IDIS450 Chapter 22 – 23 Nutrition and Herbal Medicine Reflective journal Journal on any Reflections chapter 22 and 23 APA FORMAT INTEXT CITATION CITATIO

IDIS450 Chapter 22 – 23 Nutrition and Herbal Medicine Reflective journal Journal on any Reflections chapter 22 and 23

APA FORMAT

INTEXT CITATION

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450 – 500 Words CHAPTER
22
Nutritional Supplements
OBJECTIVES
This chapter should enable you to
• Describe the components of dietary reference intakes
• Discuss the development of the nutritional supplement industry
• List factors to consider in assessing the need for supplements
• Describe facts that are listed on supplement labels
• List the antioxidants and their sources
• Define the term phytochemical
• Discuss health conditions for which nutritional supplements can be beneficial
The importance of proper and sensible nutrition, as stated in a previous chapter, cannot be
emphasized enough. In its Healthy People 2020 report, the U.S. government’s Office of Disease
Prevention and Health Promotion states that what people eat, especially when they exercise
regularly and do not smoke and/or drink excessively, is the most significant controllable risk
factor affecting their long-term health (U.S. Department of Health and Human Services,
2016). Basic dietary principles supporting optimum health include the following:
• Eating a wide variety of foods that provide adequate nutrients, including plenty of fresh fruits and
vegetables, complex carbohydrates, plant protein, and fiber.
• Keeping consumption of sugary foods, caffeinated beverages, and alcohol to a minimum.
• Eating only a small amount of animal protein and fat.
• Matching calories consumed with energy expenditure to assure the amount of energy derived from
consumed food is sufficient to support biological and physiological activities
• Drinking plenty of water.
It was once thought that anyone who followed these principles was considered properly
nourished and did not need supplementation; however, the dietary habits of most Americans lead
them to be overweight and undernourished.
Views on Nutritional Supplements
There has been much debate regarding vitamins and minerals as nutritional supplements and how
(or if) they should be taken daily. The early 1900s focused largely on deficiencies of vitamins
and minerals that caused diseases such as scurvy and beriberi. Vitamins began to be added to
food—a process called fortification. Through the 1950s and 1960s, a number of foods were
fortified, such as breads, cereals, and milk. The addition of calcium has been among the recent
fortification of many food products.
By the mid-1970s, however, the focus was less on vitamin deficiency and more on the value of
vitamin and mineral supplementation for the prevention of illness and disease. Vitamin C was
thought to prevent and alleviate symptoms of the common cold. Vitamin E was said to help keep
the heart healthy. A low-fat, high-fiber diet was the order of the decade. The late 1970s saw the
response of the U.S. Senate Select Committee on Nutrition (1977) that listed the number one
public health problem in this country as poor nutrition. Experts believed Americans consumed
too much food of too little nutritive value and that this was a contributing factor to poor quality
of life and increased disease.
KEY POINT
In 1994, an office was created within the National Institutes of Health (NIH) for overseeing research on dietary supplements th
supplements to include the words dietary supplement on product labels.
How the Government Is Involved
Recommended Dietary Allowances
Since the 1940s, the Food and Nutrition Board of the National Academy of Sciences has made
recommendations for nutrient intake. These recommendations have been termed recommended
dietary allowances (RDAs) and represent the minimum standards that should meet the needs of
most healthy people in the United States.
In the 1990s the Food and Nutrition Board determined that a different approach to guidelines
was needed to address the growing use of dietary supplements, food fortification, and awareness
of the role of higher intakes of some nutrients in disease prevention. Because RDAs did not
provide guidelines that addressed the needs of specific groups (e.g., nursing homes, schools,
prisons), Dietary Reference Intakes (DRIs) were developed by the Institute of Medicine to
provide recommendations for different settings (U.S. Department of Agriculture, 2016). DRIs
include several reference values:
• RDAs: the average daily intake of a nutrient to meet the needs of nearly all healthy people
• Adequate Intake (AI): an alternative when RDAs cannot be determined which is based on the
observed intakes of a nutrient by healthy people
• Tolerable Upper Intake Level (UL): the highest level of daily intake of a nutrient that is likely to be
safe for most people
• Estimated Average Requirement (EAR): the amount of a nutrient estimated to meet the requirement
of half of all healthy people in a population
Each of the values considers differences in life stages and gender.
