Date: 20 Aug 1994 07:47:11 -0700 From: taltar@vertigo.helix.net (Ted Altar) Subject: More Vitamins is Not Always Better (repost) Newsgroups: rec.food.veg Organization: Helix Internet Lines: 248 MORE IS NOT ALWAYS BETTER Ted Altar A. Preamble B. The Case Of Vitamin A C. The Complexity Of Interactions D. High Doses Of Water Soluble Vitamins Can Induce Dependency States And Withdrawal Symptoms E. Other Problems A. PREAMBLE It is worrisome that the FDA estimated that 40% of the American adult population uses vitamin and mineral supplements on a daily basis, vitamin C being the most widely consumed synthetic nutrient. Maybe it has something to do with the technocratic ethos that `if a little is good for you then lots must be better'. Of course, this is false. I've already posted a concern about "vitamin D", and we also have the recent example of new research suggesting that excess iron in the diet is a risk factor for cardiovascular disease. The following is from Consumer Reports 1986 review article on "The Vitamin Pushers: From Drug company to Drug Store, Sellers Tell You That you Need Vitamin Supplements. Do You Really?": Fat-soluble vitamins are not excreted efficiently. They are generally stored until they can be used up, and thus can accumulate to toxic levels. For example, prolonged excessive intake of vitamin A can cause headache, increased pressure on the brain, bone pain, and damage to the liver. Excessive vitamin D can cause kidney damage. Though the water-soluble vitamins are generally excreted quickly when taken in excess, some of them can cause trouble. Large doses of niacin can cause liver damage, severe flushes, and skin rash. High doses of vitamin C can cause diarrhea. And high doses of vitamin B6 over long periods can cause permanent damage to the nervous system. Reports of cases of vitamin toxicity are uncommon. But they are particularly sad because most people who get into trouble with vitamins have essentially poisoned themselves in the pursuit of health. Consumer Report's medical consultants then point out that the best way to get vitamins is from foods. There is no known and documented advantage for healthy adults to take vitamins, unless they enjoy seeing their urine turn a brilliant yellow ;-) One would do better to spend the money not on vitamin pills but on quality, fresh fruits and vegetables, organically grown if possible. Yet, we are constantly told by vested interests like the General Nutrition Corp. (they operate about 1300 health-food stores) that vitamin pills are "nutritional insurance" and that: "It would take a computer and a good deal of conscious effort to devise a diet that each day would give all the nutrients in optimal amounts . . . From the viewpoint of . . . nutrition, a complete supplement may be the best possible buy in health insurance" Experts like Victor Herbert, however, strongly disagree: Vitamin pushers use deception by omission. They list all the terrible things that can happen if your diet is lacking. But they never tell you that vitamin deficiency is RARE unless a person's diet is extremely unbalanced. Most important, they never tell how to measure whether or not your diet is adequate. If they did, they'd lose customers. Determining dietary adequacy is actually quite easy. It surprises me to no end how very begrudging people are about spending a mere few pennies more on organic produce, but will quite willingly waste hundreds of dollars per year on vitamin pills or magic herbal teas. There are no magic pills or herbs to better health, there is only the good sense to do daily exercise and eat a variety of quality whole foods properly prepared. B. THE CASE OF VITAMIN A To take the example of vitamin A, consider this listing of problems: "prolonged use of vitamin A in excessive doses can cause a variety of symptoms, including dry, coarse scaly skin, angular stomatitis, pain and tenderness of the bone, hyperstosis, hypercalcemia, disease syndrome of pseudotumor cerebri (which may produce increased intracranial pressure with headache, papilledema, and diplopia), hepatosplenomegaly, and disturbed blood clotting with hemorrhage. in children, anorexia, pruritus, and failure to gain weight are followed by irritability, bone pain, and the limitation of join motion. Large doses of vitamin A, furthermore, are teratogenic" from "Council Report: Vitamin Preparations as Dietary Supplements and as Therapeutic Agents" JAMA, 1987, 257(14, April 10):1929) Indeed, as one researcher reported, "the toxicity of vitamin A in early pregnancy, for which a safe intake level is known, is stressed. On many grounds these suggested lower RDI values are preferable to the 1980 RDA values" (from Olson, "Recommended dietary intakes (RDI) of vitamin A in humans" Am J Clin Nutr 1987, 45:704) While the RDA levels are 1000 ug for men and 800 for woman, Olson recommended, for instance, that RDI levels be 700 for adult men and 600 for women and 0 for early pregnant woman (200 for 6-9 month pregnancies; 400 for earlier lactation and 320 for 6+ months of lactation)! Olson also observed that: "toxic signs also appeared when 25000IU of vitamin A was superimposed on a vegetarian diet containing 25000IU of provitamin A. If vegetarians would only stay with beta, alpha or gamma-carotene as naturally found in a wide variety of vegetables and fruits, there simply would be no worry about toxicity as the body is more able to regulate these precursors as opposed to the pre-formed vitamin A found in vitamin pills. What is interesting is that the 1980 RDAs