Medicine For People!
The Pills We Take
- Multiple Vitamins – What Should You Take?
- What Studies Show
- Why Results Conflict
- For More Information
Multiple Vitamins – What Should You Take?
People often ask me what nutritional supplements they should take. The short answer is . . . that depends. For those of you who want the long answer, I’ve put together this series of newsletters about nutritional supplements. In last month’s newsletter I talked about micronutrient needs and deficiencies. Some research shows that nine out of 10 people fail to obtain necessary micronutrients. But how these deficiencies affect people varies radically. In some people – like little Joey, the baby who goes into seizure without massive doses of vitamin B6 – the deficiency smacks you in the face. Other people carry on just fine, though many have reduced vitality, premature aging, or illness.
In this month’s newsletter I’ll discuss vitamin supplements. Even though we know many people are deficient, we must answer the question, “do supplements make up for the deficiency?” The answer is anything but clear. Long have dietary surveys shown that those who consume foods richer in vitamins C and E have less heart disease, but repeated studies have failed to show any benefit from supplemental vitamins C and E.
I’ll discuss the studies supporting and negating the value of supplements, who should take supplements and who should not. The final segment of our series will give you some information about choosing a supplement and discuss vital nutrients you need that can’t be found in a pill.
What Studies Show
Studies of vitamin supplementation give results that are all over the map, some finding that they help  , others not  . On the positive side, we know that among people with certain illnesses, those who take vitamin supplement do much better than those who do not. Children taking multiple vitamin supplements test smarter. Seniors who take multivitamins seem to get fewer colds.
Sometimes, however, supplements can do more harm than good. Take the case of beta-carotene. It came out some years ago that people with lung cancer who took the supplement got sicker and died more frequently than those who did not. Vitamin A at doses of 10,000 units a day and above can cause birth defects and fragile bones. Vitamin B12 without folic acid (and vice versa) can result in dementia and neuropathic problems. Excessive iron can cause arthritis, heart failure, liver failure, and more.
Why Results Conflict
These results are frustrating but understandable. There are a number of reasons that results are so inconsistent.
- There is no standard "daily multiple vitamin."
- Some vitamin manufacturers use a cheaper but less effective form of a micronutrient. For instance, vitamin E and beta-carotene supplements often contain just one form of the more complex vitamin suite found in nature.
- There is no standard human being. Individual needs vary. That's why I think it better to tailor recommendations to the individual. Little Joey, you, your neighbor-all have individual requirements.
The recommendations below represent general directions for large groups of people, first the hale and hearty in the prime of their life and then special groups.
Prime of Life: If you are hale and hearty, look at what you are eating and the state of your health. If either could be better, build more activity into your life and improve your nutrition. It is unlikely that a daily vitamin will benefit you. If you’re strongly motivated to take one, I’d take a modest B-complex vitamin and let it go at that.
Women in the child-bearing years: Folic acid deficiency leads to birth defects, for which reason food manufacturers are required to add it to certain staples. Traditionally we give folic acid to pregnant women. Folic acid, however, is of most value at conception, when most women do not yet know they are pregnant. Any woman in the child-bearing years, even if she is on birth control (no method works every time), should take a pre-natal vitamin. While you won’t find omega-3 fatty acids in a multivitamin, mothers who consume more produce more intelligent children, on average. Menstruating and pregnant women easily become deficient in iron and should take a supplement.
Chronic Illness: Most people with a chronic illness are on medication, and many medications cause nutrient depletion. For example, a common medication for diabetes, metformin, depletes vitamin B12. So if your toes are turning numb, remember it may not be the diabetes, it may be the vitamin B12 deficiency. Cancer is, thankfully, becoming a chronic rather than acute illness for many, and those with a better micronutrient supply survive better. For example, most observations of people with various cancers find that vitamin supplement users survive much those who obtain only the RDA.
One common and under-recognized illness, gluten intolerance (AKA celiac disease), causes malabsorption of many micronutrients with resulting difficult-to-diagnose symptoms. Many digestive illnesses impair absorption of micronutrients.
