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Senior Nutrition, Vitamins, Supplements
Government Panel Has Ideas on Supplements, Undecided
on Multivitamins
They do want more government oversight on
vitamins and dietary supplements
By Tucker Sutherland, editor
May 18, 2006 – The vast majority of senior citizens
take multivitamins and other dietary supplements. Although usage
increases with age, it is a growing trend for all Americans, with more
than half spending $23 billion a year for the hope of better health.
Unfortunately, the National Institutes of Health's panel concluded their
extensive study yesterday with the conclusion – "more rigorous
scientific research is needed before strong recommendations can be made
regarding MVM use to prevent chronic diseases." Their report is not
without some minimal guidance about supplements, including two
recommendations for seniors, and also adds new questions to the debate,
particularly about regulation.
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on
Nutrition, Vitamins
& Supplements |
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Most Americans, however, will remain perplexed
about what they should be taking and if these expensive multivitamins
and other supplements make us healthier.
The conclusion by the independent panel, which was
convened this week by the NIH Office of Medical Applications of Research
and the Office of Dietary Supplements, followed two days of expert
presentations, public discussion, and panel deliberations to assess the
available evidence on the safety and effectiveness of
multivitamin/minerals (MVMs).
The panel did make recommendations regarding
certain specific supplements but ultimately concluded that more rigorous
scientific research is needed on MVMs..
The panel released a draft statement of its
findings, at the close of the conference. The panel’s findings pertain
to the generally healthy population, and do not include pregnant women,
children, or those with disease.
“Half of American adults are taking MVMs and the
bottom line is that we don’t know for sure that they’re benefiting from
them. In fact, we’re concerned that some people may be getting too much
of certain nutrients,” said J. Michael McGinnis, M.D., M.P.P., Senior
Scholar with the Institute of Medicine of the National Academy of
Sciences, who chaired the panel.
Two recommendations by the panel are important
to senior citizens:
★
The panel recommended the combined use of calcium and vitamin D
supplementation for postmenopausal women to protect bone health.
★
The panel also advocated that anti-oxidants and zinc be considered for
use by non-smoking adults with early-stage, age-related macular
degeneration, an eye condition that can cause blindness.
The panel also said:
★
The panel supports previous recommendations by the CDC that women of
childbearing age take daily folate to prevent neural tube defects (birth
defects of the brain and spinal cord) in infants.
★
Conversely, it found no evidence to recommend beta carotene supplements,
a form of vitamin A, for the general population, and strong evidence to
caution smokers against taking them. Specifically, beta-carotene was
linked to an increase in lung cancer among smokers who took the vitamin
regularly.
In looking specifically at MVMs for chronic disease
prevention, however, the panel found that the available data are
insufficient to make a firm recommendation for or against their use in
the general population.
Of note, rates of MVM use are highest among those
who engage in other positive health behaviors such as regular exercise
and eating a healthier diet, making it difficult to determine whether
the MVM alone is truly responsible for any observed improvement in
health.
Most of the public assumes that the components of
MVM supplements are safe, because many of the ingredients are found in
everyday foods and the products are available over-the-counter. The
panel identified several possible risks associated with MVM consumption,
however.
Among these is the potential for overconsumption of
certain nutrients, with the resulting possibility of adverse effects.
Though health-conscious individuals are likely to be focused on ensuring
that they meet the recommendations for essential nutrients, the combined
effects of eating fortified foods, taking MVMs, and consuming single
vitamins or minerals in large doses, may lead them to unwittingly exceed
the Upper Levels (ULs) of nutrients, which can be harmful.
Changes in Regulation
Given these safety concerns and the limitations of
the available evidence, the panel advocated for changes in the
regulation of dietary supplements — including MVMs — by the Food and
Drug Administration (FDA).
Specifically, the panel recommends that Congress
expand FDA’s authority and resources to require manufacturers to
disclose adverse events, to ensure quality production, and to facilitate
consumer reporting of adverse events by including reporting information
on dietary supplement labels.
The panel also made several specific
recommendations regarding future research, including but not limited to
the following:
● Design and conduct rigorous randomized,
controlled trials of the impact of individual supplements to test their
efficacy and safety in prevention of chronic disease, using
well-validated measures;
● Build new MVM databases that detail the exact composition of
supplements, update them on a continuous basis, and assure their
constant availability to the research community; and
● Develop a strategy to support a better understanding of possible
interactions between MVMs and prescribed or over-the-counter
medications.
