Thanks to Nutrition Science News for the use of this article!
by Michael Janson, M.D.
For decades people have believed that eating a balanced diet provided all the nutrients they needed. It's simply not true. This erroneous belief is largely based on government pronouncements that the Recommended Dietary Allowances (RDAs) are the bottom line in nutrient requirements. Although a huge amount of work went into developing these dietary guidelines, they don't tell the whole story.
The RDAs were developed with one purpose in mind: to determine the lowest amount of a nutrient that must be consumed in order to prevent a specific disease (in this case, called a "deficiency disease") from developing. For example, if your diet is deficient in vitamin B3 (niacin), you will develop pellagra. Because of extensive research on this once common deficiency disease, the minimum amount of niacin required to prevent pellagra is now well known.
Nutritional guidelines based on this concept, however, face three fundamental problems. First, a vitamin or mineral deficiency is much different from an insufficiency. A deficiency suggests that there is a level needed to prevent a disease, while an insufficiency suggests that there is a level necessary for optimal functioning.
Second, the widely accepted concept of biochemical individuality, developed in the 1950s by Roger Williams, Ph.D., holds that individuals are biochemically unique. Williams showed that nutritional needs within the same species--in this case, human--can vary up to 40 times. 
How is this so? Genetic variation results in variable enzyme activity. Enzymes are the proteins that drive biochemical reactions. The level of enzyme activity in the body determines many things such as hormone production, fat metabolism, energy supply and antioxidant activity. Vitamins and minerals act as "cofactors" for most enzymes, meaning that they are necessary for the enzymes to work. Higher amounts of particular cofactors can "push" enzyme activity. For instance, one person may require 2 mg of vitamin B5, while another needs 80 mg to achieve the same level of a certain enzyme activity.
Third, we all live in different environmental situations and are subjected to different stresses, so quite naturally we may have different nutritional needs. Researchers know, for instance, that our ability to detoxify a variety of environmental toxins is based, in part, on certain key nutrients. People exposed to high levels of pollutants may have increased demands for specific nutrients. 
Why Take Supplements?
Many people have parents and grandparents who lived to old age without taking the best care of themselves--and without taking supplements. These elders grew up during a time when the environment and the food supply were healthier, and certainly not dangerous. Today, frequent and early-onset degenerative diseases such as heart disease, diabetes, arthritis and cancer are much more common among the U.S. population than they were several generations ago. Unfortunately, the average modern diet comes up short in nutrients that might help solve the problem.
Modern agricultural practices such as over-fertilization and heavy pesticide use diminish soil quality and, consequently, affect the foods grown in it. In one region of China, an investigation found, low levels of certain key nutrients were associated with increased risk for a number of cancers.  Picking foods before they are ripe (for better transport and storage) also affects their nutritional value. The detectable flavor difference between a home-grown tomato and a typical supermarket variety reflects their different nutrient levels. In addition, plant breeding today often concentrates on improving food's appearance, pest resistance and shipping resilience rather than increasing its nutritional value.
Supplements help make up the difference. Numerous studies show that supplements can help prevent degenerative diseases and often can be part of an effective treatment program. [4-8] On a preventive level, they also ensure that we have enough nutrients for our needs. Human cells need a constant, abundant supply of nutrients including vitamins, minerals, protein, carbohydrates and fats. This requires a healthy diet--and, in many cases, additional nutrient intake.
Nutrients also protect against environmental toxins and the cellular damage they cause. Whether from food or water toxins, mercury in dental fillings, or aluminum in cookware and antiperspirants, our bodies are bombarded with a huge variety of toxins. Such exposure taxes the body's detoxification system that relies on specific vitamins and minerals. Inadequate nutrient levels in the face of rising demand may lead to health problems. 
Tap water can be contaminated with heavy metals such as lead and cadmium, and much of our drinking supply also contains fluoride. Although fluoride is good for bones and teeth, it also may increase cancer risk, lead to digestive and kidney problems, and discolor the teeth (a condition known as fluorosis).  Industrial chemicals and wastes, as well as pesticides and other farm chemicals, seep through the soil and contaminate the water table. Volatile chemicals, (hydrocarbons that readily vaporize) can combine with chlorine to form even more toxic products called chlorinated hydrocarbons (such as PCBs--polychlorinated biphenyls). 
Many of these pollutants increase the number of oxygen-derived, high-energy, molecular fragments in the body known as free radicals. These free radicals can severely damage tissues, destroy nutrients, and lead to premature aging, heart disease and cancer. Other sources of free radicals are certain highly processed foods and food additives; ultraviolet sunlight; processed vegetable oils, margarine and shortenings; charcoal-broiled, charred or burned foods; heavy metals; excessive iron; and some prescription medications.
