Dietary Supplements

& Vitamins
Sheri Barke, MPH, RD, CSSD
LA Mission College
 Do you take supplements?
What do you take and why?

“Dietary supplement” definition: a product intended to supplement the diet containing EITHER vitamins,
minerals, amino acids, fatty acids, herbs, enzymes or extracts from plants or animals.
DSHEA 1994
Dietary Supplement & Health Education Act
 Supplements do NOT have to prove they work to be sold.
i.e. Airborne/Emergen-C, Hair/Nail Vitamins…

 Supplements do NOT have to prove they are safe to be sold. i.e. ephedra, bitter
orange, yohimbe, DMAA (1,3 dimethylamylamine)

 Supplement manufacturers CAN put misleading “structure-function” claims on

their labels.
 i.e. “Supports metabolism, immunity, heart health, memory*…”
*This statement has not been evaluated by the FDA. This product not intended to treat, cure, or prevent
any disease.

 Supplements SHOULD follow GMPs to ensure purity & true ingredient labeling
but this isn’t always the case.
 i.e. Diet, bodybuilding, & sexual enhancement products often spiked with Rx drugs, steroids,
or other prohibited substances
The Simple Truth: Decoding the Dietary Supplement Industry
Deceptive Advertising Techniques

 Fake testimonials, blogs, pictures…

 especially from social media influencers
 College Student Finds Secret to Weight Loss
 “Free trial offer” or “Money back guarantee”
 “America’s #1…”
 “Doctor Recommended”
 “Patented” or “Proprietary Blend” or “Secret Formula”
 “Clinically proven” or “Newest scientific breakthrough”
 "Bigger, Stronger, Faster” – on Netflix
Dietary Supplement Ingredients:
Questions to Ask
 Is it safe?
 Ever recalled/fined by FDA? http://www.fda.gov/Safety/MedWatch/
 Any USADA “red flags?” https://www.usada.org/substances/supplement-411/
 Any warnings or mention of side effects or contraindications ?

 Is there GOOD scientific evidence that it works?

 Was study unbiased (placebo-controlled, randomized, AND double blind)?
 Was study published in a reputable peer-reviewed scientific journal?
 Is study relevant? (i.e. done on humans, your population, same dose & combination of ingredients as
product)
 How many studies have shown a positive vs. negative or null effect?

 Is it a quality brand? Free of prohibited substances?

 Has it earned independent certification for purity, potency, and dissolvability by www.USPverified.org or
www.consumerlab.com
 Has it been certified for sport? www.nsfsport.com or www.informed-choice.org
Some QUALITY
Brands
USP verified:
Kirkland Signature (Costco)
Nature Made

NSF Certified for Sport:

BioProUSA (protein)
Cytosport (muscle milk)
EAS (100%whey)
Nordic Naturals (fish oil)

Informed Choice:
Optimum Nutrition (100%whey)
Dietary Supplement Resources
 Linus Pauling Institute Oregon State University

 Natural Medicines Comprehensive Database -Excellent resource,

but subscription required for full access

 www.consumerlab.com –Encyclopedia FREE, but subscription

required to access full product reviews

 National Institute of Health (NIH) Office of Dietary Supplements

 NIH, National Center for Complementary & Alternative Medicine

 U.S.Antidoping Agency Supplements 411
Vitamins: True or False?
 Vitamins give you energy.
 False. Vitamins have no calories. Do help in reactions that transform carbs, protein,
and fat to energy.
 You cannot get enough vitamins from foods.
 Mostly false (if you eat enough calories and eat all food groups). Exception = vitamin
D
 Organic or natural vitamins are nutritionally superior to synthetic
vitamins.
 False. Folate actually better absorbed in its synthetic form folic acid.

 The more vitamins, the better.

 False. Exceeding upper limit results in toxic effects.
Vitamins: Definition & Classification

 13 essential*, organic nutrients needed in small amounts by the

body.
 vitamin D (made by skin)
 vitamin K and biotin (made by gut bacteria)

 Classification:
 Fat soluble: vitamins A, D, E, & K
 Water soluble: vitamin C & “B complex”
(thiamin B1, riboflavin B2, niacin B3, folate, B12, B6, biotin,
pantothenic acid)
Water vs. Fat Soluble Vitamins
Water Soluble
 Dissolve in water
 Absorbed (mostly in small
intestine) directly into blood
 Low risk of toxicity
(excess excreted in urine, not
stored)
 Must be consumed more
frequently
 Can be destroyed by some
cooking, storage, and preparation
methods
Fat Soluble
 Absorption best with fat/oil
 Transported via lymph to blood
 High risk of toxicity
(excess stored in fatty tissues like
liver & body fat)
 Can generally be consumed less
often
 Vitamins A/D stable, but E/K can
be destroyed
Key Points: Speed Dating

