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Subject: CCNFSDU: NRV's Electronic Working Group
Dear Working Group Member,
At the recent CCNFSDU meeting in Bonn (November 2003), an
electronic Working
Group was established under the leadership of South Africa to
update the Nutrient
Reference values [Codex Guidelines on Nutrition Labeling -
CAC/GL 2-1985 (Rev.1 - 1993)].
Interested members are now invited to forward proposals for
additional or
revised NRV's for labeling purposes to the following e-mail
address before or
on 31 March 2004:
E-mail: booyza@health.gov.za
Regards,
Antoinette Booyzen
South Africa
____________________________________________________
Dear Antoinette,
I enclose (as a Microsoft Word attachment) the National Health
Federation's
proposals for additional/revised NRVs. I would also be
grateful if you could
confirm to me that the document has been safely received and
that you have
been able to open it successfully.
Hope all is well with you.
Kind regards,
Paul Anthony Taylor
on behalf of the National Health Federation (NHF)
____________________________________________________
Proposals of the National Health Federation for
additional/revised Codex NRVs for labeling purposes
Contents
NHF Contact Details
Introduction
Vitamin A
Vitamin B1
Vitamin B2
Niacin
Pantothenic Acid
Vitamin B6
Vitamin B12
Folate
Biotin
Vitamin C
Vitamin D
Vitamin E
Vitamin K
Boron
Calcium
Copper
Chromium
Iodine
Iron
Magnesium
Manganese
Molybdenum
Selenium
Zinc
References
Introduction
The World Health Organization currently attributes one-third
of all global deaths annually (15.3 million) to cardiovascular
disease (332), and in 2000 over 6 million deaths occurred
globally from cancer (333). Moreover, estimates predict that
by 2020 the total number of cases of cancer will have
increased by 73% in the developing world and by 29% in the
developed world. (333). By 2020 it is estimated that chronic
diseases will account for almost three-quarters of all deaths
worldwide (561).
Faced with these statistics we are forced to question the
wisdom of assuming that populations are healthy merely because
they don’t suffer from classical nutritional deficiency
diseases such as scurvy, rickets, beri-beri or pellagra.
Current estimates of nutritional sufficiency, be they RDAs,
AIs, EARs or NRVs, do not set nutritional intakes with the
concept of optimum health in mind. They are simply estimates
of the amounts of nutrients that healthy populations would
require to maintain normal function and health and to avoid
nutritional deficiency diseases. This approach, in our
opinion, is highly flawed.
Given the increasing prevalence in our societies of conditions
such as cardiovascular disease, cancer, obesity, diabetes,
asthma, eczema, psoriasis, allergies, arthritis, high blood
pressure, osteoporosis and depression, we believe that by
definition our current system of nutritional values is no
longer applicable.
Moreover, the consistency of evidence in the scientific
literature clearly demonstrates that individuals who consume
nutritional supplements have a lower risk of contracting
serious disease - a position that has now been taken by two of
the world's leading medical journals.
The Journal of the American Medical Association, for example,
recently reversed its historical anti-vitamin policy by
acknowledging that "it appears prudent for all adults to take
vitamin supplements" (562). The article, authored by Robert H.
Fletcher and Kathleen M. Fairfield from the Harvard School of
Medicine, examined English-language articles about vitamins in
relation to chronic diseases published between 1966 and 2002,
and concluded that inadequate intake of several vitamins has
been linked to the development of diseases including coronary
heart disease, cancer, and osteoporosis.
Similarly, the April 9, 1998 issue of the New England Journal
of Medicine featured an article entitled "Eat Right and Take a
Multivitamin" that was based on a succession of positive
studies showing the disease-prevention benefits resulting from
the consumption of nutritional supplements (563).
We therefore consider that it would be a major step forward
for global public health if the CCNFSDU were to finally accept
and support the growing medical evidence that vitamin and
mineral supplements prevent disease, promote optimum health
and prolong lifespan.
Research has shown that there appears to be little-to-no risk
to supplement users of experiencing adverse side effects due
to excessive intakes of micronutrients (564).
We therefore propose the NRVs contained in this document as
the minimum preventative intakes necessary to prevent disease,
promote optimum health and prolong lifespan in the majority of
people.
We also strongly believe that it is the duty of the CCNFSDU to
make recommendations that advance nutritional welfare, prevent
disease, promote optimum health and prolong lifespan and that
as such a general recommendation supporting the use of
nutritional supplements would admirably fulfill all of these
criteria.
Paul Anthony Taylor
NHF Board Member & Codex Delegate
29th March 2004
Vitamin A
Note: Includes provitamin A carotenoids that are dietary
precursors of retinol. Given as retinol activity equivalents (RAEs).
1 RAE = 1 µg retinol, 12 µg beta-carotene.
Infants
0-6 mo 400µg
7-12 mo 500µg
Children
1-3 y 500µg
4-8 y 650µg
Males
9-13 y 1050µg
14-18 y 1680µg
19-30 y 1800µg
31-50 y 1800µg
50-70 y 1800µg
> 70 y 1800µg
Females
9-13 y 880µg
14-18 y 1350µg
19-30 y 1400µg
31-50 y 1400µg
50-70 y 1400µg
> 70 y 1400µg
Pregnancy
≤ 18 y 1550µg
19-30y 1600µg
31-50 y 1600µg
Lactation
≤ 18 y 1750µg
19-30y 1800µg
31-50 y 1800µg
Justification: The Helsinki Consultation in 1988 set a NRV for
vitamin A of 800 microgrammes of retinol equivalent. In
setting this figure the Consultation took into consideration
the relation between carotene and the prevention of cancer,
and stated that although this subject had not yet been
resolved from the scientific point of view, it considered that
this aspect might lead to an increase in the international
recommended daily intakes in the future when new scientific
data was available. Since 1988 however a large body of
scientific evidence has clearly demonstrated that higher
intakes of carotenes and/or preformed vitamin A are protective
against the development of a number of cancers. (1-23).
Although some research exists to suggest that large doses of
beta-carotene may possibly be capable of increasing the risk
of lung cancer in smokers, we consider that in view of the
many important health benefits to be obtained from higher
intakes of carotenes it would be irresponsible for the CCNFSDU
to recommend lower intakes for the entire population, as a
means of protecting smokers, when official WHO policy is to
substantially reduce the incidence of tobacco use. Tobacco,
not carotene, is the main cause of lung cancer in smokers.
We also consider that the case for vitamin A being linked to
birth defects has been overstated in some cases. In one study,
for example, no birth defects were reported among 120 infants
exposed to maternal intakes of vitamin A greater than 50,000
IU per day. (24). In addition, compared to the infants that
were not exposed to high maternal doses of vitamin A the
infants in this study that were exposed to high doses actually
experienced a 50% decreased risk for birth defects. In fact,
excessive dietary intake of vitamin A has been associated with
birth defects in humans in fewer than 20 reported cases over
the past 30 years. (25). Other data suggests that 30,000 IU of
vitamin A per day should be considered safe for pregnant
women. (26).
