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Vitamins, Minerals, Supplements & Health
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Questions & Answers...
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Vitamins, minerals, supplements & health

MCHC Questions

Manufacturing and quality of nutritional supplements

Q. Why can't I get everything I need from my diet?

A. There are several reasons for this. First, remember that as a society, our dietary habits have changed over the past couple of generations. A healthy diet consists of plenty of fruits and vegetables and whole grains. Fruits and vegetables should be preferably fresh; fresh frozen is still good but not as good as "off the farm" fresh! Recent studies indicate that the majority of meals in the US are eaten in restaurants rather than in the home. Restaurant food tends to be too high in fat and sugar. Additionally, convenience foods now make up a much higher percentage of the average diet than in the past. In some people well over 60% of their food is from so-called "empty" calorie foods (candy, sweets, chips, or other highly processed foods that contain very little real nutritional value other than calories). Remember that the more highly processed a food is, the more likely it is to have a low nutritional value.

Another factor is the high stresses found in today's fast-paced and busy life. The greater the external stresses, the higher the nutritional demands on the body. Eating a poor-quality diet robs you of the nutritional factors necessary to help you stay healthy.

Lastly, many people are simply unaware of how to shop for healthy foods. Convenience and taste become the major criteria for food selection, while nutritional value is given little attention, if any at all.

Many nutritional researchers point to the rising problems of obesity, diabetes, heart disease and other diseases of modern society as evidence of the deteriorating quality of the diet most people consume. If you have questions about your diet, it is important that you discuss them with your healthcare provider on your next visit. Don't have a nutritionally-oriented practitioner? Click here, fill out the online form you will see and we can send by email the names or Web sites of several near you.

Q. Where do vitamins come from?

A. Vitamins are substances found in food that are required by your body to convert the food into energy. Since we cannot manufacture these substances, we need to get them from our diet. Unfortunately, the foods that many of us choose to eat have had most of the vitamins processed out. As many as thirty or forty vitamins and minerals may be taken out of our food, a dozen added back, and the food is then called "enriched." Generally the richest source of vitamins and minerals comes from fresh fruits, vegetables and grains; the worst sources are snack foods such as candy, chips, or highly-processed white flour bread or bakery items. While these may be OK in small quantities, they make up a significant proportion of many peoples' diet, which may put them at risk to nutritional deficiencies.

Q. What do vitamins do in the body?

A. In order to accomplish all of the thousands of day-to-day functions of your body, the food you eat every day must be converted into energy and raw materials (building blocks for muscles, bones, ligaments enzymes, hormones, and so on). To do all this, vitamins are required. Since we humans lack the ability to manufacture these critical nutrients in our bodies, we have to get them in our diet.

Generally, vitamins perform three major functions:
1. They are "cofactors" and catalysts for enzymes, which means they are required for the enzymes to do their jobs. The B-complex vitamins B1 and B2, for example are required for every function in the body that requires production of energy (which means every function!)
2. They act as antioxidants, which means they prevent highly reactive molecules called free radicals from damaging delicate cell membrane structure. Vitamins C and E are powerful antioxidants, protecting cell membranes from free radicals.
3. They act as "pre-hormones." For example, vitamin D functions as a hormone to facilitate calcium uptake and utilization.

Q. What do minerals do in the body?

A. Minerals have very many important functions; life could not exist without them. Iron is required for the manufacture of the chemical hemoglobin, which carries oxygen in the blood to all the cells of the body. Calcium is necessary for strong bones, and for transmission of messages within cells and from cell to cell. Magnesium is required for production of energy from the food you eat; and a selenium-containing molecule protects the body from damage by free radicals.

Q. What are antioxidants?

A. Antioxidants are a group of chemical compounds that protect against free radicals. Free radicals are highly reactive molecules produced naturally, or induced by exposure to things like radiation, certain chemical pollutants, or other sources. When free radicals come into contact with healthy cell membranes, they cause damage to the membrane and may ultimately cause the cell to die. Antioxidants prevent this damage by "quenching" the free radical and thus helping maintain health and proper function of the cell. In food, antioxidants are often the substances that give food their color or strong flavor; this is why choosing a naturally "colorful" diet can be a very healthy idea!

