Dr. Steve Blake
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 Older men and women may want to limit their supplemental vitamin A intake or take only the beta-carotene form of vitamin A. Many fortified foods such as cereal contain significant levels of preformed vitamin A. The vitamin A in fortified foods should be added to the vitamin A in any supplements to find the total intake. On the other hand, low levels of vitamin A can adversely affect bone mineral density. In older people, an intake of preformed vitamin A close to the RDA is safest. |
J. Douglas Bremner
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 They analyzed a number of factors and found that excessive intake of vitamins, whether through fortified foods or other sources, was associated with an increased risk of osteoporosis in their county. They found a link to the excessive intake of vitamins through American fortified foods, such as breakfast cereals. It seems the American predilection for fortifying everything with vitamins has gone haywire. As a result, the Danes banned Kellogg's vitamin-fortified cereal. On December 8, 2004, a spokesperson for that country was quoted by nutraingredients. |
Bill Sardi
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 European Journal Clinical Nutrition 60: 280-06, 2006] Dark-green, leafy vegetables, oranges, orange juice, asparagus, beans, eggs and fortified foods (cereal) are good dietary sources of folic acid, though most adults will benefit from taking a supplement since this vitamin is destroyed by heat during cooking. [American Journal Clinical Nutrition 28:459-64, 1975]
There is a relative 59% increased risk for breast cancer among women who consume alcohol and have low intake of folic acid. |
Mark Sircus
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 However, not a word is mentioned about magnesium as the committee goes on to recommend increasing calcium intake through the use of fortified foods and calcium supplements. Is a medical crime being committed when these pediatricians fail to address the crucial relationship between magnesium and calcium? Our affirmative answer is sustained when reviewing the materials presented below.
Experts say excessive calcium intake may be unwise in light of recent studies showing that high amounts of the mineral may increase risk of prostate cancer. |
Dr. Steve Blake
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| It is a manmade product and not found in the human body unless it is taken as supplements or in fortified foods. Milk is often fortified with ergocalciferol in the amount of 100 IU per cup. Ergocalciferol has the same biological activity as cholecalciferol and can also be converted to calcidiol and calcitriol.
Sunlight and Vitamin D
Vitamin D3, cholecalciferol, is made in the skin when a form of cholesterol (7-dehydrocholesterol) reacts with UVB ultraviolet light with wavelengths between 290 and 315 nanometers, as seen in Figure 4-1. |
| These experts recommend an additional 200 IU on top of the AI, either from fortified foods, or from supplements. These higher levels may help to reduce the risk of osteoporosis and cancer.
Food sources of vitamin D are limited to a few fatty fish such as salmon, sardines, and mackerel. Some fish liver oils have high vitamin D content, but that is not the healthiest choice for vitamin D supplementation. Vitamin D is added to the feed of some laying hens to produce eggs with vitamin D. Some cereals, breads, and orange juices are fortified with vitamin D. |
| The vitamin A in fortified foods should be added to the vitamin A in any supplements to find the total intake. On the other hand, low levels of vitamin A can adversely affect bone mineral density. In older people, an intake of preformed vitamin A close to the RDA is safest.
The best way to assure safe levels of vitamin A is to eat plenty of fruits and vegetables and, if supplements are needed, to use the beta-carotene form.
Quiz
Refer to the text in this chapter if necessary. A good score is at least 8 correct answers out of these 10 questions. |
| Healthy foods rich in thiamin include soy milk, acorn squash, pistachio nuts, fortified foods, green peas, and watermelon. Thiamin supplements and the thiamin used in food fortification are usually in the form of thiamin hydrochloride or thiamin nitrate. Thiamin is not toxic in food or in the amounts found in most vitamin supplements.
Cooking can reduce thiamin in two ways. Thiamin is destroyed by heat. Also, thiamin is easily leached out of food by water, as seen in Figure 1 -4. |
Jonny Bowden, Ph.D., C.N.S.
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 That same 3 ounces also has 55 percent of the Daily Value for zinc,
50 percent of niacin, a surprising 50 percent of folate (which is usually associated with vegetables and fortified foods), 40 percent of thiamin and B6, and about a third of the RDI for iron. For goodness' sake, it even has some vitamin C! And of course, liver is a superb source of protein.
Now let's talk for a minute about the common advice to avoid liver while pregnant because of its vitamin A content.
Should Pregnant Women Avoid Vitamin A? |
Ray D. Strand
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 We also take in vitamin D orally via fortified foods and milk, but it must then be converted to its biologically active form, vitamin D3. Often the impaired conversion of vitamin D to vitamin D3 may be more of a problem than deficient intake. This is why I recommend supplementation of vitamin D by using the active form, D3.
The New England Journal of Medicine reported a study in which researchers looked at the level of vitamin D in 290 consecutive patients admitted to the medical ward of Massachusetts General Hospital. |
J. Douglas Bremner
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| Finally, there has been a major change in our diet, including a massive increase in exposure to vitamins and minerals through fortified foods as well as a shift from grain- to corn-based nutrition. There is some evidence that changes in the American diet may have contributed to the increase in asthma, which I review on pages 138-140.