If you have a chronic illness, talk to your doctor about what nutrient deficiencies may be contributing, what nutrient deficiencies your medication may be causing, and what you should do.
Weight-loss diet: If you are restricting calories, or have had weight-loss surgery, you are also restricting micronutrients and you need a supplement.
Children: Traditionally, we give vitamins to our children. A review of several studies indicated that children taking multiple vitamins scored higher on certain intelligence tests, but most of the actual proof that they help comes from developing countries and the inner cities here, where good food may be scarce. Certainly, however, a child is building a body we hope will work well for many decades, so providing the nutritional building blocks, especially during the early years, seems reasonable.
The Elderly: Appetite diminishes with age. Older people assimilate nutrients less completely than younger people. Many studies show benefits. For example, about a hundred independently living oldsters took either a placebo or a low-dose multiple vitamin, and the former were ill from respiratory infections 7 weeks in the year compared with 3 weeks for the vitamin users. Older folks go outside less and many of them are vitamin D deficient. Age can bring cerebral degeneration; vitamin D supplements seem to improve cognition in older women. In my office, if we can’t convince a senior citizen to get a vitamin D level test, we try to convince them to take it as a supplement, because I’ve never seen a vitamin supplement that contained amounts of vitamin D adequate for people in this cloudy northwest climate.
As we age, we absorb vitamin B12 less well. Most multiple vitamins contain an adequate amount for seniors, about two and a half- micrograms per day.
Dollar deficiency: Fruits and vegetables cost more than pasta and pizza. If you are (I hope only temporarily) light in the wallet and unable to afford more than an occasional stroll through the produce section, you are much more likely to benefit from a daily vitamin than the yuppies around you.
Coming Next Month
Next month I will get into some of the details - what to look for on the label; what are the more effective forms of a micronutrient; and how to get what you need. Stay tuned.
For more information
See our previous articles on individual supplements.
- Micronutrients: Individual needs and the RDI http://rienstraclinic.com/newsletter/2011/April
- Supplement quality http://rienstraclinic.com/newsletter/2007/April
- Beta-carotene http://rienstraclinic.com/health-info/maintenance-prevention/nutrition/beta-carotene
- Vitamin A http://rienstraclinic.com/health-info/maintenance-prevention/nutrition/vitamin-a
- Vitamin B12 and folic acid: http://rienstraclinic.com/newsletter/2006/September#06
- Folic acid: http://rienstraclinic.com/newsletter/2004/December
- Vitamin E
- Vitamin D
- Calcium: http://rienstraclinic.com/newsletter/2005/March#calcium
- Lithium http://rienstraclinic.com/newsletter/2007/April
- Co-enzyme Q10 http://rienstraclinic.com/newsletter/2006/April1
 A Systematic Review of the Evidence Supporting a Causal Link Between Dietary Factors and Coronary Heart Disease
Arch Intern Med. 2009;169(7):659-669.
Background Although a wealth of literature links dietary factors and coronary heart disease (CHD), the strength of the evidence supporting valid associations has not been evaluated systematically in a single investigation.
Methods We conducted a systematic search of MEDLINE for prospective cohort studies or randomized trials investigating dietary exposures in relation to CHD. We used the Bradford Hill guidelines to derive a causation score based on 4 criteria (strength, consistency, temporality, and coherence) for each dietary exposure in cohort studies and examined for consistency with the findings of randomized trials.
Results Strong evidence supports valid associations (4 criteria satisfied) of protective factors, including intake of vegetables, nuts, and "Mediterranean" and high-quality dietary patterns with CHD, and associations of harmful factors, including intake of trans–fatty acids and foods with a high glycemic index or load. Among studies of higher methodologic quality, there was also strong evidence for monounsaturated fatty acids and "prudent" and "western" dietary patterns. Moderate evidence (3 criteria) of associations exists for intake of fish, marine -3 fatty acids, folate, whole grains, dietary vitamins E and C, beta carotene, alcohol, fruit, and fiber. Insufficient evidence (2 criteria) of association is present for intake of supplementary vitamin E and ascorbic acid (vitamin C); saturated and polyunsaturated fatty acids; total fat; -linolenic acid; meat; eggs; and milk. Among the dietary exposures with strong evidence of causation from cohort studies, only a Mediterranean dietary pattern is related to CHD in randomized trials.