were based upon amounts needed to (1) correct night blindness among subjects with a vitamin deficiency and (2) raise plasma vitamin A levels to a normal level in DEPLETED subjects. To these amounts of the vitamin necessary to correct deficiency symptoms was added a generous margin of safety. The 1980 to 1985 RDA Committee took a different approach based upon the amounts of the vitamin needed to maintain a given body- pool size in well-nourished subjects (I gave an example of this approach for protein in an earlier posting). With this approach, recommended levels were reduced to 700 for adult men and 600 for women, but these recommendations were NEVER OFFICIALLY accepted. They appear, however, in the literature and are referred to as the "recommended dietary intakes" or RDI. The official RDA levels are also made problematic due to the wide amount of individual differences in need/absorption/utilization. Based on a study of adult men, the subcommittee of the 10th edition of the RDAs chose to leave recommendations for vitamin A at those higher than RDI levels, simply because a few subjects appear to need such levels There is here, however, simply a wide variation of vitamin utilization and need. Some individual differences for a greater need are produced by such things like alcoholism, pancreatic disease, liver disease, gall bladder disease, respiratory disease, chronic nephritis, measles, steatorrhea, measles, protein deficiency, intestinal parasites, children under 6, and the prolonged use of cortisone or neomycin sulfate. C. THE COMPLEXITY OF INTERACTIONS Besides the potential toxic effects of consuming too much, there is also the interaction effects of vitamins on each other, especially due to high amounts again. I think this is an even more widespread problem and one of concern for everybody. For example, mega-doses of vitamin C can reduce B12 absorption. Normally, 80-90% of intakes up to 100 mg/day are absorbed by humans, but with higher intakes vitamin C is less well absorbed. Some other examples: large doses of A and E inhibit vitamin K absorption or action; mineral oil and cholestyramine can reduce absorption of the fat-soluble vitamins; excess intakes of copper and iron have adverse effects on vitamin C nutritional status; too much zinc, copper, iron, and absorbic acid form complexes with riboflavin to alter its bioavailability; and so on and so forth. Frankly, things are so complex that the atomistic approach of simply orally ingesting those "VITA-amins" simply ignores that whole foods are immensely complex substances which no chemical soup can replace. Patients on long-term IV feeding loose weight and begin to suffer nutritional deficiencies in spite of the assurance of biochemists that the IV solutions are "complete". Remember, it was not too long ago that these same dieticians and non-holistically orientated nutritionists assured us that reinforced white bread was equivalent in nutritional value as whole wheat bread. Well, we wrongly bought and eat that tasteless white bread then, why should we now be buying so many vitamin pills? D. HIGH DOSES OF WATER SOLUBLE VITAMINS CAN INDUCE DEPENDENCY STATES AND WITHDRAWAL SYMPTOMS As Alhadeff et al. report: "Water-soluble vitamins taken in high doses over long periods of time may induce dependency states, and users may shows signs of deficiency or withdrawal symptoms when the dose is lowered or the substance is discontinued. Although the mechanism for this is not well understood it may be related to the fact that most of the water-soluble vitamins induce the enzymes required in their own metabolism or action. It is also possible that large doses of vitamins promote catabolism of unneeded amounts. All of the B- complex vitamins are converted in the body to coenzymes. High levels of coenzymes may induce the formation of their respective apoenzymes which may be considered binding proteins. When the coenzyme level falls rapidly after discontinuation of high dose vitamin intake, distortion of metabolic pathways may occur." (Nutrition Reviews, 1984, 42(2):33) As you can see, the effect is real but the reason is still unknown. Dependency and withdrawal of this sort has even been found in people who grew accustomed to daily doses of vitamin C as low as 200 mgm! "Rebound scurvy" is the term used in the literature to describe this phenomena of real scurvy occurring after one stops consuming vitamin C pills. It has even been reported to occur in the infants of mothers who were taking C supplements during pregnancy. Pyridoxine withdrawal symptoms have occurred in adults taking daily doses of only 200 mg. E. OTHER PROBLEMS Some other problems, which I will here simply list as this posting is already getting too long, are: a) vitamins can mask the symptoms or signs of a pre-existing disease process or vitamin deficiency. b) vitamins interact with drugs and other vitamins c) use of megadoses water-soluble vitamins may be accompanied by the concurrent use of other, more toxic vitamins, like vitamin A and D. Again, for healthy adults, vitamin pills are simply a waste of money at best and potentially harmful at worst. There are, however, special circumstances and needs. Pregnant and lactating vegan woman, for instance, ought to take B12 and iron supplements. There is, however, no justification for the indiscriminate use of multivitamins by healthy individuals who would do much better to maybe increase their levels of physical exercise, reduce their intake of fat, or expand their range of good quality whole foods. ted