4 questions | Applied Sciences homework help

1. They warn you not to trust your doctor. 29. They sue or libel their critics. 30. They encourage patients to lend political support to

their treatment methods. 30 tips to help spot VitamiN pushers aNd Food Quacks Table 11-2 Modified from Barrett S, Herbert V. The Vitamin Pushers: How the “Health Food” Industry Is Selling America a Bill of Goods.7 Part Three Nutrition and Fitness198 food. The most commonly used supplements are vita- mins and minerals.11 Many products sold as supplements contain substances not needed in the human diet. It is not legal to market any product with therapeu- tic claims unless satisfactory evidence of safety and effectiveness is presented to the FDA. However, many products are marketed as “dietary supplements” even though they are nutritionally insignificant or are intended for treating a health problem. Intended therapeutic uses seldom appear on product labels but are communicated in other ways to retailers and prospective customers. Thus, although customers are led to believe that various “supplements” can function as effective drugs, the FDA cannot regulate them as drugs. The Dietary Supplement Health and Education Act (DSHEA) of 1994 defines “dietary supplement” as any product (except tobacco) that contains at least one of the following: (a) a vitamin, (b) a mineral, (c) an herb or other botanical, (d) an amino acid, (e) a dietary substance “for use to supplement the diet by increasing total dietary intake,” or (f) any concentrate, metabolite, constituent, extract, or combination of any of the afore- mentioned ingredients. Herbal supplements, of course, are not consumed for a nutritional purpose and often are marketed with therapeutic claims. The supplement industry, which lobbied vigorously for passage of this act, included them in this definition to weaken the FDA’s ability to regulate their marketing. Although herbal supplement products can properly be viewed as “drugs in disguise,” they are discussed in this chapter rather than the drug chapter because their marketing and regulation differ considerably from that of real drugs. Spices and other products intended for use as flavoring agents are not within DSHEA’s scope. DSHEA enables marketers to state how their prod- ucts may influence body structure or function as long as they do not relate this to the prevention or treatment of a disease. All such statements must be accompanied by a disclaimer that they have not been evaluated by the FDA and that the product is not intended to “diagnose, treat, cure, or prevent any disease.”12 Structure/function claims have little or no practical value because even if they are literally true, they cannot specify or explain who might benefit from taking the product. They should be regarded as a sales gimmick written into the law by Congressional representatives who wanted to enable supplement marketers to suggest intended uses without getting into trouble. Vitamins are sold individually and combined with other vitamins and/or minerals. Multivitamin-mineral combinations may contain as many as 60 ingredients, but some ingredients, such as bioflavonoids, inositol, rutin, and para-aminobenzoic acid (PABA), are not nutrients and are not needed in the human diet. Herbs are sold individually, in herbal mixtures, and combined with vitamins, minerals, and/or amino acids. The variety of products sold as dietary supplements (including many that contain no essential nutrients) is huge. Altogether, several hundred companies market more than 50,000 such products. Nutrition Business Journal13 estimates that in 2009 Americans spent over $27 billion for supplement and herbal products. Most people who use multivitamins think they are getting “nutrition insurance,” but many erroneously believe that extra vitamins can provide ex- tra energy, improve general health, and protect against stress. Most who supplement with individual nutrients believe that these products have medicinal value. In a 1999 survey, users of vitamin and mineral supplements, herbs, and “specialty supplements” said they took them to ensure good health; improve energy or stamina; pre- vent or treat common illnesses like colds and the flu; improve memory or mental sharpness; prevent or treat more serious medical conditions; reduce anxiety, stress, or tension; slow down the aging process; improve mood or alleviate depression; lose weight or control appetite; The Science of Foolology10 One evening at Mory’s, Dink Stover sits listening to Ricky Rickets discourse on how he plans to become a millionaire in 10 years. That certain route to wealth lies in “making an exact science” of beguiling the