KEY POINT
RDAs, AIs, and ULs offer dietary guidelines for individuals; EARs provide guidelines for groups and populations.
EARs would satisfy 50% of requirements for men and women for specific age groups and are
intended for use by nutritional professionals. If calculations of EARs are not available, adequate
intakes are used instead of RDAs. RDAs continue to be considered as sufficient amounts of
nutrients to meet nearly all needs. Tolerable upper intake levels indicate the largest amount of a
nutrient that someone can ingest without adverse effect.
The Food and Drug Administration (FDA) describes acceptable claims that can be made for
relationships between a nutrient and the risk of a disease or health-related condition. These
claims must be clear as to the relationship of the nutrient to the disease and be understandable by
the general public. The claims can be made in several ways—through third-party references
(such as the National Cancer Institute), symbols (such as a heart), and vignettes or descriptions
(see Exhibit 22-1).
EXHIBIT 22-1 STATUS OF HEALTH CLAIMS
APPROVED HEALTH CLAIMS FOR DIETARY SUPPLEMENTS AND CONVENTIONAL FOODS
• Calcium and osteoporosis
• Folate and neural tube defects
• Soluble fiber from whole oats and coronary heart disease
• Soluble fiber from psyllium husks and coronary heart disease
• Sugar alcohols and dental caries
APPROVED HEALTH CLAIMS FOR CONVENTIONAL FOODS ONLY
• Dietary lipids and cancer
• Dietary saturated fat and cholesterol and coronary heart disease
• Fiber-containing grain products, fruits, and vegetables and cancer
• Fruits and vegetables and cancer (for foods that are naturally a “good source” of vitamin A, vitamin C, or dietary fiber)
• Fruits, vegetables, and grain products that contain fiber, particularly soluble fiber, and coronary heart disease
• Sodium and hypertension
HEALTH CLAIMS NOT AUTHORIZED
• Antioxidant vitamins and cancer
• Dietary fiber and cancer
• Dietary fiber and cardiovascular disease
• Omega-3 fatty acids and coronary heart disease
• Zinc and immune function in older individuals
EXHIBIT 22-1 STATUS OF HEALTH CLAIMS
Data from U.S. Food and Drug Administration. (2016). Guidance for Industry: Substantiation for Dietary Supplement Claims Made Under S
from http://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/DietarySupplements/ucm073200.ht
The FDA does not allow claims for healing, treatment, or cure of specific medical conditions on
the labels or advertisements of nutritional supplements. This would put supplements in the
category of drugs. The DSHEA allows only three types of claims to be used with supplements—
nutrient content, disease, and nutrition support claims. The nutrient content explains how much
of a nutrient is in a supplement. Claims regarding disease must have a basis in scientific evidence
and refer to health-related conditions or diseases and a particular nutrient. Nutrition support
claims (which may be used without FDA approval, but not without notification to that agency)
are set up to explain how a deficiency could develop if the diet was deficient in that nutrient.
These claims are accompanied by an FDA disclaimer on the label of the supplement and are
therefore easy to determine. In March 1999, the DSHEA required that all nutritional supplements
carry a supplement facts panel (see Figure 22-1).
Figure 22-1 Supplement Label
Reproduced from United States Pharmacopeial Convention. (2016). How to read a supplement label. Retrieved
from http://qualitymatters.usp.org/how-read-supplement-label
REFLECTION
What motivates you to use supplements? Do you carefully evaluate claims about them?
A Supplement Extravaganza
Vitamins and minerals were what traditionally made up typical nutritional supplements. Today
the definition of nutritional supplements is expanded to include vitamins, minerals, herbs,
botanicals, and other plant-derived substances; and amino acids, concentrates, metabolites,
constituents, and extracts of these substances (U.S. Food and Drug Administration, 2015).
Consumers can easily become confused by the burgeoning of scientific studies on nutrients; the
immediate release of single studies relating to nutrition, diet, and health; and supplement
advertisements that use health claims to increase sales. In many cases, one report contradicts
another—what was touted as good yesterday is considered harmful today. The following are
some considerations when evaluating studies on supplements:
• Who conducted the research? Was it an independent source or a person/company with a financial
interest in the product?