 Chemical names / Forms

 Key functions
 Primary food sources
 Factors affecting stability and/or bioavailability
 Deficiency (name, symptoms, high risk groups)
 Toxicity (symptoms, maximum safe supplement dose UL)
 Thiamin Name(s) Thiamin / Vitamin B1

Functions Co-enzyme in energy metabolism

(esp. carbohydrate, so important for nerve
cell function)

Food sources Pork, whole & enriched grains,

peas, beans
Stability Destroyed by heat
Bioavailability

Deficiency Beriberi (neuropathy)

NOTE: All “enriched” grains are At risk: alcoholics (alcohol interferes
with B1 absorption & requires coenzyme for
fortified with thiamin, riboflavin,
metabolism)
niacin, folic acid, & iron.
Toxicity NA
Riboflavin Name(s) Riboflavin / Vitamin B2

Functions Co-enzyme in energy metabolism

(redox reactions in Krebs cycle
FAD+/FADH2), Neurotransmitter
metabolism, Vit A, folate, niacin
synthesis
Food sources Cow’s milk products, meat, whole
& enriched grains
Stability -Destroyed by light
Bioavailability -Better in animal foods
Deficiency Ariboflavinosis (cheilosis,
stomatitis, glossitis, dermatitis)
Toxicity NA
 Name(s) Niacin / Vitamin B3
Niacin
Functions Co-enzyme in energy metabolism
(redox reactions in Krebs cycle
NAD+/NADH),
Vit C & folate metabolism,
Synthesis of fatty acids & DNA

Food sources Meat, poultry, fish, any protein-

containing food with tryptophan,
enriched grains
Stability -Stable
Bioavailability -Increased in plants/corn with
alkaline treatment (e.g. lime)

Deficiency Pellagra (4D’s – diarrhea,

dermatitis, dementia, death)

Toxicity UL 35 mg from supplements

(flushing reaction >100mg)
 Vitamin B6 Name(s) Pyridoxine / Vitamin B6

Functions Co-enzyme in amino acid

metabolism (converting EAA to non-
methionine EAA, tryptophan to serotonin or niacin,
• Folate + B12 hemoglobin synthesis)

Food sources Meat, poultry, fish, beans,

potatoes, fortified cereals
homocycsteine
Stability Destroyed by heat & cold
Bioavailability

• B6 Deficiency Microcytic anemia (weakness),

Depression & insomnia,
Homocysteinemia (risk for CHD)
cysteine Toxicity UL >100 mg
(neurological problems)
 Name(s) Folate (natural food form)
Folate Folic acid (fortified foods / supplements)
Tetrahydrofolate (THF) (active form)
DFE = Dietary Folate Equivalents

Functions Synthesis of new cells (including RBCs)

& DNA, single carbon transfers in amino
acid metabolism

Food Leafy greens, orange juice, beans,

sources enriched grains

Stability Destroyed by heat

Bioavailability Folic acid form better absorbed (400 mcg
folic acid = 680 mcg DFE)

Deficiency Macrocytic megaloblastic anemia

NOTE:
Folate + 4 H = THF
THF + methyl group = 5-MTHF
(~25% of people have double MTHF mutation
& need folic acid supplement)
Neural tube defects (infants)
Homocysteinemia
Toxicity UL 1000 mcg folic acid
(masks B12 deficiency)
Vitamin B12 Name(s) Cobalamin / Vitamin B12

Functions Coenzyme, works with folate Amino acid

metabolism & RBC production
Maintains nerve myelin sheath

Food Only animal sources (since made by animal gut

sources microbes) or fortified foods

Stability Absorption requires stomach acid &

Bioavailability intrinsic factor (IF)

Deficiency Pernicious anemia (lack of IF)

Secondary folate deficiency
Neurological damage
At risk: vegans (& newborns breastfed by them),
older adults (poor absorption)

Toxicity NA
 Pantothenic Acid & Biotin
 Name: Pantothenic Acid/Vit B5
 Functions: Coenzyme in energy
metabolism, hemoglobin and
phospholipid synthesis
 Food Sources: found in almost
every plant and animal food
 Stability: destroyed by heat
 Deficiency: very rare, burning feet
syndrome
 Toxicity: NA
 Name: Biotin/Vit B7
 Functions: Coenzyme in energy
metabolism
 Food Sources: peanuts, tree nuts,
mushrooms, egg yolk, tomatoes
Synthesized by gut bacteria
 Stability: destroyed by heat
 Absorption: impaired by alcohol &
avidin in egg whites (until cooked)
 Deficiency: uncommon, may include
depression and hair loss
At risk: people with IBD, smokers
 Toxicity: NA
Vitamin C Names Ascorbic Acid, Vitamin C

Functions Antioxidant
Needed for collagen (bones, wound
healing), Immune system
Iron absorption
Food Sources Citrus fruits, strawberries, sweet
peppers, broccoli, tomatoes

Stability Destroyed by heat & oxygen

Bioavailability

Deficiency Scurvy (breakdown of collagen)