Vitamin B1
Infants
0-6 mo 3mg
7-12 mo 6mg
Children
1-3 y 8mg
4-8 y 13mg
Males
9-13 y 23mg
14-18 y 37mg
19-30 y 40mg
31-50 y 40mg
50-70 y 40mg
> 70 y 40mg
Females
9-13 y 23mg
14-18 y 37mg
19-30 y 40mg
31-50 y 40mg
50-70 y 40mg
> 70 y 40mg
Pregnancy
≤ 18 y 38mg
19-30y 41mg
31-50 y 41mg
Lactation
≤ 18 y 39mg
19-30y 42mg
31-50 y 42mg
Justification: There is now a wealth of research demonstrating
that higher intakes of thiamin can improve general health and
prevent disease. (27-49). This research also includes evidence
that currently used assays may not be adequate to assess
thiamin status, and that thiamin deficiency is under diagnosed
in life, in part because the classical clinical presentations
are uncommon.
Furthermore, given that some of this research has shown that
alcohol use, even moderate, interferes with thiamin metabolism
(more so than with any other nutrient), we consider this
increase in the NRV for thiamin to be both appropriate and
essential.
No adverse effects associated with thiamin from food or
supplements have ever been reported.
Vitamin B2
Infants
0-6 mo 3mg
7-12 mo 6mg
Children
1-3 y 8mg
4-8 y 13mg
Males
9-13 y 23mg
14-18 y 37mg
19-30 y 40mg
31-50 y 40mg
50-70 y 40mg
> 70 y 40mg
Females
9-13 y 23mg
14-18 y 37mg
19-30 y 40mg
31-50 y 40mg
50-70 y 40mg
> 70 y 40mg
Pregnancy
≤ 18 y 38mg
19-30y 41mg
31-50 y 41mg
Lactation
≤ 18 y 39mg
19-30y 42mg
31-50 y 42mg
Justification: Riboflavin has been shown to be protective
against the development of degenerative diseases (62, 68), and
studies have repeatedly demonstrated that worldwide intakes of
riboflavin are below recommended values (50, 51, 52, 55, 59,
65).
Research has also shown that supplementation of riboflavin can
improve health and wellbeing; either taken with other
nutrients (53, 54, 60, 63, 69), or alone (56, 58); and that
early detection of vitamin deficiency is difficult to diagnose
due to the fact that it often occurs without any of the
clinical signs of vitamin deficiency being present. (53).
Given that riboflavin intake has additionally been found to be
inversely associated with coronary heart and vascular disease
deaths and hospitalizations, as well as being a contributory
factor in a number of other disease conditions when intake is
insufficient (61, 64, 67), we consider this increase in the
NRV for riboflavin to be entirely appropriate. (57).
Finally, we also note that a supplement of 15mg riboflavin has
been shown to be insufficient to achieve normal biochemical
indices in pregnancy (66), and that no adverse effects
associated with riboflavin from food or supplements have been
reported.
Niacin
Includes nicotinic acid amide, nicotinic acid
(pyridine-3-carboxylic acid), and derivatives that exhibit the
biological activity of nicotinamide.
Infants
0-6 mo 15mg
7-12 mo 30mg
Children
1-3 y 40mg
4-8 y 60mg
Males
9-13 y 120mg
14-18 y 190mg
19-30 y 200mg
31-50 y 200mg
50-70 y 200mg
> 70 y 200mg
Females
9-13 y 120mg
14-18 y 190mg
19-30 y 200mg
31-50 y 200mg
50-70 y 200mg
> 70 y 200mg
Pregnancy
≤ 18 y 200mg
19-30y 210mg
31-50 y 210mg
Lactation
≤ 18 y 205mg
19-30y 215mg
31-50 y 215mg
Justification: Increased consumption of niacin has been shown
to prevent a range of diseases, illnesses and adverse health
events; including heart attacks (70), migraine headaches (71),
and cancer (72, 73). It has also been found to be effective in
the treatment of schizophrenia (74-80), arthritis and joint
disorders (81, 82), insulin-dependent diabetes (83), and
hypoglycemia (84), and has repeatedly been shown to lower
blood levels of cholesterol and triglycerides (85-93).
Pantothenic Acid
Infants
0-6 mo 15mg
7-12 mo 30mg
Children
1-3 y 40mg
4-8 y 60mg
Males
9-13 y 120mg
14-18 y 190mg
19-30 y 200mg
31-50 y 200mg
50-70 y 200mg
> 70 y 200mg
Females
9-13 y 120mg
14-18 y 190mg
19-30 y 200mg
31-50 y 200mg
50-70 y 200mg
> 70 y 200mg
Pregnancy
≤ 18 y 200mg
19-30y 210mg
31-50 y 210mg
Lactation
≤ 18 y 205mg
19-30y 215mg
31-50 y 215mg
Justification: Pantothenic acid and its natural derivatives
have been shown to prevent and alleviate arthritis (94, 95);
lower levels of cholesterol and other lipids (96-100); boost
energy and athletic ability (101); and improve immune response
(102).
Vitamin B6
Infants
0-6 mo 3mg
7-12 mo 7mg
Children
1-3 y 10mg
4-8 y 16mg
Males
9-13 y 29mg
14-18 y 47mg
19-30 y 50mg
31-50 y 50mg
50-70 y 50mg
> 70 y 50mg
Females
9-13 y 29mg
14-18 y 47mg
19-30 y 50mg
31-50 y 50mg
50-70 y 50mg
> 70 y 50mg
Pregnancy
≤ 18 y 49mg
19-30y 52mg
31-50 y 52mg
Lactation
≤ 18 y 50mg
19-30y 53mg
31-50 y 53mg
Justification: Studies in the elderly have repeatedly shown
prevalences of B6 deficiency of around 25% (103). The
prevalence of B6 deficiency, demonstrated biochemically, in
population studies in developed countries, generally ranges
from 9% in pre-school children (104), to 68% in pregnant women
on low incomes (105). Studies in adults repeatedly show
prevalences of B6 deficiency of around 25% (106).
Oral contraceptives have been shown to deplete levels of
vitamin B6 (110-114). Not surprisingly then, vitamin B6
supplements can restore normal biochemical values (115, 116)
and protect against metabolic imbalances in women taking these
drugs (117).
Vitamin B6 supplements have also been shown to boost immunity
in the elderly (107), reduce the risk of developing kidney
stones in women (108), and relieve symptoms of pre-menstrual
tension (109); as well as being effective in the treatment of
autism (118), asthma (119), sickle cell anaemia (120), and
morning sickness (121, 122). It has additionally been shown
that patients with carpal tunnel syndrome are deficient in
vitamin B6 (123), and that vitamin B6 is an effective
treatment for this disorder (124, 125). Researchers have also
demonstrated that levels of homocysteine, a risk factor for
heart disease and stroke, can be reduced by supplements of
vitamin B6, vitamin B12 and folic acid (126-129), and that
levels of vitamins B6 are inversely related to homocysteine
levels (126, 130). Levels of vitamin B6 are also inversely
related to risk of lung cancer in men. (131).
Finally, we note that vitamin B6 is considered safe during
pregnancy, and that it has been used in pregnant women without
any evidence of foetal harm (132). Furthermore, it has also
been found to have a positive effect upon pregnancy outcome
(133), and to prevent certain types of seizures in infants
(134).
Given all of the above evidence therefore, we consider this
increase in the NRV for pyridoxine to be entirely appropriate.