• Are the details of the studies provided or just the results?
• How many people participated in the research and how were they selected?
• Was the dose standardized?
• Have the findings been replicated?
• Has the research been published in a reputable journal and has it been included in the Cochrane
Database of Systematic Reviews (http://www.cochranelibrary.com/), which evaluates health-care
research?
KEY POINT
More than half of all adults in the United States use nutritional supplementation on a regular basis.
The new millennium was accompanied by buzzwords, such
as antioxidants, phytochemicals, functional foods, and nutriceuticals. It is yet to be determined
whether these new compounds deserve the onslaught of press, print, and manufacture they so
readily receive. When a new study has been completed that suggests a benefit from a nutrient, it
is released immediately. Americans rush to purchase the latest combination of vitamins,
minerals, and nutritive supplements—spending billions of dollars on dietary supplements
annually. Are the supplements worth taking, and are the claims made by manufacturers true?
Nutritional supplements may be helpful, but they may also be harmful. Taking supplements
without knowledge of their actions and interactions could lead to imbalances of other nutrients
and, potentially, toxicity; however, if taken properly and with forethought, supplements can
increase general health and ward off some diseases.
When making the decision to take nutritional supplements, evaluation of the information
available should be done in a carefully planned manner as part of a total nutrition program. If
people hear of studies that seem to relate to their circumstances, it is important for them to do
some investigating on their own. Studies need to be assessed in the context they were performed
and their relationship to a person’s particular situation. Health professionals can assist
individuals in understanding what studies reveal. In any case, taking a supplement based on what
has been read or heard in the news does not guarantee that a given person will have the same
outcome.
The nutritional supplement industry is still young and grows exponentially each day. There
continues to be an increasing variety of supplements readily available, which can be bought over
the Internet, by mail order, at supermarkets, in drug stores, and in other types of stores.
Supplements are no longer the domain of natural food stores. The FDA regulates and oversees
manufacturing, product information, and safety; and the Federal Trade Commission regulates
advertising of supplements; however, decisions regarding whether supplements should be taken,
in what form, and how much, still remain a personal choice.
There is increasing interest among Americans to use nutritional supplements for optimum health.
Some experts are also indicating a definite need for supplementation as part of a nutritional plan
as relying solely on diet to meet the body’s needs for vitamins and minerals may not assure
adequate intake. We no longer eat food picked fresh from the local garden and cooked
within hours. Additionally, many food preparation practices decrease the nutritive value of food.
Vitamins and minerals play an important role in optimum health and in reducing the risk of
chronic diseases. Is the diet a person is consuming, however, giving him or her enough nutrients
and meeting individual needs? If so, then all that may be needed is a good quality multivitamin
and mineral; however, if a person has poor nutritional habits, is under a great deal of stress, is
pregnant or planning a pregnancy, or has a health problem, supplementation is a must. The
supplements that are needed, how much of each, and for how long they need to be taken then
becomes the issue. The research is promising, but for many nutrients, the results are still not
definite.
KEY POINT
Supplements can never substitute for a healthy, sensible nutrition program where whole foods, containing hundreds of substanc
supplementation.
Age, nutritional lifestyle, quality and quantity of food, gender, life stage, environment, family
history, personal history, diet, exercise, and rest patterns should be considered in determining a
person’s need for nutritional supplementation.
As with all holistic approaches, knowledge, self-care, balance, and using what nature provides
are the keys. Individual nutritional needs can be determined by looking at the responses made on
your nutritional lifestyle survey (earlier in this book) and by considering several factors, which
include the following:
Age. There are factors that increase the need for nutrient supplementation with age.
Some nutrients are not absorbed as well as a person ages, even if they are
consumed in good quantity. Older adults may be affected by poor lifelong
nutrition habits, social isolation, and chronic diseases that require special diets
or affect food intake. Children need a balanced diet, along with a good quality
multivitamin and limited sweets and fats to promote their growth and
development.
Chronic health problems. Some chronic conditions create special nutritional
needs, whereas others produce symptoms that threaten a healthy nutritional
status. If a person has a chronic health problem, is taking medication, and wants
to take nutritional supplements, a thorough knowledge of drug–supplement
interactions is necessary. Nurses and other health practitioners can help in this
area.
