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Choosing the Best Supplements: Part Two

In Part One I discussed some guidelines to help ensure that you are getting the best out of your supplements. Read on for more pointers.

Mineral Bioavailability
There isn’t much point in taking a supplement in a form that your body cannot use. Mineral bioavailability simply refers to the proportion of a mineral that is actually absorbed into the blood to be used by the body.

A ‘bioavailable’ mineral must be soluble in the intestine so that it can be absorbed. Minerals should be bound to different compounds to aid their absorption. This binding, or ‘chelation’, helps the mineral to survive the acid environment of the stomach and pass through into the small intestine for absorption.

If the mineral is bound too tightly, or not tightly enough, it can be released at the wrong time.  This is why the ‘form’ of the mineral is an important consideration.

Generally inorganic forms of minerals – carbonates, sulphates and oxides are not well absorbed. On the other hand, organic forms such as citrates, gluconates, aspartates and amino-acid chelates are more bioavailable.

Better quality minerals, i.e. those that are in a bioavailable, organic form do tend to be more expensive. However, cheaper supplements may be a false economy if they are poorly utilised by the body. Choosing a supplement becomes a case of weighing the cost of the supplement against its bioavailability. For example, in the New Optimum Nutrition Bible, Patrick Holford (1) explains that iron amino acid chelate is four times better absorbed than other forms, making it worth the additional cost.

Holford lists the most bioavailable forms of each mineral. All of the following forms are the most readily available to the body. In descending order (the very best first), he lists:

multi-nutrient
A multi-mineral supplement including Chronium, Calcium, Magnesium, Iron, Zinc, Manganese and Selenium.

Calcium – amino acid chelate, ascorbate, citrate, gluconate, carbonate

Magnesium – amino acid chelate, ascorbate, citrate, gluconate, carbonate

Iron – amino acid chelate, ascorbate, citrate, gluconate, sulphate, oxide

Zinc – picolinate, amino acid chelate, ascorbate, citrate, gluconate, sulphate

Manganese – amino acid chelate, ascorbate, citrate, gluconate

Selenium – Selenocysteine or selenomethionine, sodium selenite

Chromium – Picolinate, polynicotinate, ascorbate, gluconate

Tablets or Capsules?
Deciding between capsules or tablets is often a personal preference. Those who find tablets difficult to swallow often favour easy-to-swallow capsules. Sensitive individuals also tend to prefer capsules which are more likely to be free from fillers or binders. On the other hand, tablets can be compressed meaning that a higher dosage can be delivered in a single pill. They also allow for ‘sustained-release’ formulas. This can be useful for water-soluble vitamins such as Vitamin C, where absorption is better when given as a steady release formula rather than in a single dose.

For very sensitive individuals or for the delivery of light-sensitive nutrients such as coenzyme Q-10, capsules are the best choice. There are of course advantages to both types of supplements, which are listed below.

Capsules Tablets
Superior protection against oxygen and light Low cost
No need for fillers and binders Allows for sustained-release formulas
Odorless and tasteless Can fit more ingredients in through compression
Less gastrointestinal irritation Can be notched to divide the dose

Quality Assurance
The simplest way to be certain of the quality of a supplement is to check that it is GMP certified. Good Manufacturing Practice (GMP) is an assurance of quality of manufacture. While medical drugs are held to these strict standards, it is not currently a legal requirement for food supplements in the UK. However, most reputable supplement companies voluntarily submit their products to GMP certification. This compliance requires thorough record keeping, quality testing, and standards consistent with the manufacture of drugs.

Reference

1. Holford, P (2004) Patrick Holford’s New Optimum Nutrition Bible. London: Piatkus.

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Choosing the Best Supplements: Part One

Choosing the right kind of supplement is extremely important, and yet the choice available can create lots of confusion. I am frequently asked about how to select the most suitable type of supplement. Will the supplement be absorbed properly, and is a ‘natural’ form always better than a synthetic form? Are capsules better than tablets? Which brand is best? Some simple pointers can help you to choose the right supplement for you.