Vitamin B12
Infants
0-6 mo 7µg
7-12 mo 15µg
Children
1-3 y 20µg
4-8 y 30µg
Males
9-13 y 60µg
14-18 y 90µg
19-30 y 100µg
31-50 y 100µg
50-70 y 100µg
> 70 y 100µg
Females
9-13 y 60µg
14-18 y 90µg
19-30 y 100µg
31-50 y 100µg
50-70 y 100µg
> 70 y 100µg
Pregnancy
≤ 18 y 94µg
19-30y 104µg
31-50 y 104µg
Lactation
≤ 18 y 97µg
19-30y 107µg
31-50 y 107µg
Justification: A number of population groups have been shown
to have dietary intakes below the RDA for vitamin B12
(135-137), and vitamin B12 deficiency is estimated to affect
10%-15% of individuals over the age of 60 (138). Vitamin B12
deficiency becomes increasingly common with advancing age
(139), and current findings in the scientific literature
suggest that even subtle B12 deficiency is clinically
significant (140). Frank deficiencies carry many health risks,
and low serum levels of vitamin B12 are known to increase the
risk of breast cancer in women (141), as well as being
associated with a doubling of the risk of developing
Alzheimer's disease (142).
Vitamin B12, when taken with folic acid, has been shown to be
effective in the treatment of osteoarthritic hands (143), and
has been found to reduce the incidence of bronchial squamous
metaplasia, a precancerous change - even in heavy smokers
(144-145). It has also been demonstrated to be capable of
curing sciatica (146), reversing some of the effects of
chronic nitrous oxide exposure (147), and when taken with the
amino acid carnitine, has been shown to be effective in the
treatment of anorexia nervosa (148).
There is now abundant evidence that high levels of
homocysteine are associated with an increased risk of
developing cardiovascular disease (149-161), and that serum
levels of vitamin B12 are inversely related to homocysteine
levels (162-163). It has also been shown that a deficiency of
vitamin B12 can raise levels of homocysteine (164), and that
supplementation with combinations of folic acid, vitamin B6
and vitamin B12 is an effective means to reduce elevated
levels of homocysteine (165-168). Raised levels of
homocysteine have also been shown to increase the risk of
developing Alzheimer's disease (169).
Observational studies have found that as many as 30% of
patients hospitalized for depression are deficient in vitamin
B12 (170), and that vitamin B12 deficient women over the age
of 65 are twice as likely to be severely depressed as
non-deficient women (171). Indeed, there is also
epidemiological evidence that even a moderate deficiency of
vitamin B12 may lead to mental illness (172).
Supplementation of vitamin B12 has been shown to have a
significant positive effect upon memory (173), and to improve
emotional state, even in the absence of deficiency (174).
Studies have additionally shown that vitamin supplements that
include vitamin B12 are associated with better performance on
difficult visuospatial and abstraction tests (175), and that
regular use of such supplements confers some degree of
protection against vitamin B12 deficiency in older adults
(176).
Finally, researchers have also shown that vitamin B-12
dependency disorders are common and that they are neglected by
the medical profession (174), and that the cut-off point of
serum concentration should be raised, because many elderly
people with "normal" serum vitamin B12 concentrations are
metabolically deficient in cobalamin (177).
We therefore have no hesitation in recommending the above
increase in the NRV for vitamin B12.
Folate
Infants
0-6 mo 65µg
7-12 mo 120µg
Children
1-3 y 155µg
4-8 y 260µg
Males
9-13 y 465µg
14-18 y 750µg
19-30 y 800µg
31-50 y 800µg
50-70 y 800µg
> 70 y 800µg
Females
9-13 y 465µg
14-18 y 750µg
19-30 y 800µg
31-50 y 800µg
50-70 y 800µg
> 70 y 800µg
Pregnancy
≤ 18 y 780µg
19-30y 830µg
31-50 y 830µg
Lactation
≤ 18 y 815µg
19-30y 865µg
31-50 y 865µg
Justification: Many studies have shown that an inadequate
intake of folate is relatively common (178-187), and research
over the past 30 years has demonstrated a relationship between
folic acid deficiency and psychopathology (188).
Neuropsychiatric diseases secondary to folate deficiency may
include dementia, schizophrenia-like syndromes, insomnia,
irritability, forgetfulness, endogenous depression, organic
psychosis, peripheral neuropathy, myelopathy, and restless
legs syndrome (189). Low serum folate levels are also known to
be associated with a doubling of the risk of developing
Alzheimer's disease (142).
Higher levels of folate however have been shown to be related
to a lower incidence of nuclear lens opacities, which are
associated with the development of cataracts (193).
Data from the Nurses' Health Study conducted at the Harvard
Medical School found that long-term supplementation with folic
acid reduces the risk of colon cancer in women by 75% (190).
Indeed, there is an inverse relationship between the intake of
folate and the risk of developing various esophageal and
gastric cancers (191), and folic acid is known to be effective
in the treatment of atrophic gastritis, where it prevents or
reverses precancerous lesions (192). Furthermore, folic acid
taken with vitamin B12 has been found to be effective in the
treatment of osteoarthritic hands (143), and in the reduction
of the incidence of bronchial squamous metaplasia (a
precancerous change) - even in heavy smokers (144-145).
Folic acid supplements have also been shown to reduce blood
pressure in smokers (194), and research has established that
supplementing the diet with vitamins C, E, B6 and folate is
conducive to the prevention of cardiovascular disease (195).
In this respect there is now abundant evidence that high
levels of homocysteine are associated with an increased risk
of developing conditions such as cardiovascular disease
(149-161) and Alzheimer's disease (169), and studies have
shown that supplementation with combinations of folic acid,
vitamin B6 and vitamin B12 is an effective means to reduce
elevated levels of homocysteine (165-168).
High levels of homocysteine accompanied by low levels of
folate are also known to be risk factors for heart attack
(197). This link has been further established through research
showing that folic acid supplements can reduce levels of
homocysteine (198) and hence protect against heart attacks
(199). As such it is noteworthy that children with a family
history of CVD have been found to have lower intakes of folate,
lower serum folate levels, and higher levels of homocysteine
(196), and that supplements of folic acid, vitamin B6 and
vitamin B12 have even been shown to reduce the progression of
atherosclerosis in hyperhomocysteinemic renal-transplant
recipients (200).
Scientific evidence has now clearly demonstrated that women
given folic acid supplements during pregnancy have a lower
incidence of delivering babies with neural tube birth defects
(201-203), and researchers have therefore emphasised the
importance of all fertile women, regardless or not of whether
they are intending to become pregnant, taking daily
multivitamins that contain 400µg (0.4 mg) of folic acid (204).
Folic acid-containing multivitamins have additionally been
shown to reduce the risk of gestational hypertension (205).
It is now known that in the elderly even moderate folate
depletion will only respond to an intake of folate in excess
of the RDA (206). Researchers have also shown that folic acid
supplements are more effective than increased dietary folate
intake in elevating serum folate levels (207). Indeed, the use
of nutritional supplements is particularly beneficial in
promoting adequate intakes of folate in women aged 18-50 years
(208), and research has made it clear that people who do not
take folic acid supplements are at increased risk for
functional folate deficiency (209).
Given that research has already shown that the current RDA for
folate is insufficient to attain optimal homocysteine levels
(210), and that micronutrients both prevent cancer and delay
aging (211), there can now be little doubt that the Helsinki
Consultation’s recommendation to reduce the NRV for folate
from 400µg to 200µg was a step in the wrong direction.
