Nutrition Supplements Jennifer Click Redlich MS, RD, CSO, LDN - PowerPoint PPT Presentation

Nutrition Supplements Jennifer Click Redlich MS, RD, CSO, LDN

Natural Products are Powerful – Even Western Medicine uses “natural products” to treat illnesses every day – Many prescription drugs are created or inspired from nature (synthetic versions of natural substances)

Examples of drugs made from (or inspired by) plants – Pacific yew  Taxol – Goat’s Rue  metformin

We’d all love to believe…. – That supplements have power to – Heal – Improve our health – Add quality and years to our life – That supplements are totally safe without side effects or toxicities – But, can we expect to have it both ways? – If you believe something has POWER, you also have to respect that it has power….potential for good AND potential for harm

The Problem of Supplements – Some of the same problems as when studying diet and nutrition. – No one “only” eats – No one “only takes supplements” – Regulatory agencies want “proof” of effectiveness without side effects or risks – Prescription drugs are not without side effects or risks, but a MD is in control – Many studies; various results – Only sales clerks seem to have confidence in recommendations

The Topsy-Turvy Conundrum – Nutrients protect cells – Nutrients feed cells – Nutrients regulate cells – Nutrient deficiencies can damage cells – Damaged cells can lead to cancer – Nutrients feed & protect cancer cells

Supplements to Protect Against Lung Cancer: Epic Fail – ATBC Study (Alpha-Tocopherol Beta-Carotene Prevention Study) – 29,133 male smokers in Finland – Supplements increased risk; study stopped early – CARET study (Beta-Carotene and Retinol Efficacy Trial ) – Tested combination of 30 mg beta-carotene and 25,000 IU retinyl palmitate against placebo in 18,314 men and women at high risk of developing lung cancer – Stopped 21 months early : “clear evidence …no benefit …substantial evidence of possible harm” – 28% more lung cancers and 17% more deaths in the active intervention group

Se & Vitamin E Supplements: Fail to Prevent Prostate Cancer – SELECT study (Selenium and Vitamin E Cancer Prevention Trial) Double-blind, placebo-controlled 4-arm study,: 35,533 men – – Selenium – Vitamin E (400 IU dl-alpha tocopheryl acetate) – Selenium and vitamin E together – placebo – Fall 2008- “stop taking ”: neither vitamin E nor selenium supplements associated with the prevention of prostate cancer – 2011 analysis: 17% increase in prostate cancer incidence in participants who were on the vitamin E only arm (significant); also increased risk in other interventional groups (non-significant)

The Sum of the Parts… Does Not Equal the Whole – The flip side – Milk/dairy lowers risk of colorectal cancer (CRC) – In some genetic populations, calcium supplements may bind too much – Calcium supplements seem to magnesium, thus increasing risk of CRC lower risk for most people When taking a supplement: how do you – – In small % raised risk know if you (as an individual) are one of those in the smallest % that might have increased risk from supplements? – Go with food when possible. Milk/dairy is protective because it contains BOTH calcium and magnesium …

Not too hot, not too cold...but just right! – AIs, RDAs, EARs, DVs, Uls – Prevention of deficiency through avoidance of toxicity… but how much is optimal ? – Fortification (example: folic acid) – Fortification of the food supply has decreased birth defects Is fortification increasing CRC, breast and other cancers? – – Individualized Nutrition – How much is optimal for each person and at what time in their life?

“Science is so easy!!!” -- said nobody…EVER! Nature is complex Our bodies are complex – Folic acid isn’t folate – Bodies tightly regulate absorption, metabolism and excretion – dl-alpha tocopheryl acetate isn’t mixed tocopherals – Vitamin C and cancer treatment: PO vs IV – Beta carotene isn’t carotenoids – Turmeric vs curcumin – Natural products have both Ratios and rates are likely important – desirable and undesirable properties – Whole soy vs refined soy products – Tea: aluminum Timing matters (prior to puberty through – – Flaxseed: cadmium post menopausal…it’s not all the same)

Are there any supplements we should be taking?

