B vitamins are a class of water-soluble vitamins that play important roles in cell metabolism and synthesis of red blood cells . They are a chemically diverse class of compounds.
116-689: Dietary supplements containing all eight are referred to as a vitamin B complex . Individual B vitamins are referred to by B-number or by chemical name, such as B 1 for thiamine , B 2 for riboflavin , and B 3 for niacin , while some are more commonly recognized by name than by number, such as pantothenic acid (B 5 ), biotin (B 7 ), and folate (B 9 ). B vitamins are present in protein -rich foods, such as fish , poultry , meat , dairy products , and eggs ; they are also found in leafy green vegetables , beans , and peas . Fortified foods , such as breakfast cereals , baked products, and infant formulas , may contain B vitamins. Each B vitamin
232-676: A nasal spray , or topically , as a lotion applied to the skin, do not qualify. FDA-approved drugs cannot be ingredients in dietary supplements. Supplement products are or contain vitamins , nutritionally essential minerals , amino acids , essential fatty acids and non-nutrient substances extracted from plants or animals or fungi or bacteria , or in the instance of probiotics , are live bacteria. Dietary supplement ingredients may also be synthetic copies of naturally occurring substances (for example: melatonin ). All products with these ingredients are required to be labeled as dietary supplements. Like foods and unlike drugs, no government approval
348-570: A plant-based diet of whole foods, minimizing ultra-processed food , salt and sugar and to get exercise daily, and to abandon Western pattern diets and a sedentary lifestyle. The regulation of food and dietary supplements by the U.S. Food and Drug Administration (FDA) is governed by various statutes enacted by the United States Congress . Pursuant to the Federal Food, Drug, and Cosmetic Act and accompanying legislation,
464-478: A 2017 review found that supplementation with DHA and AA does not appear to be harmful or beneficial to formula-fed infants. Dietary supplements can be manufactured using intact sources or extracts from plants, animals, algae, fungi or lichens, including such examples as ginkgo biloba , curcumin , cranberry , St. John's wort , ginseng , resveratrol , glucosamine and collagen . Products bearing promotional claims of health benefits are sold without requiring
580-703: A claim then the FDA stipulates the exact wording of the QHC to be used on labels and in marketing materials. The wording can be onerous: "One study suggests that selenium intake may reduce the risk of bladder cancer in women. However, one smaller study showed no reduction in risk. Based on these studies, FDA concludes that it is highly uncertain that selenium supplements reduce the risk of bladder cancer in women." Protein-containing supplements, either ready-to-drink or as powders to be mixed into water, are marketed as aids to people recovering from illness or injury, those hoping to thwart
696-672: A combination of ingredients in manufactured vitamins, minerals or other supplement products, with 92% of tested herbal supplements containing lead and 80% containing other chemical contaminants. Using undercover staff, the GAO also found that supplement retailers intentionally engaged in "unequivocal deception" to sell products advertised with baseless health claims, particularly to elderly consumers. Consumer Reports also reported unsafe levels of arsenic , cadmium , lead and mercury in several protein powder products. The Canadian Broadcasting Corporation (CBC) reported that protein spiking, i.e.,
812-651: A consumer center to assist reports of false health claims in product advertising for dietary supplements. In 2017, the FTC successfully sued nine manufacturers for deceptive advertising of dietary supplements. In the United States, manufacturers of dietary supplements are required to demonstrate safety of their products before approval is granted for commerce. Despite this caution, numerous adverse effects have been reported, including muscle cramps, hair loss, joint pain, liver disease , and allergic reactions , with 29% of
928-405: A dietary substance for use by man to supplement the diet by increasing the total dietary intake, or a concentrate, metabolite , constituent, extract , or combination of any of the aforementioned ingredients. Furthermore, a dietary supplement must be labeled as a dietary supplement and be intended for ingestion and must not be represented for use as conventional food or as a sole item of a meal or of
1044-491: A dietary supplement health claim for calcium and vitamin D and the reduction of the risk of osteoporotic fractures by reducing bone loss. The U.S. FDA also approved Qualified Health Claims (QHCs) for various health conditions for calcium, selenium and chromium picolinate . QHCs are supported by scientific evidence, but do not meet the more rigorous "significant scientific agreement" standard required for an authorized health claim. If dietary supplement companies choose to make such
1160-465: A few hours. Aggressive surgical management has improved survival and the functions of infants with spina bifida, meningoceles and mild myelomeningoceles. The success of surgery often depends on the amount of brain tissue involved in the encephalocele. The goal of treatment for NTDs is to allow the individual to achieve the highest level of function, and independence. Fetal surgery in utero before 26 weeks gestation has been performed with some hope that there
1276-406: A general rule, dietary supplement labeling and marketing are not allowed to make disease prevention or treatment claims, the U.S. FDA has for some foods and dietary supplements reviewed the science, concluded that there is significant scientific agreement, and published specifically worded allowed health claims. An initial ruling allowing a health claim for calcium dietary supplements and osteoporosis
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#17327720370141392-486: A group of birth defects in which an opening in the spine or cranium remains from early in human development. In the third week of pregnancy called gastrulation , specialized cells on the dorsal side of the embryo begin to change shape and form the neural tube . When the neural tube does not close completely, an NTD develops. Specific types include: spina bifida which affects the spine , anencephaly which results in little to no brain , encephalocele which affects
1508-422: A huge contributing factor to the prevalence rates; one study found that in 1986 only a quarter of the pregnancies with an identified NTD were aborted, but that number had already doubled by 1999. Through this data, it is clear that excluding data from abortions could greatly affect the prevalence rates. This could also possibly explain why prevalence rates have appeared to drop. If abortions are not being included in
1624-479: A license is issued when a supplement product has been proven by the manufacturer and government to be safe, effective and of sufficient quality for its recommended use, an eight-digit Natural Product Number is assigned and recorded in a Licensed Natural Health Products Database. The European Food Safety Authority maintains a compendium of botanical ingredients used in manufacturing of dietary supplements. Neural tube defects Neural tube defects ( NTDs ) are