Conclusions The evidence supports a valid association of a limited number of dietary factors and dietary patterns with CHD. Future evaluation of dietary patterns, including their nutrient and food components, in cohort studies and randomized trials is recommended.
 Nutrition Journal 2007, 6:30 doi:10.1186/1475-2891-6-30
Usage patterns, health, and nutritional status of long-term multiple dietary supplement users: a cross-sectional study
Abstract: Background: Dietary supplement use in the United States is prevalent and represents an important source of nutrition. However, little is known about individuals who routinely consume multiple dietary supplements. This study describes the dietary supplement usage patterns, health, and nutritional status of long-term multiple dietary supplement users, and where possible makes comparisons to non-users and multivitamin/mineral supplement users. Methods: Using a cross-sectional study design, information was obtained by online questionnaires and physical examination (fasting blood, blood pressure, body weight) from a convenience sample of long-term users of multiple dietary supplements manufactured by Shaklee Corporation (Multiple Supp users, n = 278). Data for non-users (No Supp users, n = 602) and multivitamin/mineral supplement users (Single Supp users, n = 176) were obtained from the National Health and Nutrition Examination Survey (NHANES) 2001–2002 and NHANES III 1988–1994. Logistic regression methods were used to estimate odds ratios with 95% confidence intervals. Results: Dietary supplements consumed on a daily basis by more than 50% of Multiple Supp users included a multivitamin/mineral, B-complex, vitamin C, carotenoids, vitamin E, calcium with vitamin D, omega-3 fatty acids, flavonoids, lecithin, alfalfa, coenzyme Q10 with resveratrol, glucosamine, and a herbal immune supplement. The majority of women also consumed gamma linolenic acid and a probiotic supplement, whereas men also consumed zinc, garlic, saw palmetto, and a soy protein supplement. Serum nutrient concentrations generally increased with increasing dietary supplement use. After adjustment for age, gender, income, education and body mass index, greater degree of supplement use was associated with more favorable concentrations of serum homocysteine, C-reactive protein, high-density lipoprotein cholesterol, and triglycerides, as well as lower risk of prevalent elevated blood pressure and diabetes. Conclusion: This group of long-term multiple dietary supplement users consumed a broad array of vitamin/mineral, herbal, and condition-specific dietary supplements on a daily basis. They were more likely to have optimal concentrations of chronic disease-related biomarkers, and less likely to have suboptimal blood nutrient concentrations, elevated blood pressure, and diabetes compared to non-users and multivitamin/mineral users. These findings should be confirmed by studying the dietary supplement usage patterns, health, and nutritional status of other groups of heavy users of dietary supplements.
 Carroll D,Ring C,Suter M,Willemsen G. "The effects of an oral multivitamin combination with calcium, magnesium, and zinc on psychological well-being in healthy young male volunteers: a double-blind placebo-controlled trial." Psychopharmacology (Berl). 2000 Jun;150:220-5. (Issue number 2) Language- eng Research reported by School of Sport and Exercise Sciences, University of Birmingham, UK. email@example.com. =16615= = Conclusion: These findings demonstrate that Berocca significantly reduces anxiety and perceived stress. = Author's abstract: RATIONALE: Vitamin and mineral supplements may be associated with improved psychological status. OBJECTIVE: The present study tested the effects of a multivitamin and mineral supplement (Berocca) on psychological well-being. METHODS: In a double-blind randomised-control trial, 80 healthy male volunteers were assigned to either Berocca or placebo. Questionnaires measuring psychological state were completed and a blood sample taken to determine plasma zinc concentration on day 1 (pre-treatment) and again on day 28 (post-treatment), following 28 days of treatments, which were administered at a dosage of one tablet daily. At the end of the study, the acceptability of the treatment and participants' awareness of treatment condition were assessed, as was habitual dietary behaviour. RESULTS: Relative to placebo, treatment with Berocca was associated with consistent and statistically significant reductions in anxiety and perceived stress. Participants in the Berocca group also tended to rate themselves as less tired and better able to concentrate following treatment. In addition, participants registered more somatic symptoms following placebo than following Berocca. These effects cannot be attributed to differences in the acceptability of the two treatments or to participants guessing what treatment they received.