Q. Why is it necessary to take vitamin supplements to be healthy?

A. The simplest answer is because most people eat a poor diet. Studies show that the average diet in the US consists of too much fat, too much sugar, not enough fiber and not enough fresh fruits and vegetables. We are eating plenty of calories, but they are often "empty" calories, meaning that they have very low levels of the essential vitamins and minerals we need to stay healthy. Since the majority of meals in the US are currently eaten in restaurants or "on the run" it makes good sense to take a vitamin supplement to fill in the gaps in our diet.

While it is important to remember the value of a nutritional supplement in maintaining health, we should never think that taking a supplement replaces a good diet. In other words, the first and by far most important step is to improve the quality of our diet, and then take a supplement as a nutritional insurance policy to make sure we get all we need.

Q. In order to stay healthy, what is a good basic supplement program?

A. Each person is unique, so each person's nutritional needs would also be unique to them. Having said that, a prudent course of action to stay healthy would begin with eating a healthy diet. This means to avoid highly processed foods (candies, snack foods, convenience foods), or foods high in refined sugar or flour, as these tend to have low levels of important vitamins and minerals. A high quality multiple vitamin-mineral supplement is helpful to "fill in the gaps" in the diet. While other nutrients also may be helpful, it is important to remember our individuality and discuss the specific additional nutrients you might need with your nutritionally-oriented health care practitioner. (Find a practitioner near you).

Q. Are vitamins safe to take?

A. Generally, Yes, in the ranges that most vitamins are available as supplements. Vitamins are divided into two categories: fat soluble and water soluble. The water soluble vitamins (B vitamins and vitamin C) cannot be stored by the body, so they are generally quite safe, even in quantities higher than you would normally get in your diet. The fat soluble vitamins such as vitamins A or D can be stored by the body, so it is possible to build up a level that could be harmful. It is therefore important that you discuss ALL your vitamin consumption with your healthcare provider, to make sure you are getting the optimal amount for your health while not running the risk of taking more than would be safe for you.

Q. Are minerals safe to take?

A. While the levels of most vitamins and minerals recommended by your healthcare practitioner is considered safe, remember that too much of anything can be potentially harmful. Even such life-sustaining things as water and sunlight have an upper limit of safety. While certain minerals such as calcium are generally quite safe even when taken in relatively high amounts, your body's requirements for other minerals such as iron or selenium are much lower and therefore have a smaller safety range as well. Be sure and inform your healthcare provider of all supplements, herbs or medications you are taking so the optimal levels can be determined for you, including an adequate safety margin.

Q. Are herbs safe to take?

A. Most herbs, when used according to longstanding herbal traditions, are not only effective but safe. Herbs have been used in the treatment and support of human health for thousands of years. During that time much has been learned about what herbs can do, how to prepare them and which herbs are to be used for what purposes. In the hands of an experienced and qualified professional, herbs can work wonders! But herbs contain complex chemicals that, when used improperly, can cause harm as well. It is important to remember that the fact that herbs do work also means that they cause chemical changes in the body (that's how they work!) and that sometimes those changes may not be what is desired. Caution is particularly advised during pregnancy, when taking herbs and pharmaceutical medications together, or when taking herbs for extended periods of time. For these reasons, it is always advisable to discuss all herbs or supplements you are taking (or considering whether to take) with your health care practitioner. (Find a practitioner near you).

Q. Are vitamins safe during pregnancy?

A. Most vitamins are safe during pregnancy; in fact that is precisely the time when they are most needed! Not only must your diet support the mother's health and vitality, but that of her developing baby as well. A deficiency of certain nutrients (such as vitamin B12 or folic acid) during the early stages of pregnancy has been shown to significantly increase the risk to birth defects such as spina bifida.

There is some animal evidence however that high levels of other vitamins may increase risk to birth defects. Vitamin A for example has been shown in dosages higher than 8,000 IU to increase risk. For that reason it is not advisable to take high levels of vitamins during pregnancy without first consulting your healthcare provider. (Find a practitioner near you.)

Q. What is a "megavitamin?"

A. A megavitamin is the term applied to a nutritional supplement that contains levels of vitamins and minerals much higher than what would normally be obtained from your diet.

Q. Are minerals safe during pregnancy?

A. As is true with vitamins, most minerals are safe (and even required) during pregnancy. Minerals have a relatively narrower safety margin than do vitamins, but still significantly broader than do almost all pharmaceutical drugs. But unless research has specifically addressed a mineral's relative safety during pregnancy, it is not advisable to take amounts beyond what would be in a normal, healthy diet. If you are pregnant, be sure and discuss any supplement or herbal product you are considering with your healthcare provider. (Find a practitioner near you.)