Many supplements, particularly antioxidants, can help control the damage that follows toxic exposure. [12,13] Supplements replace nutrients destroyed by toxins and supply nutrients that help prevent the harmful effects of foreign chemicals. Vitamins A, C and E; carotenes; the trace minerals selenium, manganese and zinc; bioflavonoids; and Co-Q10 all help scavenge free radicals. They may also help prevent cancer, heart disease, premature aging and tissue degeneration. [14,15]
Numerous studies support the role of nutrients in amounts that exceed what diet alone can provide. One study, for instance, demonstrated that 800 IU of vitamin E each day enhanced immune function in the elderly.  Another study showed that bladder cancer recurrence was reduced by half in a group given high doses of vitamins C, A, E and B6.  Neither of these helpful doses can be supplied by even a healthy diet.
Designing A Personal Plan
How should a personal supplement program be designed? The various kinds of supplements and approaches to health programs can be overwhelming, and many people give up in frustration. Here are some basic health enhancement and preventive medicine guidelines that should make it simple.
No one practice cures or prevents all illness and degeneration, though any one of them will help to some degree. Nutrients work in complex synergies. A look at the literature suggests that almost any one nutrient helps with almost any health problem. For example, vitamins C and E help with heart disease, but so do essential fatty acids, selenium and magnesium, the B complex vitamins, some flavonoids, as well as the amino acids carnitine, lysine and proline and the accessory nutrient Co-Q10. [18-20]
Keep health programs simple--complex plans are easily abandoned. Take dietary supplements at breakfast and dinner, or take the first dose with lunch and the second dose with the evening meal at least six to eight hours later. Some supplements, like calcium and magnesium, can be taken right before bedtime. Supplements are less likely to be forgotten if they don't have to be carried around.
For general preventive medicine and assuming you are in good health, start with basic supplements such as a comprehensive daily multivitamin/mineral formula. A good multivitamin also contains some vitamins C and E, but I always recommend extra vitamin C (3,000-4,000 mg), vitamin E (400 IU), and natural carotenes (15-30 mg). The extra vitamin E and carotenes can be taken any time of day, since they are fat-soluble and not easily metabolized and excreted. For best absorption, they should be taken with food. Divide water-soluble supplements such as vitamin C into at least two doses per day, because they metabolize rapidly. A single dose may result in higher levels for part of the day but not the whole day. Water-soluble supplements still have benefits, but perhaps not as much as if you divided their doses. I recommend a multivitamin that contains:
- 25-100 mg of most of the B-complex vitamins
- 15,000-25,000 IU of the carotenoids
- 200 mcg each of selenium and chromium
- 10-20 mg of manganese
- 400-500 mg each of magnesium and calcium
(There is some controversy regarding the ideal amount of calcium to take, but it depends on a person's sugar, caffeine, protein, soda and alcohol consumption, as well as exercise habits.)
Unfortunately, such a multivitamin is not available in one pill. It usually requires from three to six pills a day to get these doses, and there are several variations available on the market. If you cannot find such a multivitamin, you can make up the approximate amounts with individual nutrients.
Supplements And Disease
When I design supplement programs for my patients, I consider not only their diagnoses but their lifestyles, attitudes and interests in different parts of a comprehensive health program. Therefore, when I refer to treating heart disease or diabetes with supplements, understand that these are general guidelines which are only part of a whole program tailored to an individual. Here are some examples of supplement programs that I use in my practice.
Heart disease: The following daily supplements are generally beneficial for conditions including angina and congestive heart failure:
- a multivitamin/mineral
- 4,000-6,000 mg vitamin C
- 800 mg magnesium
- 240 mg GLA (borage or primrose oil)
- 800 IU vitamin E
- 25,000 IU natural carotenes
- 200 mg Co-Q10
- 1,000 mg L-carnitine
- 800 mg inositol hexaniacinate
- 500 mg taurine
- 750 mg hawthorn berry (Crataegus oxyacantha)
- 1,200 mg fish oil containing EPA and DHA
In addition to the above supplements, patients with hypertension may also benefit from taking 1,000-2,000 mg deodorized garlic (Allium sativum). Garlic taken in a variety of forms, including deodorized supplements, helps to relax blood vessels.  In addition, taurine and magnesium are particularly good for some forms of arrhythmia.
Diabetes: I recommend many of the same supplements for diabetic patients but add an additional 1,000 mcg of chromium and 300 mg of milk thistle extract (Silymarin). To prevent disease complications such as damaged blood vessels and vision loss, I suggest flavonoids such as quercetin (800 mg), proanthocyanidins from grape seed or pine bark extracts (100 mg), ginkgo (Ginkgo biloba) (120 mg), and bilberry (Vaccinium myrtillus) (200 mg). People with diabetes must also pay close attention to their diet. The most well-documented diet that helps control blood sugar is a high-fiber, high-complex-carbohydrate diet.