 Multivitamin use and the risk of myocardial infarction: a population-based cohort of Swedish women Am J Clin Nutr 2010;92:1251–6.
Susanne Rautiainen, Agneta A°kesson, Emily B Levitan, Ralf Morgenstern, Murray A Mittleman, and Alicja Wolk
ABSTRACT Background: Dietary supplements are widely used in industrialized countries. Objective: The objective was to examine the association between multivitamin use and myocardial infarction (MI) in a prospective, population-based cohort of women. Design: The study included 31,671 women with no history of cardiovascular disease (CVD) and 2262 women with a history of CVD aged 49–83 y from Sweden. Women completed a self-administered questionnaire in 1997 regarding dietary supplement use, diet, and lifestyle factors. Multivitamins were estimated to contain nutrients close to recommended daily allowances: vitamin A (0.9 mg), vitamin C (60 mg), vitamin D (5 lg), vitamin E (9 mg), thiamine (1.2 mg), riboflavin (1.4 mg), vitamin B-6 (1.8 mg), vitamin B-12 (3 lg), and folic acid (400 lg). Results: During an average of 10.2 y of follow-up, 932 MI cases were identified in the CVD-free group and 269 cases in the CVD group. In the CVD-free group, use of multivitamins only, compared with no use of supplements, was associated with a multivariableadjusted hazard ratio (HR) of 0.73 (95% CI: 0.57, 0.93). The HR for multivitamin use together with other supplements was 0.70 (95% CI: 0.57, 0.87). The HR for use of supplements other than multivitamins was 0.93 (95% CI: 0.81, 1.08). The use of multivitamins for 5 y was associated with an HR of 0.59 (95% CI: 0.44, 0.80). In the CVD group, use of multivitamins alone or together with other supplements was not associated with MI. Conclusions: The use of multivitamins was inversely associated with MI, especially long-term use among women with no CVD. Further prospective studies with detailed information on the content of preparations and the duration of use are needed to confirm or refute our findings.
 Arch Intern Med. 2009;169(3):294-304.
Multivitamin Use and Risk of Cancer and Cardiovascular Disease in the Women's Health Initiative Cohorts
Marian L. Neuhouser, PhD; Sylvia Wassertheil-Smoller, PhD; Cynthia Thomson, PhD, RD; Aaron Aragaki, MS; Garnet L. Anderson, PhD; JoAnn E. Manson, MD, DrPH;Ruth E. Patterson, PhD; Thomas E. Rohan, MD, PhD; Linda van Horn, MD, PhD; James M. Shikany, DrPH; Asha Thomas, PhD; Andrea LaCroix, PhD; Ross L. Prentice, PhD
Background Millions of postmenopausal women use multivitamins, often believing that supplements prevent chronic diseases such as cancer and cardiovascular disease (CVD). Therefore, we decided to examine associations between multivitamin use and risk of cancer, CVD, and mortality in postmenopausal women.
Methods The study included 161 808 participants from the Women's Health Initiative clinical trials (N = 68 132 in 3 overlapping trials of hormone therapy, dietary modification,and calcium and vitamin D supplements) or an observational study (N = 93 676). Detailed data were collected on multivitamin use at baseline and follow-up time points. Studyenrollment occurred between 1993 and 1998; the women were followed up for a median of 8.0 years in the clinical trials and 7.9 years in the observational study. Disease end points were collected through 2005.
We documented cancers of the breast (invasive), colon/rectum, endometrium, kidney, bladder, stomach, ovary, and lung; CVD (myocardial infarction, stroke, and venous thromboembolism); and total mortality.