Q. Are herbs safe during pregnancy?

A. Less research has been done on herb use during pregnancy than on vitamins or minerals, but it is helpful to recall that herbs have been in use for hundreds and even thousands of years (long before isolated vitamins, minerals or prescription pharmaceuticals were available!) While research is beginning to establish safety in humans during pregnancy (echinacea for immunity and ginger for nausea, for example), it is generally not advised to take herbs during this time, unless specifically directed by your healthcare practitioner. As is true at all times, but especially during pregnancy or while nursing, be sure and discuss these questions with your healthcare provider. (Find a practitioner near you.)

Q. What are tablet excipients?

A. Tablet excipients are agents used during the tableting process to help the powder flow through the equipment without sticking, or to improve the tablets' consistency, compressibility, or other desired characteristics.

Q. What do tablet "binders and fillers" do?

A. Binders and fillers are used during the tableting process to ensure that the tablet sticks together properly rather than crumbling in the bottle. For example, some vitamins are oils and others are powders. Binders, fillers and excipients help ensure the bulk powder flows smoothly through the equipment without caking or gumming, and helps make sure the tablet size and hardness are consistent.

Q. Are tablet excipients, binders or fillers good or bad?

A, It depends. Some excipients, binders or fillers are bad, because they can contribute to unwanted reactions in some people. Others are neutral (meaning they are neither digested nor absorbed), but they improve tablet function by ensuring it breaks down when it supposed to. The highest quality ingredients in a nutritional supplement could be useless if the tablet doesn't disintegrate properly, or crumbles in the bottle. It is also important to remember that excipients can be made of natural, vegetable materials that are unlikely to contribute to any health problems of the patient, or they can be made from other chemicals that may cause problems for some people. Artificial colors, dyes, preservatives or coating agents have been implicated for years as possible concerns. A reputable company producing high quality nutritional supplements will exercise great care in the selection of tableting agents to ensure consistent quality throughout the product, not just in the raw material selection.

Q. Why are tablet excipients necessary?

A. Tableting agents and excipients are required to ensure quality control in the tablet-manufacturing process. Tableting is part art and part science. Knowing how even small differences in temperature and humidity will affect the tableting process requires years of experience to develop. Tablet excipients help ensure that the bulk powder flows smoothly through the equipment, and that the tablets are of the right consistency so they will break down in your body as predicted.

Q. Are capsules better than tablets?

A. Capsules have some advantages in certain uses, but tablets have proven advantageous in others. For example, capsules increase the cost to the end user, it generally takes more capsules to contain the nutrients found in tablets, if the bottle is allowed to get too warm the capsules can melt or stick together, and the capsules have to be digested (broken down) before the nutrients inside can be released. On the "plus" side, capsules are generally easier to swallow, you can't tablet a liquid (which thus MUST be in capsules), and capsules can be made opaque to protect delicate and easily-lost nutrients (such as CQ 10). A reputable company will not be tied exclusively to capsules OR tablets, but will select the delivery method that is most appropriate to the nutrient and the marketplace, considering all variables in the selection process.

Q. What is stearic acid and from what is it derived?

A. Stearic acid is an essential saturated fatty acid that is found in all vegetable, seed, nut and animal oils. Although stearic acid can be from several sources, the most common source in better quality nutritional supplements is vegetable stearic acid.

Q. Why is stearic acid used in tablet manufacturing?

A. During tablet manufacturing certain substance such as stearic acid are use to help powders flow smoothly through the tableting machines and to help the tablets hold their shape. Stearic acid is an ideal fatty acid to use because it is naturally occurring in food, is inert and therefore does not interfere with the proper utilization or absorption of the active ingredients in the tablet.

Q. Does stearic acid interfere with the absorption of vitamins and minerals?

A. No. There is no evidence that stearic acid, in the levels used in tablet manufacturing, in any way interferes with or blocks breakdown and absorption of nutrients. Remember that the amount of stearic acid used in a tablet is much less than would be obtained from a salad with olive oil and vinegar dressing. (Olive oil is a source of stearic acid).

Q. What does "bioavailability" mean?

A. Bioavailability refers to the potential a product has to be absorbed into the bloodstream and have the desired impact on the consumer. In other words, a product with very high quality raw materials but is made in such a way that the tablet doesn't break down properly would have low bioavailability and would thus not do the patient any good. Disintegration time is an example of a test that measures aspects of bioavailability; it is the time it takes under controlled conditions for a tablet to break down completely. If a supplement breaks down when it is supposed to, there is a greater likelihood that it will be absorbed into the system.