1740-419: A major portion of the brain and skull. Infants born with this condition lack the main part of the forebrain and are usually blind, deaf and display major craniofacial anomalies. The lack of a functioning cerebrum will prevent the infant from even gaining consciousness. Infants are either stillborn or usually die within a few hours or days after birth. For example, anencephaly in humans can result from mutations in
1856-541: A moderate degree of evidence in favor of whey protein supplements use as a safe and effective adjunct to an athlete's training and recovery, including benefits for endurance , average power, muscle mass , and reduced perceived exercise intensity . According to US and Canadian Dietary Reference Intake guidelines, the protein Recommended Dietary Allowance (RDA) for adults is based on 0.8 grams protein per kilogram body weight. The recommendation
1972-877: A modest reduction of antibiotic-associated diarrhea and acute diarrhea in children taking probiotics. There is limited evidence in support of adults using mono-strain and multi-strain containing probiotics for the alleviation of symptoms associated with irritable bowel syndrome . Probiotic supplements are generally regarded as safe. A meta-analysis provided preliminary evidence that men treated with supplements containing selenium , zinc , omega-3 fatty acids , coenzyme Q 10 or carnitines reported improvements in total sperm count, concentration, motility, and morphology. A review concluded that omega-3 taken through supplements and diet might improve semen quality in infertile men. A 2021 review also supported selenium, zinc, omega-3 fatty acids, coenzyme Q 10 or carnitines, but warned that "excessive use of antioxidants may be detrimental to
2088-447: A neural tube defect. Other areas of research include tissue engineering and stem cell therapy but this research has not been used in humans. Neural tube defects resulted in 71,000 deaths globally in 2010. It is unclear how common the condition is in low income countries. Prevalence rates of NTDs at birth used to be a reliable measure for the actual number of children affected by the diseases. However, due to advances in technology and
2204-765: A neural tube defect. These include having a first or second degree relative or partner with a history of neural tube defects, having a gastrointestinal condition that affects normal absorption patterns, advanced kidney disease , kidney dialysis , alcohol over-use, or had another pregnancy resulting in a congenital abnormality that was folate sensitive. Medium risk individuals would also include those taking medications that can interfere with folate absorption such as anticonvulsants , metformin , sulfasalazine , triamterene , and trimethoprim . Low risk would include everyone else that do not fall into either medium or high risk categories. Recommendations on when to start folic acid supplementation for all individuals looking to become pregnant
2320-482: A novel way. The sensory overload is treatable with oral potassium gluconate . In 2020, the American market for dietary supplements was valued at $ 140.3 billion, with the economic impact in the United States for 2016 estimated at $ 122 billion, including employment wages and taxes. A 2020 analysis projected that the global market for vitamins and dietary supplement products would reach $ 196.6 billion by 2028, where
2436-454: A popular dietary supplement ingredient with claims made for sports performance, is technically not an amino acid. It is synthesized in the body from the amino acid cysteine . Fish oil is a commonly used fatty acid supplement because it is a source of omega-3 fatty acids . Fatty acids are strings of carbon atoms, having a range of lengths. If links are all single (C−C), then the fatty acid is called saturated ; with one double bond (C=C), it
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#17327720370142552-555: A prescription in pharmacies , supermarkets , specialist shops, military commissaries , buyers clubs , direct selling organizations, and the internet. While most of these products have a long history of use in herbalism and various forms of traditional medicine, concerns exist about their actual efficacy, safety and consistency of quality. Canada has published a manufacturer and consumer guide describing quality, licensing, standards, identities, and common contaminants of natural products. In 2019, sales of herbal supplements just in
2668-503: A recommendation that women pregnant or lactating consume an additional 100 to 200 mg/day of DHA. In the United States and Canada are Adequate Intakes for ALA and LA over various stages of life, but there are no intake levels specified for EPA and/or DHA. Supplementation with EPA and/or DHA does not appear to affect the risk of death, cancer or heart disease. Furthermore, studies of fish oil supplements have failed to support claims of preventing heart attacks or strokes . In 2017,
2784-480: A risk factor for NTDs. Studies have shown that both maternal cigarette smoking and maternal exposure to secondhand smoke increased the risk for neural tube defects in offspring. A mechanism by which maternal exposure to cigarette smoke could increase NTD risk in offspring is suggested by several studies that show an association between cigarette smoking and elevations of homocysteine levels. Cigarette smoke during pregnancy, including secondhand exposure, can increase
2900-437: A single vitamin, mineral, lipid product, and herbal product were less likely to cause adverse effects related to excess supplementation. Among general reasons for the possible harmful effects of dietary supplements are: a) absorption in a short time, b) manufacturing quality and contamination, and c) enhancing both positive and negative effects at the same time. The incidence of liver injury from herbal and dietary supplements
3016-475: A source of supplement ingredients, such as collagen from chickens or fish for example. These are also sold individually and in combination, and may be combined with nutrient ingredients. The European Commission has also established harmonized rules to help insure that food supplements are safe and appropriately labeled. Creating an industry estimated to have a value of $ 151.9 billion in 2021, there are more than 50,000 dietary supplement products marketed in
3132-558: A supplement containing 4.0 mg daily, following advice provided by their doctor. In Canada, guidelines on folic acid intake when trying to conceive is based on a risk assessment of how likely they are to experience a neural tube defect during pregnancy. Risk is divided into high, moderate, and low risk categories. High risk would include those that had a past experience with neural tube defects, either themselves or during another pregnancy. Medium risk individuals are those with certain conditions that put them at higher risk for experiencing
3248-504: A supplement. To the right, a diagram of some of the major B vitamins (2, 3, 5, 9, and 12) are shown as precursors for certain essential biochemical reactants (FAD, NAD+, coenzyme A, and heme B respectively). The structural similarities between them are highlighted, which illustrates the precursor nature of many B vitamins while also showing the functionality of the end product used by essential reactions to support human, animal, or cellular life. FAD, NAD+, and coenzyme A are all essential for