It is not uncommon to treat different health problems--from chronic fatigue and headaches to asthma, allergies and premenstrual syndrome--with variations of these supplement regimens. Many conditions have similar metabolic abnormalities and the nutrients and botanicals included in these health programs have varying functions.
Don't Leave Health To Chance
The idea of what constitutes a balanced diet, what food components are essential, and what amounts are beneficial is not as simple as the RDAs would have us believe. Dietary supplements can foster good health and vigor in all stages of life. You may have inherited a strong constitution, but is it wise to wait 40 or 50 years to find out? Dietary supplements are good preventive medicine--consider them a form of health insurance. But remember, there is more to a health program than supplements. An exercise program, stress management and a whole-foods diet combined with a positive, energetic outlook on life and lots of laughter will increase your chances of living a long and vigorous life.
How To Start A Supplements Regimen
1. Williams, R.J. Biochemical Individuality: The Basis of the Genetrotropic Concept: New York: John Wiley, 1956.
2. Guengerich, R. "Effects of nutritive factors on metabolic processes involving bioactivation and detoxification of chemicals." Ann Rev Nutr, 4: 207-31, 1984.
3. Taylor, P.R., Li, B., et al. "Prevention of esophageal cancer: The nutrition intervention trials in Linxian, China. Linxian Nutrition Intervention Trials Study Group." Cancer Res, 54(7 Suppl): 2029s-31s, 1994.
4. Stephens, N., Parsons, A., et al. "Randomized controlled trial of vitamin E in patients with coronary disease: Cambridge heart antioxidant study (CHAOS)." Lancet, 347: 781-86, 1996.
5. Anderson, R. "Chromium, glucose tolerance and diabetes." Bio Trace Element Res, 32: 19-24, 1992.
6. Lamm, D.L., Riggs, D.R., et al. "Megadose vitamins in bladder cancer: A double-blind clinical trial."
J Urol, 151(1): 21-26, 1994.
7. Buring, J.E., Hennekens, C.H. "Beta-carotene and cancer chemoprevention." J Cell Biochem Suppl, 22: 226-30, 1995.
8. Anderson, Cheng, et al. "Beneficial effects of chromium for people with type II diabetes." Diabetes, 45: 124A, 1996.
9. Bland, J., Barrager, E., et al. "A medical food supplemented detoxification program in the management of chronic health problems." Alt Therapies
1: 62-71, 1995.
10. Marshall, E. "The fluoride debate: One more time." Science, 247: 276-77, 1990.
11. Frackelmann, K. "Hints of a chlorine-cancer connection." Science News, 142(2): 23, 1992.
12. Halliwell, B. "Antioxidants and human disease: A general introduction." Nutr Rev, 551(Ii): Suppl S44-52, 1997.
13. McCord, J. "Free radicals and pro-oxidants in health and nutrition." Food Technology, 48(5): 106-11, 1994.
14. Girodon, F., Blache, D., et al. "Effect of a two-year supplementation with low doses of antioxidant vitamins and/or minerals in elderly subjects on levels of nutrients and antioxidants." J Amer College Of Nut, 16(4): 357-65, 1997.
15. Block, G., & Langseth, L. "Antioxidant vitamins and disease prevention." Food Technology, 48(7): 80-84, 1994.
16. Meydani, S., Meydani, M., et al. "Vitamin E supplementation and in vivo immune response in healthy elderly subjects." JAMA, 277(17): 1380-86, 1997.
17. Lamm, D., Riggs, D., et al. "Megadose vitamins in bladder cancer: A double-blind clinical trial." J Urol, 151(1): 21-6, 1994.
18. Jacob, R. "The case for vitamin supplementation." J Amer Coll Nutr, 13(2): 111-12, 1994.
19. Langsjoen, P., Willis, R., et al. "Treatment of essential hypertension with coenzyme Q10." Molec Aspects Med, 15 Suppl: S265-72, 1994.
20. Crestanello, J., Kamelgard, J., et al. "Elucidation of a tripartite mechanism underlying the improvement in cardiac tolerance to ischemia by coenzyme Q10 pretreatment." J Thoracic Cardio Surg, 111: 443-50, 1996.
21. McMahon. Pharmacotherapy, 13(4): 4, July-August, 1993.
Michael Janson, M.D., is president of the American Preventive Medical Association and a fellow and president-elect of the American College for Advancement in Medicine. Janson is the author of The Vitamin Revolution in Health Care (Arcadia Press, 1996). He practices nutrition therapy, chelation therapy and preventive medicine at the Center for Preventive Medicine in Barnstable, Mass.
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