Is Natural better than Synthetic?

Many people prefer to take vitamins in their natural form as they believe that nutrients derived from plants and other natural materials are more effective. Although this is not always the case, there are certainly instances where this belief holds up. Vitamin E, for example, is almost 40% more potent in its natural form that in its synthetic form. The natural form of Vitamin E is called d-alpha-tocopherol and this natural form, usually derived from wheat germ or soya oil, is undoubtedly superior.

Likewise, the natural form of Vitamin D, cholecalciferol or D3, has a more sustained effect on Vitamin D levels in the body than its synthetic counterpart Vitamin D2.

Generally, however, the natural and synthetic forms of most vitamins and minerals tend to behave in similar ways. Synthetic forms of some nutrients, such as Vitamin C, can in fact work out cheaper and can be more concentrated.

Perhaps the most important consideration is that vitamin supplements derived from natural sources may well contain as yet unknown nutrients that help increase their effectiveness. Vitamin C, for example, is more effective when taken alongside bioflavonoids, and these nutrients are almost always found together in nature. Supplement manufacturers can utilise this natural Vitamin C ‘boost’ by combining a potent synthetic Vitamin C supplement with additional bioflavonoids. By replicating this natural combination manufacturers can improve the supplement’s potency.

Improving supplement absorption

Getting the best out of your supplements also means making sure that you are taking them correctly. There are a number of lifestyle and dietary factors that can affect supplement absorption. Supplements should always be taken separately from alcohol, especially if the supplements contain magnesium or B vitamins. Alcohol lowers levels of digestive enzymes from the pancreas, meaning that supplements may not be broken down and digested (1). Alcohol also damages the cells lining the stomach and intestines, impairing absorption (2).

Cal-mag
Calcium and magnesium are better absorbed alongside proteins

As smoking influences the absorption of minerals such as calcium, it is not recommended to smoke during meal times, especially if you are taking your supplements with a meal.

Stress is another lifestyle factor that can hinder supplement absorption. As stress can effectively shut down digestion, it would be wise to try to take your supplements after a leisurely meal rather than on the run during a busy day.

To ensure maximum absorption, most vitamin and mineral supplements are best taken immediately after a meal. Calcium and magnesium are better absorbed alongside proteins. Vitamins A, E and D are all fat-soluble, and so are best taken alongside a meal containing fats or oils.

Other important factors when choosing a nutritional supplement include bioavailability, the form of delivery (tablet or capsule) and the manufacturing standards of the supplement company.

References

(1) Korsten, M.A. Alcoholism and pancreatitis: Does nutrition play a role? Alcohol Health & Research World 13(3):232-237, 1989. 

(2) Feinman, L. Absorption and utilization of nutrients in alcoholism. Alcohol Health & Research World 13(3):207-210, 1989. 

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Optimising supplements for managing joint pain and inflammation

Osteoarthritis is the most common cause of musculo-skeletal disability in the elderly and, within the secondary care system, its management is primarily focused on palliative relief using pharmaceutical drugs such as non-steroidal anti-inflammatory drugs (NSAIDs) and analgesics. As with many pharmaceutical drugs, there are potential side effects, with treatment regimens also failing to address the progressive and complex nature of the condition.

The potential role of pharmaconutrients
Not surprisingly, given the safety profile of the majority of nutritional interventions, practitioners are continually striving to identify disease-modifying pharmaconutrients that are capable of both improving symptoms and preventing, slowing, or even reversing the degenerative process. Clinically, osteoarthritis is characterised by joint pain, crepitus (grating or cracking sounds on movement), stiffness after immobility and general limited movement. Identifying nutrients that can aid and support these symptoms are crucial to providing both relief from pain and treating the condition itself [1, 2].

Fatty acids as immunomodulators
Marine omega-3 fatty acids such as eicosapentaenoic acid (EPA) and the omega-6 fatty acid gamma-linolenic acid (GLA) exhibit anti-inflammatory effects through the production of eicosanoids – substances with both anti-inflammatory and immunoregulatory properties. As such, both are well documented as useful natural agents to help treat inflammatory diseases, alone and in combination.