foolish. “What’s the principle of a patent medicine?” Ricky asks rhetorically, and then answers himself. “Advertise first, then concoct your medicine.” “All the science of Foolology,” he elaborates, “is: first, find something all the fools love and enjoy, tell them it’s wrong, hammer it into them, give them a substitute and sit back, chuckle, and shovel away the ducats. Why, Dink, in the next 20 years all the fools will be feeding on substitutes for everything they want . . . and blessing the name of the foolmaster who fooled them.” Ricky’s prediction [made in a fictional work published in 1912!] contained much truth. Many blessings, and ducats too, have enriched critics of the regular diet who have provided some substitute promoted to preserve and restore health. James Harvey Young, Ph.D. Historical Perspective Chapter Eleven Nutrition Fads, Fallacies, and Scams 199 improve sexual function or pleasure; and/or help with menopause (women only).14 Multivitamins vary greatly in the types and amounts of their individual ingredients. Many products contain amounts that exceed the RDA. Vitamin A is present in amounts up to 25,000 IU (international units), or five times its RDA; vitamin D is present in amounts up to 5000 IU, 121/2 times its RDA; vitamin B6 as high as 500 mg, 250 times the RDA; vitamin E up to 1000 IU, 100 times its RDA; and vitamin C up to 1000 mg, 11 times its RDA. Single supplement tablets of vitamin C may contain as much as 2000 mg. Dosages this high are un- necessary, costly, and sometimes harmful. Most mineral supplements contain below-RDA amounts, but a few contain slightly more. Several scientific and professional groups have recommended that the FDA limit the dosage of certain ingredients in over-the-counter (OTC) vitamin and min- eral products. However, the Proxmire Amendment to the Food, Drug, and Cosmetic Act prevents the agency from regulating the dosages of vitamin products that are not inherently dangerous. The amendment was passed in 1976 after a massive lobbying campaign spearheaded by the health-food industry.15 Curiously, the American public is not highly con- fident that dietary supplements are safe or accurately labeled. A 1999 survey found that (a) only 41% were very confident about the safety of vitamin and mineral supplements, (b) 34% believed the information on the labels was very accurate, (c) 24% were very confident that herbal products are safe, (d) and 32% believed herbal products were very accurately labeled. In addition, 12% of herbal product and 13% of specialty supplement users experienced adverse reactions to these products.14 “Nutrition Insurance” Most nutrition authorities agree that healthy individuals can get all the nutrients they need by eating sensibly. Most Americans believe this, too, but many worry that their eating habits place them at risk for deficiency. The fear of not getting enough nutrients is promoted vigorously, not only by food faddists and health-food industry publicists, but also by major pharmaceutical manufacturers and trade associations. Faddists tend to stress unscientific ideas that people cannot get sufficient nourishment from ordinary foods, while the drug com- panies use more subtle suggestions that various people may not be getting enough. Both groups fail to suggest how to obtain nutrients from foods or how to tell whether you are getting enough. Dr. Paul Thomas,16 a former staff scientist for the Food and Nutrition Board, says that tak- ing supplements is more like gambling than insurance (see Personal Glimpse box). One of the main arguments used to support recom- mendations for “insurance” by vitamin supplements is that reputable health and nutrition surveys have found that intakes of some vitamins by some segments of the population are below the RDAs. Dr. Alfred E. Harper,17 a former chairman of the Food and Nutrition Board, has explained why the above argument is misleading:

• The RDAs are set high enough to encompass the needs of individuals with the highest requirements. Using them directly as standards for evaluating the adequacy of indi- vidual nutrient intakes would be like setting the standard for a person’s height at 7 feet and concluding that all those under 7 feet have suffered growth retardation.
• Surveys often identify vitamin A as a “problem nutrient.” However, when the results of dietary surveys are based on measurements of nutrient intakes for a single day, many people who consume adequate amounts of vitamin A over a longer period of time are classified as having a “low” intake. Since vitamin A is stored efficiently in the liver, a surplus consumed on one day will provide a reserve that is available on subsequent days.

