Vitamins and supplements:
Understanding when and how to use them
Should you be taking vitamins and supplements? If so, which ones? Are there any real benefits? What about risks? Most of us have asked these questions in one form or other. So what does the science say.
At present about half of American adults take a multivitamin. But taking a multivitamin should not keep you from eating a varied and nutritious diet. Studies on taking vitamins to prevent disease have been disappointing. They have not shown that a multivitamin can replace a healthy diet; one high in fruits and vegetables.
Vitamins and supplements: The Study
The Harvard-led Physicians Health Study II (PHS II), an 11 year study of 15,000 doctors taking vitamins and supplements published in 2012, found:
- No effect on the risk of heart attacks, strokes and death from cardiovascular disease.
- And an 8% decrease in the risk of being diagnosed with cancer.
What does it mean?
It is difficult to relate these results to the average American. Compared to most people, the doctors in the study ate better diets, were more active and had fewer unhealthy habits.
- Less than 4% were smokers
- 60% exercised at least once a week.
By comparison, the average American is overweight, does not exercise as much and takes in too much fat and sodium. Would a multivitamin help?
Taking Vitamins and supplements
When it comes to vitamins and supplements more is NOT better. These nutrients can be harmful when taken in amounts above what is considered good for you.
Deciding on the right dose of vitamins and supplements is tricky. Each has a range that starts with the lowest daily dose necessary to meet the needs of most healthy people. This is called the Recommended Dietary Allowance (RDA). The highest dose is the upper intake level (UL) for each particular nutrient that a healthy person can tolerate. The correct dose must be determined for each person and must be based on each individual’s needs, so talk to your doctor before taking new vitamin and mineral supplements.
Vitamins and supplements vs food
Food contains a variety of healthful ingredients and is a better source of nutrients than vitamins and supplements. Stop and ask why you think you need them and what you expect to gain, if planning to take vitamins and supplements. Remember:
- Vitamins and supplements are not going to replace nutrients missing from your diet.
- The money you are spending on vitamins and supplements, is best spent at the farmer’s market or grocery store on healthy foods.
Vitamins and supplements: who needs them?
If you are convinced you need vitamins and supplements here are a few things to know.
The Dietary Guidelines for Americans make the following recommendations:
- People over age 50 should take vitamin B12 in its crystalline form, as in fortified foods (like some fortified breakfast cereals) or as a supplement .
- Older adults often have a reduced ability to absorb vitamin B12 from food.
- Crystalline vitamin B12, the type used in supplements and fortified foods, is much more easily absorbed.
- Pregnant women and those in their child bearing years should eat foods that are a source of heme-iron (such as meats).
- They should eat iron-rich plant foods (like cooked dry beans or spinach) or iron-fortified foods (like fortified cereals).
- Pregnant women and those in their child bearing years should eat foods that area a rich source of vitamin C.
- They should take in adequate synthetic folic acid daily (from fortified foods or supplements) in addition to food forms of folate from a varied diet.
- Older adults, people with dark skin, and people who get insufficient exposure to sunlight should consume extra vitamin D from vitamin D-fortified foods and/or supplements.
Vitamins and supplements: The deciding factors
It can not be overstated, vitamins and supplements are not a replacement for a healthful diet. Foods also contain hundreds of additional natural substances that help protect your health.
The Food and Drug Administration (FDA) recommends asking yourself and discussing with your doctor the following questions, when considering whether you should take vitamins and supplements:
- Do you eat fewer than 2 meals per day?
- Is your diet restricted? Do you not eat meat, or milk or milk products, or eat fewer than 5 servings of fruits and vegetables per day?
- Do you eat alone most of the time?
- Without trying, have you lost or gained more than 10 pounds in the last 6 months?
- Do you take 3 or more prescription or over-the-counter medicines a day?
- Do you have 3 or more drinks of alcohol a day?
You and your doctor should work together to determine if a vitamin or mineral supplement is right for you. If you are already taking dietary supplements, you should inform your doctor. Studies show that many people don’t inform their doctors about dietary supplements they take or are considering taking.
- Your doctor is a good source of valid scientific information about vitamins and supplements.
- Other good sources are pharmacists and registered dietitians.
- The National Institute of Health (NIH) Office of Dietary Supplements, has a series of Vitamin and Mineral Fact Sheets that provide scientific summaries for a number of vitamins and minerals. They can be a good discussion starter for you and your doctor about your need for vitamin and mineral supplements.
- MedlinePlus is another good source of information.
- The Food and Drug Administration (FDA) has many of articles and consumer advisories to inform consumers about dietary supplements. They cover things such as warnings, safety, labeling and evaluation information and describe the FDA’s role in regulating dietary supplements.
