Offer multivitamins to benefit your patients’ health and increase your ancillary services profitability
Chiropractors have been urging patients to take nutritional supplements for many years. Until recently, modern medicine has flatly denied that subclinical nutrient deficiency is a big problem, and that supplements are useful and needed by many people. This changed on June 19th, 2002, when two articles devoted to supplements were published in the Journal of the American Medical Association.1,2
Fletcher and Fairfield stated:2 “In the absence of specific predisposing conditions, the usual North American diet is sufficient to prevent overt vitamin deficiency diseases...However, insufficient vitamin intake is apparently a cause of chronic diseases...A large proportion of the general population is apparently at increased risk for this reason...We recommend that all adults take a multivitamin daily.”
Educate Your Patients
More than likely, few medical doctors will jump on the nutritional supplement bandwagon, as they are philosophically predisposed to prescribe drugs. However DCs can use this information to their advantage. These articles are great patient education tools for practices. Third-party recommendations are effective, especially when they come from highly reputable sources. If you already have been recommending supplements to your patients, they will see you as a nutritional visionary.
Decreasing DNA injury. More compelling evidence regarding the importance of multinutrient supplements is validated in a recent article3 that outlines how subclinical vitamin deficiencies can promote DNA injury that resembles radiation damage. According to Ames from the University of California at Berkeley: “A deficiency of any of the micronutrients: folic acid, vitamin B12, vitamin B6, niacin, vitamin C, vitamin E, iron, or zinc, mimics radiation in damaging DNA by causing single- and double-strand breaks, oxidative lesions, or both...Common micronutrient deficiencies are likely to damage DNA by the same mechanism as radiation. Remedying micronutrient deficiencies should lead to a major improvement in health and an increase in longevity at low cost.”
Ames explains that the recommended daily allowance (RDA) is based mainly on acute effects, and the optimum amount for long-term health is generally not known. Optimum intake of a micronutrient can vary with age and genetic constitution, state of well-being, and is also influenced by other aspects of diet. The optimum amount to protect against genomic damage is generally thought to be higher than the current recommended daily allowance, and it is presently known that a sizeable percentage of the population is deficient relative to the current RDA.3 Consider for example that “inadequate micronutrient intake among older adults is common despite the increased prevalence of fortified/enriched foods in the American diet.”4 This problem probably exists because 80% of American children and adolescents and 68% of adults do not eat the recommended five portions of fruits and vegetables a day.3
Researchers now believe that genomic stability is dependent on adequate nutrient intake5,6 to the point that Fenech stated “that there is a need for an international effort to establish RDAs for genomic stability is self-evident.”6 Fenech explained that micronutrient deficiencies cause a DNA repair defect that can be genotoxic, resulting in DNA damage that can promote infertility, cancer, and aging.
Lowering incidences of birth defects. The incidence of cleft lip with or without cleft palate (CLP) is approximately 1 in 1,000 infants, and cleft palate alone affects about 1 in 2,500 infants.7 Botto et al found a 48% risk reduction for CLP among mothers who used multivitamins during the periconceptional period or who started multivitamin use during the first postconceptional month, after controlling for several covariates.
The article stated that the magnitude of the risk reduction in the study is comparable to those of other recent studies; this study does not support the contention that only large dosages of folic acid are needed to prevent orofacial clefts. More studies are needed to test the effects of multivitamins and varying dosages of folic acid on the recurrence and/or occurrence of orofacial clefts to provide information needed to determine possible prevention strategies.7
Minimizing aging-related diseases. In the Medicare budget, cataracts are the number one expense item.8 A recent study9 found that there could be tremendous medical savings if people took multivitamins. Compared with nonusers, the 5-year risk for any cataract was 60% lower among persons who, at follow-up, reported using multivitamins or any supplement containing vitamin C or E for more than 10 years. These data add to a body of evidence suggesting lower risk for cataracts amoung users of vitamin supplements and stronger associations with long-term use. The article also notes that the specific nutrients responsible cannot be ascertained at this time, and unmeasured lifestyle differences between supplement users and nonusers may explain these results.9
An 8-week double-blind, placebo-controlled clinical trial10 was conducted to examine how a multinutrient would impact micronutrient status, plasma antioxidant capacity, and cytokine production in subjects ranging in age from 50 to 87 years. All were characterized as healthy, free-living older adults already consuming a fortified diet. McKay et al concluded that, “supplementation with a multivitamin formulated at about 100% daily value can decrease the prevalence of suboptimal vitamin status in older adults and improve their micronutrient status to levels associated with reduced risk for several chronic diseases.”10
In another double-blind, placebo-controlled trial,11 Chandra examined whether supplementation with vitamins and trace elements in modest amounts could influence cognitive function in apparently healthy, elderly subjects. The study included men and women older than 65 years of age, who were randomized to receive a supplement of trace elements and vitamins or a placebo for 12 months. Cognitive function was determined by assessing immediate and long-term memory, abstract thinking, problem-solving ability, and attention.