Gamma-linolenic acid
GLA is found in certain plant-seed oils, including evening primrose seed oil, and is metabolised to dihomo-gamma-linolenic acid (DGLA) the direct precursor to anti-inflammatory and immunoregulatory products. Supplemental GLA has been shown to suppress acute and chronic inflammation in several conditions, including arthritis [3].

Omegaflex Duo
Omegaflex Duo is one supplement that combines glucosamine, calcium and EPA which is beneficial for bone health.

Eicosapentaenoic acid
The specific ratio of the principal omega-3 and omega-6 fatty acids AA (arachidonic acid) and EPA provides valuable information on the measure of the body’s eicosanoid balance and the AA:EPA ratio provides a direct indication of the inflammatory state of the body. Developing an anti-inflammatory treatment regime means preventing or reducing the accumulation of AA from the diet. By reducing AA through EPA supplementation, we reduce the substrate for the formation of inflammatory eicosanoids and increase the production of anti-inflammatory eicosanoids directly from EPA. Interestingly, whilst the benefits of EPA as a potent anti-inflammatory and immune-regulating fatty acid are well established, [4] these benefits are significantly superior for osteoarthritis sufferers when combined with glucosamine [5].

Glucosamine
As well as pain and joint degeneration, osteoarthritis also involves progressive loss of cartilage. Glucosamine is an amino monosaccharide believed to stimulate production of compounds called glycosaminoglycans and proteoglycans, the ‘building blocks’ of cartilage. Whilst glucosamine is important as a structural component, it is also known to exert specific pharmacologic effects by decreasing the production of inflammatory products. Glucosamine does this by regulating their production at the genetic level, by switching off genes that are directly involved in their production, thereby interfering with the inflammatory signalling cascade. When administered exogenously, it is used for the treatment of osteoarthritis as a prescription drug or a dietary supplement [6].

Calcium
The synovial fluid within joints contains calcium, as does the cartilage lining the joints. When that calcium crystallises, the resulting tiny shards wear away the joint surface and spur the release of enzymes that further break down cartilage. Not surprisingly, it is sometimes thought that because osteoarthritis is aggravated by calcium deposition in joints, osteoarthritis patients should avoid taking calcium. Formation of calcium crystals can, however, result in calcium deficiency and, whilst calcium serves to maintain healthy bones and teeth, it is also essential for the normal functioning of muscles, blood vessels and nerves. If proper management of calcium is not carried out, this could be harmful for osteoarthritis patients, who may be at a higher risk of also developing osteoporosis, especially if they are long-term users of NSAIDs [7].

 

Written by Dr Nina Bailey

References
1. Lopez HL: Nutritional interventions to prevent and treat osteoarthritis. Part I: focus on fatty acids and macronutrients. PM & R : the journal of injury, function, and rehabilitation 2012, 4:S145-154.
2. Lopez HL: Nutritional interventions to prevent and treat osteoarthritis. Part II: focus on micronutrients and supportive nutraceuticals. PM & R : the journal of injury, function, and rehabilitation 2012, 4:S155-168.
3. Dawczynski C, Hackermeier U, Viehweger M, Stange R, Springer M, Jahreis G: Incorporation of n-3 PUFA and gamma-linolenic acid in blood lipids and red blood cell lipids together with their influence on disease activity in patients with chronic inflammatory arthritis–a randomized controlled human intervention trial. Lipids in health and disease 2011, 10:130.
4. Calder PC: Omega-3 polyunsaturated fatty acids and inflammatory processes: Nutrition or pharmacology? British journal of clinical pharmacology 2012.
5. Gruenwald J, Petzold E, Busch R, Petzold HP, Graubaum HJ: Effect of glucosamine sulfate with or without omega-3 fatty acids in patients with osteoarthritis. Advances in therapy 2009, 26:858-871.
6. Rovati LC, Girolami F, Persiani S: Crystalline glucosamine sulfate in the management of knee osteoarthritis: efficacy, safety, and pharmacokinetic properties. Therapeutic advances in musculoskeletal disease 2012, 4:167-180.
7. Vestergaard P, Rejnmark L, Mosekilde L: Fracture risk associated with use of nonsteroidal anti-inflammatory drugs, acetylsalicylic acid, and acetaminophen and the effects of rheumatoid arthritis and osteoarthritis. Calcified tissue international 2006, 79:84-94.