3364-529: A systematic review in 2012 shows there is no evidence except in the case of prostate cancer which indicates a modest reduction in risk. There have been studies showing the relationship between NTDs, folate deficiency and the difference of skin pigmentation within human populations across different latitudes. There are many factors that would influence the folate levels in human bodies: (i) the direct dietary intake of folic acid through fortified products, (ii) environmental agents such as UV radiation. In concern with
3480-507: A vital nutrient in limited amounts. An organic chemical compound (or related set of compounds) is called a vitamin when it cannot be synthesized in sufficient quantities by an organism and must be obtained from the diet. The term is conditional both on the circumstances and on the particular organism. For example, ascorbic acid (vitamin C) is a vitamin for anthropoid primates, humans , guinea pigs and bats , but not for other mammals. Vitamin D
3596-414: Is 100 μg (4,000 IU), but products are available without prescription at 10,000 IU. Minerals are the exogenous chemical elements indispensable for life. Four minerals – carbon , hydrogen , oxygen , and nitrogen – are essential for life but are so ubiquitous in food and drink that these are not considered nutrients and there are no recommended intakes for these as minerals. The need for nitrogen
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3712-501: Is a good predictor of open neural tube defects, however the test has a very high false positive rate, (2% of all women tested in Ontario, Canada between 1993 and 2000 tested positive without having an open neural tube defect, although 5% is the commonly quoted result worldwide) and only a portion of neural tube defects are detected by this screen test (73% in the same Ontario study). MSAFP screening combined with routine ultrasonography has
3828-454: Is a health risk, require that the company conduct a recall. Only after a dietary supplement product is marketed, may the FDA's Center for Food Safety and Applied Nutrition (CFSAN) review the products for safety and effectiveness. The European Union 's (EU) Food Supplements Directive of 2002 requires that supplements be demonstrated to be safe, both in dosages and in purity. Only those supplements that have been proven to be safe may be sold in
3944-688: Is about 16–20% of all supplement products causing injury, with the occurrence growing globally over the early 21st century. The most common liver injuries from weight loss and bodybuilding supplements involve hepatocellular damage with resulting jaundice , and the most common supplement ingredients attributed to these injuries are green tea catechins , anabolic steroids , and the herbal extract , aegeline . Weight loss supplements have also had adverse psychiatric effects . Some dietary supplements may also have adverse interactions with prescription medications that may enhance side effects or decrease therapeutic effects of medications. Work done by scientists in
4060-489: Is addressed by requirements set for protein, which is composed of nitrogen-containing amino acids. Sulfur is essential, but for humans, not identified as having a recommended intake per se. Instead, recommended intakes are identified for the sulfur-containing amino acids methionine and cysteine . There are dietary supplements that provide sulfur, such as taurine and methylsulfonylmethane . The essential nutrient minerals for humans, listed in order by weight needed to be at
4176-409: Is against federal regulations for supplement manufacturers to claim that these products prevent or treat any disease. Companies are allowed to use what is referred to as "Structure/Function" wording if there is substantiation of scientific evidence for a supplement providing a potential health effect. An example would be "_____ helps maintain healthy joints", but the label must bear a disclaimer that
4292-549: Is at least three months preconception. If an individual is in the high risk category, the recommended dose is 4–5 mg of folic acid daily until 12 weeks gestation and then decrease to 0.4–1 mg until 4–6 weeks postpartum or for however long breastfeeding lasts. If an individual is in the medium risk category, the recommended dose is 1 mg of folic acid daily until 12 weeks gestation and then they can either continue at 1 mg or decrease to 0.4 mg daily until 4–6 weeks postpartum or however long breastfeeding lasts. If
4408-466: Is benefit to the outcome including a reduction in Arnold–Chiari malformation and thereby decreases the need for a ventriculoperitoneal shunt but the procedure is very high risk for both mother and baby and is considered extremely invasive with questions that the positive outcomes may be due to ascertainment bias and not true benefit. Further, this surgery is not a cure for all problems associated with
4524-990: Is by using dietary supplements . B vitamins are commonly added to energy drinks , many of which have been marketed with large amounts of B vitamins. Because they are soluble in water, excess B vitamins are generally readily excreted, although individual absorption, use and metabolism may vary. The elderly and athletes may need to supplement their intake of B 12 and other B vitamins due to problems in absorption and increased needs for energy production. In cases of severe deficiency, B vitamins, especially B 12 , may also be delivered by injection to reverse deficiencies. Both type 1 and type 2 diabetics may also be advised to supplement thiamine based on high prevalence of low plasma thiamine concentration and increased thiamine clearance associated with diabetes. Also, folate deficiency in early embryo development has been linked to neural tube defects . Thus, women planning to become pregnant are usually encouraged to increase daily dietary folate intake or take
4640-415: Is called monounsaturated ; if there are two or more double bonds (C=C=C), it is called polyunsaturated . Only two fatty acids, both polyunsaturated, are considered essential to be obtained from the diet, as the others are synthesized in the body. The "essential" fatty acids are alpha-linolenic acid (ALA), an omega-3 fatty acid, and linoleic acid (LA), an omega-6 fatty acid . ALA can be elongated in
4756-555: Is common in many countries (including the United States) that the B vitamins thiamine, riboflavin, niacin, and folic acid are added back to white flour after processing. This is referred to as " enriched flour " on food labels. B vitamins are particularly concentrated in meat such as turkey, tuna and liver. Sources for B vitamins also include spinach , legumes ( pulses or beans), whole grains, asparagus , potatoes, bananas, chili peppers, breakfast cereals . The B 12 vitamin
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4872-580: Is due to a gene-environment interaction such as vulnerability caused by the C677T methylenetetrahydrofolate reductase (MTHFR) variant. Supplementing folic acid during pregnancy reduces the prevalence of NTDs by not exposing this otherwise sub-clinical mutation to aggravating conditions. Other potential causes can include folate antimetabolites (such as methotrexate ), mycotoxins in contaminated corn meal, arsenic , hyperthermia in early development, and radiation. Maternal obesity has also been found to be