Another factor in the low values found in surveys is that people tend to under-report the amount they eat. Even under highly controlled conditions, the under- reporting of caloric intake can be nearly 20%.18 The best strategy for people worried about the ad- equacy of their diet is to monitor and evaluate what they eat in a typical week. As explained in Chapter 10, indi- viduals can do this on the MyPlate.gov Web site or can consult a physician or registered dietitian. If a problem Nutrition Insurance or Nutrition Roulette? Those who recommend that healthy people supplement their diet with extra vitamins and minerals often call it a form of dietary insurance. I disagree. When you purchase insurance, the benefits and costs of the policy are detailed and you choose a specific level of protec- tion. The terms of a dietary insurance policy, though, can never be known, much less specified. Taking supplements without a clear need is more analogous to playing the lottery. You hope to win some money, and ideally the jackpot, by buying lottery tickets. You won’t hurt yourself unless you buy more tickets over time than you can afford, but you are not likely to win anything either, especially the big prize. Paul R. Thomas, Ed.D., R.D.16 Personal Glimpse Part Three Nutrition and Fitness200 exists, it usually is better to correct the diet than to take supplements. Several manufacturers have pushed “meals in a can” with nutrition insurance claims like those made for vitamin pills. The major brands are Ensure, Susta- cal, Nutra-Start, Boost, and Resource. The first such product (Ensure) was developed many years ago for use in hospitals and nursing homes for people who were too ill or too weak to eat. However, they have been advertised aggressively to the general public and sold in grocery stores and pharmacies. These products cost between $1 and $2 per 8-ounce can and contain protein, carbohydrates, a modest amount of fat, and significant amounts of a few vitamins and minerals. However, most contain little or no fiber, and all lack carotenoids and other health-protecting plant-based chemicals.19 Canned supplements can benefit ill people who are having dif- ficulty consuming enough calories, but they are a waste of money for people whose appetite is not impaired. Table 11-3 analyzes common sales pitches for “nutri- tion insurance.” Perspectives on Food Processing To promote the use of supplements, the health-food in- dustry suggests that the processing of food removes its nutritional value. It is true that processing can change the nutrient content of food, but the changes are not drastic. Only a few nutrients are affected by processing, and most losses are insignificant to the overall diet. Food processing and home food preparation can destroy cer- tain vitamins with heat and remove some water-soluble vitamins and minerals through contact with water during cooking. Usually these are only partial losses. Moreover, the nutrients lost from certain foods between the farm and the table are readily obtainable from other foods. For example, although pasteurization of milk destroys some of its vitamin C content, milk is not a significant source of vitamin C anyway. The chief dietary sources of vitamin C are fruits and vegetables. Some nutrient losses in processing (for example, vitamin losses dur- ing the milling of flour) are restored by enrichment. The negative effects of some food-processing operations are more than balanced by the overall positive effects, especially the continuous availability of most types of food items at reasonable cost. As noted in Chapter 10, eating moderate amounts of a wide variety of foods, including some uncooked fruits and vegetables, provides an adequate supply of nutrients. “Stress Supplements” Many vitamin manufacturers advertise that extra vita- mins are needed to protect against “stress.” While some companies list only physical stresses that supposedly increase vitamin needs, some include mental stress, overwork, and the like. Some companies market products for the “special needs” of athletes, housewives, busy executives, and smokers. Others make no health claims at all, relying only on the product’s name to sell it. “Stress-formulas” typically contain several times the RDA for vitamin C and several B vitamins. The products manufactured by drug companies do not provide toxic amounts of these ingredients. But some marketed by health-food industry companies contain enough vitamin C to cause diarrhea, and some contain enough B6 to cause nerve damage over a long period. Some formulas contain questionable food substances such as spirulina, bee pollen, and ginseng to make them appear more “complete.” Herbal and homeopathic “stress formulas” are also available. Although vitamin needs may rise slightly in certain physical conditions, they seldom exceed the RDA, and they are easily met by eating a balanced diet. Anyone really in danger of deficiency as a result of illness would be very ill and probably require hospitalization. Some vitamin manufacturers suggest that strenuous physical activity increases the need for vitamins so that people who engage in vigorous exercise or athletics should take supplements. Strenuous exercise does in- crease the need for calories, water, and a few nutrients. However, the