 

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The importance of bone health

Bone health is an issue which is becoming increasingly more prominent in today’s society. According to the National Osteoporosis Society (1), one in two women and one in five men over the age of 50 in the UK will suffer with a bone fracture. This is mainly due to poor bone health which means that we all need to know how important it is to build and maintain strong bones.

In addition to weight baring exercise, nutrition is absolutely vital for establishing strong bones in childhood and adolescence as this is when the body passes through the bone growth stages to create individual peak bone mass. Within the 4 years surrounding an adolescent’s peak height, around 39% of their total body bone mineral is gained. This highlights how crucial this time is for building strong bones for the future as we go in to adulthood, as low bone mineral growth during youth is linked to the risk of developing brittle bones and osteoporosis in older age.

Fresh Orange Juice
Many Fresh Orange Juice's can be bought fortified with Calcium, Magnesium or Vitamin D.

Nutrients such as calcium, vitamins D and K and magnesium have all been specifically identified for bone health and having an influence on bone mineral density. A recent review (2) published in the journal Clinical Biochemistry focuses in particular on calcium’s effect on bone health. They reviewed numerous research papers looking into the effects of certain calcium rich foods on bone density.

For example, one study reported that women who had a lower intake of milk in childhood and adolescence had low bone density in adulthood and as a result they had a much greater risk of fractures later in life. Additionally, the authors reported on findings that with low intake of cow’s milk, even pre-pubertal children can have a higher risk of fractures which shows how important calcium intake is in early life.

As well as dietary calcium intake, calcium supplementation has also been found to be a fantastic contributor to bone mineral accretion. So be sure you add calcium to your family’s supplement regime to ensure all your bones are as strong as they can be to help prevent breakages.

Once peak bone mass is achieved around the age of 20 it needs to be maintained in the bone maintenance stage which lasts around 10-20 years. Then as we reach middle age our bone density starts to reduce by approximately 0.5–1.0% per year. However, it is important to note that female bone losses can be considerably more around the time of the menopause, at around 2–3% per year due to decreases in oestrogen levels. This represents a crucial time for maintaining bone density through our food and nutrition choices. Not surprisingly, calcium intake has been linked to the prevention of bone loss around this time.

Within the review paper, the research indicates that baseline calcium intakes of 500–1000 mg/day (meeting the recommended intake of 700mg a day) which were increased by 500–1200 mg/day prevented bone loss.

In order to be within this calcium intake, try to include the following foods into your typical day’s food intake, which combined equates to around 1578mg of calcium:

Typical servings: plain low fat yoghurt, 225g (415 mg of calcium), cheddar cheese, 40g (307mg), milk (around 300mg), pink salmon, 85g (181mg), Orange juice, calcium-fortified, 170ml (375mg). Dietary calcium is also available from sources such as other dairy products, bony fish, legumes, certain nuts (such as almonds and Brazil nuts), fortified soya milk and some fortified breakfast cereals also contain smaller amounts of calcium.

However, the report noted that most people’s calcium intake from dietary sources is often not sufficient especially for those that do not drink milk e.g. Chinese cultures. They therefore recommended calcium supplementation to meet the requirement. Vitamin D is also a great contributor to healthy bones on its own however when combined with calcium it has a much greater effect and the review noted that supplemental vitamin D combined with supplemental calcium can help to slow bone loss. This study included 1200 mg/day calcium and 1000 IU/day vitamin D supplementation and found that the two nutrients used together had a greater effect on maintaining bone density than when used individually.