The 13-member panel included experts in the fields
of food science and human nutrition, biostatistics, biochemistry,
toxicology, geriatric medicine, family medicine, pediatrics and
pediatric endocrinology, cancer prevention, epidemiology, disease
prevention and health promotion, and consumer protection. A brief
biography on Dr. McGinnis is available online
HERE. A listing of the panel members and their institutional
affiliations is included in the draft conference statement.
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2003 Report |
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Government Task Force in 2003 Did Not Recommend For or
Against Vitamins
According to the results of most large clinical studies, there
is little evidence that any type of vitamin supplement reduces
the risk of developing cancer, and some may actually increase
the risk. This was the conclusion in July of 2003 of the United
States Preventive Services Task Force (USPSTF), an independent
panel of experts in primary care and prevention.
Reviewing studies of antioxidants such as vitamins A, C, and E,
as well as multivitamins, the task force concluded that there
wasn’t enough evidence to recommend for or against supplement
use specifically to prevent cancer. The panel did recommend
against the use of beta carotene supplements, based on studies
showing it may actually increase the risk of lung cancer among
heavy smokers.
The Task Force members stressed that they examined only vitamin
supplements, not the levels of vitamins people consumed in
foods. To date, there is no solid evidence that any vitamin or
other supplement can reduce a person’s risk of developing
cancer.
They said they were looking at vitamin supplement use only for
specific purposes, and that they may be appropriate for other
reasons in certain people with unmet nutritional needs. What’s
more, with the exception of beta carotene, there appears to be
little potential harm from taking vitamin supplements in doses
generally considered to be safe.
Certain vitamins (such as A and D) may be harmful at high doses.
People considering taking high doses need to weigh the possible
benefits and risks accordingly, say the experts, and may want to
speak with their health care providers before taking them.
People "should be reminded that taking vitamins does not replace
the need to eat a healthy diet," the Task Force members
concluded.
The Task Force’s recommendations were published in the Annals of
Internal Medicine (Vol. 139, No. 1: 51-55).
More at American Cancer Society, click here |
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Notes about the study:
In addition to the material
presented at the conference by speakers and the comments and concerns of
conference participants presented during discussion periods, the panel
considered pertinent research from the published literature and the
results of a systematic review of the literature commissioned by the NIH
Office of Medical Applications of Research (OMAR).
The systematic review
was prepared through the Agency for Healthcare Research and Quality (AHRQ)
Evidence-based Practice Center (EPC) program, by the Johns Hopkins
University Evidence-based Practice Center.
The EPCs develop evidence
reports and technology assessments based on rigorous, comprehensive
syntheses and analyses of the scientific literature, emphasizing
explicit and detailed documentation of methods, rationale, and
assumptions. The evidence report on Multivitamin/Mineral Supplements and
Prevention of Chronic Diseases is available online
HERE.
The panel’s statement is an
independent report and is not a policy statement of the NIH or the
federal government. The NIH Consensus Development Program, of which this
conference is a part, was established in 1977 as a mechanism to judge
controversial topics in medicine and public health in an unbiased,
impartial manner. NIH has conducted 118 consensus development
conferences, and 27 state-of-the-science (formerly “technology
assessment”) conferences, addressing a wide range of issues. A
backgrounder on the NIH Consensus Development Program process is
available online
HERE.
The Office of the Director, the
central office at NIH, is responsible for setting policy for NIH, which
includes 27 Institutes and Centers. This involves planning, managing,
and coordinating the programs and activities of all NIH components. The
Office of the Director also includes program offices which are
responsible for stimulating specific areas of research throughout NIH.
Additional information is available online
HERE.
The National Institutes of Health (NIH)
— The Nation's Medical Research Agency — includes 27 Institutes and
Centers and is a component of the U.S. Department of Health and Human
Services. It is the primary federal agency for conducting and supporting
basic, clinical and translational medical research, and it investigates
the causes, treatments, and cures for both common and rare diseases. For
more information about NIH and its programs:
www.nih.gov.
★
The full text of the panel’s draft state-of-the-science
statement is available at
http://consensus.nih.gov. The final version will be available at the
same Web site in four to six weeks.
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