Original article by Dag Viljen Poleszynski, PhD, in Orthomolecular Medicine News Service
One of the most vitamin-restrictive countries in the world is Norway. There, authorities limit potencies to only slightly higher than RDA (Recommended Dietary Allowance) levels for dietary supplements sold outside of pharmacies. The traditional reasoning is that most people receive the nutrients they need from a “balanced diet.” [1] The authorities are also obsessively concerned that some vitamins and minerals are harmful in high doses. And, since an intake of water-soluble vitamins in excess of needs is excreted in the urine, Norwegian “experts” advise that taking supplements is a waste of money. Accordingly, the argument goes, the public should be protected not only from possible harm, but also from wasting money on unnecessary nutrients. The official policies on nutritional supplements vary within OECD (Organization for Economic Cooperation and Development) countries. Some are more liberal, while others are even more restrictive.
The official view on the connection between nutrient intake and possible toxicity is illustrated by the Norwegian Food Authority in a graph. [2]
Perceived risk from intake of nutrients. (Source: Expert Group on Vitamins and Minerals. Safe upper limits for Vitamins and Minerals. May 2003: Food Standards Agency, UK.)
The graph illustrates the official view on nutrients, assuming that nutrients function in the same way as pharmaceuticals, which they do not. Supplements of most vitamins, but also minerals and other nutrients, do not have very serious side effects even when taken at very high levels – in contrast with most drugs. [3,4] The fact that most of the chemotherapeutic drugs used against cancer have none or even just marginal effects against most cancers [5], while at the same time cause a lot of serious side effects, is rarely up for discussion.
The idea that nutritional supplements are not safe has a legal underpinning in Norwegian Food Law, which in section 16 prohibits sale of any food which is not safe: “Any food shall be considered not to be safe if it is seen as detrimental to health or not fit for consumption.” [6]
However, the Norwegian authorities do admit that vitamin D supplements are needed during part of the year. [1] Only part of the year? One third of Norway is within the Arctic Circle. Norway has far too little sunshine (especially during winter months) to get adequate levels of vitamin D from UVB radiation on the skin. The authorities also recommend that pregnant women take folic acid to prevent birth defects, and omega-3-fatty acids may be advisable for those who do not eat fish regularly. Norwegians have a long tradition of giving children cod liver oil, which in a daily tablespoon provides enough vitamin A and D and essential fatty acids to cover basic needs.
Essential and conditionally essential nutrients
There are thousands of dietary supplements on the market, including 40+ essential nutrients alone and in various combinations, i.e. vitamins, minerals, trace elements and fatty acids. However, a number of other nutrients are “conditionally essential”, meaning that the body normally can make these molecules, but some people do not make optimal amounts. Examples are L-carnitine, alpha-lipoic acid, the methyl donor betaine, [7] chondroitin sulfate, coenzyme Q10, choline, amino acids such as tyrosine or arginine, and “essential” sugars normally formed in the body. [8]
Healthy young people normally make sufficient amounts of conditionally essential molecules in the body, although the levels are not always optimal. With inadequate levels of minerals or vitamins, key enzymes in biochemical pathways may not function optimally. Due to genetic mutations, some enzymes may have increased needs for certain cofactors (vitamins), which can prevent them from functioning optimally.[9] Some enzymes only function normally when supplied with cofactors in greater amounts than normally required. If supplements of essential nutrients prove insufficient for optimal enzyme function, “conditionally essential” nutrients may be added as part of a comprehensive, therapeutic program.
Some reservations
Parents are advised to become familiar with the literature on essential nutrients, for instance by consulting the Orthomolecular News Service. Children should be given supplements in appropriate doses and in a suitable form. Pills should not be given before children can control the swallowing reflex. Multivitamin powder can be given dissolved in water or juice. Parents should not dose vitamin C so high that a child comes to school or kindergarten with loose bowels or diarrhea. In high doses, niacin may cause unpleasant side effects such as flushing and itching lasting up to several hours. [10] Although this is not dangerous, it may cause a child to feel unwell and anxious. Starting niacin supplementation with a low dose and gradually increasing it will allow the body to adapt and avoid the niacin flush. A multivitamin supplement containing moderate amounts of niacin is often adequate until a child is 8-10 years old. For younger children, the dosage should start with only a few tens of milligrams, and not increased to more than 50-100 mg/day. Adults may gradually get used to taking 1,000-1,500 mg/d divided into 3 doses per day.