Biotin
Infants
0-6 mo 60µg
7-12 mo 120µg
Children
1-3 y 155µg
4-8 y 260µg
Males
9-13 y 465µg
14-18 y 750µg
19-30 y 800µg
31-50 y 800µg
50-70 y 800µg
> 70 y 800µg
Females
9-13 y 465µg
14-18 y 750µg
19-30 y 800µg
31-50 y 800µg
50-70 y 800µg
> 70 y 800µg
Pregnancy
≤ 18 y 780µg
19-30y 830µg
31-50 y 830µg
Lactation
≤ 18 y 810µg
19-30y 860µg
31-50 y 860µg
Justification: There is good evidence that
biotin deficiency is by no means uncommon (212-216). Biotin is
essential for numerous biochemical, dermatological and
neurological processes, and long-term auditory and visual
complications can result from a deficiency in this nutrient
(217, 218). Biotin deficiency has also been found to cause mitochondrial decay with oxidant leakage leading to
accelerated aging and neural decay (219). Biotin has
furthermore been shown to improve glucose metabolism
(220-223), and research suggests that biotin supplements may
be particularly useful in the prevention of diabetes (224).
High doses of biotin may also synergize with chromium
picolinate to enable a definitive nutritional therapy for type
II diabetes, and may likewise be useful in the prevention and
management of gestational diabetes, as well as being an aid to
glycemic control in type I patients. (225). Indeed, drugs such
as metformin and troglitazone, which are expensive and require
regular physician monitoring to avoid potentially dangerous
side effects, would appear to be less practical options from
cost-effectiveness, convenience and safety standpoints, given
the fact that the population at risk for diabetes is huge.
(226). Finally, biotin supplements have also been found to
effect a marked improvement in patients suffering from severe
diabetic peripheral neuropathy (227), and have been shown to
significantly increase the growth rate and strength of hair in
children (228). Worldwide, the number of cases of diabetes is
estimated to be around 150 million, and is expected to double
by 2025 (229). Because of the wealth of research demonstrating
the ability of biotin supplements to both prevent diabetes and
improve glucose metabolism we have no hesitation in
recommending the above NRVs.
Vitamin C
Infants
0-6 mo 200mg
7-12 mo 400mg
Children
1-3 y
600mg
4-8 y 1000mg
Males
9-13 y 1750mg
14-18 y 2800mg
19-30 y
3000mg
31-50 y 3000mg
50-70 y 3000mg
> 70 y 3000mg
Females
9-13 y 1750mg
14-18 y 2800mg
19-30 y 3000mg
31-50 y 3000mg
50-70 y 3000mg
> 70 y 3000mg
Pregnancy
≤ 18 y 2900mg
19-30y
3100mg
31-50 y 3100mg
Lactation
≤ 18 y 3000mg
19-30y 3200mg
31-50 y 3200mg
Justification: Studies have shown that several population
groups have an inadequate intake of vitamin C, and that
deficiencies of ascorbic acid are far more prevalent than is
commonly believed (230-241). Moreover, patients suffering from
dementia (242), epilepsy (243), preeclampsia (244, 245),
gallbladder disease (246), schizophrenia (247, 248), coronary
artery disease (249-253), cerebral vascular disease (254),
esophageal, stomach and colorectal cancers (255, 256) and
gastric cancer (257), have all been found to have
significantly lower levels of vitamin C than are found in
normal healthy people.
Similarly, the risk of stroke has been shown to increase
significantly with a decreased intake of vitamin C (258), and
low levels of ascorbic acid are implicated in the development
of gastric cancer (259-261), periodontal disease (262), and
cardiovascular disease (263). A high intake of ascorbic acid,
on the other hand, has been found to be protective against the
development of gastric cancer (264-269, 292-296), as well as
cancers of the esophagus (270), uterus (290), oral cavity,
stomach, pancreas, cervix, rectum, lung (291), breast (291,
298, 299), ovaries (310), and others (271). In this respect it
is interesting to note that megadoses of vitamin C and other
nutrients have been shown to significantly reduce the
recurrence of tumours in patients with bladder cancer (297),
and that male smokers with a high intake of vitamin C have
been shown to have a lower risk of cancer than male smokers
with a lower intake of vitamin C (300).
Hospital patients with low levels of ascorbic acid have a
greater frequency of postoperative complications, and
administering ascorbic acid until blood levels returned to
normal has been proven to prevent postoperative complications
(327). Other researchers have demonstrated that a mixture of
vitamins C, E and A also dramatically reduces the
postoperative complication rate (328).
People with the highest levels of vitamin C have also been
found to have a significantly lower incidence of nuclear
opacities. In fact, it has been found that the longer the
duration that vitamin C supplements are taken for the lower is
the prevalence of nuclear opacities. This has led researchers
to conclude that vitamin C plays a strong role in preventing
nuclear opacities (272). Other studies recommend the use of
vitamin C and other antioxidant supplements in the prevention
of age-related cataract and macular degeneration (273), and
research also shows that that ascorbic acid can protect the
cornea from ultraviolet radiation (274).
Research has shown that a high dietary intake of vitamin C and
vitamin E may lower the risk of Alzheimer disease (329). Other
researchers have confirmed this, and have demonstrated that
long-term supplement users of vitamin E with vitamin C have
significantly better mental performance than do people who
have never used vitamin E or vitamin C supplements (331), and
that vitamins C and E may prevent dementia and improve
cognitive functioning in later life (330).
Studies have also confirmed that vitamin C has a protective
effect against the development of coronary heart disease (275,
276), and that vitamin C is beneficial in preventing the
advancement of arteriosclerosis in heart transplant patients
(277). Indeed, researchers have shown that human
cardiovascular disease is the direct consequence of the
inability of man to synthesize ascorbate in combination with
insufficient intake of ascorbate in the modern diet. Since
ascorbate deficiency is the common cause of human CVD,
ascorbate resupplementation is the universal treatment for
this disease (278). As such, the therapeutic use of vitamin C
and other nutrients may well pave the way towards a new
therapeutic goal, namely, the noninvasive reversal of existing
cardiovascular disease with nutritional supplements (279). In
that respect it is now increasingly clear that vitamin C
should be used in the treatment of coronary arterial disease
patients, and those with heart attacks, strokes, or
hypertension (301).
A daily dose of 2700 mg of Vitamin C, when taken with other
nutrients, has been shown to halt the progression of early
coronary atherosclerosis (280), and other researchers have
similarly found that the combination of vitamin C and vitamin
E can slow the advancement of atherosclerosis (281).
Furthermore, a review of studies of vitamins A, C and E and
cardiovascular disease found significant evidence to support
the supplementation of these vitamins to lower the risk of
death from this illness, and concluded that diabetics, smokers
and those with hypertension would all benefit from taking
supplemental vitamin C (282). As such, it is now clear that
the progression of early stages of coronary calcifications can
be stopped or limited by the synergistic effect of vitamins
and essential nutrients (283, 289), and that supplementing the
diet with nutrients including vitamins C, E, B6 and folate is
conducive to the prevention of cardiovascular disease (284).
In this respect it is also interesting to note that some
researchers particularly recommend dietary supplementation of
vitamin C and E in Northern Europe, where cardiovascular
disease is most prevalent (285).
Deaths from stomach cancer and cardiovascular disease and
cerebrovascular disease are all associated with low levels of
vitamin C (286); in fact it has been demonstrated that
mortality for all causes of death decreases strongly with an
increased intake of supplemental vitamin C (287). A study of
8,453 Americans’ serum ascorbic acid (SAA) levels and
mortality rates from disease, for example, found that those
with a normal to high level of SAA had a 21%-25% lower risk of
dying from cardiovascular disease, and that they had a 25%-29%
decrease in risk of mortality from all causes compared to
those with low levels of SAA (288).