4988-587: Is either a cofactor (generally a coenzyme ) for key metabolic processes or is a precursor needed to make one. Note: Other substances once thought to be vitamins were given B-numbers, but were disqualified once discovered to be either manufactured by the body or not essential for life. See #Related compounds for numbers 4 , 8 , 10 , 11, and others. B vitamins are found in abundance in meat, eggs, and dairy products . Processed carbohydrates such as sugar and white flour tend to have lower B vitamin content than their unprocessed counterparts. For this reason, it
5104-695: Is for sedentary and lightly active people. Scientific reviews can conclude that a high protein diet, when combined with exercise, will increase muscle mass and strength, or conclude the opposite. The International Olympic Committee recommends protein intake targets for both strength and endurance athletes at about 1.2–1.8 g/kg body mass per day. One review proposed a maximum daily protein intake of approximately 25% of energy requirements, i.e., approximately 2.0 to 2.5 g/kg. The same protein ingredients marketed as dietary supplements can be incorporated into meal replacement and medical food products, but those are regulated and labeled differently from supplements. In
5220-438: Is for stimulating muscle protein synthesis. A review of the literature concluded this claim was unwarranted. In elderly people, supplementation with just leucine resulted in a modest (0.99 kg) increase in lean body mass. The non-essential amino acid arginine , consumed in sufficient amounts, is thought to act as a donor for the synthesis of nitric oxide, a vasodilator. A review confirmed blood pressure lowering. Taurine ,
5336-582: Is high over the year. One body natural adaptation is to elevate the concentration of melanin inside the skin. Melanin works as either an optical filter to disperse the incoming UV radiation rays or free radical to stabilize the hazardous photochemical products. Multiple studies have demonstrated the highly melanized integument as a defense against folate photolysis in Native Americans or African Americans correlates with lower occurrence of NTDs in general. As reported by Bruno Reversade and colleagues,
5452-526: Is in proportion to their body. However, after a few weeks, the infants develop increased muscle tone and irritability. After a few months, the brain start to fill with cerebrospinal fluid (hydrocephalus). This has several consequences. Infants start to develop problems with seeing, hearing, growing, and learning. The missing parts of the brain and the amount of cerebrospinal fluid can also lead to seizures, spasm, problems with regulating their body temperature, and breathing and digestion problems. Besides problems in
5568-428: Is lacking, that shows that any kind of dietary supplementation does more good than harm for people who are healthy and eating a reasonable diet but there is clear data showing that dietary pattern and lifestyle choices are associated with health outcomes. As a result of the lack of good data for supplementation and the strong data for dietary pattern, public health recommendations for healthy eating urge people to eat
5684-500: Is little evidence of benefit when vitamins are consumed as a dietary supplement by those who are healthy and have a nutritionally adequate diet. The U.S. Institute of Medicine sets tolerable upper intake levels (ULs) for some of the vitamins. This does not prevent dietary supplement companies from selling products with content per serving higher than the ULs. For example, the UL for vitamin D
5800-502: Is no vitamin B 4 ). Some of them, though not essential to humans, are essential in the diets of other organisms; others have no known nutritional value and may even be toxic under certain conditions. Dietary supplement A dietary supplement is a manufactured product intended to supplement a person's diet by taking a pill , capsule , tablet , powder, or liquid. A supplement can provide nutrients either extracted from food sources, or that are synthetic (in order to increase
5916-498: Is not abundantly available from plant products (although it has been found in moderate abundance in fermented vegetable products, certain seaweeds, and in certain mushrooms, with the bioavailability of the vitamin in these cases remaining uncertain), making B 12 deficiency a legitimate concern for those maintaining a vegan diet. Manufacturers of plant-based foods will sometimes report B 12 content, leading to confusion about what sources yield B 12 . The confusion arises because
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#17327720370146032-701: Is not an essential nutrient for people who get sufficient exposure to ultraviolet light , either from the sun or an artificial source, as they synthesize vitamin D in skin. Humans require thirteen vitamins in their diet, most of which are actually groups of related molecules, "vitamers", (e.g. vitamin E includes tocopherols and tocotrienols , vitamin K includes vitamin K 1 and K 2 ). The list: vitamins A, C, D, E, K, Thiamine (B 1 ), Riboflavin (B 2 ), Niacin (B 3 ), Pantothenic Acid (B 5 ), Vitamin B 6 , Biotin (B 7 ), Folate (B 9 ) and Vitamin B 12 . Vitamin intake below recommended amounts can result in signs and symptoms associated with vitamin deficiency. There
6148-461: Is pyridoxine). General side effects may include restlessness, nausea and insomnia. These side effects are almost always caused by dietary supplements and not foodstuffs. Many of the following substances have been referred to as vitamins as they were once believed to be vitamins. They are no longer considered as such, and the numbers that were assigned to them now form the "gaps" in the true series of B-complex vitamins described above (for example, there
6264-559: Is recommended as the primary screening tool for NTDs, and MSAFP as a secondary screening tool. This is due to increased safety, increased sensitivity and decreased false positive rate of ultrasound as compared to MSAFP. Amniotic fluid alpha-fetoprotein (AFAFP) and amniotic fluid acetylcholinesterase (AFAChE) tests are also used to confirming if ultrasound screening indicates a positive risk. Often, these defects are apparent at birth, but acute defects may not be diagnosed until much later in life. An elevated MSAFP measured at 16–18 weeks gestation
6380-426: Is required to make or sell dietary supplements; the manufacturer confirms the safety of dietary supplements but the government does not; and rather than requiring risk–benefit analysis to prove that the product can be sold like a drug, such assessment is only used by the FDA to decide that a dietary supplement is unsafe and should be removed from market. A vitamin is an organic compound required by an organism as
6496-715: Is substantial evidence that direct folic supplementation increases blood serum levels of bioavailable folate even though at least one study have shown slow and variable activity of dihydrofolate reductase in human liver. A diet rich in natural folate (350 μg/d) can show as much increase in plasma folate as taking low levels of folic acid (250 μg/d) in individuals However a comparison of general population outcomes across many countries with different approaches to increasing folate consumption has found that only general food fortification with folic acid reduces neural tube defects. While there have been concerns about folic acid supplementation being linked to an increased risk for cancer,