There are two categories of asthma: allergic, also known as extrinsic asthma, and nonallergic, or intrinsic asthma. Allergic asthma, the most common form, which affects 20 million individuals in the U.S. |
| They found a link to the excessive intake of vitamins through American fortified foods, such as breakfast cereals. It seems the American predilection for fortifying everything with vitamins has gone haywire. As a result, the Danes banned Kellogg's vitamin-fortified cereal. On December 8, 2004, a spokesperson for that country was quoted by nutraingredients.com as saying that "the Danish population already has a high intake of calcium, iron, B6 and folic acid . . . the knowledge on toxicity of vitamins and minerals is very limited and practically nonexistent for children . . . |
| Based on the results of the studies I've reviewed, I recommend that you not take any amount of vitamin A or beta-carotene in the form of fortified foods like breakfast cereal or vitamins and supplements.
VITAMIN C
Vitamin C is a water-soluble vitamin that is required for the growth and repair of many tissues of the body. As I discussed earlier, from the late 1960s until just before his death in 1994, Nobel Prize-winning scientist Linus Pauling was convinced that megadoses of vitamin C were not only good for you in general but specifically were able to prevent colds. |
Ann M. Coulston and Carol J. Boushey
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 Thus, fortified foods and/or supplements are needed to attain this level of intake. Plant stanols and sterols are now included in many foods such as margarine, low-fat milk, yogurt, cereal bars, and orange juice, as well as gel-capped sterol and stanol supplements to assist in increasing consumption.
VIII. SUPPLEMENTS
The dietary supplement market is one of the fastest growing industries [243]. Data from the Third National Health and Nutrition Examination Survey (NHANES III) and the more recent 1999-2002 NHANES found that approximately 55% of U.S. |
Brenda Davis and Tom Barnard
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 Fortified foods: Some breakfast cereals
Fortified nondairy beverages Some veggie "meats"
Red Star Vegetarian Support Formula Animal foods:
Nutritional Yeast (not all Red Star yeast Dairy, eggs, and meat is fortified)
Special considerations
Vitamin B12 in fortified foods or supplements is essential for vegans. As we get older, our ability to utilize the B]2 in animal products is reduced. Thus, vegans, along with anyone over 50 years of age, should include B12 in the form of fortified foods or a supplement. |
Ann M. Coulston and Carol J. Boushey
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| However, through the use of heavily fortified foods or dietary supplements, intake exceeding 2500 mg/d is possible. Intakes above the UL for calcium carry an increased risk of milk-alkali syndrome, a potentially serious metabolic disorder.
The UL for magnesium for adults is 350 mg/d from pharmacological forms. Because magnesium salts can cause osmotic diarrhea, intakes above 350 mg/d are not recommended. Food sources of magnesium do not cause diarrhea and thus are not included in this UL. |
Dr. Steve Blake
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| Y
Synthetic riboflavin used in supplements and fortified foods and drinks is very likely to have been produced using genetically modified Bacillus subtilis. These bacteria have been altered to increase the bacteria's production of riboflavin. The genes of the bacteria may also have been altered by the addition of antibiotic resistance to ampicillin. This is one possible difference between synthetic and naturally-occurring riboflavin.
Heat does not normally degrade riboflavin. |
J. Douglas Bremner
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| The implications of this research is that folate in fortified foods like bread and cereals may be related to the increase in asthma in children that has occurred over the past few decades, although no one has shown a direct link so far.
Low folate in the blood has been linked to depression. However, obtaining adequate folate in the diet should be enough to prevent depression as well as problems related to birth defects in pregnant women.
There is a small fraction of the population of women who have antibodies to folate. |
Ann M. Coulston and Carol J. Boushey
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| Osteoporosis, osteomalacia formulas, vitamin and mineral supplements, and fortified foods can reduce the risk of deficiencies. See Table 3 for a list of nutrition-related problems.
G. Nutrition Fears, Concerns, and Quality of Life Indicators Expressed by Persons with Inflammatory Bowel Disease
Patients often share concerns regarding their symptoms and potential outcomes, as outlined in Table 4. Although no studies have been reported on nutritional quality of life, IBD and its symptoms offers much to deal with in diet and nutrition. |
| Dietary sources of vitamin D are limited and mostly consumed as fortified foods, especially milk. A summary of studies on vitamin D status in children and adolescents worldwide was recently compiled by El-Hajj Fuleihan [ 107]. The range in mean serum 25-hydroxyvitamin D levels (the best status indicator for vitamin D) was large: 13-142 nmol/liter. |
| Plant foods such as mushrooms that when briefly exposed to UVB produce significant amounts of vitamin D2 [38] and some fortified foods may contain vitamin D2. Such foods can appeal to vegetarians who may prefer to consume a plant-based form of vitamin D [39].
B. Supplement Sources of Vitamin D
Supplements provide another source of intake. Vitamin D (i.e., cholecalciferol or ergocalciferol) is usually (but not always) found in multivitamin preparations at 10 ug (400 IU) per tablet, some with only 5 pg (200 IU) but new ones being introduced with 25 pg (1000 IU). |
Alan R. Gaby, M.D., Jonathan V. Wright, M.D., Forrest Batz, Pharm.D. Rick Chester, RPh., N.D., DipLAc. George Constantine, R.Ph., Ph.D. Linnea D. Thompson, Pharm.D., N.D.
