Nutrient supplementation is a controversial subject and a lucrative business. Vitamins, antioxidants and herbal supplements are used by over 40% of Americans for health promotion and disease prevention yet clear documentation of beneficial effects are lacking for most of the supplements that are used.

Nutrient supplements are not regulated as stringently as prescription medications. No testing is required to prove effectiveness. Also, nutrient supplements do not have to prove safety. Frequently, health claims are made based on experiments performed only in the test tube. Not uncommonly, making inferences from the test tube to a living human being prove inaccurate.

Many people live by the philosophy that "If a little is good, then more must be better". Right? ....Usually not.

Vitamin A and Vitamin D clearly are harmful at high doses. High doses of vitamin A may cause birth defects, enlarged liver and bone and joint pain. Vitamin D in excess can actually paradoxically make osteoporosis worse. High doses of niacin can cause hepatitis and high doses of pyridoxine (vitamin B6) can cause damage to nerves. Be careful to take the proper dose when using nutrient supplements.

We must be cautious when health claims are based on preliminary investigations. The story of b ("beta")-carotene makes a good example. Epidemiologic studies have consistently shown that diets high in fruits and vegetables are protective against certain cancers. Fruits and vegetables are also high in b-carotene and since b-carotene has some theoretical actions that may prevent cancer, b-carotene was touted as the active ingredient responsible for the beneficial effects of fruits and vegetables. Subsequently, people began to market purified b-carotene supplements. Recent studies evaluating the use of b-carotene supplements alone (instead of fruits and vegetables) showed no benefit in preventing cancer or heart disease. In fact, smokers using b-carotene supplementation actually did worse. (They had an increased risk of lung cancer). The truth is that many people jumped on the b-carotene bandwagon before all the evidence was available and now most physicians believe that b-carotene supplementation is not a good idea. Many health professionals chose to maintain a healthy skepticism of health claims made for nutrient supplements until research shows good evidence of benefit with little or no risk.

Definitive scientific evidence is lacking for most supplements reported to have some beneficial effect. However, based on current evidence and the lack of evidence for harm, it would be reasonable to consider the following supplements.

Vitamin E up to 400 IU/day

Vitamin C up to 500 mg/day

Folate between 0.4-1.0 mg/day

These supplements are primarily reported to decrease the risk of subsequent heart problems in patients who already have heart disease.

Most Americans do not need nutrient supplements. If you feel you are lacking in any certain nutrient, it is usually better to get this nutrient from whole foods. Most Americans could stand to increase their consumption of fruits, vegetables and whole grains and this change alone would have a more beneficial effect on overall health than any specific nutrient supplement.

However, there are certain people who should consider taking a multivitamin, including those people who:

• smoke
• consume alcohol daily
• are on a restrictive diet
• use birth control pills
• are elderly
• are pregnant, breast feeding or contemplating pregnancy

There is nothing magical about herbs. Whatever health effects they possess are due solely to the pharmacologic properties of their active ingredients. Many believe herbs are a panacea. Others believe they have no value. The truth is probably somewhere in between.

Herbs with some evidence of benefit include:

fever few     treats migraine headaches

Herbs with known toxicity include:

Disclaimer: Although there might be some evidence of benefit for these herbs, we are not endorsing these products. Rather, if you are using herbal products, please inform your physician about your use of these products. Prescription drugs may interact adversely with these herbal products.

Most Americans receive adequate vitamins and nutrients in their diet. To make the greatest impact on their health Americans should

DECREASE consumption of

• Total and saturated fats from meat
• high fat dairy products
• pastries
• fast foods

INCREASE consumption of

• unprocessed plant foods (fresh or frozen fruits and vegetables)
• whole grain starches (pasta, baked potatoes, brown rice)

Certain groups of people benefit from multivitamin supplementation. If you have heart disease, then consider taking Vitamin E, Vitamin C and folate. If you choose to take a herbal supplement, be aware of the potential risks and the lack of documented benefit in most cases. This area of medicine is constantly evolving as newer information becomes available. If you have some new information related to nutrient supplements, please let us know about it.