6612-500: The Food and Drug Administration (FDA) "has not evaluated the claim" and that the dietary supplement product is not intended to "diagnose, treat, cure or prevent any disease", because only a drug can legally make such a claim. The FDA enforces these regulations and also prohibits the sale of supplements and supplement ingredients that are dangerous, or supplements not made according to standardized good manufacturing practices (GMPs). In
6728-506: The NUAK2 kinase. Encephaloceles are characterized by protrusions of the brain through the skull that are sac-like and covered with membrane. They can be a groove down the middle of the upper part of the skull, between the forehead and nose, or the back of the skull. Due to the range in its location, encephaloceles are classified by the location as well as the type of defect it causes. Subtypes include occipital encephalocele, encephalocele of
6844-569: The New York Attorney General (NY-AG) identified four major retailers with dietary supplement products that contained fraudulent and potentially dangerous ingredients, requiring the companies to remove the products from retail stores. According to the NY-AG, only about 20% of the herbal supplements tested contained the plants claimed. The methodology used by the NY-AG was disputed. The test involves looking for DNA fragments from
6960-589: The Recommended Dietary Allowance or Adequate Intake are potassium , chlorine , sodium , calcium , phosphorus , magnesium , iron , zinc , manganese , copper , iodine , chromium , molybdenum , selenium and cobalt (the last as a component of vitamin B 12 ). There are other minerals which are essential for some plants and animals, but may or may not be essential for humans, such as boron and silicon . Essential and purportedly essential minerals are marketed as dietary supplements, individually and in combination with vitamins and other minerals. Although as
7076-463: The sarcopenia of old age, to athletes who believe that strenuous physical activity increases protein requirements, to people hoping to lose weight while minimizing muscle loss, i.e., conducting a protein-sparing modified fast , and to people who want to increase muscle size for performance and appearance. Whey protein is a popular ingredient, but products may also incorporate casein , soy , pea , hemp or rice protein . A meta-analysis found
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#17327720370147192-435: The skull , and iniencephaly which results in severe neck problems. NTDs are one of the most common birth defects , affecting over 300,000 births each year worldwide. For example, spina bifida affects approximately 1,500 births annually in the United States, or about 3.5 in every 10,000 (0.035% of US births), which has decreased from around 5 per 10,000 (0.05% of US births) since folate fortification of grain products
7308-525: The American Heart Association issued a science advisory stating that it could not recommend use of omega-3 fish oil supplements for primary prevention of cardiovascular disease or stroke, although it reaffirmed supplementation for people who have a history of coronary heart disease . Manufacturers have begun to include long chain polyunsaturated fatty acids DHA and arachidonic acid (AA) into their formula milk for newborns, however,
7424-695: The EU without prescription. As a category of food, food supplements cannot be labeled with drug claims but can bear health claims and nutrition claims. The dietary supplements industry in the United Kingdom (UK), one of the 28 countries in the bloc, strongly opposed the Directive. In addition, a large number of consumers throughout Europe, including over one million in the UK, and various doctors and scientists, had signed petitions by 2005 against what are viewed by
7540-448: The FDA and FTC had issued warning letters to dozens of companies advertising scam products, which were purported "to be drugs, medical devices or vaccines. Products that claim to cure, mitigate, treat, diagnose or prevent disease, but are not proven safe and effective for those purposes, defraud consumers of money and can place consumers at risk for serious harm" Examples of ongoing government research organizations to better understand
7656-690: The FDA as food products subject to compliance with current Good Manufacturing Practices (CGMP) and labeling with science-based ingredient descriptions and advertising. When finding CGMP or advertising violations, FDA warning letters are used to notify manufacturers of impending enforcement action, including search and seizure , injunction , and financial penalties . Examples between 2016 and 2018 of CGMP and advertising violations by dietary supplement manufacturers included several with illegal compositions or advertising of vitamins and minerals. The U.S. Federal Trade Commission , which litigates against deceptive advertising in marketed products, established
7772-444: The FDA exercises differ from one category to the next. Furthermore, the FDA has been granted a variety of means by which it can address violations of the standards for a given category of substances. Dietary supplement manufacture is required to comply with the good manufacturing practices established in 2007. The FDA can visit manufacturing facilities, send Warning Letters if not in compliance with GMPs, stop production, and if there
7888-493: The FDA has authority to oversee the quality of substances sold as food in the United States, and to monitor claims made in the labeling about both the composition and the health benefits of foods. Substances which the FDA regulates as food are subdivided into various categories, including foods, food additives , added substances (man-made substances which are not intentionally introduced into food, but nevertheless end up in it), and dietary supplements. The specific standards which
8004-484: The United States alone were $ 9.6 billion, with the market growing at approximately 8.6% per year, with cannabidiol and mushroom product sales as the highest. Italy, Germany, and Eastern European countries were leading consumers of botanical supplements in 2016, with European Union market growth forecast to be $ 8.7 billion by 2020. Claimed benefits of using probiotic supplements are not supported by sufficient clinical evidence. Meta-analysis studies have reported
8120-409: The United States, where about 50% of the American adult population consumes dietary supplements. Multivitamins are the most commonly used product among types of dietary supplements. The United States National Institutes of Health states that supplements "may be of value" for those who are nutrient deficient from their diet and receive approval from their medical provider. In the United States, it
