory Affairs
Council for Responsible Nutrition,Washington, DC USA

Scientific studies have proven that good diets and generous nutrient intakes can help optimize health and protect against serious diseases, including heart disease, osteoporosis, cancer and even some birth defects. Now, consumers can use new food and supplement pyramids to improve eating habits and build a sensible long-term supplement program.

Foods and supplements, the best plan: A good diet is the foundation for better health, but obviously even the most knowledgeable consumers don?t always eat the way they should. And some nutrients, like vitamin E, are beneficial in amounts far beyond the levels that can be obtained even in a good diet. This year, researchers at Tufts University developed a modified Food Guide Pyramid for the elderly, featuring a flag on top as a reminder that some nutritional supplements may be advisable. This concept can easily be extended to the general population. (See attached illustration of a food pyramid with a supplement flag.) Supplements are easy to add to the daily diet, and are often the first step consumers take toward greater nutritional awareness and the adoption of other healthy lifestyle choices. About half of American consumers now use supplements, according to recent surveys.

Dietary Supplement Pyramid: The Council for Responsible Nutrition (CRN), a trade association representing dietary supplement manufacturers, has developed a Dietary Supplement Pyramid to help consumers identify the key elements of a sound supplement to complement a healthy diet. (See attached illustration.) The food and supplement pyramids are similar in form, but the parallels are not complete. Both sit on a base deliberately chosen to highlight a key component?grain products in the case of the food pyramid and multivitamins in the case of the supplement pyramid. But the food pyramid is topped with fats and oils, with the message to use such products sparingly, whereas the top of the dietary supplement pyramid encompasses a wide variety of products which are valuable to different population groups, depending on their particular needs and lifestyles. As the year progresses, CRN will be exploring other graphics that may more fully capture the role of dietary supplements.

Foundation is a multivitamin: The base of any supplementation program is a multivitamin with minerals, containing at least 400 micrograms (0.4 milligram) of the B vitamin folic acid. Multivitamins are the most commonly used product in the dietary supplement category. There are 13 recognized vitamins and products have all of them in addition to an assortment of minerals. There are 12 minerals for which “Reference Daily Intakes” have been established by the Food and Drug Administration, for purposes of nutrition labeling.

A multivitamin/mineral product will fill most nutrient gaps in normal diets. It will also easily provide the 400 mcg of folic acid that women of childbearing age should get every day, for the sake of their unborn babies. Most pregnancies are unplanned, so being ready for the unexpected means taking that multivitamin every day. Folic acid taken before pregnancy and during the first trimester can greatly reduce the risk of having a baby with neural tube birth defect such as spina bifida, according to the March of Dimes and the Centers for Disease Control and Prevention (CDC).

But multivitamins are not just for young women. Multivitamins with folic acid may also help reduce the risk of heart disease and stroke in men and women of all ages. Folic acid, vitamin B-6 and vitamin B-12 help reduce blood levels of homocysteine (an amino acid produced in the body), and people with lower homocysteine levels have a lower risk of heart disease and stroke. It is the long-term use of multivitamins that is most beneficial, so consumers should resolve in the year 2000 to make this a lifelong habit.

Calcium to build and retain strong bones: Most people don?t get enough calcium. Children, teenagers and young adults need more calcium to build strong bones during the growth years. Middle-aged and older adults (men as well as women) slowly lose bone as they age and the longer they live, the more likely they are to develop osteoporosis. High calcium intakes, preferably with vitamin D, can slow the rate of bone loss and help protect against fractures. The Food and Nutrition Board of the Institute of Medicine, National Academy of Sciences, says everyone over the age of 8 needs at least 1,000 mg of calcium per day, and teens and seniors need even more (1,200 to 1,300 mg). Even people who regularly consume dairy products may not get enough calcium. For example, a glass of milk contains about 300 mg. So if you don?t drink 3 or 4 cups of milk a day (or the equivalent), take 300 mg of calcium for every glass you fall short. Most multivitamins with minerals won?t have this much calcium, because there simply isn?t room in the tablet or capsule. Consumers who need calcium must take it separately. Seniors should consider a combination product with vitamin D as well as calcium.

Antioxidants like vitamin E and vitamin C: Studies suggest that people who take vitamin E and vitamin C on a regular basis may get some protection against diseases or conditions caused by oxidative damage, such as heart disease, cancer and cataracts. The optimum amount for vitamin E may be more than 100 or 200 International Units (IU) and for vitamin C may be at least 200 mg. The most commonly purchased quantity of these two vitamins is 400 IU for vitamin E and 500 mg for vitamin C. Other nutrients that are important antioxidants include two of the carotenoids?lutein and lycopene. Lutein is critical to healthy eyesight, and recent scientific evidence suggests it has a role in protecting against cataracts and against macular degeneration, the leading cause of age-related blindness. Some minerals including selenium and zinc also have an important role in antioxidant enzymes.

Special needs: Many other dietary supplements are available and their use is often tied to special needs or specific dietary lacks. For example, omega-3 fatty acids, found in fish oils, are believed to help reduce the risk of heart disease. People who don?t (or won?t) eat fish regularly may wish to supplement with omega-3 fatty acids. Millions of women rely on supplements of isoflavones derived from soy or red clover, for a healthier menopause. Sports enthusiasts may have a special interest in creatine to improve performance or in protein supplements to help support a body-building regimen. People with joint pain or stiffness may wish to explore supplements such as glucosamine or chondroitin sulfate.

Botanicals: Among the most popular supplements in the market today are a wide variety of herbs and other botanicals, with a long history of use. Many have also been proven in clinical trials. Popular references such as Dr. Varro Tyler?s The Honest Herbal can help consumers understand some of the uses of botanicals. A few key botanical products account for a large fraction of sales in this category. These include:

    • Gingko biloba for memory
    • Ginseng as a general tonic
    • Garlic for maintaining cardiovascular health (cholesterol, blood pressure)
    • St. John?s wort for mood disorders or mild depression
    • Echinacea at the first sign of an upper respiratory infection, such as a cold
    • Saw Palmetto for a healthy prostate


StopGettingSick Team

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