Vitamin C supplements have also been shown to improve the
body’s ability to metabolize glucose and lipids and as such
are seen as being beneficial to those with Type II diabetes
(302). Similarly, people with higher levels of vitamin C have
been found to have a lower incidence and risk of hyperglycemia
(303).
Critically ill surgery patients have been shown to be
significantly less likely to experience organ failure, spend
less time using mechanical ventilation and have shorter times
in intensive care units when they are given supplements of
vitamin C and vitamin E (304).
Vitamin C supplements have been shown to be an effective
treatment for hypertension, both in non-diabetics (305-308),
and in diabetics (309), and have been found to reduce muscle
soreness and improve muscle function after exercise (317,
318).
Research has also demonstrated the ability of higher doses of
vitamin C to delay bone loss (311), and to increase bone
density (312). Similarly, an increased intake of vitamins C
and E has been shown to reduce the risk of hip fractures
(313).
Studies have also found that the duration and severity of
colds can be decreased by an increased intake of vitamin C
(314, 315), and that doses of vitamin C between 500-2000mg
improve antioxidant protection (316).
Some researchers have argued for higher intakes of vitamin C
to be recommended for populations chronically exposed to air
pollutants (such as ozone), cigarette smoking, or those doing
vigorous exercise (319). Other studies have made similar
recommendations for people who are exposed to passive smoking
(320, 321). Indeed, it has been shown that high doses of
vitamin C can reduce or eliminate the negative effect that
smoking has on blood flow (322), and that vitamin C
supplements can protect against the cardiovascular problems
caused by cigarette smoke inhalation (323). In this respect it
is also interesting to note that vitamin C supplements have
been shown to significantly reduce cholesterol, LDL-C and
triglycerides, as well as increase serum HDL (324).
Researchers also recommend that people who are smokers,
diabetics, pregnant, users of antibiotics, people who ingest
alcohol, and users of contraceptives all need to supplement
with vitamin C. (325). Indeed, vitamin C is depleted in women
who use oral contraceptives, which may result in cardiac
problems and thrombosis. (326). Since vitamin supplements are
routine for pregnancy, they should also be routine for the
pseudopregnancy of oral contraception (326).
Finally, we note that the World Health Organization currently
attributes one-third of all global deaths annually (15.3
million) to cardiovascular disease (332), and that in 2000
over 6 million deaths occurred from cancer (333). Moreover,
estimates predict that by 2020 the total number of cases of
cancer will have increased by 73% in the developing world and
by 29% in the developed world. (333). Given therefore the
proven safety and efficacy of ascorbic acid in the prevention
and treatment of both cardiovascular disease and cancer, we
have no hesitation in recommending the above NRVs for this
nutrient.
Vitamin D
Note: 1µg calciferol = 40 IU vitamin D.
Infants
0-6 mo 5µg
7-12 mo 5µg
Children 1-3 y 5µg
4-8 y 6.5µg
Males 9-13 y 12µg
14-18 y 18µg
19-30 y 20µg
31-50 y 20µg
50-70
y 20µg
> 70 y 20µg
Females
9-13 y 12µg
14-18 y 18µg
19-30 y
20µg
31-50 y 20µg
50-70 y 20µg
> 70 y 20µg
Pregnancy
≤ 18 y
20µg
19-30y 20µg
31-50 y 20µg
Lactation
≤ 18 y 20µg
19-30y
20µg
31-50 y 20µg
Justification:
Nowadays, severe deficiency of vitamin D is not a common
finding in most developed countries. However, the prevalence
of vitamin D insufficiency is relatively high and it can
contribute to the lowering of bone mass in osteoporosis risk
populations (334). In this respect it is important to note
that Vitamin D deficiency can occur without any symptoms, and
that if symptoms are present it indicates severe deficiency
(349). Moreover, serum calcium and phosphorus values do not
often predict the existence of deficiency (349).
A decrease in bone mineral density is the most important cause
of fracture (335). Among other factors, Calcium and vitamin D
deficiencies are important risk factors for a decrease in bone
mineral density, and can consequently induce osteoporosis
(335). In this respect it is interesting to note that the high
prevalence of vitamin D deficiency in healthy elderly people
in southern European countries increases the risk of
osteoporotic fractures in these populations to levels above
those anticipated for the general elderly population of the
European community (335). As such, the ageing of the European
population will double the number of osteoporotic fractures
over the next 50 years unless adequate preventative measures
are undertaken (335).
Research assessing the cost implications for a preventive
treatment strategy for institutionalised elderly women found
that the incidence of hip and other fractures was reduced by
vitamin D and calcium supplements, and concluded that such
strategies are cost saving (336). The doses given in this
study were 1200 mg/day calcium and 20µg (800 IU) daily of
vitamin D, and the data used in the research was collected
from studies conduced in seven European countries (336).
Other research concurs that a daily dose of 20µg (800 IU) of
vitamin D (or the equivalent 2500µg/100,000 IU given three
times per year) reduces the frequency of both falls (337) and
fractures (338-340). Moreover, research has shown that severe
vitamin D deficiency is present in virtually all elderly
institutionalized subjects, and that as such, routine vitamin
D supplementation is warranted for such people (341).
Studies also suggest that a daily supplement of 10µg (400 IU)
is helpful in maintaining an adequate concentration of vitamin
D in infants (342), and that vitamin D supplementation during
infancy is associated with higher bone mineral mass in
prepubertal girls (343).
Research has also shown that most cases of colon cancer may be
prevented with an intake of vitamin D in the range of 20µg
(800 IU) per day, and epidemiological data suggest that such
an intake may additionally be associated with enhanced
survival rates among breast cancer cases (344). Other evidence
from diverse areas of study - epidemiologic, molecular,
genetic, cellular, animal models, and clinical trials -
suggests that vitamin D may be an effective preventive agent
against prostate cancer (345).
Dietary supplementation of vitamin D is also associated with
reduced risk of Type-1 diabetes, and children who take a 20µg
(2000 IU) dose of vitamin D daily have been shown to have a
lower risk of developing the disease than children who do not
(346).
Women with the highest vitamin D intake from supplements
(10µg/400 IU or more per day) have been shown to be 40 percent
less likely to develop multiple sclerosis than those women who
do not use supplements (347). Similarly, women who consume
vitamin D in both supplement and food form have also been
shown to have a lower risk of developing multiple sclerosis;
whereas women who derive their intake of this vitamin from
food only do not experience a reduced risk of developing the
disease (347). In addition, patients already suffering from
multiple sclerosis who are given supplements of vitamin D,
calcium and magnesium have been shown to have a decreased rate
of relapse (348).
Research has also shown that vitamin D deficiency exists in
patients with tuberculosis, and that it is possibly a cause
rather than an effect of this disease (349). Given the fact
therefore that the incidence of this disease is currently
increasing in many countries, there exists an urgent need for
effective, affordable preventative measures to be instigated
at the earliest opportunity.