At risk: smokers

Toxicity UL 2000 mg (diarrhea)

NOTE: RDA = 75-90 mg, Optimal = 200-300 mg

Vitamin A Names Retinol (pre-formed vitamin A)
RAE = Retinol Activity Equivalents Retinal, Retinoic acid
900 mcg/3000 IU retinol = 10,800 mcg beta carotene *Beta-carotene (pro-vitamin A)
Functions Part of rhodopsin for night vision
Needed for epithelial tissues (skin, mucus
membranes) & bones
Immune system, Antioxidant
Food Retinol – in animals (liver, fortified milk, egg yolk,
fish oil)
Sources Beta-carotene – in plants (orange fruits, green &
orange veggies)
Stability Stable, best absorbed with heat/fat
Bioavailability
Deficiency Night blindness, hyperkeratosis (dry skin)
At risk: malnourished, nonimmunized
children in developing countries

Toxicity UL 3000 mcg or 10,000 IU retinol (liver

damage, birth defects)*Hypercarotenodermia from plant
beta carotene is harmless!
 Names Ergocalciferol/Vit D2 (in plants)
Vitamin D Cholecalciferol/Vit D3 (in animals)
Calcitriol (active form)
Functions Maintains blood calcium levels
Bone mineralization
MANY other possible roles
Food Sources *sunlight on skin
Liver, egg yolk, fish oil, fortified milk
Most people require supplement
Stability Stable, best absorbed with fat
Bioavailability

Deficiency Rickets (in children), Osteomalacia or

+ 2 hydroxyl groups added in liver, kidneys 
1,25 dihydroxy vitamin D or calcitriol
Toxicity
Osteoporosis (in adults)
High risk: breastfed infants (w/out
supplement), elderly, people w/little sun
exposure (e.g. northern countries)
UL 4000 IU or 100 mcg
calcium deposits in kidneys/stones & heart
Vitamin D is
activated by PTH
 Vitamin D Daily Needs (debatable)
Age (years) Institute of Medicine Endocrine Society
RDAs Recommendations

Youth 0-18 400-600 IU 400-1000 IU

(10-15 mcg) (10-25 mcg)

Adults 19-70 600 IU 1500-2000 IU

(15 mcg) (37- 50 mcg)

Adults >70 800 IU 1500-2000 IU Sun or Supplement?

(20 mcg) (37-50 mcg)

Sun Exposure
Recommendations
TIP: Blood vitamin D levels >32 ng/mL are sufficient for bone, 5-30 min. between 10am-3pm,
but >40 ng/mL offer superior benefits for muscle performance, >2 x per week to face, arms,
injury prevention, immunity. legs, or back
Vitamin E Names Alpha-tocopherol
(main form in foods/body)

Functions Antioxidant (protect cell

membranes with PUFAs)

Food Sources Vegetable oil, almonds,

sunflower seeds

Stability Easily destroyed by heat &

Bioavailability oxygen

Deficiency Uncommon

Toxicity UL 1000 mg or 1100 IU

Vitamin K Names Phylloquinone/Vit K1 (in plants/food)
Menoquinone/Vit K2 (made by bacteria)
Manadione/Vit K3 (injected water-soluble)

Functions Blood clotting (activates prothrombin)

Bone formation

Food Sources Green leafy vegetables

Synthesized by gut bacteria (~10-15%)

Stability Destroyed by light & heat

Bioavailability

Deficiency Defective blood clotting

At risk: newborns (due to sterile gut + low intake),
people on long-term antibiotics
Toxicity NA
Test your Vitamin IQ
 Match Vitamins to Best Food Sources

 Vitamin A beta carotene  Nuts, seeds, oils

 Vitamin B1, B2, B3  Green leafy vegetables

 Vitamin B12  Carrots, sweet potatoes

 Enriched grains
 Vitamin C
 Animal proteins
 Vitamin E
 Citrus fruits
 Vitamin K

Answers: A (carrots), Bs (enriched grains), B12 (animal proteins), C (citrus), E (nuts, seeds), K (greens)
 Match Vitamins to Deficiency
 Vitamin A  Neural tube defects
 Thiamin  Scurvy
 Niacin  Rickets
 Vitamin C  Pellagra
 Folate  Defective blood clotting
 Vitamin D  Night blindness
 Vitamin K  Beriberi

Answers: A (night blindness), thiamin (beriberi), Niacin (pellagra), C (scurvy), Folate (neural tube defects), D (rickets),
K (defective blood clotting)
 Match Vitamins to Names

 Vitamin A  Ascorbic acid

 Vitamin B6  Retinol
 Vitamin B12  Cholecalciferol
 Vitamin C  Alpha tocopherol
 Vitamin D  Pyridoxine
 Vitamin E  Cobalamin

Answers: A (retinol), B6 (pyridoxine), B12 (cobalamin), C (ascorbic acid), D (cholecalciferol), E (alpha

tocopherol)