nutrient needs are unlikely to exceed the RDAs. Even if above-RDA amounts were necessary, they would be supplied by the increase in food intake normally associated with exercising. The belief that extra vitamins are useful to athletes is also tied to the idea that extra vitamins provide extra energy—which is un- true. Vitamin concoctions pitched to athletes (so-called ergogenic aids) are discussed further in Chapter 13. Smokers tend to have lower blood levels of vitamin C than do nonsmokers. In 2000 the RDA for vitamin C was set at 75 mg for men and 90 mg for women, with an additional 35 mg for smokers. However, no evidence ex- ists that smokers are deficient in vitamin C.20 Regardless of whether smokers need extra vitamin C, all of these amounts are readily obtainable from food. No scientific evidence shows that emotional stress increases one’s need for vitamins. In 1985 E.R. Squibb & Sons, Inc., agreed to pay $15,000 to New York State and to stop making false and misleading claims for its Theragran Stress Formula. In 1986 Lederle Laborato- ries agreed to pay $25,000 and to stop suggesting that Stresstabs could reduce the effects of psychologic stress or the ordinary stress of life. Both cases were prosecuted by New York’s attorney general. In a 1985 interview, Lederle’s chief of nutrition science acknowledged that Chapter Eleven Nutrition Fads, Fallacies, and Scams 201 aNalysis oF misleadiNg ads that promote “NutritioN iNsuraNce” Table 11-3 Claim Remember that the health of your eyes, teeth, bones, and internal systems depends upon a sufficient intake of these vital nutrients.a No matter how hard you try, in our fast food society, it’s often difficult to make sure you’re getting enough es- sential vitamins and minerals in the food you eat.b You might not always take the time to count nutrients. Isn’t it nice to know we’ve done that for you?c How much of your vitamin C gets lost on the way to the table? Picking, packing, processing. All these plus transportation can lead to the destruction of part of the vitamin C in your foods.d It would take a computer and a good deal of conscious effort to devise a diet that each day would give all the nutrients in optimum amounts. Even well-trained nutri- tionists find it difficult to get complete nutrition in their diet.e Getting a balanced diet can be tough, especially when you’re busy with other things. So to avoid taking chances, take a supplement.d Most packaged foods have many, if not all, of the natural nutrients removed during processing and replaced with chemicals.f Our soils are depleted of minerals and therefore cannot grow nutritious foods. “I take my vitamins every day. Just to be on the safe side.” (Said by man pictured climbing a steep mountain.)d Most of the water-soluble vitamins—B-complex and C—should be replaced daily. That’s why a good diet is so important. Stresstabs high potency stress formula vitamins can help you to back up your diet because they concentrate on vitamins your body can’t store.g Theragran-M is “fine-tuned for the way you live.” (Said during a television commercial depicting attractive young people doing various athletic activities.) Scientists are now studying the nutritional role of vita- mins, minerals and other nutrients in helping to protect against diseases such as cancer, heart disease, and osteoporosis.h Geritol Extend has all the vitamins the National Academy of Sciences recommends for people over 50.i Rich in Vitamin B Complex and Biotin, the “energy re- leasers” essential for converting food into energyj Comment Messages of this type, intended to make one nutrient-con- scious, are true but misleading. They never say how to tell if one is getting enough. Falsely suggests that balancing one’s diet is difficult. Counting nutrients is not necessary. Food-group systems require only the counting of portions. The real issues are how much remains in one’s diet and whether it is enough. Most Americans consume ad- equate amounts of vitamin C. Falsely implies that ordinary people are at risk unless they take supplements. Food-group systems such as the USDA Food Guidance System (see Chapter 10) provide for adequate amounts of nutrients and are easy to follow. Falsely suggests that busy people have difficulty in eating a balanced diet. Greatly exaggerates the amount of nutrients lost in pro- cessing; exploits public fear that our foods contain too many “chemicals.” Falsely suggests that adequate nutrition can be obtained only by ingesting food supplements or special foods. Misleading comparison of dangers of mountain climbing and of not taking daily vitamin pills. Water-soluble vitamins do not need to be replaced daily. Using vitamins to “back up” a good diet is a waste of money. If a supplement is desired, there is no reason to select a “high-potency” (above-RDA) product. Except for food intake, lifestyle characteristics have little to do with vitamin or mineral needs. The imag- ery falsely suggests that the product is likely to make people more vigorous. The fact that various nutrients are being studied does not mean that supplementation with these nutrients has been proven beneficial. The RDAs are higher than most people need. The Acad- emy does not recommend supplementation for everyone over 50. Subtly suggests that taking