When it comes to omega-3 fatty acids (omega = ω) such as EPA and DHA, children may be given cod liver oil and served fish and/or other seafood 2-3 times a week. It is important to check the dose of vitamin A supplied, as it can be toxic in high doses, especially for children. One problem with cod liver oil today is that vitamin D has been removed during processing, thus changing the natural ratio of the two vitamins so that we ingest relatively too much of vitamin A. [11]
Higher dosages may be given after having consulted a therapist who has measured the ratio of omega-6 to omega-3 fatty acids in relevant cell membranes (red blood cells). In most industrialized countries, many people get too much of the omega-6 fatty acids, and would therefore benefit from eating more seafood or taking supplements with omega-3 fatty acids derived from organisms low in the food chain (algae, krill). Flax seeds contain a high level of the essential omega-3 fatty acid alpha-linolenic acid, and freshly ground flaxseed meal or flax oil can be mixed with breakfast cereals or smoothies. Note that it may be advisable to limit eating farmed fish to once per week, since their fodder contains less omega-3 fatty acids than the food eaten by wild fish, and possibly also contains more contaminants. [12] Some researchers even warn against letting children eat too much fish because of the content of environmental toxins. [13,14]
Reasons for high-dose supplements of micronutrients
I have identified a number of arguments in favor of supplementing the modern diet with essential nutrients, here summarized with 7 headlines. Most people should consider taking a multivitamin supplement containing vitamins and minerals even if they eat a nutritionally balanced diet. Additional nutrients may contribute to better health and, in some cases, can be of vital importance in our modern world. The arguments are presented in random order, i.e. the order does not reflect priority.
1. The agricultural revolution has reduced food quality
The transition from an existence as hunter and gatherers to urban agriculture around 10,000 years ago began an epoch when foods were mass-produced but had lower nutritional density, compared with the previous food eaten by our ancestors. The nutritional density in many foods has fallen significantly since human societies transformed from hunter-gatherers into resident farmers. This is especially true in the last 60-70 years after agriculture was changed from small, versatile ecologically driven family farms to large, chemical-based, industrial agriculture. [15] The reduction of nutritional content in modern crops, compared with older varieties, is well documented. [16] It is a consequence of soil erosion, loss of essential minerals from continual heavy use, combined with breeding of new varieties, which has increased the size and growth rate of plants by increasing the content of sugar and water and decreasing their mineral content compared to ancient species. At the same time, the relative content of other macronutrients (fat, protein/amino acids) and antioxidants may have been reduced.
Reduced nutritional density in many foods, combined with the use of refined “foods” like sugar, white flour and refined oils, places a greater priority on eating the most nutritious foods. Farm produce grown organically generally has higher levels of essential nutrients such as trace minerals because the soil contains higher levels of trace minerals and the produce grows slower and thus has more time to absorb nutrients from the soil. Examples of nutrient dense foods are sardines, wild salmon, shellfish, eggs, liver, kale, collards and spinach, sea plants (seaweed), garlic, blueberries, and dark chocolate. [17]
2. Nutritional content of food varies with geographical location
Nutritional density varies considerably geographically between different regions, even with the same agricultural methods. This was documented in the United States in 1948 by a researcher at Rutgers University in the so-called Firman Bear report. [18] At that time agriculture was little mechanized, and artificial fertilizers and pesticides were hardly used. The analysis found large differences in the content of minerals in the same food. The largest variations were found for potassium, sodium, boron and iron in spinach, while the greatest differences in calcium, magnesium and copper content were found in tomatoes.
The soil in areas with relatively low rainfall may in some cases contain an extremely high concentration of minerals, which is reflected in the plants growing there. This was well documented 70 years ago in the book Tomorrow’s Food. [19] The Dentist George W. Heard found that the soil in Hereford, Texas, was exceptionally rich in minerals.[20] Hereford became known as the “town without a toothache” after a newspaper article from January 29, 1942, reported that Hereford had the lowest incidence of tooth decay of any city in the United States. [21] Heard found that people in Hereford had exceptionally few dental cavities and also that the soil locally was especially rich in minerals. He emphasized that the population in the county ate unprocessed food and was drinking raw milk. [19]
Recent research shows that differences in the content of the selenium in the soil can cause major differences in the concentration of selenium in meat. [22] For instance, since the soil in Finland is poor in selenium, the authorities decided in the early 1980s to add selenate to commercial fertilizers. A survey of selenium status among 108 healthy young people showed an increase in the blood selenium level of about 50 percent after four years. [23]
A similar problem with the level of minerals in the soil exists for the content of magnesium. Often when the soil gets depleted of magnesium from heavy use, this essential mineral is not included in soil amendment with fertilizers. Produce grown in soil with an adequate level of magnesium will contain more magnesium than produce grown in soil deficient in magnesium. Perhaps as many as 70-80% of the US population is magnesium-deficient, which causes many health problems. [24] Magnesium supplements (chloride, malate or citrate) can provide an adequate level when vegetables grown in soil with adequate magnesium are not available.
