Vitamins – Health or Hype?
Vitamins – Health or Hype?
Author: Mark Parkinson BsPharm: President AFC-CE
Credit Hours 1- Approximate time required: 60 min.
Educational Goal
Provide a more scientifically based understanding of the effect and use of vitamins.
Educational Objective
- Expose the fallacy of some myths about the benefits of vitamins.
- Provide a list of vitamins and explain how vitamins got their names
- Explain the chemical basis of how vitamins work
- Discuss the consequences of under and overdosing
- Tell about the difference between synthetic natural supplements
- Discuss factors that affect how much vitamins we get from our diet
Procedure:
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Disclaimer
The information presented in this activity is not meant to serve as a guideline for patient management. All procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this article should not be used by care providers without evaluation of their patients’ Doctor. Some conditions and possible contraindications may be of concern. All applicable manufacturers’ product information should be reviewed before use. The author and publisher of this continuing education program have made all reasonable efforts to ensure that all information contained herein is accurate in accordance with the latest available scientific knowledge at the time of acceptance for publication. Nutritional products discussed are not intended for the diagnosis, treatment, cure, or prevention of any disease.
Vitamins – Health or Hype?
The recent Covid-19 health crisis has created a new desire in people to get and remain healthy. There are many who are turning to half-remembered health lessons about healthy eating and vitamin supplements. Over the years, though, those memories have been tainted by advertisers, pseudoscientists and well-meaning but uninformed friends and family. It’s time to cut through all the hype and get to the real facts about health and vitamins.
Before we get started, I have a few questions for caregivers. Should foster caregivers worry about vitamins? Isn’t that the doctor’s job to decide which pills are needed? Isn’t it true that a normal, healthy person can get all the vitamins they need in a balanced diet? On the other hand, are your residents considered to be normal? Don’t they need something more to feel normal, like vitamins? How do you balance a diet for optimal vitamin intake? Can you take too many vitamins?
Let’s see if we can find some answers.
What are vitamins?
I went online to see what advertisers have to say about vitamin supplements.
“Discover total wellness for mind, body and home. Quality backed immune support. Energizers with more invigorating nutrients. Great top-rated selection of vitamins for energy. The best vitamins for energy and weight loss, natural, organic…”
Advertisers make it sound like vitamins are on-demand miracles. Wonder pills, magically harvested from nature. They don’t come right out and say it, but they imply that if you need more of some health benefit (energy, wellness, or a multitude of other claims), all you have to do is take their product. The result of all this advertising is that popular myths arise that are just not true.
What vitamins really are is a group of powerful chemical compounds— synthetically produced or derived from the foods we consume—that have the following properties:
- They are organic molecules, meaning they contain several carbon atoms in their structure.
- They are a micronutrient, needed in small quantities only.
- They are essential for a healthy body. Without them, we grow sick and die.
- They act predominantly as regulators of metabolic processes.
- They are not broken down to produce energy or used as a structural component to build up the parts of our bodies.
- The body can’t make them or cannot produce them in sufficient quantities to maintain good health. We have to either get them from the foods we eat or take a vitamin supplement.
What are their names?
There are 13 recognized vitamins: A, B1, B2, B3, B5, B6, B7, B9, B12, C, D, E, and K. Most of them are not a single chemical compound but are a group of related molecules that share similar chemical structures and chemical names.
- vitamin A (as all-trans-retinol, all-trans-retinyl-esters, as well as all-trans-beta-carotene and other provitamin A carotenoids)
- vitamin B1 (thiamine)
- vitamin B2 (riboflavin)
- vitamin B3 (niacin)
- vitamin B5 (pantothenic acid)
- vitamin B6 (pyridoxine)
- vitamin B7 (biotin)
- vitamin B9 (folic acid or folate)
- vitamin B12 (cobalamins)
- vitamin C (ascorbic acid)
- vitamin D (calciferols)
- vitamin E (tocopherols and tocotrienols)
- vitamin K (phylloquinone and menaquinones)
Why the funny alphabet names?