Finally, we are of the opinion that the alleged dangers of
vitamin D supplements have been exaggerated in many cases, as
single doses ranging from 200,000 units to over 500,000 units
have been given to infants both orally and by injection
without any ill effects. (350). Moreover, the weight of
evidence shows that the currently accepted, no observed
adverse effect limit of 2,000 IU per day is too low by at
least 5-fold (351). One hour of total-body sun exposure easily
provides the equivalent of 10,000 IU of vitamin D, for example
(351); clearly, many people get this on a regular basis
without experiencing toxicity symptoms. Doses of 15000µg
(600,000 IU) of vitamin D have also been given to pregnant
women in the 7th and 8th months of pregnancy without evidence
of harm (352).
Vitamin E
Infants
0-6 mo 30 IU
7-12 mo 60 IU
Children
1-3 y 80 IU
4-8 y
130 IU
Males
9-13 y 230 IU
14-18 y 370 IU
19-30 y 400 IU
31-50
y 400 IU
50-70 y 400 IU
> 70 y 400 IU
Females
9-13 y 230 IU
14-18 y 370 IU
19-30 y 400 IU
31-50 y 400 IU
50-70 y 400 IU
>
70 y 400 IU
Pregnancy
≤ 18 y 385 IU
19-30y 415 IU
31-50 y 415
IU
Lactation
≤ 18 y 400 IU
19-30y 430 IU
31-50 y 430 IU
Justification: The World Health Organization currently
attributes one-third of all global deaths annually (15.3
million) to cardiovascular disease (332), and patients with
coronary artery disease have been shown to have significantly
lower blood levels of vitamin E than normal healthy people.
(249).
Studies have demonstrated that vitamin E supplements are
effective in the treatment of cardiovascular disease
(353-355), and that the combination of vitamin E and vitamin C
can slow the advancement of atherosclerosis (281).
Furthermore, a review of studies of vitamins A, C and E and
cardiovascular disease found significant evidence to support
the supplementation of these vitamins to lower the risk of
death from this illness (282). As such, it is now clear that
the progression of early stages of coronary calcifications can
be stopped or limited by the synergistic effect of vitamins
and essential nutrients (283, 289), and that supplementing the
diet with nutrients including vitamins E, C, B6 and folate is
conducive to the prevention of cardiovascular disease (284).
In this respect it is also interesting to note that some
researchers particularly recommend dietary supplementation of
vitamin E and C in Northern Europe, where cardiovascular
disease is most prevalent (285).
Vitamin E therapy has also been shown to reduce arterial
blockage in patients suffering from intermittent claudication
(356, 357), and recent research has indicated that it
normalizes high blood pressure (358-360). Vitamin E also
promotes collateral circulation; consequently offering great
benefits to diabetes patients (361).
A recent study looked at patients with colon cancer who
received a daily dose of 750 mg of vitamin E during a period
of 2 weeks. The researchers found that supplementation with
high doses of dietary vitamin E produced a significant
improvement in the immune functions of these patients, all of
whom had advanced cancer. It is especially notable that this
improvement was achieved in only two weeks (362).
Other research suggests that vitamin E supplementation also
improves immune function in healthy elderly people (366, 367).
Research has additionally shown that a high dietary intake of
vitamin E and vitamin C may lower the risk of Alzheimer
disease (329). Other researchers have confirmed this, and have
demonstrated that long-term supplement users of vitamin E with
vitamin C have significantly better mental performance than do
people who have never used vitamin E or vitamin C supplements
(331), and that vitamins E and C may prevent dementia and
improve cognitive functioning in later life (330). Similarly,
a Columbia University study reported that the progression of
Alzheimer's disease was significantly slowed in patients
taking high daily doses (2,000 IU) of vitamin E for two years
(363).
In another study, 400 IU of vitamin E per day given to
epileptic children for several months reduced the frequency of
seizures in most of them by over 60 percent, whilst half of
them had a 90 to 100 percent reduction in seizures. This study
is also notable for the fact that the researchers specifically
stated that the children suffered no adverse side effects from
the vitamin E treatment (364). Similarly, preterm infants
given 100 mg of vitamin E per kilogram body weight (as a
preventative treatment for incubator oxygen retina damage - a
major cause of retrolental fibroplasia and subsequent
blindness in premature infants) suffer no detrimental side
effects from such therapy. (365).
It is also notable that a statistical analysis of published
clinical results showed as early as 1940 that vitamin E
supplements reduce the rate of recurrent miscarriage (368).
An increased intake of vitamins E and C has been found to
reduce the risk of hip fractures (313), and researchers have
also demonstrated that a mixture of vitamins E, C and A
dramatically reduces the postoperative complication rate
(328). Similarly, critically ill surgery patients have been
shown to be significantly less likely to experience organ
failure, spend less time using mechanical ventilation and have
shorter times in intensive care units when they are given
supplements of vitamin E and vitamin C (304).
Finally, research has shown that healthy centenarians have
high levels of both vitamin E and vitamin A, and that this
seems to be important in guaranteeing their extreme longevity
(369).
We also note that the 2000 report by the Institute of Medicine
of the National Academy of Sciences acknowledges that 1,000 mg
(1,500 IU) vitamin E is a "tolerable upper intake level . . .
that is likely to pose no risk of adverse health effects for
almost all individuals in the general population."
Vitamin K
Infants
0-6 mo 45µg
7-12 mo 90µg
Children
1-3 y 120µg
4-8 y
190µg
Males
9-13 y 350µg
14-18 y 560µg
19-30 y 600µg
31-50 y
600µg
50-70 y 600µg
> 70 y 600µg
Females
9-13 y 350µg
14-18 y
560µg
19-30 y 600µg
31-50 y 600µg
50-70 y 600µg
> 70 y 600µg
Pregnancy
14-18 y 580µg
19-30 y 620µg
31-50 y 620µg
Lactation
14-18 y 605µg
19-30 y 645µg
31-50 y 645µg
Justification: Research using healthy adults aged 19-36 years
who were given vitamin K supplements has shown that a daily
phylloquinone intake of approximately 1000µg is required to
maximally gamma-carboxylate circulating osteocalcin (370), and
that a diet low in vitamin K1 can result in a functional
subclinical deficiency of vitamin K (decreased urinary gamma-carboxyglutamic
acid excretion) without affecting blood coagulation (371).
Current estimates suggest that the dietary intake of vitamin K
is in the range 124-375 µg /d in a European population (372).
Studies have repeatedly shown that higher intakes of vitamin K
reduce the risk of hip fracture (373, 374) and that low
intakes may increase the risk of hip fracture in women (375).
This data supports the case for a reassessment of the vitamin
K requirements that are based on both blood coagulation and
bone health (375).
Low dietary vitamin K intake is also associated with low bone
mineral density in women (376), and evidence from
observational studies and first intervention trials indicate
that vitamin K intakes much higher than the current
recommendations improve both biochemical markers of bone
formation and bone density (377). In deed, the mechanistic
data as well as the observational data and the results of the
first controlled clinical trials in humans point to a
beneficial effect of additional intakes of vitamin K in bone
health (377).
Supplements of vitamin K (containing 45mg of menatetrenone)
have been shown to promote bone formation in postmenopausal
women when taken for a period of 48 weeks (378), and therapy
combining vitamin K(2) and D(3) has been shown to be useful
for increasing vertebral bone mass in postmenopausal women
(379). Similarly, research findings indicate that the combined
administration of vitamin D3 and vitamin K2 appears to be
useful in increasing the bone mineral density of the lumbar
spine in postmenopausal women with osteoporosis (380), and
that vitamin K (as menatetrenone) may be beneficial in the
prevention of bone loss in patients with anorexia nervosa
(381).