Q. How can I tell if a vitamin-mineral supplement is of high quality?

A. It is difficult to tell quality simply by looking at a tablet. Many factors (most of which are hidden to the naked eye) go into a high quality nutritional supplement, but the three main variables are

1)the quality of the science behind the product
2)the quality of the ingredients themselves
3)the quality of the manufacturing process.

Quality of the science behind the product: the human body has often been compared to an extremely complex and wonderfully efficient machine. To function normally, it is extremely dependent upon a large variety of raw materials such as protein, fats, carbohydrates, vitamins, minerals, and so forth. If any of these critical substances are lacking in sufficient quantities, the efficiency of the "machine" suffers. The therapeutic use of nutrition supplements usually involves combining as many of these rate-limiting nutrients together as economically and physically possible, to provide everything required to focus on a particular health goal. If the nutritional supplement is poorly designed, key nutrients may be left out, or less important "window dressing" may be added that don't bring significant additional benefit. The product may then be inadequate to meet the therapeutic goals, or may be more expensive than needed. A reputable company will be able to provide scientific studies to support the formulation and its therapeutic value.

Quality of the ingredients: the same nutrient may be available in different forms. For example, vitamin E can be a natural (derived from food) or it can be synthetic (manufactured). The natural, food-identical vitamin E is called d-alpha tocopherol, while the synthetic form is called dl-alpha tocopherol. That "l" in the dl-alpha tocopherol is the only way you can tell a natural from a synthetic vitamin E by looking at the label, but science has shown that there is a significant difference in the way the body uses it. Natural vitamin E is significantly better in its biological activity that the synthetic. Another example is found in minerals such as calcium or iron. Minerals are not found alone in supplements but as chemical compounds. The nature of that compound is related to the ability of the body to absorb and use the mineral. For example, calcium may be found as "calcium carbonate" which is inexpensive but relatively more difficult to absorb. Other forms of calcium, such as calcium citrate or MCHC (microcrystalline hydroxyapatite) may be more expensive as raw materials, but may also be much better utilized by the body. A manufacturer of high quality products will be able to provide documentation from the scientific literature on the specific ingredients selected that will help to explain their superiority.

Quality of the manufacturing process: even if the supplement is well-formulated and has high quality ingredients, care must still be exercised during the manufacturing process to ensure a quality finished product. If the supplement doesn't break down properly during the digestive process it doesn't matter how well it's designed or what is used as ingredients! A manufacturer of high-quality nutritional supplements will perform a number of different tests before, during and after the tableting process to ensure quality in the finshed product, and should be able to provide you with documentation to support their processes upon request.

Q. Why do some supplements cost more than others that look like they contain the same ingredients?

A. Simply looking at the ingredients does not necessarily provide enough information to assess value. For example, the same amount of elemental calcium can be found as, among others, citrate or carbonate, but have significantly different absorption dynamics. Carbonates are much cheaper, and so are often used by supplement manufacturers, even though the more expensive citrates are better absorbed. Frequently, higher quality comes with a higher price. To learn more about how high quality nutritional supplements are produced, go to the menu of this Web site and browse through the "Quality" section for a more in-depth discussion of quality in nutritional supplements.

Q. How can I tell if an herb is of high quality?

A. This is a very important question. Many people have tried herbal products only to be disappointed when they don't work as hoped. A large part of this must be laid at the feet of manufacturers hoping to profit from the explosion of interest in herbs without understanding herbal medicine. For example, many people know of Echinacea as being an important herb for supporting healthy immune function. But only certain parts of the plant contain the substances that have established benefits. Some companies simply grind up the whole plant (stems, roots, leaves, flowers-everything) and sell that as "Echinacea." People taking the whole plant expecting to get the therapeutic benefits described will often be disappointed! A high quality product will have the active ingredients necessary to give the health benefits known by traditional herbalists. So if you've tried herbs before and been disappointed in the results, it may not be the fault of herbal medicine.