3. Stress and the modern lifestyle increase the need for nutrients
Mental stress increases the excretion and hence the need for many nutrients. Among the most important are magnesium and vitamin C, both of which are used by the body in larger quantities during periods of physical and mental stress. [24,25] Compared with our past as hunters and gatherers, today´s stress is often of a more permanent nature. Instead of experiencing occasional situations where we had to fight or flee, many of us live with recurring stress day in and out.
Vitamin C protects the brain and nervous system from damage caused by stress because the synthesis and maintenance of chemical neurotransmitters such as adrenaline and noradrenaline requires adequate levels of vitamin C. [25] Vitamin C is also needed to repair collagen which is essential for skin, blood vessels, bones and joints, and muscles. When these are damaged by physical stress, extra vitamin C is necessary. A controlled trial of 91 adults who experienced increased anxiety and stress 2-3 months after an earthquake in New Zealand in 2011 was divided into three groups, two were given a broad spectrum supplement of micronutrients in low or higher doses. [26] The supplements were found to alleviate the experience of stress, with the biggest dose having the biggest effect.
Our sedate, modern lifestyle reduces the need for energy from food, which implies a lower food intake or obesity. Loren Cordain, PhD, and coworkers have estimated that hunter-gatherers had significantly higher energy needs than the typical modern office worker. [27] A lower energy intake generally reduces the absolute intake of all nutrients, while the need for some nutrients is not always reduced proportionally with energy intake. Overall this suggests that more exercise along with a more nutritious diet, including supplements of essential nutrients and less carbohydrates, will help to prevent obesity and maintain health.
Processing of food reduces its nutritional content, and the finished products are often based on fractions of the original foods. One example is milling grain to make white flour, [1] which has a lower nutritional density than whole grain flour. The reduction in nutritional value has accelerated since whole foods are now divided into pieces, for example, boneless chicken breast. When meat is injected with saline to increase the volume, the relative level of essential nutrients is reduced. In the United States, many supermarkets in low-income rural and inner city areas have a limited selection of nutrient-dense foods, compared with high-income areas. [28]
4. Environmental pollutants increase the need for nutrients
The need for efficient detoxification and excretion is greatly increased by environmental pollution from the chemical industry, herbicides and pesticides used by industrial agriculture, antibiotic treatment of animals, transport, and plastic packaging. [29] In our polluted world, the increased toxic load may be compensated for by an increase in nutrients to promote detoxification. One can respond by taking large doses of supplements of essential nutrients, for example, antioxidants vitamin C and E, and an adequate dose of selenium, which help the body detoxify harmful chemicals. Also helpful is regularly taking sauna baths, fasting periodically, and eating an excellent diet that includes generous portions of dark green leafy vegetables and colorful vegetables and fruits. [30]
A recent study predicts that global warming may reduce the nutrient density in many foods worldwide. [31] Atmospheric CO2 is estimated to surpass 550 ppm in the next 30-80 years, leading to larger crops with lower content of protein, iron and zinc per energy unit. Assuming that diets remain constant, while excluding other climate impacts on food production, the researchers estimated that elevated CO2 could cause an additional 175 million people to be zinc deficient and an additional 122 million people to be protein deficient in 2050. Anemia would increase significantly if crops lose even a small amount of iron. The highest risk regions – South and Southeast Asia, Africa, and the Middle East – are especially vulnerable, since they do not have the means and access to compensate using nutritional supplements.
5. The RDA for essential nutrients is too low
The recommended nutrient reference intake (NRI) has been defined by UK authorities and the EU Food Safety Agency as the dose that is adequate for 95 percent of the population. [32] These authorities have given recommendations for a total of 41 chemical substances, [33] including 13 vitamins, 17 minerals/trace elements, 9 amino acids and two fatty acids. The problem with such guidelines is that when using the same 0.95 fraction for just 16 of the essential nutrients, the fraction of the overall population that has their needs met with the RDA is less than half (0.9516 = 0.44). Given the above assumption, the proportion of the population having all nutrient needs met falls below 25 percent for 30 nutrients (0.9530 = 0.21). These 25 percent will not necessarily get optimal amounts, just enough so that they probably will have no deficiencies in accordance with established standards. Each individual is different and has different biochemical needs, so we all need different doses of essential nutrients. Many vitamins and minerals can give additional benefit when taken at higher doses.