Vitamin K (as menatetrenone) has also been shown to reduce the
risk of hip fracture in elderly female Parkinson's disease
patients (382). Significant reduction in bone mineral density
occurs in patients with Parkinson's disease, resulting in an
increasing risk of hip fracture, especially in elderly women.
(382).
Research also suggests that it would be prudent to consider
routine vitamin K supplementation in patients with cystic
fibrosis, severe noncholestatic and cholestatic liver disease,
major small-bowel resection, and pancreatic insufficiency or
lung disease necessitating frequent use of antibiotics (383).
Patients with Crohn's disease have also been found to have low
serum levels of vitamin K, and as such are at particular risk
of osteoporosis (384).
Studies have demonstrated that oral vitamin K is as effective
as injectable Vitamin K in newborns, and researchers are now
recommending its usage to reduce the complications and costs
of parenteral therapy (385). Other data has confirmed the
effectiveness of oral vitamin K given to newborns in reducing
infant mortality and morbidity from bleeding disorders such as
intracranial hemorrhage (386). Indeed, additional research
suggests that supplementation of infants with vitamin K is
highly advisable, and that increments of vitamin K during
pregnancy and lactation should also be recommended (387). In
this respect it is interesting to note that maternal vitamin K
supplementation can maintain the vitamin K status of infants
throughout the late neonatal period and prevent an onset of
vitamin K-deficient hemorrhage (388).
Finally, research has also shown that low dietary vitamin K
intake is associated with an increased risk of aortic
calcification (389), and that vitamin K may play an important
role in the acute insulin response in glucose tolerance (390).
Boron
Based upon the knowledge that we have at this time, we
consider that the science suggests an optimal intake of
1.5-3mg for men and women aged 18 years and above, and that
dietary boron is sufficiently important to be considered
essential in human beings.
Justification: The daily intake of boron in humans has been
estimated to range from 0.3-41 mg. The wide range is due to
the variation of the analytical methods used and differences
in the soil content of boron (464).
Dietary boron influences the activity of many metabolic
enzymes, as well as the metabolism of steroid hormones and
several micronutrients, including calcium, magnesium, and
vitamin D (465).
Research shows that a boron supplement of 3 mg/day markedly
reduces the urinary excretion of calcium and magnesium in
post-menopausal women (466).
Because boron deprivation causes changes similar to those seen
in women with postmenopausal osteoporosis, this element is
apparently needed for optimal calcium metabolism and is thus
needed to prevent the excessive bone loss which often occurs
in postmenopausal women and older men (467).
The elevation of endogenous estrogen as a result of
supplementation suggests a protective role for boron in
atherosclerosis (468).
When contrasted with the high boron intake, low dietary boron
results in significantly poorer performance on tasks
emphasizing manual dexterity; eye-hand coordination;
attention; perception; encoding and short-term memory; and
long-term memory. Data indicates that boron may play a role in
human brain function and cognitive performance, and provides
additional evidence that boron is an essential nutrient for
humans (469).
Evidence suggests boron is a safe and effective treatment for
some forms of arthritis. Epidemiologic evidence shows that in
areas of the world where boron intakes usually are 1.0 mg or
less/day the estimated incidence of arthritis ranges from 20
to 70%, whereas in areas of the world where boron intakes are
usually 3 to 10 mg, the estimated incidence of arthritis
ranges from 0 to 10%. Experimental evidence from a
double-blind placebo-boron supplementation trial with 20
subjects with osteoarthritis showed a significant favorable
response to a 6mg boron/day supplement, in that 50% of
subjects receiving the supplement improved compared to only
10% receiving the placebo. This data indicates that boron is
an essential nutrient for healthy bones and joints (470).
Finally, men who ingest the greatest amount of boron have been
shown to be 64% less likely to develop prostate cancer
compared to men who consumed the least amount of boron (471).
Calcium
Infants
0-6 mo 210mg
7-12 mo 270mg
Children
1-3 y 500mg
4-8 y 800mg
Males
9-13 y 1300mg
14-18 y 1300mg
19-30 y 1000mg
31-50 y 1000mg
50-70 y 1200mg
> 70 y 1200mg
Females
9-13 y 1300mg
14-18 y 1300mg
19-30 y 1000mg
31-50 y 1000mg
50-70 y 1200mg
> 70 y 1200mg
Pregnancy
≤ 18 y 1300mg
19-30y 1000mg
31-50 y 1000mg
Lactation
≤ 18 y 1300mg
19-30y 1000mg
31-50 y 1000mg
Justification: The above figures are the current US NRVs for
calcium (391), and we broadly concur with both the US
supporting data and with other research which suggests that
the daily consumption of calcium in the diet should,
optimally, be at least 1200 mg/day (392).
Copper
Infants
0-6 mo 200µg
7-12 mo 290µg
Children
1-3 y 390µg
4-8 y
645µg
Males
9-13 y 1160µg
14-18 y 1870µg
19-30 y 2000µg
31-50
y 2000µg
50-70 y 2000µg
> 70 y 2000µg
Females
9-13 y 970µg
14-18 y 1570µg
19-30 y 1680µg
31-50 y 1680µg
50-70 y 1680µg
>
70 y 1680µg
Pregnancy
≤ 18 y 1670µg
19-30y 1780µg
31-50 y
1780µg
Lactation
≤ 18 y 1770µg
19-30y 1880µg
31-50 y 1880µg
Justification: Several national food surveys in the United
States have revealed marginally to moderately low contents of
copper in the typical American diet (393), and the dietary
intake of copper has been shown to be below the recommended
daily allowance in several different population groups.
(394-396).
Metabolic balance studies have demonstrated that daily copper
losses are approximately 1.3mg/day (397). In order to remain
in copper balance, the average adult male must consume a diet
that contains at least 2mg copper/day. (397). However, some
research suggests that up to eighty-one per cent of people
consume less than 2mg of copper in their daily diets (398),
and that a marginal deficiency of this trace element exists in
up to 62% of people suffering from hypertension (399). In this
respect it is interesting to note that supplementation with
5mg of copper per day has been shown to decrease both systolic
and diastolic blood pressure in patients with mild stable
hypertension (399).
Research has shown that the recovery from mild copper
depletion may require more aggressive intervention than 2mg
per day of copper taken for 35 days (400), and a review of
studies of experimental copper deprivation conducted in adult
humans indicated that 2.6mg of copper per day taken for
periods of up to 42 days is similarly sufficient for recovery
from copper deprivation (401). Studies from animal models and
in human volunteers have permitted to construct a provisional
continuum of acceptable intakes of copper that would avoid
copper deficiency and/or toxicity: acceptable intakes may vary
between 10 and 50µg/kg body weight (402).
Men and women fed diets close to 1mg of copper per day,
amounts quite frequent in the United States, responded with
reversible, potentially harmful changes in blood pressure
control, cholesterol and glucose metabolism, and
electrocardiograms (403). Copper deficiency is also known to
impair cell-mediated immunity (408).
Numerous anatomical, chemical and physiological similarities
between animals deficient in copper and people with ischemic
heart disease have been noticed (403, 406), and a correlation
has been established between low intake of copper and
prevalence of ischemic heart disease, dyslipoproteinemia,
arterial hypertension and excessive body mass (404). Dietary
copper deficiency may also impair cardiovascular health by
contributing to enhancement of inflammation, anemia and
reduced blood clotting (405).