the product will cause users to have more energy, which is untrue. aVitamin, mineral and food supplement guide (flyer), Safeway, 1979. bAdvertising flyer, Sears, 1979. cAd for Ensure at www.myhealthpro.net, 2005. dMagazine ads, Hoffmann-La Roche, 1981-1983. eThompson RW. Why you should take vitamins and minerals (flyer). General Nutrition Corporation, 1983. fNeo-Life Corporation. Sharing the new life through better nutrition . . . every day of your life! Counselor, Feb 1979, pp 3–5. gMagazine ad, Lederle Laboratories, 1991-1992. hMagazine ad, Council for Responsible Nutrition, 1989. iMagazine ad, SmithKline Beecham, 1990. jMagazine ad, E.R. Squibb & Sons, 1988. Part Three Nutrition and Fitness202 “people who eat a balanced diet do not need stress vi- tamins—or for that matter any vitamin supplement at all.”21 In 1990 Miles Laboratories (makers of One-A-Day products) signed a three-year “assurance of discontinu- ance” order with the attorneys general of New York, California, and Texas and agreed to pay $10,000 to each of these three states. Without admitting wrongdoing, the company pledged not to claim that (a) the average consumer needs a supplement to prevent mineral and vitamin loss, (b) vitamins can prevent or reverse lung damage caused by pollution, (c) routine daily stress de- pletes vitamins, and (d) routine physical exercise (such as the aerobics shown in Miles’ television ad) depletes essential minerals. In 1994 Dr. Stephen Barrett22 petitioned the FDA to (a) remove vitamins and other ineffective ingredients from products marketed for the prevention or relief of “stress” and (b) to issue a public warning that although the FDA has permitted “stress formulas” to be sold, it does not recognize them as effective against emotional stress or ordinary stress. In 1996 the petition was denied. The agency’s denial letter to Dr. Barrett indicated that the FDA regarded the claims as statements of “nutritional support” and that the mandatory DSHEA disclaimer (see page 198) was “sufficient to inform consumers that FDA has not evaluated a claim made for a dietary supplement.” “Natural” vs Synthetic Vitamins Many promoters claim that “natural” vitamins are better than the synthetic vitamins. Such claims are unfounded. A few synthetic vitamins have slightly different struc- tures than their natural counterparts, but these differences are of no importance inside the body. As noted by Her- bert,23 vitamins are specific molecules; the body makes no distinction between vitamins made in the “factories” of nature and those made in the factories of chemical companies. The prices of “natural” vitamins tend to be higher than those of synthetic vitamins. Antioxidants and Other Phytochemicals Many “antioxidant” products are marketed with claims that, by blocking the action of free radicals, they can help prevent heart disease, cancer, and various other conditions associated with aging. Figure 11-1 shows an ad with this type of message. Free radicals are atoms or groups of atoms that have at least one unpaired electron, which makes them highly reactive. Free radicals promote beneficial oxidation that produces energy and kills bacterial invaders. In excess, however, they produce harmful oxidation that can dam- age cell membranes and cell contents. It is known that people who eat adequate amounts of fruits and vegetables high in antioxidants have a lower incidence of cardiovas- cular disease, certain cancers, and cataracts. Fruits and vegetables are rich in antioxidants, but it is not known which dietary factors are responsible for the beneficial effects. Each plant contains hundreds of phytochemicals (plant chemicals) whose presence is dictated by heredi- tary factors. Only well-designed long-term research can determine whether any of these chemicals, taken in a pill, would be useful for preventing any disease. The most publicized nutrients with antioxidant properties are vitamin C, vitamin E, and beta-carotene (which the body converts into vitamin A). Many large clinical trials have tested their effectiveness.24 In 2007, a Cochrane Collaboration team25 concluded that com- monly taken antioxidant supplements may do more harm Figure 11-1. Ad that appeared in many health-food industry publications during 1994. Small print at the bottom cited a report in Medical Tribune (a newspaper for doctors) as the source of the “8 out of 10” statistic. No survey on antioxidant usage had actually been done; the editor had merely asked for opinions on the use of vitamin E. About 80% who responded wrote favorable comments, many of which described their recommendations to patients. No attempt was made to determine whether the respondents were typical of Medical Tribune readers or physicians in general, or whether they personally took supplements. The percentage of people who do or don’t do something cannot be measured this way. Chapter Eleven Nutrition Fads, Fallacies, and Scams 203 than good. Their review encompassed 68 randomized controlled trials with 232,606 participants who took vari- ous combinations of beta-carotene, vitamin A, vitamin C, vitamin E, and/or selenium or a placebo or had no intervention. The reviewers concluded:

• There was no convincing evidence that antioxidant supple- ments have beneficial effects on overall death rate.