The need for several essential nutrients increases with age and sickness. This applies, for example, to vitamin C, vitamin D, magnesium, and iron. In 2017 the Norwegian Food Safety Authority proposed to revise the official maximum levels for vitamins and minerals in dietary supplements. [34] Their proposal introduced four different age categories with separate maximum intakes. Initially, the agencies proposed to revise the daily doses allowed in dietary supplements for folic acid, magnesium, calcium, vitamin C and D. At the same time, maximum rates were temporarily suspended for vitamins A, E, K, thiamine (B1), riboflavin (B2), niacin (B3), pantothenate (B5), pyridoxine (B6), cobalamine (B12), biotin, and for phosphorus, iron, copper, iodine, zinc, manganese, selenium, chromium, molybdenum, sodium, potassium, fluoride, chloride, boron and silicon. The upper limits for some nutrients may be changed in the future. Unfortunately, Norwegian nutrition “experts” will likely continue to limit allowable doses below those freely available in the US and even Sweden.
6. An optimal nutrient intake promotes health and delays aging
A spokesperson for optimal nutritional intake is the well-known biochemist Bruce Ames, who proposed the “triage theory of nutrients,” in which enzymes responsible for cell maintenance functions evolved to have lower affinity for the essential vitamin and mineral cofactors than the enzymes responsible for short-term survival, to preserve life during times of famine. [35]
Thus, higher levels of vitamins and minerals may delay mitochondrial aging, speed up the repair of large molecules such as DNA and collagen, and generally improve other cellular functions. This is an important rationale for taking higher doses of vitamins and minerals than recommended reference intakes. Dietary supplements can slow the aging process, in part by reducing the harmful effects of free radicals, known to be involved in many diseases such as cardiovascular disease and cancer. [36] Naturally-occurring hormones and/or supplements of cofactors needed for optimal hormone production in the body can have a significant life-prolonging effect if the body produces less than optimal amounts. [37] This is especially relevant for those with a genetic predisposition for disease.
An optimum intake of all nutrients is difficult to achieve even for those who eat almost exclusively an excellent diet of nutrient dense foods, such as meat and innards, fish, shellfish, fowl, eggs, nuts, mushrooms, and vegetables, berries and nutritious fruits. Some nutrients such as folic acid or carotenoids in vegetables are absorbed better from processed than unprocessed foods. Although vegetables are often considered to be a good source of vitamins, for example vitamin A from carrots, vitamin A is only found in animal products such as liver, egg yolk, fish cod and cod liver oil. Although eating raw vegetables is helpful for several reasons (vitamin C, fiber, microbiota), carotenoids (alpha/beta-carotene, lutein, lycopene) in vegetables are less well absorbed from raw than cooked food and better absorbed in the presence of added fat. [38,39]. Nutrients in vegetables are better absorbed when finely chewed, graded, or mashed [38], and cooking and grinding meat reduces the energy required to digest it [40] and increases nutrient absorption [41].
Orthomolecular pioneer Abram Hoffer and Orthomolecular News Service Editor Andrew W. Saul suggested this list of daily intakes of vitamins and minerals. [42] The Norwegian 2017 recommendations for adult men and women [43] are given in comparison. Individual needs may vary substantially from person to person and also with health status.
| Recommendations: |
Hoffer/Saul |
Norwegian Government |
| Thiamine (vitamin B1) |
25 milligrams |
1.5 mg for men; 1 mg for women |
| Riboflavin (vitamin B2) |
25 mg |
1.7 mg for men; 1.2 mg for women |
| Niacinamide (Vitamin B3) |
300 mg |
20 mg for men and 15 mg for women |
| Pyridoxine (vitamin B6) |
25 mg |
1.6 mg for men; 1.2 mg for women |
| Folate |
2,000 micrograms (mcg) |
300 mcg for men; 400 mcg for women |
| Cobalamine (vitamin B12) |
500 mcg |
2 mcg |
| Vitamin C |
2,000 mg |
75 mg |
| Vitamin D3 |
37.5 mcg |
7.5 mcg for men; 10 mcg for women |
| Vitamin E (mixed) |
140 mg |
10 mg alpha-tocopherol for men and 8 mg for women |
| Zinc (Zn) |
25 mg |
9 mg for men and 7 mg for women |
| Selenium (Se) |
200 mcg |
50 mcg for men and 40 mcg for women |
| Chromium (Cr) |
200 mcg |
35 mcg indicated for men and 25 mcg for women |
The figures for optimal intake are obtained from the Independent Vitamin Safety Review Panel of physicians, researchers and academics, who concluded:
“People are deceived in believing that they can get all the nutrients they need from a ‘balanced diet’ consisting of processed foods. To achieve an adequate intake of vitamins and minerals, a diet of unprocessed whole foods, along with intelligent use of dietary supplements is more than just a good idea: it is vital.” [44: 55]
A well-known example is vitamin C, which can effectively fight viral infections, prevent or reverse disease caused by bacteria, and help the body detoxify organic and inorganic toxins. [45] Vitamin C also reduces the risk for cancer, strengthens connective tissues (collagen), and counteracts stress by increasing the adrenal´s production of cortisol. The dose required is set according to the body’s need. Nobel Price Laureate Linus Pauling suggested that an optimal daily intake of vitamin C could vary from at least 250 mg up to 20 grams per day. [46] Because unabsorbed vitamin C attracts water into the gut, some people may experience loose stools, gas and/or diarrhea by ingesting only 1-2 grams at a time, while others with a higher level of stress may tolerate 5-6 grams or more. The dose that causes loose stools is called the “bowel tolerance” for vitamin C. [47] To avoid the laxative effect of high doses, it is best to take vitamin C throughout the day in smaller divided doses.