Results A total of 41.5% of the participants used multivitamins. After a median of 8.0 years of follow-up in the clinical trial cohort and 7.9 years in the observational study cohort, 9619 cases of breast, colorectal, endometrial, renal, bladder, stomach, lung, or ovarian cancer; 8751 CVD events; and 9865 deaths were reported. Multivariate-adjusted analyses revealed no association of multivitamin use with risk of cancer (hazard ratio [HR], 0.98, and 95% confidence interval [CI], 0.91-1.05 for breast cancer; HR, 0.99, and 95% CI, 0.88-1.11 for colorectal cancer; HR, 1.05, and 95% CI, 0.90-1.21 for endometrial cancer; HR, 1.0, and 95% CI, 0.88-1.13 for lung cancer; and HR, 1.07, and 95% CI, 0.88-1.29 for ovarian cancer); CVD (HR, 0.96, and 95% CI, 0.89-1.03 for myocardial infarction; HR, 0.99, and 95% CI, 0.91-1.07 for stroke; and HR, 1.05, and 95% CI, 0.85-1.29 for venous thromboembolism); or mortality (HR, 1.02, and 95% CI, 0.97-1.07).
Conclusion After a median follow-up of 8.0 and 7.9 years in the clinical trial and observational study cohorts, respectively, the Women's Health Initiative study provided convincing evidence that multivitamin use has little or no influence on the risk of common cancers, CVD, or total mortality in postmenopausal women.
 Am J Clin Nutr 2007;85(suppl):308S–13S.
 Total mortality risk in relation to use of less-common dietary supplements.
Pocobelli G, Kristal AR, Patterson RE, Potter JD, Lampe JW, Kolar A, Evans I, White E.
Am J Clin Nutr. 2010 Jun;91(6):1791-800. Epub 2010 Apr 21.
Department of Epidemiology, University of Washington, Seattle, USA. firstname.lastname@example.org <email@example.com>
BACKGROUND: Dietary supplement use is common in older US adults; however, data on health risks and benefits are lacking for a number of supplements.
OBJECTIVE: We evaluated whether 10-y average intakes of 13 vitamin and mineral supplements and glucosamine, chondroitin, saw palmetto, Ginko biloba, garlic, fish-oil, and fiber supplements were associated with total mortality.
DESIGN: We conducted a prospective cohort study of Washington State residents aged 50-76 y during 2000-2002. Participants (n = 77,719) were followed for mortality for an average of 5 y.
RESULTS: A total of 3577 deaths occurred during 387,801 person-years of follow-up. None of the vitamin or mineral 10-y average intakes were associated with total mortality. Among the nonvitamin-nonmineral supplements, only glucosamine and chondroitin were associated with total mortality. The hazard ratio (HR) when persons with a high intake of supplements (> or =4 d/wk for > or =3 y) were compared with nonusers was 0.83 (95% CI: 0.72, 0.97; P for trend = 0.009) for glucosamine and 0.83 (95% CI: 0.69, 1.00; P for trend = 0.011) for chondroitin. There was also a suggestion of a decreased risk of total mortality associated with a high intake of fish-oil supplements (HR: 0.83; 95% CI: 0.70, 1.00), but the test for trend was not statistically significant.
CONCLUSIONS: For most of the supplements we examined, there was no association with total mortality. Use of glucosamine and use of chondroitin were each associated with decreased total mortality.
 These are just several of numerous studies reports. Not all studies have been positive.