- If interested in looking directly at scientific studies, the PubMed Dietary Supplement Subset is a good database to search.
Vitamins and supplements complications
If you believe side effects only happen with prescription medicines, think again. Some vitamins and supplements can cause side effects when taken with other medications or when certain health problems exist. Even if you don’t take medication or have a chronic health problem, the wrong dietary supplement or the wrong amount, can cause problems. So check with your doctor before taking a dietary supplement.
Dealing with side effects
If you suspect you are having a side-effect from a dietary supplement,
- Stop taking it immediately.
- Contact your doctor or health care professional.
- The MedWatch Reporting Program also gives you information about how to report a problem to the Food and Drug Administration.
In summary, check with your doctor or registered dietitian about which, if any, vitamins or supplements might be right for you. Remember that while there are times when it may be appropriate to take a vitamin or mineral supplement, the best source is still a healthful diet.
Demystifying nutrition: the value of food, vitamins and supplements Longwood Seminars, March 5, 2013
HEALTHY EATING: 12 tips to get you started
Healthy eating is not about strictly limiting food intake, staying unrealistically thin, or depriving yourself of the foods you love. It is about feeling great, having more energy, improving your health and stabilizing your mood. If you are confused by all the conflicting nutrition and diet advice out there, you’re not alone. For every expert saying a certain food is good for you, you’ll find another saying exactly the opposite. Using these simple tips, you can cut through the confusion and learn how to create a tasty, varied, and healthy diet, as good for your mind as it is for your body.
Healthy eating is not about a single diet. Many eating patterns sustain good health. What they have in common is lots of fruits, vegetables, whole grains and healthy sources of protein and fats. Consistently eating foods like these will help lower your risk of heart disease, stroke, diabetes and certain forms of cancer. If you’d like to make healthy eating one of your good-health goals, here are 12 tips to get you started.
1. Build a better plate
- The Healthy Eating Plate is half vegetables and fruits, one-quarter whole grains, and one-quarter healthy protein.
- “Whole” and “healthy” are important words here.
- Refined grains (think white breads, pastas, and rice) have less fiber and fewer nutrients than whole grains, such as whole-wheat bread and brown rice.
- Healthy proteins include fish, poultry, beans, and nuts — but NOT red or processed meats.
- Many studies have linked red and processed meats with colorectal cancer.
- Healthy eating means healthier protein sources that can lower your risk for heart disease. So eat red meats sparingly (selecting the leanest cuts), and avoid processed meats altogether.
2. Pile on the vegetables and fruit
- Vegetables and fruits are high in fiber, vitamins and minerals and hundreds of beneficial plant chemicals (phytochemicals) that you can’t get in supplements.
- Healthy eating means diets rich in vegetables and fruit that can lower blood pressure, cholesterol levels and inflammation, improve insulin resistance and blood vessel function.
- Long-term studies on healthy eating, have shown people who eat more fruits and vegetables have a lower risk of heart disease, diabetes, weight gain, and lower risk of stroke.
- Fresh fruits and vegetables are great, but don’t avoid the frozen kind (or dried fruit or canned fruits and vegetables minus the heavy syrup or salt) when they’re more convenient.
3. Go for the good fats
Not long ago, healthy eating meant eating less fat, but now we know that it’s mainly the type of fat that counts. The best sources are plants and fish.
- You can help lower “bad” LDL cholesterol by eating mostly polyunsaturated fats (PUFA’s), like vegetable oils and omega-3 fatty acids, found in fish, seeds and nuts, and canola oil, and
- monounsaturated fats (MUFA’s), found in avocados and many plant-based oils, like olive and canola oil.
- Saturated fats (found in dairy and meat products) and trans fats (hydrogenated fat found in many fried and baked goods) increase LDL cholesterol and triglycerides, increasing your risk of heart disease.
- Worse, trans fats reduce your “good” HDL cholesterol.
- When you replace bad fats with good ones, you can get up to 35% of your calories from fat.
4. Eat whole grains instead of refined grains and potatoes
Whole grains retain the bran and germ of the natural grain, providing healthful fiber, vitamins and minerals, antioxidants, and phytochemicals. Many of these substances are removed from refined grains, such as white bread and white rice, and are barely present in starches such as potatoes.
- Starches and refined carbohydrates are digested quickly, causing spikes in insulin, blood sugar and triglycerides, lowering HDL (good) cholesterol.
- This increases the risk of heart disease and diabetes.
- It can also make you hungry, raising the risk of weight gain.