As is true of nutritional supplements, it is often difficult to see quality in herbs simply by looking at the finished product. This is especially true with herbs, as the standards for quality are still being developed. First and most obviously, quality in herbal products begins with high quality raw materials. This means that the manufacturer must have an intimate knowledge of herbs. One dried powder looks very much like another, so a reputable herbal manufacturer will exercise great care in the raw material purchasing process, and should be able to provide such things as Certificates of Authenticity and other documents establishing the source and quality of the herb. Because the chemical makeup of the plant changes as it matures (bite into a apple before it's ripe and you can taste the proof of that point!), selecting the herb at the correct time during the growing season is important. Additionally, different parts of the herb have different chemical constituents (and different effects in the body), so knowing which part of the herb to select is important. The delicate active principles of the herb must also be protected during the tableting process, so great care must be taken by the manufacturers here as well.

Q. Is it OK to take vitamins after their expiration date?

A. No. While vitamins generally do not deteriorate into something harmful or toxic over time, it is possible for the potency to diminish as time passes. The expiration date is there to ensure that you are getting the freshest products, with the highest possible quality and potency. To get the results you are seeking, it is best not to take a supplement that has gone past its expiration date.

Q. How long do vitamins last?

A. The US Food and Drug Administration dictates that if supplement manufacturers list an expiration date on their products, they must maintain records that prove that the products contain what the labels state, at expiration. This is because, like everything else, vitamins have a "lifespan." While they are generally quite stable, especially when kept away from direct sunlight and high temperatures, there may be a gradual loss of potency over time. A reputable company will slightly "overfill" their supplements, meaning that they put enough of each nutrient in the tablet to compensate for any loss of potency over time. A two-year expiration date means that the company is certifying that the product will continue to meet or exceed label claim for two years from the date of manufacture.

Q. Why do vitamin supplements have expiration dates?

A. As the tablets become exposed to sunlight, oxygen and moisture, vitamins may gradually lose potency. Although they do not become "toxic" or harmful, they may not provide the results the practitioner and consumer depend upon. In order to set expiration dates, the manufacturer must perform stability tests showing how much degradation of the product occurs over time, and put in enough of the raw material to compensate for any lost potency. Expiration dates ensure that the product will provide consistent results.

Q. What are slow or time released tablets?

A. Time-release or slow-release tablets are manufactured in such a way that they release their contents in the digestive tract over time rather than all at once. This can be accomplished by a variety of methods. One method is called "enteric coating," where the nutrient is coated with a substance that won't break down in the stomach but will in the small intestine. Another method coats the nutrients with a substance that will be slowly digested, so that the nutrients are gradually released. Both of these (and other) methods can be useful, but care must be exercised in the manufacturing process to ensure the desired results.

Q. When should I stop taking the vitamins recommended by my healthcare provider?

A. You should continue to take the supplements recommended by your healthcare provider until they instruct you to change dosage or stop taking them. (Find a practitioner near you.)

Q. Should I take the vitamins in the morning or at night?

A. To date, no specific research has been that definitively answer that question, although arguments could be made to support taking supplements in the morning, at night, or even for other times (such as at mealtime, for instance). The most important step is to take them.

Q. How are herbs different from drugs?

A. Drugs are made of a single, isolated compound that is generally patented, manufactured and "owned" by a company. Herbs are made from plants, and generally cannot be owned by a company, since their original source is in nature and is freely available. Generally, drugs have been extensively researched at great cost over a number of years (the need to recoup that cost is why governments allow drug companies to patent their drugs).

An additional and very important difference is in the way they work in the body. Generally, drugs have a specific mode of action; that means that they work on a specific chemical reaction in the body. They also tend to have side effects; they stronger the drug the more likely they are to have significant side effects. Herbs may also have certain side effects, but since their method of action is much more gentle, commonly the side effects (if any) tend to be very mild and resolve quickly.

When drugs and herbs are taken together, the effects of that combination may sometimes be difficult to predict. For that reason it is very important that you discuss any drugs, herbs or vitamins you are taken either singly or as combinations, with your healthcare provider. (Find a practitioner near you.)

Q. Can I hurt myself by overdosing on vitamins?

A. Everything has a range of safety, which also means that there is a potential (however small) that enough could be taken to become harmful. For example, even water and sunlight, which are essential for life, can become harmful if taken in extremely large quantities or for too long a time. In the case of most vitamins, the amounts used in supplements have been shown in repeated studies to be very safe. But because there is the possibility of taking "too much of a good thing," it is important to discuss with your healthcare provider ALL supplements (and the amounts of each) you are taking, so your specific health goals can be properly met.