8236-690: The United States, "meal replacement" products are foods and are labeled as such. These typically contain protein, carbohydrates, fats, vitamins and minerals. There may be content claims such as "good source of protein", "low fat" or "lactose free". Medical foods, also nutritionally complete, are designed to be used while a person is under the care of a physician or other licensed healthcare professional. Liquid medical food products – for example, Ensure – are available in regular and high protein versions. Proteins are chains of amino acids . Nine of these proteinogenic amino acids are considered essential for humans because they cannot be produced from other compounds by
8352-495: The United States, the Dietary Supplement Health and Education Act of 1994 provides this description: "The Dietary Supplement Health and Education Act of 1994 (DSHEA) defines the term "dietary supplement" to mean a product (other than tobacco ) intended to supplement the diet that bears or contains one or more of the following dietary ingredients: a vitamin, a mineral, an herb or other botanical, an amino acid,
8468-428: The ability to become pregnant are advised to get 400 micrograms of folic acid daily. This daily 400 mcg dose of folic acid can be found in most multivitamins advertised as for women. Higher doses can be found in pre-natal multivitamins but those doses may not be necessary for everyone. Individuals who have previously given birth to a child with a neural tube defect and are trying to conceive again may benefit from
8584-406: The ability to diagnose prenatally, the rates at birth are no longer reliable. Measuring the number of cases at birth may be the most practical way, but the most accurate way would be to include stillbirths and live-births. Most studies that calculate prevalence rates only include data from live births and stillborn children and normally exclude the data from abortions and miscarriages. Abortions are
8700-420: The addition of amino acids to manipulate protein content analysis, was common. Many of the companies involved challenged CBC's claim. In some botanical products, undeclared ingredients were used to increase the bulk of the product and reduce its cost of manufacturing, while potentially violating certain religious and/or cultural limitations on consuming animal ingredients, such as cow, buffalo or deer. In 2015,
8816-614: The addition of folic acid to enriched breads, cereals, flour and other grain products. Similar regulations made it mandatory to fortify selected grain products with folic acid in Canada by 1998. During the first four weeks of pregnancy (when most women do not even realize that they are pregnant), adequate folate intake is essential for proper operation of the neurulation process. Therefore, any individuals who could become pregnant are advised to eat foods fortified with folic acid or take supplements in addition to eating folate-rich foods to reduce
8932-450: The adulterated supplements were marketed for weight loss and sexual performance, with many containing prescription erectile dysfunction medication. Muscle building supplements were contaminated with anabolic steroids that can lead to health complications affecting the kidney, the heart, and cause gynecomastia . Multiple bodybuilding products also contained antidepressants and antihistamines . Despite these findings, fewer than half of
9048-510: The adulterated supplements were recalled. The European Commission has published harmonized rules on supplement products to assure consumers have minimal health risks from using dietary supplements and are not misled by advertising. In the United States and Canada, dietary supplements are considered a subset of foods, and are regulated accordingly. The U.S. Food and Drug Administration (FDA) monitors supplement products for accuracy in advertising and labeling. Dietary supplements are regulated by
9164-506: The adverse effects resulting in hospitalization, and 20% in serious injuries or illnesses. The potential for adverse effects also occurs when individuals consume more than the necessary daily amount of vitamins or minerals that are needed to maintain normal body processes and functions. The incidence of adverse effects reported to the FDA were due to "combination products" that contain multiple ingredients, whereas dietary supplements containing
9280-509: The best detection rate although detection by ultrasonography is dependent on operator training and the quality of the equipment. Incidence of neural tube defects has been shown to decline through maintenance of adequate folic acid levels prior to and during pregnancy. This is achieved through dietary sources and supplementation of folic acid. In 1996, the United States Food and Drug Administration published regulations requiring
9396-488: The body to create other omega-3 fatty acids: eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Plant oils, particularly seed and nut oils, contain ALA. Food sources of EPA and DHA are oceanic fish, whereas dietary supplement sources include fish oil, krill oil and marine algae extracts. The European Food Safety Authority (EFSA) identifies 250 mg/day for a combined total of EPA and DHA as Adequate Intake, with
9512-441: The brain, hydranencephaly can also be seen on the outside of the body. Hydrocephalus leads to more cerebrospinal fluid in the brain, which can result in an enlarged head. The cause of hydranencephaly is not clear. Hydranencephaly is a result of an injury of the nervous system or an abnormal development of the nervous system. The neural tube closes in the sixth week of the pregnancy, so hydranencephaly develops during these weeks of
9628-444: The catabolic release of free energy (dG) to power the activity of the cell and more complex life forms. See the article on Catabolism for more details on how these three essential biochemical reactants help support life. Tetrahydrofolate is a necessary co-reactant for synthesizing some amino acids, such as glycine . Heme B is the porphyrin derivative macrocycle molecule that holds the iron atom in place in hemoglobin , allowing for
9744-429: The cranial vault, and nasal encephaloceles (frontoethmoidal encephaloceles and basal encephaloceles), with approximately 80% of all encephaloceles occurring in the occipital area. Encephaloceles are often obvious and diagnosed immediately. Sometimes small encephaloceles in the nasal and forehead are undetected. Despite the wide range in its implications, encephaloceles are most likely to be caused by improper separation of
9860-463: The data but half of the identified cases are being aborted, the data could show that prevalence rates are dropping when they actually are not. However, it is unclear how much of an impact these could have on prevalence rates due to the fact that abortion rates and advances in technology vary greatly by country. There are many maternal factors that also play a role in prevalence rates of NTDs. These factors include things like maternal age and obesity all
9976-829: The diet. Nevertheless, the European judges acknowledged the Advocate General's concerns, stating that there must be clear procedures to allow substances to be added to the permitted list based on scientific evidence. They also said that any refusal to add the product to the list must be open to challenge in the courts. During the COVID-19 pandemic in the United States, the FDA and Federal Trade Commission (FTC) warned consumers about marketing scams of fraudulent supplement products, including homeopathic remedies , cannabidiol products , teas, essential oils , tinctures and colloidal silver , among others. By August 2020,