Vitamins were unkn
own before 1910. The ability to identify minute chemical compounds in the body just did not exist. Then, in Japan, and later, in England, a group of chemicals was discovered that seemed to be vital for maintaining good health. Kazimierz Funk, a Polish biochemist working in London, described them as vital-amines (amines are compounds containing nitrogen). Publications later shortened the name to vitamines. The term was soon used to describe other chemical compounds that were essential for good health. Instead of giving the chemical name, writers found it was easier to call them vitamine A, B, C, and so forth. The name vitamine was used even when there was no amine group in the compound. For clarity, the name was shortened to simply vitamin. As our biochemistry knowledge grew, further adjustments to the naming systems had to occur. For example, folic acid was originally called vitamin M. Then it was reclassified to vitamin B9. Vitamin G (riboflavin) become Vitamin B2, and so forth. The word vitamin soon made its way into advertising and popular culture. What was once a shortcut name for medical writers became the word that everyone used.
What do vitamins do?
Vitamins are biochemical compounds that are involved in multiple chemical processes throughout the body. They provide vital components that enable chemical processes to occur. They do not provide energy; they enable us to more efficiently get energy from the foods we eat. They don’t make strong bones; they enable our body to make strong bones. They do not provide immunity; they enable the body to protect itself.
In other words. taking vitamins does not give extra abilities. They facilitate the proper functioning of the body. It appears that you are getting extra, when in fact you are just functioning closer to your original natural potential. The truth of the matter is taking more vitamins will never enable you to get extra power or ability.
Vitamin groups: fat soluble vs. water soluble
Vitamins are functionally organized into two categories: fat soluble and water soluble. This grouping is based on whether the chemical compounds mix easily with water or oils and fats. It is a very important factor that can determine how the vitamin is absorbed, distributed, and stored in the body. It is also a major factor in how the body handles excess amounts of the vitamin.
Water-soluble vitamins are C and the B complex (B1–B12). They follow the water. Wherever the water goes, that is where the vitamins are found. They are absorbed along with the water in the digestive tract. They flow into the bloodstream and are carried along with the current. Unless the body stores them away, they are peed out when we urinate. Because of the ready loss, our supply of water-soluble vitamins needs replacing often.
The fat-soluble vitamins are A, D, E, and K. They follow the fats and oils of the foods we eat. Since they do not mix with water easily, fat-soluble vitamins need help getting into and around in the body. That assistance is found in the gallbladder and its bile acids, which facilitate these vitamins’ absorption in the intestine. Special transport proteins also help them get through cell walls and move around in the bloodstream. The fat-soluble vitamins are easily stored in the lipid components of our tissues and cells. The quantities of fat-soluble vitamins tend to last longer in the body, so their need for resupply is less than that of the water-soluble vitamins.
Under-dosed and over-dosed
Bodily functions, at their most basic level, run on chemical processes. Every action the body takes is dependent on step-by-step chemical activities. The chemicals we know as vitamins are key components of many of the body’s chemical procedures. Without a vitamin compound present, the chemical reactions cannot occur. We feel that lack of chemical activity as weakness, being tired, and failure to thrive. If the lack of a specific chemical activity becomes severe enough, we start to feel a set of symptoms, and we call that a disease. A lack of vitamin C results in scurvy. A lack of vitamin D results in rickets. Thiamine, beriberi; niacin, pellagra; folate, neural tube defects; and so forth. In modern diets, it is fairly easy to get enough vitamins to avoid disease states. So today, the main emphasis is getting enough vitamins to thrive.
DRI
Getting enough vitamins to thrive has always been a tricky thing. Circumstances vary considerably between individuals and our knowledge of the role of vitamins is constantly changing. To assist in determining how much is enough, governments around the world have gathered experts who publish intake recommendations. In the United States, the Food and Nutrition Board of the Institute of Medicine, National Academy of Sciences, has published the Dietary Reference Intakes (DRI).