Q. Are herbs safe to take with prescription drugs?

A. In general, herbs are very safe, but should not be taken with prescription drugs without the supervision of a healthcare provider. Recall that herbs have been used for supporting health for literally thousands of years. Remember, however, that herbs are complex compounds containing dozens of different chemicals. When combined with very powerful pharmaceutical drugs there is always the possibility of an effect other than what is desired. For this reason it is always important to discuss any combination of herbs, vitamins, and prescription drugs you are thinking of taking together with your healthcare provider. (Find a practitioner near you.)

Q. Why would herbs be supplied in combination blends?

A. Historically, the people who studied, catalogued and used herbs in treating people would use them in combinations. Traditional herbalists knew which combinations of herbs, when prepared in certain ways, would yield the results they were interested in. An herbalist would take several different plants, prepare them together as a tea, poultice, blend of dried powders, etc. and administer them. Drawing on this rich history of application improves can improve the successes of modern treatments as well.

Q. What makes urine change color when I take a multivitamin?

A. Vitamin B2 (riboflavin) causes urine to become a bright yellow when consumed in relatively high amounts.

Q. Can I still take vitamins if I have a cold or flu?

A. While preventing illness is where nutritional supplements and herbs have been shown to have their best effects, it is certainly helpful to continue on your supplement program when sick; in fact, the added stresses of fighting an infection significantly increase your body's nutritional requirements. Continue taking your supplements until advised to stop or change dosages by your healthcare provider.

Q. Can I still take vitamins if I am involved with a detoxification program?

A. Detoxification is a complex, energy-demanding process. The hundreds of different enzymes and biochemical pathways involved in detoxification require the presence of specific vitamins and minerals in order to function optimally. Additionally, research has shown that the process of detoxification can be compromised by insufficient energy reserves in the form of readily available calories. It is important to discuss your specific nutrition requirements with your healthcare provider, especially during detoxification programs.

Q. Can I take vitamins if I have cancer?

A. While there is some controversy surrounding the use of nutritional supplements during cancer treatment, especially as it relates to folic acid or antioxidants (which some believe may interfere with chemotherapeutic agents), latest research seems to show that supplements may increase the body's ability to fight diseases such as cancer. However, it is important to remember that not all people respond the same way, and to discuss this question very thoroughly with your healthcare provider.

Q. Should I take extra antioxidants if I am working out?

A. Exercise increases the flow of blood to the muscles, to deliver more oxygen and other nutrients. As oxygen usage increases, so does the production of free radicals. Since antioxidants help protect against the damage caused by free radicals, it would be sensible to increase your body's supply of antioxidants. The important first step in doing so is to eat a diet rich in fresh vegetables and fruits, since that is where many of the antioxidants are found in the first place. A good, broad-based nutritional supplement may be helpful in filling in any gaps in your diet, but should never be used instead of eating a healthy diet. Remember to always discuss your nutritional supplement use with your healthcare provider.

Q. Will I destroy any of the properties in a tablet if I crush it?

A. Generally, no. Sometimes crushing a tablet and sprinkling the powder on apple sauce or some other food helps those who have difficulty swallowing tablets. The only exception to this is if the supplement is enteric coated to allow it remain intact in the stomach and break down in the small intestine. Crushing the tablet may reduce the amount of the nutrient that gets into the bloodstream, so if you have any questions about this please be sure and discuss them with your healthcare provider on your next visit.

Q. What if I find a tablet in my stool?

A. That means that the tablet did not break down during the digestive process, and the nutrients in the tablet were not absorbed. A well-manufactured tablet should break down within 20 or 30 minutes after you swallow it. Reputable companies routinely perform disintegration tests on tablets during manufacturing to ensure they meet appropriate standards.

Q. When should a child take vitamins?

A. Both children and adults should always strive to eat a healthy diet, full of various different naturally colorful vegetables and fruits (it is the substances that give color to our food that often contain the greatest value!) A nutritional supplement should be taken to improve the overall value of the diet, not to replace the necessity of healthy dietary choices. But because in our hectic lifestyle many people cannot, or do not make the healthiest choices, a basic nutritional supplement targeted towards children's increased nutritional needs makes good nutritional "insurance."

Q. Should an infant take Acidophilus? I have heard they should only take Bifidus.

A. While it is true that bifidobacterium infantis is commonly found in the digestive tract of healthy infants, remember that there are hundreds of different bacteria strains in a healthy digestive tract. Different strains such as Lactobacillus acidophilus may provide specific and desired health benefits and could be part of your healthcare provider's strategy. Be sure and discuss this with your nutritionally-oriented health care practitioner. (Find a practitioner near you.)