When the body is stressed by disease, the gut will naturally absorb more vitamin C because the body needs more. To find the optimal dose, the intake should be increased until bowel tolerance is reached. Some people can tolerate more than 100,000 mg/d of vitamin C in divided doses during serious illness without having loose stool. Liposomal vitamin C bypasses the normal bowel tolerance because it is absorbed directly through cell membranes, so higher doses can be tolerated without diarrhea.
7. A human right to receive correct information
Access to correct information about food and essential nutrients, including knowledge about the importance of food for health is a fundamental human right. Such information should not only provide a summary of the nutrient content of food, but in our opinion should also explain how dietary supplements can counteract deficiencies and prevent and reverse disease caused by nutrient deficiencies. We should be free to purchase quality-controlled supplements of essential nutrients and to use them to counteract aging and damage from stress as part of a long-term health plan. The right to reject recommendations by doctors for symptomatic treatment with synthetic, some times life-threatening, drugs to alleviate symptoms should be included. [48,49]
I have not found any formulation of such rights from the Norwegian authorities. The role of parents and their right to receive correct health information is addressed in a book by lawyer Anne Kjersti C. Befring, a fellow at the University of Oslo since 2014. [50]
Summary
The use of dietary supplements is widespread. High doses of vitamins are thought to be helpful because they help the body recover from damage and maintain itself long-term. Many vitamins are not harmful in doses even 10 to 100-fold higher than officially recommended. Some governments warn about possible negative side effects, even including increased mortality from “excessive” intake of certain supplements. However, supplements of essential nutrients have been available for more than 80 years. They are known to be safe, and the observed side effects are generally mild with few exceptions.
It is possible to ingest too much of certain vitamins and minerals (vitamin A, calcium, iron, copper, selenium) which may exacerbate an existing imbalance or lack of another mineral (magnesium, zinc). It is also important to balance intake of fatty acids in the omega-6 and omega-3 series, as most people get too much omega-6 and not enough omega-3. Small children can be overdosed with adult doses of for example vitamin A or iron, and pills may be dangerous for babies or young children because they can get stuck in the throat. Therefore, I recommend consulting a doctor or nutritionist educated in orthomolecular medicine. Most people are likely to benefit from taking a broad-spectrum multivitamin/mineral supplement as a basic insurance against deficiencies.
Compared to pharmaceutical drugs, supplements of most essential nutrients are quite harmless. However, some supplements may have poor quality, or contain toxic metals such as lead or cadmium. Therefore, it is the duty of our authorities to ensure that potentially hazardous products or supplements of poor quality are not sold, and that consumers are offered fair prices in a free market. An example where the Norwegian authorities do not follow up such basic duties is that pharmacies demand more than 1,600 Norwegian Kroner (about $190) per kg of vitamin C in powder form, which would cost less than $20 with free competition and no restrictions in permitted doses or outlets.
Those who want to use natural healing methods, such as the use of food and supplements of essential nutrients to prevent or reverse illness, should consult therapists who are qualified to give advice on how natural therapies can help. I recommend that anyone interested in supplements read the references for this article as well as the archives of the Journal of Orthomolecular Medicine http://orthomolecular.org/library/jom/ and the Orthomolecular Medicine News Service http://orthomolecular.org/resources/omns/index.shtml . Both are free access online.
(Dag Viljen Poleszynski, PhD, is the editor of Helsemagasinet [Health Magazine] https://vof.no/arkiv/ . He has translated and published a large number of OMNS releases in Norwegian.)
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Nutritional Medicine is Orthomolecular Medicine
Orthomolecular medicine uses safe, effective nutritional therapy to fight illness. For more information: http://www.orthomolecular.org