“DRI is the general term for a set of reference values used to plan and assess nutrient intakes of healthy people. These values, which vary by age and sex, include:
Recommended Dietary Allowance (RDA): average daily level of intake sufficient to meet the nutrient requirements of nearly all (97%-98%) healthy people.
Adequate Intake (AI): established when evidence is insufficient to develop an RDA and is set at a level assumed to ensure nutritional adequacy.”
Source: https://ods.od.nih.gov/HealthInformation/Dietary_Reference_Intakes.aspx
The DRI is the reference used in determining the nutrition facts that are required to be published on the packaging of the foods and supplements we consume. To make the information easier to use, the nutritional facts are published as a percentage of the recommended dietary allowance (RDA) per serving of the product.
Overdose
Chemical reactions occur when compounds come into contact with each other. The greater the concentrations of compounds, the more reactions occur. It is an automatic occurrence, and they happen even if we don’t want them to. For example, vitamin C is an antioxidant used in our immune system, but it can also create kidney stones. Taking too much vitamin C, for some people, will cause very painful problems.
Under normal circumstances, getting too many vitamins from our diet is not a problem. But toxic levels of vitamins can occur if too many supplements are taken on a continuing basis. Toxic levels are a particular concern for the fat-soluble vitamins, where large quantities can be easily stored in the fat stores of our body.
- Vitamin C. Although vitamin C has relatively low toxicity, high doses of it can cause gastrointestinal disturbances, including diarrhea, cramps, nausea, and vomiting. Migraines can occur at doses of 6 grams per day.
- Vitamin B3 (niacin). When taken in the form of nicotinic acid, niacin can lead to high blood pressure, abdominal pain, impaired vision, and liver damage when consumed in high doses of 1–3 grams per day.
- Vitamin B6 (pyridoxine). Long-term overconsumption of B6 can cause severe neurological symptoms, skin lesions, sensitivity to light, nausea, and heartburn, with some of these symptoms occurring at intakes of 1–6 grams per day.
- Vitamin B9 (folate). Taking too much folate or folic acid in supplement form may affect mental function, negatively impact the immune system, and mask a potentially severe vitamin B12 deficiency.
- Vitamin A. While vitamin A toxicity, or hypervitaminosis A, can occur from eating vitamin-A-rich foods, it’s mostly associated with supplements. Symptoms include nausea, increased intracranial pressure, coma, and even death.
- Vitamin D. Toxicity from taking high doses of vitamin D supplements can lead to dangerous symptoms, including weight loss, appetite loss, and irregular heartbeat. It can also raise blood calcium levels, which can lead to organ damage.
- Vitamin E. High-dose vitamin E supplements may interfere with blood clotting, cause hemorrhages, and lead to hemorrhagic stroke.
Source: https://www.healthline.com/nutrition/can-you-overdose-on-vitamins
To assist in preventing hyper-vitamin quantities, the DRI also publishes the tolerable upper intake level (UL), which is the maximum daily intake unlikely to cause adverse health effects in healthy individuals. If caregivers start to see troubling symptoms of vitamin overdose, consult with the doctor.
Natural vs. synthetic
The “natural” way of getting the vitamins we need is from the food we eat. Simple to understand, but more complicated to actually achieve. There are many factors that can prevent us from getting a sufficient supply of the chemical compounds we need. Poor health, bad diet choices, picky eaters, genetic defects, unhealthy lifestyles, and stress can all combine to create a need to take additional vitamins from supplements.
Vitamin supplements can be divided into two groups: naturally produced or synthetically derived. Naturally produced means that the chemical compounds were created by plants and animals. Synthetically produced means that the compounds were manufactured by using chemical reactions.
Chemically speaking, the body doesn’t care where the vitamin comes from. As long as the compound is the right shape and has all the right components, it will get the job done.
Economically speaking, naturally produced vitamins usually cost more. This is partly due to advertising hype. People are fooled into thinking that “natural” means better so they will pay more for the product. The main reason for the extra cost comes from the fact that it takes a lot more effort to produce naturally sourced vitamins. You have to harvest the food source, isolate the parts that have the vitamin compound, remove the vitamin, concentrate its supply, and then package it in a consumable form. It’s ironic that naturally sourced vitamins require so many unnatural processes.