10092-577: The diet. In addition, a dietary supplement cannot be approved or authorized for investigation as a new drug , antibiotic , or biologic, unless it was marketed as a food or a dietary supplement before such approval or authorization. Under DSHEA, dietary supplements are deemed to be food, except for purposes of the drug definition." Per DSHEA, dietary supplements are consumed orally, and are mainly defined by what they are not: conventional foods (including meal replacements ), medical foods , preservatives or pharmaceutical drugs . Products intended for use as
10208-943: The early 20th century on identifying individual nutrients in food and developing ways to manufacture them raised hopes that optimal health could be achieved and diseases prevented by adding them to food and providing people with dietary supplements; while there were successes in preventing vitamin deficiencies , and preventing conditions like neural tube defects by supplementation and food fortification with folic acid , no targeted supplementation or fortification strategies to prevent major diseases like cancer or cardiovascular diseases have proved successful. For example, while increased consumption of fruits and vegetables are related to decreases in mortality, cardiovascular diseases and cancers, supplementation with key factors found in fruits and vegetable, like antioxidants , vitamins, or minerals, do not help and some have been found to be harmful in some cases. In general, as of 2016, robust clinical data
10324-498: The functional enzymes in this pathway during embryogenesis combined with high demand for post translational methylations of the cytoskeleton in neural cells during neural tube closure. Failure of post-translational methylation of the cytoskeleton, required for differentiation has been implicated in neural tube defects. Vitamin B 12 is also an important receptor in the folate biopathway such that studies have shown deficiency in vitamin B 12 contributes to risk of NTDs as well. There
10440-525: The growth in market size is largely attributed to recent technological advancements in product manufacturing, increased demand for products advertised as healthy, increased product availability, and population aging . Over the period 2008 to 2011, the Government Accountability Office (GAO) of the United States received 6,307 reports of health problems (identified as adverse events ) from use of dietary supplements containing
10556-419: The human body and so must be taken in as food. Recommended intakes, expressed as milligrams per kilogram of body weight per day, have been established. Other amino acids may be conditionally essential for certain ages or medical conditions. Amino acids, individually and in combinations, are sold as dietary supplements. The claim for supplementing with the branched-chain amino acids leucine, valine and isoleucine
10672-406: The inactivation of the NUAK2 kinase in humans leads to anencephaly . This fatal birth defect is believed to arise as a consequence of impaired HIPPO signalling. Other genes such as TRIM36 have also been associated with anencephaly in humans. A deficiency of folate itself does not cause neural tube defects. The association seen between reduced neural tube defects and folic acid supplementation
10788-456: The latter, the UV radiation-induced folate photolysis has been shown via in vitro and in vivo studies to decrease the folate level and implicate in etiology of NTDs not only in humans but other amphibian species. Therefore, a protection against the UV radiation-induced photolysis of folate is imperative for the evolution of human populations living in tropical regions where the exposure to UV radiation
10904-407: The most common form, spina bifida . Closed NTDs occur when the spinal defect is covered by skin. Types of closed NTDs include lipomeningocele, lipomyelomeningocele, and tethered cord . Anencephaly (without brain) is a severe neural tube defect that occurs when the anterior-most end of the neural tube fails to close, usually during the 23rd and 26th days of pregnancy. This results in an absence of
11020-423: The mother and fetus . Although prenatal vitamins are not meant to substitute for dietary nutrition, prenatal supplementation may be beneficial for pregnant women at risk of nutrient deficiencies because of diet limitations or restrictions. The most common components in prenatal vitamins include vitamins B 6 , folate , B 12 , C , D , E , iron and calcium . Sufficient intake of vitamin B 6 can lower
11136-491: The mother's health other than a risk reduction on low pre-delivery serum folate and megaloblastic anemia. There is little evidence to suggest that vitamin D supplementation improves prenatal outcomes in hypertensive disorders and gestational diabetes . Evidence does not support the routine use of vitamin E supplementation during pregnancy to prevent adverse events, such as preterm birth, fetal or neonatal death, or maternal hypertensive disorders. Iron supplementation can lower
11252-462: The neck is absent. The skin of the face connects directly to the chest and the scalp connects to the upper back. Individuals with iniencephaly generally die within a few hours after birth. Spina bifida is further divided into two subclasses, spina bifida cystica and spina bifida occulta. Inadequate levels of folate (vitamin B 9 ) and vitamin B 12 during pregnancy have been found to lead to increased risk of NTDs. Although both are part of
11368-782: The petitioners as unjustified restrictions of consumer choice . In 2004, along with two British trade associations, the Alliance for Natural Health (ANH) had a legal challenge to the Food Supplements Directive referred to the European Court of Justice by the High Court in London. Although the European Court of Justice's Advocate General subsequently said that the bloc's plan to tighten rules on
11484-538: The plants named as the dietary supplement ingredients in the products. One scientist said that it was possible that the extraction process used to create the supplements removed or destroyed all DNA. This, however, would not explain the presence of DNA from plants such as rice or wheat, that were not listed as ingredients. A study of dietary supplements sold between 2007 and 2016 identified 776 that contained unlisted pharmaceutical drugs , many of which could interact with other medications and lead to hospitalization. 86% of
11600-493: The potential clinical efficacy of supplements for maintaining health or lowering disease risk. As continual research on the properties of supplements accumulates, databases or fact sheets for various supplements are updated regularly, including the Dietary Supplement Label Database, Dietary Supplement Ingredient Database, and Dietary Supplement Facts Sheets of the United States. In Canada where
11716-902: The potential health properties and safety of dietary supplements are the European Food Safety Authority , the Office of Dietary Supplements of the United States National Institutes of Health , the Natural and Non-prescription Health Products Directorate of Canada, and the Therapeutic Goods Administration of Australia. Together with public and private research groups, these agencies construct databases on supplement properties, perform research on quality, safety, and population trends of supplement use, and evaluate
