Clinical Use and Safety of Vitamins and Minerals

Clinical Use and Safety of Vitamins and Minerals

Safety and efficacy are crucial but separate issues for vitamin and mineral supplements. Misinterpretation of “safe and adequate” to mean “safety limit” would impose restrictions on vitamin and mineral intakes that are not needed to ensure safety.

Substantial evidence indicates that intakes greater than the recommended dietary allowances (RDAs) of certain vitamins and minerals such as calcium, folic acid, vitamin E, selenium, and chromium reduce the risk of certain diseases for some people.

Limitation of intakes to the RDAs would preclude reductions in disease risk from these nutrients. The margin of safety between the usual dietary intake and the intake that would produce adverse effects varies greatly among the different nutrients.

Very high intakes of vitamins A and D, niacin, pyridoxine, and selenium have produced adverse effects. Many widely discussed putative adverse effects of vitamin C, vitamin E, and trivalent chromium have little factual basis.

There is no evidence of adverse effects from beta-carotene supplements except in current heavy smokers.

VITAMINS

Any of various organic substances that are essential in minute quantities to the nutrition of most animals and some plants, act especially as coenzymes and precursors of coenzymes in the regulation of metabolic processes but do not provide energy or serve as building units, and are present in natural foodstuffs or sometimes produced within the body.

Vitamin A

RDI for adults (>18 yo), Women: 700 μg; Men: 900 μg
Dose range used in practice: 10,000–50,000 IU/day orally in divided doses. Not recommended for more than 2 weeks without medical supervision.

Major uses:

  • Treating deficiency
  • Prevention of secondary deficiency (e.g. coeliac disease, cystic fibrosis, pancreatic disease)
  • Reducing severity of infectious diseases in children
  • Dermatology—many uses
  • Slowing progression of retinitis pigmentosa

Cautions:

  • Hypersensitivity
  • Pregnancy
  • Hypervitaminosis A
  • Retinoid analogue use
  • Lactation
  • Chronic renal failure or liver disease

Side-effects:

Early signs

  • Dry rough skin and mucous membranes, desquamation
  • Coarse sparse hair, alopecia of eyebrows
  • Diplopia
  • Bone and joint pain

Later signs

  • Irritability
  • Increased intracranial
  • Pressure and headache
  • Dizziness
  • Hepatotoxicity

Toxicity:

Cumulative toxicity if >100,000 IU long term.
Acute toxicity possible if >2,000,000 IU taken.
If taken long term in pregnancy, >1500 IU may be teratogenic, causing craniofacial abnormalities.

Vitamin B1 (thiamin)

RDI for adults (>18 yo), Women: 1.1 μg; Men: 1.2 μg
Dose range used in practice: 15–3000 mg

Major uses:

  • Treating deficiency
  • Prevention of secondary deficiency (e.g. hyperemesis and malabsorption states)
  • Acute alcohol withdrawal
  • Alzheimer’s dementia
  • Dysmenorrhoea

Cautions:

  • Hypersensitivity
  • None

Side-effects:

  • Well tolerated

Toxicity:

Non-toxic.

Vitamin B2 (riboflavin)

RDI for adults (>18 yo), Women: 1.1 μg; <70 yo: 1.3 mg; Men: 1.3 μg; >70 yo: 1.6 mg
Dose range used in practice: 10–400 mg/day

Major uses:

  • Treating deficiency
  • Prevention of secondary deficiency (e.g. chronic, diarrhoea, liver disease, chronic alcoholism)
  • Prevention of migraine headaches
  • Reducing incidence of both nuclear and cortical cataract

Cautions:

  • Hypersensitivity
  • None

Side-effects:

  • Well tolerated

Toxicity:

Non-toxic.

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