Lamm DL,Riggs DR,Shriver JS,vanGilder PF,Rach JF,DeHaven JI. "Megadose vitamins in bladder cancer: a double-blind clinical trial." Journal of Urology. 1994 Jan;151:21-6. (Issue number 1) Language- eng according to TLFD #150 page pg 28. Research reported by Department of Urology, West Virginia University School of Medicine, Morgantown.. =3540= Mean survival time with Transitional Cell Carcinoma of the bladder was 19 months in the BCG Vaccine group, 33 months in the BCG Vaccine plus vitamins supplemented group. (Gaby abstract). = Author's abstract: Epidemiological and laboratory studies suggest that vitamin supplements may be helpful in the prevention of some cancers but clinical trials to date have failed to demonstrate protection with naturally occurring vitamins. Without substantiation of the highly touted benefits of vitamins, few physicians who care for cancer patients have recommended their use. A total of 65 patients with biopsy confirmed transitional cell carcinoma of the bladder enrolled in a randomized comparison of intravesical bacillus Calmette-Guerin (BCG) with or without percutaneous administration was also randomized by closed envelope to therapy with multiple vitamins in the recommended daily allowance (RDA) versus RDA multivitamins plus 40,000 units vitamin A, 100 mg. vitamin B6, 2,000 mg. vitamin C, 400 units vitamin E and 90 mg. zinc. The addition of percutaneous BCG did not significantly lessen tumor recurrence but recurrence after 10 months was markedly reduced in patients receiving megadose vitamins. The 5-year estimates of tumor recurrence are 91% in the RDA arm and 41% in the megadose arm (p = 0.0014, Mantel-Cox). Overall recurrence was 24 of 30 patients (80%) in the RDA arm and 14 of 35 (40%) in the high dose arm (p = 0.0011, 2-tailed Fisher's exact test). Megadose vitamins A, B6, C and E plus zinc decrease bladder tumor recurrence in patients receiving BCG immunotherapy. Further research will be required to identify which ingredient(s) provide this protection.
Do nutraceutics play a role in the prevention and treatment of colorectal cancer?
Markle B, May EJ, Majumdar AP.
Cancer Metastasis Rev. 2010 Sep;29(3):395-404.
Department of Internal Medicine, Wayne State University, Detroit, MI 48201, USA. firstname.lastname@example.org
Colorectal cancer is the third most common cancer worldwide with a 5-year survival of 50%. Current chemotherapeutic regimens used for advanced colorectal cancer provide an average survival of approximately 20 months. Non-toxic agents such as nutraceutics and supplements have been shown to aid in the prevention and adjuvant treatment of colorectal cancer. This article will discuss the epidemiology, progression, prevention, treatment, and recurrence of colorectal cancer and the role of nutraceutics and supplements in the treatment process.
Nutraceutical use in late-stage cancer.
Wargovich MJ, Morris J, Brown V, Ellis J, Logothetis B, Weber R.
Cancer Metastasis Rev. 2010 Sep;29(3):503-10.
Department of Cell & Molecular Pharmacology and Experimental Therapeutics, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC 29245, USA. email@example.com
Access to a wealth of information on the internet has led many cancer patients to use complementary methods as an adjunct to traditional therapy for cancer, with, and more often, without informing their primary caregiver. Of the common complementary modalities, the use of dietary supplements appears to be highly prevalent in patients in active treatment for cancer, and later in cancer survivors. Emerging research suggests that some plant-based agents may, indeed, impact late-stage cancer, influencing molecular processes corrupted by tumor cells to evade detection, expand clonally, and invade surrounding tissues. The intent of this article is to review some of the current science underpinning the use of nutraceuticals in the latter stages of cancer.
 Multiple micronutrient supplementation for improving cognitive performance in children: systematic review of randomized controlled trials Am J Clin Nutr 2010;91:115–30.
ABSTRACT Background: Although multiple micronutrient interventions have been shown to benefit children’s intellectual development, a thorough evaluation of the totality of evidence is currently lacking to direct public health policy. Objective: This study aimed to systematically review the present literature and to quantify the effect of multiple micronutrients on cognitive performance in schoolchildren. Methods: The Institute for Scientific Information Web of Knowledge and local medical databases were searched for trials published from 1970 to 2008. Randomized controlled trials that investigated the effect of 3 micronutrients compared with placebo on cognition in healthy children aged 0–18 y were included following protocol. Data were extracted by 2 independent researchers. The cognitive tests used in the trials were grouped into several cognitive domains (eg, fluid and crystallized intelligence), and pooled effect size estimates were calculated per domain. Heterogeneity was explored through sensitivity and meta-regression techniques. Results: Three trials were retrieved in children aged ,5 y, and 17 trials were retrieved in children aged 5–16 y. For the older children, pooled random-effect estimates for intervention were 0.14 SD (95% CI: 20.02, 0.29; P = 0.083) for fluid intelligence and 20.03 SD (95% CI: 20.21, 0.15; P = 0.74) for crystallized intelligence, both of which were based on 12 trials. Four trials yielded an overall effect of 0.30 SD (95% CI: 0.01, 0.58; P = 0.044) for academic performance. For other cognitive domains, no significant effects were found. Conclusions: Multiple micronutrient supplementation may be associated with a marginal increase in fluid intelligence and academic performance in healthy schoolchildren but not with crystallized intelligence. More research is required, however, before public health recommendations can be given.