• In 47 trials with 180,938 participants, the antioxidant supplements significantly increased the death rate.
• Beta-carotene, vitamin A, and vitamin E given singly or combined with other antioxidant supplements significantly increase mortality.
• The potential roles of vitamin C and selenium on mortality need further study.
• Considering that 10% to 20% of the adult population in North America and Europe may consume the assessed supplements, the public health consequences may be sub- stantial.
• Because the study examined only the influence of synthetic antioxidants, its findings should not be applied to the po- tential effects of eating fruits and vegetables.

Charles Hennekens, M.D.,26 who participated in two of the large studies, has pointed out that even if antioxidants could provide the benefits suggested by epidemiologic studies, smoking cessation and other lifestyle factors would have a far greater effect on the rates of lung cancer and coronary heart disease. The Medical Letter27 has concluded that (a) there is no convincing evidence that taking supplements of vitamin C prevents any disease and (b) no one should take high-dose beta-carotene supplements. Research is also being done to determine whether taking supplements or eating foods rich in antioxidants can protect against age-related macular degeneration (AMD), a disease in which the central portion of the retina deteriorates so that only peripheral vision remains. So far, the results have been conflicting. Referring to the most promising study, The Medical Letter28 has cau- tioned that (a) the magnitude of the reported benefit was modest, (b) no data suggest any benefit for people who do not have AMD or who have only mild disease, and (c) the increased death rate from lung cancer in smok- ers who took beta-carotene in other studies is evidence enough that high doses of vitamins and minerals are not necessarily harmless. The negative publicity has not deterred manufactur- ers from continuing to market antioxidants as though they have been proven beneficial. Some have responded by hyping new mixtures of beta-carotene and other ca- rotenoids, which, they suggest, may provide the same benefits as fruits and vegetables. Many types of pills described as “concentrates” of fruits and/or vegetables are being marketed. However, it is not possible to condense large amounts of produce into a pill without losing fiber, nutrients, and many other phytochemicals.29 Although some products contain sig- nificant amounts of nutrients, these nutrients are readily obtainable at lower cost from foods. In 2002, Pharmanex began promoting its BioPho- tonic Scanner for measuring “the antioxidant level in the body” when a person’s hand is placed in front of the device. The test is said to measure the carotenoid level, but virtually everyone who takes the test is advised to buy expensive supplements. Barrett24 warns that neither the scan nor the products have been proven to lead to improved health outcomes. Amino-Acid Products Many supplement products containing amino acids are marketed as weight-loss and/or ergogenic aids de- spite lack of evidence that they are effective for either purpose (see Chapters 12 and 13). The Federation of American Societies for Experimental Biology (FASEB) has sharply criticized this situation. After extensive review of the scientific literature, FASEB experts concluded: (a) single- or multiple-ingredient capsules, tablets, and liquid products are used primarily for phar- macologic purposes or enhancement of physiologic functions rather than for nutritional purposes; (b) little scientific literature exists on most amino acids ingested for these purposes; (c) no scientific rationale has been presented to justify ingestion of amino-acid supplements by healthy individuals; (d) safety levels for amino-acid supplement use have not been established; and (e) a systematic approach to safety testing is needed.30 megaVitamiN claims Vs Facts Claims are widespread that high dosages of vitamins and minerals can prevent or cure a great diversity of ailments. Dr. Linus Pauling, a Nobel Prize winner in chemistry and former professor of chemistry at Stanford University, was the chief theoretician for this approach, which he termed “orthomolecular” treatment (ortho is Greek for “right”). This approach supposedly provides the correct amounts of nutritionally “right” molecules normally found in the body. It began during the early 1950s as megavitamin therapy for schizophrenia and is also called “nutritional medicine.” This section examines some megavitamin claims, the evidence against them, and the dangers involved. Megavitamin treatment for emotional problems is discussed in Chapter 6. Part Three Nutrition and Fitness204 Pauling and Vitamin C Controversy over the use of massive dosages of vitamin C stems largely from Pauling’s publications. His 1970 book, Vitamin C and the Common Cold, claimed