It was also noted that calcium and vitamin D supplementation, at an intake of around 1000–1200mg calcium (depending on dietary calcium intake) and 800 IU vitamin D daily, is particularly important for those with osteoporosis or those at risk of its development. However, make sure that you are not exceeding the recommended upper limit of calcium which is 3,000 mg/day for children and adolescents aged 9–18 years, 2,500 mg/day for 19–50 year olds and 2,000mg/day for those aged> 50 years.

What all of this means it that it is really important to get enough calcium and vitamin D in both food and supplement forms to help keep bones healthy and strong, and also that your kids are getting enough to help build their bones for the future.

Written by Lauren Foster

(1) National Osteoporosis Society

(2) Zhu, K. & Prince, R.L. (2012) Calcium and bone. Clinical Biochemistry, p7.

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Calcium and Vitamin D may reduce abdominal fat

A new trial has found that calcium and vitamin D may decrease levels of abdominal fat in overweight adults.

Abdominal fat is linked with a higher risk of several diseases, including heart disease, hypertension and type 2 diabetes. Reducing excess levels of this type of fat is crucial for those wanting to improve their long-term health.

Fresh Orange Juice fortified with calcium and vitamin D may help reduce abdominal fat
Fresh Orange Juice fortified with calcium and vitamin D may help reduce abdominal fat

The trial, published in the American Journal of Clinical Nutrition, was carried out by researchers at Massachusetts General Hospital, in Boston. It tested the effect of fortified orange juice on the fat levels of 171 healthy overweight and obese adults between the ages of 18 and 65.

The research team carried out two double-blind, placebo-controlled trials. One trial tested a regular Calcium and Vitamin D (CaD) fortified orange juice. The second trial tested a reduced calorie (‘lite’) CaD-fortified orange juice. Abdominal fat or ‘visceral adipose tissue’ (VAT) was measured by x-ray before and after the trial.

The trials lasted 16 weeks, during which each participant drank three 240ml glasses of orange juice fortified with 350mg calcium and 100IU vitamin D per day. The control groups drank unfortified regular or unfortified ‘lite’ orange juice.

The results showed that abdominal fat in those drinking the regular fortified orange juice decreased by 12.7cm2 on average. Those who drank the unfortified juice saw a decrease on just 1.3cm2.

In addition, those who drank the fortified ‘lite’ juice saw a decrease in abdominal fat of 13.1cm2, compared with just 6.4cm2 in the unfortified ‘lite’ juice control group.

“Our results suggest that, in overweight and obese adults, a moderate reduction in energy intake and supplementation of calcium and vitamin D in juice beverages lead to a reduction in intraabdominal fat”, concluded the researchers.

Many experts believe that calcium and vitamin D are involved in the healthy metabolism of fat. It is also thought that calcium might accelerate weight loss by binding to fat in the intestine and removing it from the body.

“A large portion of the population is deficient in vitamin D, and dietary calcium intake often does not meet current recommendations,” the researchers stated.

To improve your calcium levels, you should ensure that you are eating plenty of calcium-rich foods, and that you are absorbing the mineral effectively. Rich sources of calcium include dairy, sardines and salmon, leafy greens such as mustard greens, and green vegetables such as broccoli. Calcium absorption also requires adequate dietary magnesium, phosphorus, and vitamin A, C and D.

Calcium citrate is believed by many to be the most efficiently absorbed form of calcium, rather than the cheaper carbonate form. For those supplementing vitamin D, the emulsified form is often considered to be well absorbed.

Written by Nadia Mason, BSc MBANT NTCC CNHC

References

Jennifer L Rosenblum, Victor M Castro, Carolyn E Moore, Lee M Kaplan. Calcium and vitamin D supplementation is associated with decreased abdominal visceral adipose tissue in overweight and obese adults. American Journal of Clinical Nutrition. January 2012.

Image courtesy of Paul

 

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