Solving the Mystery of the Multivitamin Part II
A previous article, “Solving the Mystery of the Multivitamin,” discussed the basics of setting up a daily nutritional foundation by choosing a multivitamin-mineral formulation appropriate for one’s basic needs and expectations. As pointed out, with regard to nutrition it matters whether one is old or young, male or female, an athlete, etc. Also discussed were issues such as determining the quality of a product and improving absorption of nutrients. Setting up a nutritional foundation is always the place to start when considering supplementation. Nevertheless, a foundation is just that, something to build upon.
What is built depends upon the needs and desires of the builder. In nutrition, sex differences are very important, often in surprising ways. Therefore, the next steps after the foundation deserve some thought. Let us start with the special nutritional needs of women. Some of these needs can be generalized to all women, and these are the ones that will be discussed first. Afterwards, there are needs based on age and condition-specific concerns.
General Nutrition for All Women
Under this category heading are many nutrients that are fairly bulky and ideally should be supplied by a good diet. The problem is changes in food growing, processing, the increasing consumption of fast foods and so forth have distorted almost beyond recognition the nutrient profile found in pre-Twentieth Century diets. To a striking extent, food processing and the consumption of refined and processed foods by themselves largely account for obesity, diabetes and many other health problems. Processing not only makes even good carbohydrates act like sugar, it also removes fiber, vitamins, minerals and most of the phytonutrients normal to plant foods in their more crude states.
Replace the Minerals Calcium, Magnesium and Potassium
Over the last six decades, the quantity of major minerals found in grains, fruits and vegetables has dropped dramatically. Calcium, magnesium and potassium have decreased in many instances between 20 and 90 percent in staple foods. This means that basic nutrition from grains such as corn, and vegetables such as broccoli and tomatoes just is not what it once was.
• Calcium—Food sources include green leafy vegetables, dairy and canned salmon with bones. The usual recommendation is that woman below the age of 50 should supplement with 1,000 mg of calcium per day while women over 50 should supplement with 1,200 mg daily. The caveat with calcium for bone health is the research supports supplementation as a benefit in reducing fracture risk only when calcium is consumed along with vitamin D and supporting nutrients, such as magnesium. Excessive calcium in relation to magnesium intake can exaggerate a magnesium deficiency with a number of health consequences. Calcium should always be balanced with magnesium at a ratio of 2:1 or more magnesium, e.g., 1000 mg calcium should be balanced by at least 500 mg magnesium.
• Magnesium—Dark green leafy vegetables, nuts and seeds are generally the best sources for magnesium. The suggested intake level for magnesium is 400 mg per day, but more should be taken if calcium is being supplemented. Magnesium is one of the cofactors that keep calcium in the bones rather than in the soft tissues. Moreover, although calcium is associated with bone mineral density (BMD), magnesium is one of the nutrients that improve the dynamic strength of bone, something arguably far more important than BMD. Magnesium-insufficient bone is fragile upon mechanical loading despite high bone mineral density.
• Potassium—Supplementation in capsules and tablets is regulated at the absurdly low level of 99 mg per dose. Potassium is well represented in avocado, apricots, cantaloupes, lima beans, oranges, green leafy vegetables and nuts. Meats tend to be high in potassium, but also are high in sodium at the same time, which is counterproductive. Americans consume on average 2.8 grams of potassium per day, which is far below the suggested 4.7 grams and below the amount shown to improve blood pressure in the DASH (Dietary Approach to Stop Hypertension) diet. Tomato juice is a convenient source of potassium.
• Iron—The iron content of foods has declined over the last several decades. Women below the age of menopause should consider carefully their need for iron. The RDI for iron for women in this group is 15 mg (30 mg when pregnant).
• Folic Acid—A given for preventing neural tube birth defects. The RDI is 400 mcg/day.
Replace Vitamins A, C, D and Phytonutrients
As is true of mineral content in common foods over the last half-century, the content of tested vitamins, including vitamins A, C and D, have declined. As noted in an article entitled, “Looks Great, Less Nutritious?”, the vitamin A content of broccoli and tomatoes purchased today is probably 50 percent less than that of the same vegetables purchased in the 1950s. Vitamin C suffers the same fate, the amount of vitamin D found in fish oils is far less than was true a century ago, and many phytonutrients, for example, the anthocyanidins responsible for deep red and purple colors, today are far below their previous levels in fruits, such as blueberries. Blame modern agricultural practices and the selection of cultivars grown.