that taking 1000 mg of vitamin C daily would reduce the incidence of colds by 45% for most people, but that some needed much larger amounts. The book’s 1976 revision, Vitamin C, the Common Cold and the Flu, suggested even higher dosages. A third book, published in 1979, claimed that high dosages of vitamin C may be effective against cancer.31 A flyer distributed in 1991 by the Linus Pauling Institute recommended daily doses of 6000 to 18,000 mg of vitamin C, 400 to 1600 IU of vitamin E, and 25,000 IU of vitamin A, plus various other vitamins and minerals. Pauling himself reportedly took 12,000 mg of vitamin C daily and raised the amount to 40,000 mg if symptoms of a cold appeared. However, most medical and nutritional scientists strongly disagree with Pauling’s views concerning vitamin C. Experiments on the possible value of vitamin C for preventing infections have been conducted by medical investigators ever since the vitamin became commercial- ly available during the 1930s. At least 15 well-designed double-blind studies have shown that supplementation with vitamin C does not prevent colds, and that, at best, it may slightly reduce the symptoms of a cold.32 Slight symptom reduction may occur because of an antihistamine-like effect, but whether this has practical value is debatable. Pauling’s views were based on the same studies that other scientists have analyzed, but his conclusions differed. The largest clinical trials, involving thousands of volunteers, were directed by Dr. Terence Anderson, professor of epidemiology at the University of Toronto. Taken together, his studies suggest that extra vitamin C intake may slightly reduce the severity of colds, but it is not necessary to take the high doses recommended by Pauling to achieve this result. Nor is there anything to be gained by taking vitamin C supplements year-round in the hope of preventing colds.33 Another important study was reported in 1975 by scientists at the National Institutes of Health who had compared the effects of vitamin C pills with a placebo before and during colds. Although the experiment was designed to be double-blind, half the subjects guessed which pill they were getting. When the results were tabu- lated, the average number of colds reported per person was 1.27 for the vitamin group and 1.36 for the placebo group over a 9-month period. But among the half who had not guessed which pill they had been taking, no difference in the incidence or severity was found. This illustrates how people who think they are doing some- thing effective (such as taking a vitamin) can report a favorable result even when none exists.32 In 1976 Pauling and Ewan Cameron, a Scottish phy- sician, reported that most of 100 patients with terminal cancer treated with 10,000 mg of vitamin C daily had survived three to four times longer than similar patients who did not receive vitamin C supplements. However, Dr. William DeWys, chief of clinical investigations at the National Cancer Institute, found that the study was poorly designed because the patient groups were not comparable. The vitamin C patients were Cameron’s, whereas the other patients were under the care of other physicians. Cameron’s patients started taking vitamin C when he labeled them untreatable by other methods, and their subsequent survival was compared with the survival of the “control” patients after they had been labeled un- treatable by their doctors. DeWys34 reasoned that if the two groups were comparable, the lengths of time from entry into the hospital to being labeled untreatable should be similar in both groups. However, Cameron’s patients were labeled untreatable much earlier in the course of their disease—which means that they entered the hospital before they were as sick as the other doctors’ patients and would naturally be expected to live longer. In 1979 the Mayo Clinic reported a double-blind study of 123 patients with advanced cancer. Half of the patients received 10,000 mg of vitamin C daily, while the others were given a placebo. No differences were found between the two groups in survival time, appe- tite, weight loss, severity of pain, or amount of nausea and vomiting.35 Other well-designed studies reported in 1983 and 1985 yielded similar results.36,37 Pauling died of prostate cancer in 1995. Therapeutic Claims for Megavitamin E Claims have been made that large dosages of vitamin E are effective treatment for acne, atherosclerosis, cancer, diabetes, sexual frigidity, infertility, repeated spontane- ous abortions, muscular dystrophy, peptic ulcers, rheu- matic fever, and fibrocystic disease of the breast. Some proponents have claimed that vitamin E will increase stamina, prolong life, and protect against the effects of atmospheric pollution. Vitamin E is added to aftershave lotions, soaps, and underarm deodorants. However, it has no proven therapeutic, nutritional, or cosmetic value for any of the these.32 