- Potatoes aren’t all bad; they’re a good source of vitamin C, potassium, and fiber. But eat them only occasionally, in small amounts and with the skins on (that’s where the fiber is).
- Some whole grains can be cooked like hot cereal or rice and some are ground into flour for baking.
- Be adventurous; in addition to whole wheat and brown rice, try quinoa, millet, farro, and amaranth.
5. Eliminate liquid sugars
- Diet and non-diet sodas, sugary fruit drinks, iced teas with added sugar, and sports drinks — provide calories and little else.
- These drinks can make you feel less full, increasing the amount you eat and promoting weight gain. A 2011 Harvard study found that sugar-sweetened beverages were one of the dietary components most strongly linked to long-term weight gain among healthy women and men.
- What about 100% fruit juice with no added sugar? Even all-natural fruit juice has a lot of calories. Drink no more than one small glass a day (4 to 6 ounces). Add carbonated water to your “one small glass” for full-glass satisfaction.
6. Drink enough water
- Many foods contain water, so you may get enough every day without special effort.
- It can be helpful to drink water (or another no-calorie liquid, such as black or green tea, coffee, or carbonated water) with meals or as an alternative to snacking. A reasonable goal is 4 to 6 cups of water a day.
- When you add whole grains to your diet, water helps move the fiber smoothly through your digestive tract, reducing the risk of constipation.
7. Learn to like less sodium
The body needs sodium for proper muscle and nerve function and fluid balance, but large amounts can increase blood pressure and the risk of heart disease and stroke. The dangers of a salty diet (salt is 40% sodium) are greatest in people over age 50, African Americans, and women. You’ll do yourself a favor if you wean your taste buds from salt. Limit your daily sodium intake to 2,300 milligrams (mg) — the amount in one teaspoonful of salt.
- If you have high blood pressure or are at risk for it, get no more than 1,500 mg per day.
- Most of the sodium Americans consume comes from processed and restaurant foods.
- Choose fresh, unprocessed foods, and prepare them yourself.
- Read the nutrition content on labels and make sure that the per-serving sodium content is less than the calories per serving.
8. Rethink supplements
- It’s best to get your vitamins and minerals from food rather than supplements.
- This is difficult when you’re cutting calories or your energy needs are low.
- You can meet almost all your nutrient needs through food alone, even if you’re consuming 1,500 calories or less per day.
- Choose nutrient-rich foods, like leafy greens, low-fat yogurt, dried beans, whole grains and salmon.
- The exception is vitamin D. Here a supplement is probably a good idea, because it’s difficult to get the recommended daily intake (600 to 800 IU) through foods.
- You can get enough calcium on a 1,500-calorie-a-day diet by eating low-fat dairy products and nondairy foods such as canned salmon, tofu, sesame seeds, dark leafy greens like collards and kale, and legumes such as pinto and kidney beans.
9. Dine mindfully
- Take time to savor your food; it makes eating more enjoyable and can help control your appetite.
- Your sense of fullness and satisfaction depends on hormone signals from your intestines. If you eat too quickly, your brain may not receive the signals that say you’re full.
- Try putting down your fork between bites and chewing more slowly.
- Savor your food’s aroma, taste, texture, and stop eating when you feel full.
Some studies suggest this approach may help some people make healthier food choices. To start, try taking one mindful bite at the beginning of each meal; a kind of eating speed bump.
10. Keep alcohol under control
Many studies link moderate alcohol consumption to heart benefits. This includes a reduced risk of heart attack, type 2 diabetes, gallstones, and dementia. It also increases “good” HDL cholesterol. Moderate consumption means no more than one drink per day for women and two for men. One drink per day also slightly increases your risk for breast cancer, and the risk increases steadily the more alcohol you consume.
- There are plenty of other ways to get heart benefits, so if you don’t like alcohol, don’t have it.
- If you enjoy an occasional cocktail or glass of wine with dinner, you need to weigh the risks and benefits to your own situation.
- If you find one drink often turns into two or more, consider quitting or getting help to cut back.
11. Eat breakfast
It’s easy to skip breakfast when you’re rushing, not hungry, or cutting calories. A healthy breakfast causes smaller rises in blood sugar and insulin throughout the day. This lowers your risk of overeating and impulse snacking.
Eating breakfast every day is one shared characteristic common to participants in the National Weight Control Registry, who lost at least 30 pounds and kept the weight off longer than a year.
- A healthy, balanced breakfast is moderate in size and includes healthy protein, whole-grain carbohydrates, and fruit — for example, an egg, whole-wheat toast, and strawberries.
- If you like cereal, have whole-grain cereal with fruit and low-fat yogurt or milk.