• Antioxidant Vitamins and Phytonutrients—The Reference Daily Intake of vitamin C is 60 mg per day. This amount prevents scurvy, but vitamin C is useful in many other areas, such as the production of collagen. The reduced levels of vitamin C found in modern foods can stand for reduced levels of other phytonutrients. It is a good idea to increase consumption of brightly and deeply colored vegetables and fruit, especially various deep-colored berries and green and leafy vegetables. Supplements might include anthocyanidins, proanthocyanidins, resveratrol, pterostilbene, quercetin, catechins, curcumin, chlorgenic acid and polyphenols more generally.
• Vitamin D—Research shows that Vitamin D3 (cholecalciferol), the form that can be synthesized by humans in the skin upon exposure to ultraviolet radiation from sunlight, is more useful than vitamin D2 (ergocalciferol). Aside from bone health, vitamin D has been shown to be important for immune health, insulin secretion and glucose tolerance, blood pressure regulation and other purposes. A recent Institute of Medicine (IOM) report, which included no vitamin D experts on the panel, concluded that individuals between the ages of 1 and 70 do not need more than 600 IU of vitamin D daily with an upper limit of 4,000 IU. However, this report has been greeted by harsh criticism. As noted in previous Total Health articles, many experts argue for a normal intake in the range of 2,000 to 2,500 IU with an upper limit of 10,000 IU.
Replace Omega-3 Fatty Acids
Increased ratios of omega-3 fatty acids versus omega-6 fatty acids in the diet are associated with reduced risk of cardiovascular diseases, cancer, immune and inflammatory conditions as well as neurological development of the infant in the womb. The omega-3 fatty acids include DHA (docosahexanoic acid) and EPA (eicosapentaenoic acid) found in fatty cold-water fish ALA (alpha-linolenic acid) found prominently in flax seed oil and walnuts. Animals foraged on grass, roots and barks contained substantial omega-3 fatty acids in their meat and eggs, and even the butter of grass-fed cows supplies omega-3 fatty acids. Prior to the development of modern agricultural practices and the use of special pressing equipment to extract omega-6 oils from oilseeds, the ratio of omega-3 to omega-6 fatty acids (including linoleic acid/LA) was on the order of 1:2 to 1:5. Today the ratio is more on the order of 1:10 to 1:20 or even higher. To give examples of the importance of the ratio, women with better ratios of omega-3 to omega-6 fatty acids in their tissues are at reduced risk for breast cancer and findings are similar for other cancers. According to one authoritative review, “a ratio of 2–3/1 [omega-6:omega-3] suppressed inflammation in patients with rheumatoid arthritis, and a ratio of 5/1 had a beneficial effect on patients with asthma, whereas a ratio of 10/1 had adverse consequences.” Note it is the ratio that counts, not the total consumption of omega-3 fatty acids. Clinical trials have validated supplementation of combined EPA + DHA of 850 –1,800 mg/day and ALA of 2,900 mg/day, but remember it is the ratio of omega-3 to omega-6 fatty acids that counts. There is recent suggestive evidence that women receive superior anti-inflammatory benefits from DHA and men receive superior anti-inflammatory benefits from EPA.
Premenstrual Syndrome (PMS)
To be sure, gender-based physiological differences appear earlier than menarche, but a woman’s monthly cycle definitively ushers in a period of new nutritional needs somewhere between the ages of 10 and 17. Unfortunately, by ages 30 to 40, roughly one-third of all women suffer from the troublesome, yet often hard to define symptoms of PMS. The most common complaints include anxiety and tension, mood swings, various aches and pains, depression, cravings and fluid retention. These symptoms usually reflect an imbalance between the hormones estrogen and progesterone and the impact of this imbalance and/or other factors upon levels of aldosterone, a hormone that regulates fluid retention.
Studies of women who do and do not suffer from PMS have uncovered a number of significant differences in the intake of basic nutrients. For instance, those women who suffer from PMS tend to consume as a percentage of their total diet much greater amounts of refined carbohydrates (especially refined sugar), dairy products and sodium. They consume much less iron, manganese and zinc, which is to say that their diets are generally much poorer in the minerals tested than is true of non-sufferers. The estrogen excess so often found in PMS could well reflect the re-absorption of discarded estrogen from the intestines due to an inadequate consumption of whole grains, fruits and vegetables. Diet is definitely a factor in PMS.
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