The supplemented group showed a significant improvement in all cognitive tests except long-term memory recall. Those with blood-nutrient levels below the reference standard showed lower responses on cognitive tests. Chandra concluded: “Such a nutritional approach may delay the onset of Alzheimer’s disease.”
Reducing stress. A recent study12 suggests that multivitamins can also be used to help reduce stress. On day 1, patients were subjected to an individual, in-depth assessment that included a biographical questionnaire, four psychological scales, and collateral information from close relatives. On day 30 (end of the study period) or at the latest 7 days after the last planned supplementation intake, the assessment was repeated for purposes of pre- and postresponse comparison. There were 300 patients who completed the study; 151 in group one (multivitamin-mineral combination), and 149 in group two (placebo). There were no statistically significant differences between the two groups regarding demographics and baseline stress scores at study entry. Both groups improved between baseline and the end of treatment as assessed. The degree of improvement was statistically significant and greatest in group one for all psychometric instruments, with this beneficial effect increasing over the course of the day. The authors concluded that a multivitamin-mineral combination is well tolerated and can be used as part of a treatment program for stress-related symptoms at the recommended dose.
Increasing antioxident status. In a double-blind, placebo-controlled study,13 the antioxidative defense system was measured in 34 healthy subjects before and after multinutrient supplementation. Plasma vitamins C and E, beta-carotene, erythrocyte vitamin E, as well as whole blood selenium all showed increase at 5 weeks of supplementation. The level of reduced glutathione (a powerful antioxidant) and the activities of the antioxidant enzymes catalase and glutathione peroxidase were significantly increased at 16 weeks of supplementation. Moreover, the resistance of red blood cells to oxidation was elevated at 5 weeks after supplementation. These improvements also led to the reduction of RBC susceptibility to free radial peroxidation.
With each passing year, more and more research suggests that we all should be taking a multivitamin. The data presented in this article should help to compel the most resistant patient to consider adding a multivitamin to their diet. Our elderly patients are at the greatest risk, so it is important to educate them about this aspect of health and nutrition. CP
David R. Seaman, DC, MS, DABCN, is an assistant professor at Palmer College of Chiropractic, Florida, is on the postgraduate faculties of several chiropractic colleges, and presents postgraduate seminars for chiropractic colleges and associations. He has written a textbook on nutrition and published several articles in the Journal of Manipulative and Physiological Therapeutics. Seaman can be reached at seaman_d@palmer.edu.
References
1. Fairfield KM, Fletcher RH. Vitamins for chronic disease prevention in adults: scientific review. JAMA. 2002;287(23):3116–26.
2. Fletcher RH, Fairfield KM. Vitamins for chronic disease prevention in adults: clinical applications. JAMA. 2002;287(23):3127–29.
3. Ames B. DNA damage from micronutrient deficiencies is likely to be a major cause of cancer. Mut Res. 2001;475:7–20.
4. McKay DL, Perrone G, Rasmussen H, Dallal G, Hartman W, Cao G, et al. The effects of a multivitamin/mineral supplement on micronutrient status, antioxidant capacity and cytokine production in healthy older adults consuming a fortified diet. J Am Coll Nutr. 2000;19(5):613–21.
5. Fenech M, Ferguson LR. Micronutrients and genomic stability. Mutation Res. 2001;475:1–6.
6. Fenech M. Micronutrients and genomic stability: a new paradigm for recommended dietary allowances (RDAs). Food Chem Toxicol. 2002; 40:1113–17.
7. Botto LD, Lynberg MC, Erickson JD. Congenital heart defects, maternal febrile illness, and multivitamin use: a population-based study. Epidemiology. 2001;12:485–90.
8. Abel R. Preventing cataracts. In: Rakel D. Ed. Integrative Medicine. Philadelphia: WB Saunders; 2003:597–603.
9. Mares-Perlman JA, Lyle BJ, Klein R, Fisher AI, Brady WE, VandenLangenberg GM, et al. Vitamin supplement use and incident cataracts in a population-based study. Arch Ophthalmol. 2000;118:1556–63.
10. McKay DL, Perrone G, Rasmussen H, Dallal G, Hartman W, Cao G, et al. The effects of a multivitamin/mineral supplement on micronutrient status, antioxidant capacity and cytokine production in healthy older adults consuming a fortified diet. J Am Coll Nutr. 2000;19:613–21.
11. Chandra RK. Effect of vitamin and trace-element supplementation on cognitive function in elderly subjects. Nutrition. 2001;17:709–12.
12. Schlebusch L. A double-blind, placebo-controlled, double-centre study of the effects of an oral multivitamin-mineral combination on stress. S Afr Med J. 2000;90:1216–23.
13. Cheng T. Effects of multinutrient supplementation on antioxidant defense systems in healthy human beings. J Nutr Biochem. 2001;12:388–395.
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