Female issues. Women who are pregnant, planning to become pregnant,
breastfeeding, menopausal, or postmenopausal need added nutrients and/or
supplementation. Different supplements are needed for different life cycles.
Within the past decade, the National Academy of Sciences has addressed the
unique DRIs for folate and calcium for women (National Institutes of Health,
Office of Dietary Supplements, 2016a; National Institutes of Health, Office
of Dietary Supplements, 2016b).
Lifestyle choices. Cigarette and alcohol use reduces the levels of certain nutrients
and predisposes the body to diseases for which added protection is helpful. A
stressful lifestyle can deplete nutrients. Deficiencies also can arise from the high
consumption of caffeine and sugar.
If people presently take multivitamin/mineral supplements and believe that they may benefit
from taking additional supplements, they should first examine the labels of their food and
supplements. They need to check the DVs of each vitamin and mineral listed. They should be
receiving at least 100% of all nutrients from all food and supplements. If they are lower than
100%, they first need to determine whether they can meet this need through a change in diet. If
they cannot meet the requirements through diet, then supplements of specific nutrients may be
necessary. If the DV is over 100% for some or all nutrients, they may want to cut back on that
supplement. The guideline is to keep below 300% DV of any nutrient. A nutritional analysis can
be used, also. A registered dietician, nutritionist, or nutrition-knowledgeable health-care
professional can help with an analysis.
TIP FOR PRACTITIONERS
For every supplement they are taking, clients should be advised to know: the purpose, recommended dosage, side effects, adver
Supplement Labels
Supplements come in many forms—tablets, capsules, softgels, powders, and liquids. The USP is
the agency that oversees drug products and sets the standards for dietary supplements. All
supplements now require labels, which are regulated by the USP. The USP has certain standards
that must be met for single vitamins and those in combination, as well as dietary supplements,
and botanical and herbal preparations. Figure 22-1 shows the information that is contained on a
supplement label.
One facet of the dietary supplement label that is important to read is the DV column. The DV is
the percentage of the recommended daily amount of the nutrient that a serving gives. According
to the USP, intake should be between 50% and 100% of the DV of each nutrient. One nutrient
that would not provide 100% of the DV is calcium. If 100% of calcium were added to any
supplement, it would be too big to swallow. Calcium should be taken in divided doses
throughout the day.
The bioavailability of a particular nutrient is the amount of a nutrient that enters the bloodstream
and actually reaches the various organs, tissues, and cells of the body. Nutrients have greater
bioavailability when they are taken with compounds that help their absorption.
Fruits and vegetables contain many compounds that, when eaten, allow for synergy to take place
in the body, increasing bioavailability. Fruits and vegetables are especially affected by mode of
storage and preparation. Those that have been exposed to heat, light, or air have lost some or all
of their nutrients; their bioavailability is lowered.
Two important factors when considering the bioavailability of a supplement are ease of
absorption and the benefit of taking it in combination with another supplement. Disintegration
(how quickly a tablet/supplement breaks apart) and dissolution (how fast the supplement
dissolves in the intestinal tract) (U.S. Pharmacopeia, 2016) are two additional factors directly
related to bioavailability. Vitamin C assists with the absorption of iron into the body. If taking
iron as a supplement, people also should consider their vitamin C intake. Taking an iron
supplement with a glass of orange juice would increase the bioavailability of the iron. On the
other hand, calcium inhibits iron and magnesium absorption. This is important to remember
when adding supplements to a nutritional plan, especially if iron, calcium, and vitamin C
individually or in a multivitamin are being taken. More research is needed to determine and
document supplement interactions.
Birth Defects
One of the first vitamins addressed by the advisory committee on dietary supplements was folic
acid. The original aim was to reduce neural tube birth defects, especially spina bifida. The RDA
for folic acid was doubled from 200 to 400 mcg/day. The Centers for Disease Control, the USP,
the FDA, and the March of Dimes have all recommended that women of childbearing age
consume 0.4 mg (400 mcg) per day of folic acid, either through diet or supplements (Centers for
Disease Control and Prevention, 2016). Women who are planning to become pregnant and
who are of childbearing age should eat a varied diet and also take folic acid through
supplementation. Sufficient folate (folic acid) is critical …
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