Vitamin E deficiency symptoms in humans that are traceable only to an inadequate diet have never been re- ported, except in premature infants. In adults, deficiency has been observed only in patients with an inability to Chapter Eleven Nutrition Fads, Fallacies, and Scams 205 absorb fat during the digestive process (vitamin E is fat-soluble). More than 40 years ago several researchers placed human volunteers on a low-vitamin E diet for 41/2 years to see whether this would produce signs of deficiency. The volunteers had minor changes in their red blood cells but experienced no symptoms.32 Thus it is clearly irrational for healthy persons to take vitamin E supplements as protection against deficiency. Vitamin E may ultimately be shown to have a limited role in preventing and treating coronary heart disease, but the evidence so far indicates that vitamin E supplements are not helpful and may be harmful. Dangers of Excess Vitamins and Minerals Vitamins in excess of the body’s needs seldom serve a useful function and can be harmful. Excess amounts of fat-soluble vitamins are stored in body fat, where they can build up to toxic levels over time. Excess water- soluble vitamins are excreted through the urine, but these can still have adverse effects. Vitamin A toxicity can result from ingesting too much vitamin A on a regular basis for months or years. The problems that develop as body stores build up in- clude headache, hair loss, bone malformation, bleeding tendencies, bone fracture, muscle and joint pain, vi- sion problems, retarded growth in children, drying and cracking of the skin, and enlargement of the liver and spleen. Most adverse effects disappear after excessive intake is stopped, but permanent damage can occur to the liver, bones, and eyes. Liver damage in adults has been reported at daily doses of 25,000 IU or more.38 Vitamin A supplements taken early in pregnancy are hazardous to the developing fetus. A study published in 1995 concluded that among the babies born to women who took more than 10,000 IU per day in the form of supplements, about 1 in 57 had a birth defect attributable to the supplements.39 Prolonged excessive intake of vitamin D (usually five times the RDA or more) can cause loss of appetite, nausea, weakness, weight loss, excess urinary output, constipation, vague aches, stiffness, kidney stones, tissue calcification, high blood pressure, acidosis, and kidney failure (which can lead to death). The Personal Glimpse box describes how a supplement promoter and a customer ingested too much vitamin D from an ap- parently defective product. Niacin doses in the range of 40 to 300 times the RDA can cause severe flushing, itching, liver damage, skin disorders, gout, ulcers, and blood-sugar disorders. (Despite this, large doses administered under medical supervision can be valuable for controlling abnormal blood cholesterol levels, as described in Chapter 15.) Excessive vitamin E (usually 400 IU or more) can cause headaches, nausea, tiredness, giddiness, inflam- mation of the mouth, chapped lips, gastrointestinal disturbances, muscle weakness, low blood-sugar levels, and increased bleeding tendency. Vitamin C, in amounts upwards of 20 times the RDA, can damage growing bone, produce diarrhea, cause adverse effects in pregnancy, and cause false urine tests for glucose in diabetics. Large doses can also produce false-negative tests for blood in the stool and thereby prevent early detection of serious gastrointestinal diseases, including cancer. Very large doses of B6 (2000 mg or more; 1000 times the RDA) have caused symptoms resembling those of multiple sclerosis, including numbness and tingling of the hands, difficulty in walking, and the feeling of electric shocks shooting down the spine. Although most of the afflicted individuals recovered after they stopped taking B6 supplements, some did not. In the 1980s it was discovered that more than 100 women attending a Personal Glimpse Vitamin D Poisoning Gary Null, Ph.D., whose books bill him as “one of America’s leading health and fitness advocates,” promotes dubious treatments for many serious diseases. He hosts radio and television talk shows, writes books, gives lectures, and markets supplement products. He opposes fluoridation, immunization, food irradiation, amalgam fillings, and many forms of proven medical treatment. Null obtained a Ph.D. degree from an accred- ited school. However, Barrett40 has pointed out that (a) his Ph.D. committee members lacked expertise in the subject matter of his thesis; (b) portions of the thesis appear to have been derived from previous writings that had multiple authors; and (c) the conclusions in the thesis were based on the results of urine tests that have no scientific validity. In 2010, a man who developed nausea, vomiting, mood swings, headaches, severe cramping, pain, and fatigue after using

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