Experts say….. – Eatright.org: “Get vitamins and minerals from food” – DGA committee: “Eat ideal diet and take a vitamin D supplement” – AICR: “Don’t rely on supplements to protect you from cancer…Eat a balanced diet instead” (though some allowances are made) – FDA: “Dietary Supplements can be beneficial to your health — but taking supplements can also involve health risks” – IOM: “Take a multi -vitamin/mineral supplement with the RDA for most vitamins and minerals”

Percent of U.S. Population with Average Intake Below EAR Scientific Report of the 2015 Dietary Guidelines Advisory Committee, Fig. D1.1 From: What We Eat in America, NHANES 2007-2010

Multi-vitamin/mineral – Physician Health Study II – Large, randomized, double blind, placebo controlled, long term study – Evaluated use of multivitamin/mineral supplement as primary prevention of – Cancer – CVD – Age related diseases – Cognitive function

Multivitamins in the Prevention of Cancer in Men: The Physicians' Health Study II Randomized Controlled Trial JAMA. 2012;308(18):1871-1880. doi:10.1001/jama.2012.14641

Cumulative Incidence Rates of Total Cancer Among 13 329 Men With No Baseline History of Cancer and 1312 Men With a Baseline History of Cancer in the Physicians' Health Study II JAMA. 2012;308(18):1871-1880. doi:10.1001/jama.2012.14641

Physician’s Health Study Summary JAMA. 2012;308(18):1871-1880. doi:10.1001/jama.2012.14641 – Cancer – Findings were significant (decreased risk of cancer: not so much for prostate cancer but, especially when prostate cancer wasn’t included in results and even more so for those who had a baseline cancer diagnosis prior to participating in the study) – Cataracts Findings were significant (lowered risk of total cataracts and cataract surgeries) – Major cardiovascular events – – Neither increased nor decreased risk – Cognitive decline – Neither increased nor decreased risk

Vitamin D RDA = 600-800 IU UL = 4000 IU* * may need more to correct a deficiency – Promotes cell differentiation, reduces inflammatory cytokines, inhibits proliferation, induces apoptosis – Low vitamin D appears to be associated with risk factors for inflammation, cancer, heart disease, osteoporosis, autoimmune diseases…..maybe even autism and ADHD – “Association” does not mean “cause” or “effect” – Some conflicting study results but are we looking at the whole picture? – You’ll probably need a supplement (but get your labs checked first) – Vitamin D deficiency: Magnesium deficiency in disguise?

Calcium & Magnesium Mg: mg/day Ca: mg/day RDA = 310-420 RDA = 1000-1300 UL (supp)= 350 UL = 2000-3000 – Calcium alone – Magnesium – Doesn’t improve bone health – Found in green plants (chlorophyll), nuts, seeds, milk – Increases cardiovascular risk – Involved in DNA “spell check” – Lowers risk of CRC for most – Important for heart health and – Ratios of Ca: Mg are important bone health, making ATP, etc – Asian usual diet 1.7:1 (Ca:Mg) – Leg cramps, migraines, tremor, – USA diet (3:1) anxiety, fatigue and others – Optimal ratio seems to be 1.7-2:1 – Serves as a cofactor in vitamin D metabolism pathways <1.7 and >2.8 = detrimental –

Some Nutrients with Special Considerations – B12 (>50 year old adults, bariatric medicine and those chronically using acid blockers, possible benefits for peripheral neuropathy) – Coenzyme Q10? (possible considerations for older adults and those on statins); may interact with warfarin – Alpha lipoic acid? (Germany, prescription for tx of diabetic neuropathies; studies in MS, neurodegenerative disease, Alzheimer's) – Choline? – Some genetic polymorphisms may have higher needs – With aging?

Foods To Include Regularly – Mushrooms – Leafy greens (K, vitamin K, Mg, folate) – High fat fish (Alaskan salmon, etc) and – Ground flaxseed (breast CA) omega 3 fatty acids – Studies show benefit with CVD, arthritis, MS, – Vinegar (diabetics, triglycerides, weight DM, depression, bipolar disorder, GI diseases, decreased risk of breast cancer control) – 1-3 grams/day has been studied – Tea (countless benefits) – Caution: Fish oil supplements may protect cancer cells during treatment (in general, – Brazil nuts (source of selenium) discourage use of supplemental fish oil in patients getting active treatment- some – Nuts, seeds, oils (vitamin E)* exceptions apply ) – Food sources of probiotics and prebiotics – Herbs and spices (countless benefits) – Turmeric – *??? (mixed tocopherols??)

Turmeric – GRAS (the spice, anyway) Gene regulation – – mTOR inhibition, hedgehog inhibition – Regulates inflammation – Studies have been done on conditions such as: aging, cancers (head/neck, CRC most promising), rheumatoid arthritis, osteoarthritis, gout, ulcerative colitis, Crohn’s, MS and more – Biological availability – Curcumin – Piperine (P450 enzyme), tea, fat – Currently under investigation for druggability