 Citera G,Arias MA,Maldonado-Cocco JA,Rosemffet MG,Brusco LI,Scheines EJ,Cardinalli DP. "Effect of vitamin and trace mineral supplementation on immune responses and infection in elderly subjects" Lancet. 1992 Nov 7;340:1124. Copy in office. 93030601 =4896= In this randomized controlled trial, 96 independently living elderly subjects were given physiologic amounts of multiple vitamins and trace elements or placebo. The treated group were ill from infection 23 days per year compared to 48 days in the control group. Cells and substances associated with immunocompetence were also increased in the study group. The supplement contained vit A 400 retinol equivalents, beta-carotene 16 milligrams, thiamine 2.2 milligrams, riboflavin 1.5 milligrams, niacin 16 milligrams, pyridoxine 3 milligrams, folate 400 micrograms, vitamin B12 4 micrograms, vitamin C 80 milligrams, vitamin D 4 micrograms, vitamin E 44 milligrams, iron 16 milligrams, zinc 14 milligrams, copper 1.4 milligrams, selenium 20 micrograms, iodine 0.2 milligrams, calcium 200 milligrams, and magnesium 100 milligrams. The placebo contained calcium and magnesium.
 Dietary intake of vitamin D and cognition in older women: a large population-based study.
Annweiler C, Schott AM, Rolland Y, Blain H, Herrmann FR, Beauchet O.
Neurology. 2010 Nov 16;75(20):1810-6.
Department of Internal Medicine and Geriatrics, Angers University Hospital, Angers University Memory Center, UPRES EA 2646, University of Angers, UNAM, Angers, France. CeAnnweiler@chu-angers.fr
BACKGROUND: Serum vitamin D concentrations are associated with global cognitive function among older adults. The benefits of vitamin D intake to treat or prevent cognitive impairment remain unknown. The objective of this cross-sectional study was to determine whether weekly dietary intake of vitamin D could be associated with global cognitive performance among older adults.
METHODS: A total of 5,596 community-dwelling women (mean age 80.5 ± 0.1 years) free of vitamin D drug supplements from the Epidémiologie de l'Ostéoporose (EPIDOS) study were divided into 2 groups according to baseline weekly vitamin D dietary intake (either inadequate <35 μg/wk or recommended ≥35μg/wk). Weekly vitamin D dietary intakes were estimated from a self-administered food frequency questionnaire. Cognitive impairment was defined as a Pfeiffer Short Portable Mental State Questionnaire (SPMSQ) score <8. Age, body mass index, sun exposure at midday, season, disability, number of chronic diseases, hypertension, depression, use of psychoactive drugs, and education level were considered as potential confounders.
RESULTS: Compared to women with recommended weekly vitamin D dietary intakes (n = 4,802; mean age 80.4 ± 3.8 years), women with inadequate intakes (n = 794; mean age 81.0 ± 3.8 years) had a lower mean SPMSQ score (p < 0.001) and more often had an SPMSQ score <8 (p = 0.002). We found an association between weekly vitamin D dietary intake and SPMSQ score (β = 0.002, p < 0.001). Inadequate weekly vitamin D dietary intakes were also associated with cognitive impairment (unadjusted odds ratio = 1.42 with p = 0.002; full adjusted odds ratio = 1.30 with p = 0.024).
CONCLUSIONS: Weekly dietary intake of vitamin D was associated with cognitive performance in older women
Medicine for People! is published by Douwe Rienstra, MD at Port Townsend, Washington.