12. Plan for a snack attack
- Snacking IS NOT part of a healthy eating plan, but try telling that to a rumbling stomach at midafternoon.
- A healthy snack can boost energy levels by stabilizing blood sugar while giving you an added dose of healthful nutrients.
- Unplanned, impulsive snacking often means cookies, chips, or candy bars.
- So prepare healthy snacks ahead of time, and keep them handy at home or in your office.
- Limit calories to about 100 to 150 per snack. Good choices include a small bunch of grapes, a banana, or other fruit; a handful of unsalted nuts or sunflower seeds; and plain nonfat yogurt with a few raspberries or strawberries tossed in.
- Before giving in to a snack attack, drink an 8-ounce glass of water and wait 10 to 15 minutes to see if you’re still hungry.
- The key to healthy eating is moderation.
- It means eating only as much food as your body needs.
- You should feel satisfied at the end of a meal, but not stuffed.
- Moderation is also about balance.
- Despite what fad diets would have you believe, we all need a balance of protein, fat, fiber, carbohydrates, vitamins and minerals to sustain a healthy body.
So now that you know, think smart, eat smart, drink smart and go enjoy the first day of the rest of your life.
(Condensed from The Longwood Seminars At Harvard Medical School. Demystifying nutrition: the value of food, vitamins and supplements; March 5, 2013).
CHRONIC WOUNDS AND THE HEALING POWER OF HONEY
- A chronic wound is a wound that will not heal.
- Chronic wounds are thought to be “stuck” in the wound healing cycle and are most often seen in older adults.
- If a wound is not healing as expected within 2-3 months, it is considered chronic.
People have been using honey as a wound dressing for thousands of years. Manuka honey is an antibacterial honey. It is sold under the name Medihoney, Antibacterial Honey by Medihoney™ Pty LTD, of Richlands, Australia. It is available as a standardized medical honey in the United States. Medical researchers have only recently begun to understand the reasons for its effectiveness. Doctors are starting to understand that honey is a biologic wound dressing. It has multiple biological effects working together to hasten healing. Manuka honey has become a useful product in the treatment of chronic wounds.
COMPONENTS OF MANUKA HONEY
The physical properties of honey play a major role in the improved healing process.
- Honey’s natural acidity, increases the release of oxygen from blood.
- It decreases the activity of destructive enzymes in the wound.
- Its high sugar concentration draws fluid out of the wound (same effect obtained with vacuum therapy).
- Honey has two types of antibacterial activity and the ability to kill many types of bacteria.
- Hydrogen peroxide is the main antibacterial agent in most honeys.
- Hydrogen peroxide is easily destroyed by the enzyme catalase, found in human tissues.
- Methylglyoxal is the main antibacterial agent in manuka honey and is not destroyed by human tissues.
- Different amounts of these substances in each honey is the reason for the different potency of different honeys.
SCIENCE FACTS ABOUT MANUKA HONEY
Manuka honey can be diluted by large amounts of wound fluid and still maintain enough antibacterial activity.
Good clinical evidence for honey shows it is:
- a stimulant of the immune response.
- a promoter of tissue growth for wound repair.
- a substance that lowers inflammation and
- a substance that causes rapid separation and shedding of dead tissue.
Ongoing studies are providing scientific explanations for these effects.
- Allergic reaction, especially in people with bee allergies.
- Possible interaction with certain chemotherapy medications.
- Possible blood sugar rise.
HOW MANUKA HONEY IS USED IN CHRONIC WOUNDS
Honey used to treat wounds is a medical grade product, specially treated and prepared as a dressing. Honey is most commonly used as a surface antibacterial agent to treat infections in different wound types.
- Leg ulcers
- Pressure ulcers
- Diabetic foot ulcers
- Chronic wounds from injury or surgery
The amount of honey used depends on the amount of fluid coming from the wound.
- Large amounts of fluid need large amounts of honey.
- Dressings should be changed depending on how rapidly the honey is being diluted by fluid.
- The wetter the dressing, the more frequent the changes. This should become less frequent as the honey starts to work on healing the wound.
- Dressings should be occlusive to prevent honey from oozing out from the wound.
- The honey should be placed on a dressing, then the dressing should be applied to the wound.
- The honey should not be applied directly onto the wound.
- Dressing pads soaked with honey are commercially available as a less messy alternative.
- Cavities or deep wounds need to be filled with honey to reach deep into the tissues.
- The wound bed should be filled with honey before applying the honey dressing pad.
A doctor should see all difficult to heal wounds. The doctor should create an appropriate plan of care. The plan should be executed and carefully followed by experienced wound care medical personnel.