Appendix D to Dr. Herbertís Testimony, NY City Council, 2/10/00, re supplements:

Underreporting of Dietary Supplements to Health Care Providers does Great Harm. Victor Herbert, M.D., J.D., M.A.C.P.; in  Mayo Clinic Proceedings, 1999; 74:531-2 (May).

            In this issue of the Proceedings, Hensrud et. al.¹ present an important prospective study of 200 subjects randomly selected among patients seen for a periodic health exam, 100 from a national cohort of executives and 100 community patients .  The prevalence of dietary supplement use was 30.5% by written self-report, but 61.0% reported during the structured interview.  The most common dietary supplements  taken were multivitamins (41.5%), followed by vitamins E (24.0%) and C (23.0%).  The importance of this study is its statistical delineation of the enormous number of Americans who are taking these products.  It is only by using the sophisticated methodology of the authors that physicians generally can learn the frequency and nature of the food fortificants and  supplements that patients are taking, and thereby alert their patients to the harms from many of the supplements they are taking, and the help from a few they are not taking. 

            In 1994, this editorialist co-authored a book on supplement harms ², and, in 1996, this editorialist co-chaired a symposium on harms from the prooxidant effects of ìantioxidantî

vitamins ³.  As noted by all the researchers from the U.S. and France who spoke in that symposium, which focused particularly on various cancers promoted by supraphysiologic doses of various ìantioxidantî vitamins, these adverse effects appeared related to their prooxidant actions.  ìAntioxidantî is actually shorthand for ìredox agentî.  All ìantioxidantî fortificants and supplements, be they vitamins or herbs, are in fact redox agents, antioxidant in some circumstances, mainly in dietary reference intake ( DRI ) and lower amounts, and prooxidant in other circumstances, mainly in greater than DRI amounts ³. 

            Evaluating vitamin supplements, The Medical Letter ⁴ concluded that, ìSupplements are necessary to assure adequate intake of folic acid in young women and possibly of vitamins D and B₁₂ in the elderly.  The benefits of taking high doses of vitamin E remain to be established.  There is no convincing evidence that taking supplements of vitamin C prevents any disease.  No one should take beta carotene supplements.  A balanced diet may be more beneficial and safer than taking vitamin supplementsî. 

            Strong support for this position on antioxidant vitamins was recently published in the American Journal of Public Health ⁵. 

            All vitamin supplements are chemically factory-synthesized, except for vitamin B₁₂, which is biosynthesized ⁵.  Chemical synthesis produces racemic (d, l ) vitamins, of which only the l-form is natural (meaning it is the form present in plants and the form which is fully vitamin-active in humans) ⁵.   The d-form is its mirror image.  Supraphysiologic quantities of the d-form may promote a substantial number  of  the harms from such doses of them, as well  as promoting the harms from supraphysiologic (400µg or greater) doses of pteroylglutamic acid (PGA), the chemically synthesized PGA (folic acid) in fortificants and pills ⁷.   Biosynthesized means synthesized using bacterial enzymes, which produce only the natural l-form ⁶.  The representation that chemically synthesized vitamin supplements are natural is therefore misleading.   

            Two recent reports ^{8, 9} present a compelling case for an oral vitamin B₁₂ supplement of 100µg daily, starting at age 50 in both sexes, taken alone on arising, to prevent vitamin B₁₂

            A recent report on sterility from St. Johnís wort, echinacea, and gingko, showed that they damage reproductive cells (sperm and oocytes), and St. Johnís wort is mutagenic to sperm cells ¹¹. 

REFERENCES 

^1.   Hensrud DD, Engle DD, Scheitel SM.  Underreporting of Dietary Supplements to Health Care Providers does Great Harm.  Mayo Clinic Proceedings, this issue.

 ^2.   Barrett S, Herbert V.  The Vitamin Pushers.  Prometheus Press, 1994.

 ^3.   Herbert V. Introduction.  American Institute of Nutrition (AIN) Symposium on "Prooxidant  Effects of Antioxidant Vitamins." J Nutr 1996;126(Suppl 4):1197S-1200S.

 ^4.  The Medical Letter.  Vitamin Supplements.  The Medical Letter 1998 ; 40 (1032): 75. 

 ^5.  Hercberg S, Galan P, Preziosi P.  Antioxidant vitamins and cardiovascular disease: Dr Jekyll  or Mr. Hyde?  Am J Public Health 1999; 89: 289.