11832-466: The pregnancy is low risk to develop a neural tube defect then the recommendation for that individual is 0.4 mg daily until 4–6 weeks postpartum or however long breastfeeding lasts. All dose recommendations and risk assessment should be done with the advice of a qualified health care provider. As of 2008, treatments of NTDs depends on the severity of the complication. No treatment is available for anencephaly and infants usually do not survive more than
11948-430: The pregnancy. The cause of these injuries/development is not clear. Theories regarding the causes of hydrancephaly include: Iniencephaly is a rare neural tube defect that results in extreme bending of the head to the spine. The diagnosis can usually be made on antenatal ultrasound scanning, but if not will undoubtedly be made immediately after birth because the head is bent backwards and the face looks upwards. Usually
12064-421: The quantity of their consumption). The classes of nutrient compounds in supplements include vitamins , minerals , fiber , fatty acids , and amino acids . Dietary supplements can also contain substances that have not been confirmed as being essential to life, and so are not nutrients per se, but are marketed as having a beneficial biological effect, such as plant pigments or polyphenols . Animals can also be
12180-537: The risk of iron deficiency anemia for pregnant women. In 2020, the World Health Organization updated recommendations for adequate calcium levels during pregnancy to prevent hypertensive disorders . Individuals with hypokalemic sensory overstimulation are sometimes diagnosed as having attention deficit hyperactivity disorder (ADHD), raising the possibility that a subtype of ADHD has a cause that can be understood mechanistically and treated in
12296-433: The risk of early pregnancy loss and relieve symptoms of morning sickness . Folate is also an essential nutrient for pregnant women to prevent neural tube defects . In 2006, the World Health Organization endorsed the recommendation for women of child-bearing age to consume 400 micrograms of folate through the diet daily if planning a pregnancy. A 2013 review found folic acid supplementation during pregnancy did not affect
12412-975: The risk of neural tube defects. All of the above may act by interference with some aspect of normal folic acid metabolism and folate linked methylation related cellular processes as there are multiple genes of this type associated with neural tube defects. Folic acid supplementation reduces the prevalence of neural tube defects by approximately 70% of neural tube defects indicating that 30% are not folate-dependent and are due to some cause other than alterations of methylation patterns. Multiple other genes related to neural tube defects exist which are candidates for folate insensitive neural tube defects. There are also several syndromes such as Meckel syndrome , and triploid syndrome which are frequently accompanied by neural tube defects that are assumed to be unrelated to folate metabolism Tests for neural tube defects include ultrasound examination and measurement of maternal serum alpha-fetoprotein ( MSAFP ). Second trimester ultrasound
12528-485: The risks of serious birth defects. In Canada, mandatory fortification of selected foods with folic acid had been shown to reduce the incidence of neural tube defects by 46% compared to incidence prior to mandatory fortification. However, relying on eating a folate-rich diet alone is not recommended for preventing neural tube defects when trying to conceive because a regular diet usually does not contain enough folate to reach pregnancy requirements. All individuals who have
12644-401: The sale of vitamins and food supplements should be scrapped, he was eventually overruled by the European Court, which decided that the measures in question were necessary and appropriate for the purpose of protecting public health . ANH, however, interpreted the ban as applying only to synthetically produced supplements, and not to vitamins and minerals normally found in or consumed as part of
12760-415: The same biopathway, folate deficiency is much more common and therefore more of a concern. Folate is required for the production and maintenance of new cells, for DNA synthesis and RNA synthesis. Folate is needed to carry one carbon groups for methylation and nucleic acid synthesis. It has been hypothesized that the early human embryo may be particularly vulnerable to folate deficiency due to differences of
12876-583: The spermatic function and many of the over-the-counter supplements are not scientifically proven to improve fertility." There is low quality and insufficient evidence for the use of oral antioxidant supplements as a viable treatment for subfertile woman. A review provided evidence that taking dehydroepiandrosterone before starting an in vitro fertilization series may increase pregnancy rates and decrease miscarriage likelihood. Prenatal vitamins are dietary supplements commonly given to pregnant women to supply nutrients that may reduce health complications for
12992-452: The standard US Pharmacopeia (USP) method for measuring the B 12 content does not measure the B 12 directly. Instead, it measures a bacterial response to the food. Chemical variants of the B 12 vitamin found in plant sources are active for bacteria, but cannot be used by the human body. This same phenomenon can cause significant over-reporting of B 12 content in other types of foods as well. A common way to increase vitamin B intake
13108-418: The surface ectoderm and the neuroectoderm after the closure of the neural folds in the fourth week of gastrulation. Hydranencephaly is a condition in which the cerebral hemispheres are missing and instead filled with sacs of cerebrospinal fluid. People are born with hydranencephaly, but most of the time, the symptoms appear in a later stage. Newborns with hydrancephaly can swallow, cry, sleep and their head
13224-408: The transportation of oxygen through blood. Several named vitamin deficiency diseases may result from the lack of sufficient B vitamins. Deficiencies of other B vitamins result in symptoms that are not part of a named deficiency disease. Because water-soluble B vitamins are eliminated in the urine, taking large doses of certain B vitamins usually only produces transient side effects (only exception
13340-563: Was later amended to include calcium supplements with or without vitamin D, effective January 1, 2010. Examples of allowed wording are shown below. In order to qualify for the calcium health claim, a dietary supplement must contain at least 20% of the Reference Dietary Intake, which for calcium means at least 260 mg/serving. In the same year, the European Food Safety Authority also approved
13456-522: Was started. The number of deaths in the US each year due to neural tube defects also declined from 1,200 before folate fortification was started to 840. There are two classes of NTDs: open , which are more common, and closed . Open NTDs occur when the brain and/or spinal cord are exposed at birth through a defect in the skull or vertebrae (spinal column). Open NTDs include anencephaly , encephaloceles , hydranencephaly , iniencephaly , schizencephaly , and
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