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Multi Vitamins
It is estimated that more than one-third of American adults take multivitamin/mineral (MVM) supplements regularly. Recommendations regarding supplement use from expert groups vary widely, as does the strength of the evidence supporting such guidelines. As more and more Americans seek strategies for maintaining good health and preventing disease, and as the marketplace offers an increasing number of products to fill that desire, it is important that consumers have the best possible information to inform their choices.

The Office of Dietary Supplements and the Office of Medical Applications of Research of the National Institutes of Health will convene a State-of-the-Science Conference on Multivitamin/Mineral Supplements and Chronic Disease Prevention, May 15 to 17, 2006 in Bethesda, Maryland. The goal of the conference is to assess the evidence available on MVM use and outcomes for chronic disease prevention in adults, and to make recommendations for future research. Specifically, the conference will explore the following key questions:

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There are two main ways to use vitamins and mineral supplements: "megadose" and nutritional therapy.
The megadose approach involves taking supplements at doses far above nutritional needs in hopes of producing a specific medical benefit. This technique essentially uses nutrients as natural drugs. The individual supplement articles in this encyclopedia explain what is known about the potential risks and benefits of megadose therapy.

Taking nutrients at the level of nutritional needs. We discuss general issues regarding such "nutritional insurance," and indicate which nutrients you should consider taking on a daily basis.

There is no doubt that it's important to get enough of all necessary nutrients. However, the process of determining proper daily intake levels for vitamins and minerals is far from an exact science, and the recommendations issued by experts in various countries often disagree to a certain extent.

In general, while it is fairly easy to determine the minimum nutrient intakes that are necessary to avoid frank malnutrition, there's no straightforward way to determine optimum intake levels. Furthermore, individual needs undoubtedly vary based on numerous factors, including age, genetics, lifestyle, other foods in the diet and many additional environmental influences; no schedule of official recommendations could possibly take all these factors into account, even if all the necessary data existed (which it doesn't).

Thus, all recommendations for daily nutrient intake must be regarded as approximate. The individual supplement articles in this encyclopedia summarize the current U.S. recommendations.

Common Nutritional Deficiencies
Severe deficiencies of vitamins or minerals are rare in the developed world. However, evidence suggests that slight deficiencies in certain nutrients may be relatively common. These include calcium, chromium, folate, magnesium, vitamin B 6, vitamin C, vitamin B 12 (primarily in the elderly), vitamin D, vitamin E, and zinc.

While few people are so deficient in these nutrients to show symptoms of outright malnutrition, subtle deficiencies may increase risk of numerous diseases. For example, insufficient intake of calcium and vitamin D may increase your chances of developing osteoporosis, and inadequate folate and vitamin B 6 may speed the development of heart disease.

Thus, taking supplements to supply these important vitamins and minerals may be a good idea as a form of insurance. For standard dosage recommendations as well as safety issues, follow the links above to the full articles.

Besides vitamins and minerals, intake of essential fatty acids may be commonly inadequate. For more information, see the articles on omega-6 fatty acids and omega-3 fatty acids.

Women may develop iron deficiency, but men hardly ever do. Even in women, iron supplements are not beneficial in the absence of true deficiency. We recommend avoiding iron supplements unless tests show that you really need them.

Multivitamin/Mineral Supplements
The simplest way to support your nutrition is to take a general multivitamin and mineral supplement providing a broad range of nutrients at standard nutritional levels. However, there are a few caveats to keep in mind.

Some supplements include very high doses of certain nutrients, such as antioxidants. As described above, when you take nutrients in this fashion, you are using them as drugs rather than nutrients; you are no longer in the world of nutritional supplementation and have passed into the riskier world of megadose treatment. We recommend that you use an iron-free multivitamin and mineral supplement unless you have been tested and found to be deficient in iron.

The minerals calcium and magnesium are very bulky, and few multivitamin/mineral supplements provide the daily requirement. These minerals generally must be taken in the form of additional pills. Note: It isn't possible for your body to absorb a day's worth of calcium in a single dose. At least two doses are necessary. Finally, note that food may contain many non-essential substances such as carotenes and bioflavonoids that nonetheless enhance health. For this reason, no nutrient supplement should be regarded as a substitute for a healthy and varied diet.

One problem with multivitamin/mineral supplements is that some nutrients may interefere with the absorption of others. For this reason, there may be advantages to taking supplements separately. (The hassle factor is a strong disadvantage!) In addition, this method allows one to avoid taking vitamins and minerals one doesn't need.

Natural vs. Synthetic Vitamins
May people wonder whether "natural" vitamins are better than "synthetic" ones. This question, however, is a bit of a red herring. Ultimately, no vitamin or mineral supplement is "natural." Purified vitamins and minerals are refined, processed products analogous to white sugar or artificial fertilizer. It doesn't much matter whether they are extracted from foods or manufactured in a laboratory: the result is the same. For example, vitamin C made from rose hips is chemically identical to vitamin C synthesized from scratch. Both are ascorbic acid.

Rose hips themselves, however, supply many nutrients along with vitamin C. If you truly wish to get your vitamins naturally, you might consider taking them as freeze-dried or condensed whole food supplements rather than as purified vitamins. This might offer a specific advantage over purified vitamins: as we noted above, fruits and vegetables may provide substances that are not actually essential yet may promote better health.

Therapeutic Uses
Under certain conditions, nutritional needs for many nutrients may increase. These include illnesses such as diabetes, Crohn's disease, HIV and ulcerative colitis. Furthermore, individuals who smoke cigarettes or overuse alcohol may need additional nutrients. Follow the links to the individual articles for more information.

Medications may increase needs for certain nutrients; if you look up your own medications in the Drug Interaction section of the encyclopedia, you will find what is known about these so-called "nutrient depletions."

Incomplete, and in some cases contradictory evidence suggests that use of multivitamin and/or multimineral supplements may reduce the pain of osteoarthritis, decrease symptoms of premenstrual stress syndrome (PMS) and ordinary stress, improve fertility in women, reduce pregnancy-related nausea (“morning sickness”), enhance mental function, improve general wellbeing, and reduce antisocial behaviour in children and young adults (especially those who are malnourished).

According to most, but not all, studies, use of multivitamin/multimineral supplements, or supplements containing zinc and selenium alone, may help prevent infections in seniors and people with diabetes.

In addition, two studies found that multivitamin/multimineral tablets strengthen immune response to vaccines. Another study found a related effect: enhancement of immune response to skin testing. However, in one trial, use of multivitamins without minerals actually impaired the immune response to vaccination.

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