Indeed, some researchers believe that more features of the
etiology, pathogenesis, and pathophysiology of ischemic heart
disease can be explained in terms of copper deficiency than
can be explained by any other environmental insult (406). It
is interesting to note therefore that people with ischemic
heart disease have been shown to have decreased cardiac and
leucocyte copper and decreased activities of some
copper-dependent enzymes (407).
Chromium
Infants
0-6 mo 15µg
7-12 mo 30µg
Children
1-3 y 40µg
4-8 y 65µg
Males
9-13 y 115µg
14-18 y 190µg
19-30 y 200µg
31-50 y 200µg
50-70 y 200µg
> 70 y 200µg
Females
9-13 y 115µg
14-18 y 190µg
19-30 y 200µg
31-50 y 200µg
50-70 y 200µg
> 70 y 200µg
Pregnancy
≤ 18 y 210µg
19-30y 210µg
31-50 y 210µg
Lactation
≤ 18 y 215µg
19-30y 215µg
31-50 y 215µg
Justification: Normal dietary intake of chromium for humans is
suboptimal, and most diets contain less than 60% of the
minimum suggested intake of 50µg (409).
Suboptimal dietary intake of chromium is associated with an
increase in risk factors associated with diabetes and
cardiovascular diseases (410), and produces signs and symptoms
similar to those seen in these diseases (411).
Supplemental chromium is associated with a reduction in the
risk factors for maturity-onset diabetes and cardiovascular
diseases (412). Supplemental chromium given to people with
impaired glucose tolerance or diabetes leads to improved blood
glucose, insulin, and lipid variables (409).
Diabetics are frequently found to be low in chromium (413).
Research has also demonstrated that plasma chromium levels are
significantly lower in patients with coronary artery disease
(423), and rheumatoid arthritis (424).
A daily supplement containing 200µg has been shown in some
patients to be capable of reducing their requirements for
insulin, sulfonylurea or metformin (414). Other research
similarly confirms the beneficial effects of chromium
supplements in individuals with diabetes (415-418). However,
it is important to note that the beneficial effects of
chromium in individuals with diabetes are generally only
observed at levels higher than the upper limit of the
Estimated Safe and Adequate Daily Dietary Intake (419). 200µg
per day of supplemental chromium is adequate to improve
glucose variables of those who are mildly glucose intolerant,
whereas people with more overt impairments in glucose
tolerance and diabetes usually require more than 200µg per day
(420).
Chromium supplementation of normal adult men, as well as
diabetics, has been reported to increase high density
lipoprotein cholesterol and decrease triglycerides and total
cholesterol (421). Indeed, some researchers consider that the
beneficial effects of chromium repletion are now so well
established and the trivalent form is so free of toxicity that
it should now be used in clinical medicine for the benefit of
those with some forms of diabetes and its complications and
those suffering from atherosclerosis (422).
Chromium has also been shown to have antidepressant effects in
patients with atypical depression (425), and has been found to
be capable of increasing lean body mass in obese patients
(426). Niacin-bound chromium supplements at a daily dose of
600µg have been demonstrated to cause overweight women on a
modest dietary and exercise regimen to lose a significant
amount of fat compared to placebo (427).
Finally, most recent evidence strongly supports the conclusion
that there is little fear of toxic reactions from chromium
consumption, and that supplementation may be useful to
ameliorate many of the manifestations of ageing (411). In this
respect, we note that the 350-fold difference between the
acceptable daily intake and the calculated reference dose for
humans of 70µg per day seems without precedent with respect to
other nutritional minerals, and that the beneficial effects of
chromium on serum glucose and lipids and insulin resistance
occur even in the healthy (428).
Iodine
Infants
0-6 mo 110µg
7-12 mo 130µg
Children
1-3 y 90µg
4-8 y 90µg
Males
9-13 y 120µg
14-18 y 150µg
19-30 y 150µg
31-50 y 150µg
50-70 y 150µg
> 70 y 150µg
Females
9-13 y 120µg
14-18 y 150µg
19-30 y 150µg
31-50 y 150µg
50-70 y 150µg
> 70 y 150µg
Pregnancy
≤ 18 y 220µg
19-30y 220µg
31-50 y 220µg
Lactation
≤ 18 y 290µg
19-30y 290µg
31-50 y 290µg
Justification: The above figures are the current US NRVs for
iodine (429), and the FAO/WHO Helsinki Consultation similarly
set a figure of 150µg for Iodine when it met in 1988. We
currently see no reason to alter these figures.
Iron
Infants
0-6 mo 0.27mg
7-12 mo 11mg
Children
1-3 y 7mg
4-8 y 10mg
Males
9-13 y 8mg
14-18 y 11mg
19-30 y 8mg
31-50 y 8mg
50-70 y 8mg
> 70 y 8mg
Females
9-13 y 8mg
14-18 y 15mg
19-30 y 18mg
31-50 y 18mg
50-70 y 8mg
> 70 y 8mg
Pregnancy
≤ 18 y 27mg
19-30y 27mg
31-50 y 27mg
Lactation
≤ 18 y 10mg
19-30y 9mg
31-50 y 9mg
Justification: The above figures are the current US NRVs for
iron (430), and we broadly concur with the US supporting data.
Magnesium
Infants
0-6 mo 40mg
7-12 mo 75mg
Children
1-3 y 95mg
4-8 y 160mg
Males
9-13 y 290mg
14-18 y 480mg
19-30 y 500mg
31-50 y 500mg
50-70 y 500mg
> 70 y 500mg
Females
9-13 y 290mg
14-18 y 480mg
19-30 y 500mg
31-50 y 500mg
50-70 y 500mg
> 70 y 500mg
Pregnancy
≤ 18 y 500mg
19-30y 520mg
31-50 y 520mg
Lactation
≤ 18 y 520mg
19-30y 540mg
31-50 y 540mg
Justification: Research shows that dietary magnesium
consumption has progressively declined over the past century
from an average intake of 475-500mg in the period 1900-1908 to
an average intake of 175-225mg in the period 1990-2002 (431).
As such it is hardly surprising that suboptimal intakes of
magnesium and outright magnesium deficiencies are now
commonplace in many population groups (435-452). Indeed, a
large segment of the U.S. population may have a chronic latent
magnesium deficiency that has been linked to atherosclerosis,
myocardial infarction, hypertension, cancer, kidney stones,
premenstrual syndrome, and psychiatric disorders (453). In
this respect it should be noted that although serum levels are
commonly used to assess magnesium deficiency, red cells and
leucocytes can be still deficient despite normal serum values
(454).
Magnesium deficiency produces abnormal cardiac rhythms that
can cause sudden death from a heart attack (432, 433), and
optimal levels of magnesium are strongly related to a lower
risk of heart disease (434). Moreover, magnesium deficiency is
commonplace in patients suffering from congestive heart
failure (438), and a correlation between low magnesium
consumption and the prevalence of the ischemic heart disease
has been observed (451, 449). Further supporting evidence for
the role of magnesium in protecting the heart can be drawn
from the fact that magnesium infusions in patients with acute
myocardial infarction have been shown to reduce the incidences
of arrhythmias, death and the size of infarction (444).
In addition, serum magnesium levels are also known to be
inversely associated with the risk of hypertension (448), and
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