Bioavailability
There is one factor in the natural versus synthetic debate to consider that may be significant: bioavailability. Bioavailability is the term that describes how much of a drug or chemical is delivered to its site of action. Naturally-sourced vitamin products usually have a higher bioavailability, meaning a larger percentage of the active chemical gets to where it’s needed. The reason for that is very complicated. It involves advanced organic chemistry so I will spare you the details. If you are curious and want to know more, read the Vitamin E CE for a more detailed explanation. For most circumstances, though, bioavailability does not have as much impact as one might think. Most patients rely on their diet to supply the majority of their vitamins. The amount of supplementally supplied vitamins getting to the site of action is not very critical. Only for those with a very restricted diet or who have a comprised digestive system does bioavailability become significant. Residents with NG tubes or gastric bypasses come to mind.
Bioavailability is also a factor in the vitamins we get from our diet. Not all the vitamins in our food get to where they are needed in our body. The vitamin molecule can be broken up (denatured) by heat, acid, or alcohol. Some vitamin molecules can become oxidized when exposed to air, while others are leached or dissolved into the cooking water and never consumed. This is a particular factor for the water-soluble vitamins.
Getting enough vitamins from the foods we eat
There are many publications listing which foods are rich in which vitamin. They can be useful in planning a balanced diet. But—and this is just my opinion—there are those who take these lists far too seriously. I might be a bit too cynical but consulting a list of vitamin-rich foods does not guarantee a person will get enough vitamins. Dietary intake of vitamins is too complex an issue. It involves multiple factors that affect a vitamin’s bioavailability. For example, it may appear that eating raw fruits and vegetables gives you more vitamins. But cooking food helps break down plant cell walls, making it easier to digest and intake more vitamins. Cooking also enhances flavors, making it easier to eat greater quantities of vitamin-containing foods, thus getting more vitamins. Just to complicate the issue further, boiling vitamin-rich foods reduces the vitamin intake unless the vegetable water is also consumed.
My advice to caregivers is unless you want to hire a trained nutritionist to plan your weekly menus, I wouldn’t stress too much about these lists of vitamin-rich foods. Just be responsible in your menu planning. Cook a lot from scratch and include lots of color on the plate. Ironically, taking vitamin supplements can reduce the need to worry about naturally sourced vitamins.
Effects of cooking
Source: https://en.wikipedia.org/wiki/Vitamin
Conclusion
A lot of misinformation and misconceptions have accumulated in our culture about the subject of vitamins. This has led people (and sometimes caregivers) to develop unrealistic expectations about what vitamins can do for them. When those expectations are not met, inevitably questions arise. Knowing the facts about vitamins leads to a better overall understanding and more easily achieved outcomes. Hopefully, after reading the CE, you have had some of your questions answered—or at least have been given enough facts so that you can answer the questions your residents are asking.
As always, good luck in your caregiving.
Mark Parkinson, BS Pharm
References:
Ginnie Trinh Nguyen. How do vitamins work?. TED-Ed. Oct 6, 2014. https://www.youtube.com/watch?v=ISZLTJH5lYg
Vitamin and Mineral Supplement Fact Sheets. National Institute of Health, Office of Dietary Supplements. 2020
https://www.fda.gov/consumers/consumer-updates/fortify-your-knowledge-about-vitamins
Vitamins and Minerals: How to Get What You Need. Family Doctor.org American Academy of Family Physicians 2020.
https://familydoctor.org/vitamins-and-minerals-how-to-get-what-you-need/?adfree=true
Vitamin. Wikipedia. 6 November 2020. https://en.wikipedia.org/wiki/Vitamin
Vitamins and Minerals, Are You Getting What You Need?. Help Guide.org Harvard Health. 2020. https://www.helpguide.org/harvard/vitamins-and-minerals.htm
Kenneth Carpenter. Vitamin, chemical compound. Britannica. 2020. https://www.britannica.com/science/vitamin/Regulatory-role\
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