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 People should remember the total daily intake of vitamin D includes vitamin D from fortified milk and other fortified foods, cod liver oil (page 514), supplements that contain vitamin D, and sunlight. People who receive adequate sunlight exposure do not need as much vitamin D in their diet as do people who receive minimal sunlight exposure.
Vitamin D increases both calcium (page 483) and phosphorus absorption and has also been reported to increase absorption of aluminum. Increased blood levels of calcium (which may be a marker for vitamin D status) have been linked to heart disease (page 98). |
Ann M. Coulston and Carol J. Boushey
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| It does not include the 2S-stereoisomeric forms of a-tocopherol (SRR-, SSR-, SRS-, supplements.
'As niacin equivalents (NE). 1 mg of niacin = 60 mg of tryptophan; 0-6 months = preformed niacin (not NE).
?As dietary folate equivalents (DFE). 1 DFE ?1 pg food folate = 0.6 pg of folic acid from fortified food or as a supplement consumed with f< 8 Although AIs have been set for choline, there are few data to assess whether a dietary supply of choline is needed at all stages of the life cycle endogenous synthesis at some of these stages. |
Steven G. Pratt, M.D. and Kathy Matthews
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 The major food sources of vitamin D include fatty fish like sardines, salmon, and tuna, and fortified foods, particularly cereals and some dairy products.
How do you protect yourself from vitamin D deficiency? Add wild salmon, sardines, and tuna to your diet. Try to get about fifteen minutes of sun exposure to your arms and face at least three times a week, before i o a.m. and after 3 p.m., when the ultraviolet rays are not as damaging to the skin. Also check the labels of any fortified foods you eat, including cereals, milk, and soymilk. |
Gabriel Cousens, M.D.
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 Several forms of active B[2 work as coenzymes in the body: adeno-sylcobalamin, methylcobalamin, cyancobalamin (found in supplements and fortified foods because it is the most stable form of B12), and hydrox-ocobalamin. There are many natural Bu analogues in food, but they do not work as active coenzymes in the body and may actually block the active B[2 coenzyme function.
Understanding B12 absorption pathways in humans gives additional weight to the B,2 issue. |
Brenda Davis and Tom Barnard
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| Thus, vegans, along with anyone over 50 years of age, should include B12 in the form of fortified foods or a supplement.
Omega-3 Fatty Acids 3-5 grams per day
Plant sources
Flaxseed, hempseed, canola oil, soy foods, walnuts, dark greens, sea vegetables. Animal sources
Fish, eggs (especially omega-3-rich varieties) Special considerations
Omega-3 fatty acids are unstable, so foods rich in these fats should be refrigerated or frozen. Supplementary DHA (microalgae) can be obtained from supplements (see page 74).
5. |
Steven G. Pratt, M.D. and Kathy Matthews
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| Also check the labels of any fortified foods you eat, including cereals, milk, and soymilk. The Food and Nutrition Board has been unable to settle on an RDA for vitamin D. The current recommendations for adequate intakes are: adult males and females ages 19 to 50 should get 200 IU per day; ages 51 to 70 should get 400 IU a day; over 70 years, 600 IU per day. If you don't get enough vitamin D from all your food sources, you might consider taking a supplement, though you should be careful with vitamin D supplementation, as there is a definite risk of toxicity if you take too much. |
The Life Extension Editorial Staff
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 Comment: Adequate amounts of iron are absolutely essential to good health, but using iron supplements or iron fortified foods is not recommended for men or postmenopausal women, unless diagnosed with an iron deficiency. It is judged that approximately one of every 200 people actually has iron overload disease. Read the sections devoted to Heredity and Chelation Therapy in this protocol to learn more about hemochromatosis.
NEWER RISK FACTORS
In the last 25 yeats, the incidence of coronary fatalities has decreased 33%. This is due largely to avoiding the traditional risk factors. Dr. Paul M. |
Ralph Golan, M.D.
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 Those individuals who regularly consume vitamin D-fortified foods should avoid supplemental vitamin D and should diminish their consumption of fortified foods and find wholefood alternatives when possible.
Drugs that increase the need for vitamin D are anticonvulsants, sedatives, corticosteroids, blood cholesterol-lowering agents, antibiotics for tuberculosis, antacids, mineral oil, other cathartics, and laxatives. |
Nicola Reavley
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 Vitamin A palmitate and vitamin A acetate are synthetic forms of vitamin A found in supplements and fortified foods. Vitamin A palmitate can be absorbed in the absence of dietary fat.
Low dose supplementary vitamin A may be beneficial in the elderly and in those who cannot absorb fats. Vitamin A needs may be increased in cases of trauma, anxiety, stress, alcohol use and smoking.
Toxic effects of excess intake
As vitamin A is fat soluble and can be stored in the liver for long periods of time, it has a high potential for toxicity. |
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