Q. What vitamins, minerals or herbs might be recommended for anxiety?

A. Many nutrients have been shown to be helpful during times of anxiety, both to help you cope with anxiety and also to offset the increased nutritional demands on your body due to stress. The first place to begin is to make sure your diet has plenty of vegetables and fruit, preferably fresh. (These provide high nutritional value with low calories.) Beyond that, herbs such as St. John's Wort have been shown in scientific research to be helpful, but before you take any herbs or vitamins for anxiety, be sure and discuss them with your healthcare provider. (Find a provider near you.)

Q. Can I take probiotics if I am on an antibiotic?

A. Antibiotics can't tell the difference between friendly and unfriendly bacteria. If you take antibiotics at the same time as probiotics (friendly bacteria), the probiotics may be killed off. But also remember that one of the side effects of antibiotic use is diarrhea, which is believed to be related to the loss of friendly bacteria due to the antibiotics. To try to prevent that, many people take probiotics during the time they take antibiotics, but they space the dosages of the two apart by at least one to two hours. Before you try this for yourself, however be sure and discuss it with your healthcare provider.

Q. I have heard calcium can interfere with prescription drugs.

A. Certain drugs and nutrients may interact and in effect, reduce the strength of the drug. For this reason it is important to always discuss with your healthcare provider all the different vitamins, minerals, herbs and especially drugs you are taking.

Q. Can someone have an allergy to canola oil?

A: Although it may be possible to have an allergy to proteins found in the plant from which canola oil is extracted, in general, it is unlikely to have a true allergic reaction to canola oil. This is due to several factors. First, most plant oils are poor allergens because they contain very little protein. It is not the oil but the protein (which is usually considered an impurity of manufacturing) that causes an allergic reaction. When properly processed, high quality canola oil will have very low levels of protein particulate matter, and is thus the likelihood of an allergic reaction is extremely low. Even people with life-threatening anaphylactic reactions to peanuts generally do not react to highly processed and purified peanut oil. A simple test for potential allergenicity is to hold a clear container of the oil up to light and note how clear the oil itself is. A very clear, non-cloudy oil is likely to be free of potential allergens. Olive oil is one example of a an oil that contains high amounts of protein "impurities," although in the case of olive oil these impurities are generally considered beneficial. In any case, if you have concerns about your potential for a negative reaction, you should discuss these concerns with your healthcare provider. (Find a provider near you.)

Q. I have heard that human strains of probiotics are the best. Is that true?

A: Partly. While it is true that the most beneficial probiotics (friendly bacteria) can be isolated from humans' digestive tracts, certainly not all strains found there are healthful. In the womb, the baby's digestive tract is virtually sterile; the bacteria that will grow there following birth are due to exposure from the mother in the birth canal or at the breast during breast-feeding. Historically, our diet has contained additional sources of probiotics, including yogurt, buttermilk, fermented cheeses and even sauerkraut. So-called "human strains" of probiotics did not originate in humans therefore, but came originally from consuming them as part of a healthy diet. There are hundreds of different strains of bacteria living in the colon of a healthy person. Some of them confer benefits to humans, others are potentially harmful, and some can be either. A better question would be to determine the potential the specific strains of bacteria in question have for providing reliable and consistent health benefits.

Q. What are colloidal minerals?

A: A "colloid" is a chemical description of a gel-like suspension. Therefore, colloidal minerals would be a blend of minerals found in some form of suspension or solution. Generally, commercially-available colloidal minerals are produced from mining ancient sea beds, and then mixing the mined minerals with water or other fluid to hold them in solution. While these products provide a large number of minerals, there is no credible scientific evidence to support marketing claims for superior absorption or bioavailability. They may even contain relatively high levels of unwanted minerals such as aluminum, lead or mercury (which of course are naturally occurring), or of other contaminants.

While it is definitely true that optimal health depends upon an adequate intake of all essential nutrients, fewer than 20 minerals are currently known to be essential for humans. The exact role of other trace elements, as well as our intake of these micronutrients from food, remains to be clarified. A better solution than consuming expensive and unproven products would be to eat a healthy diet, made up of lots of mineral-rich vegetables and whole grains.

Q. What is myo-inositol, and how does it differ from "regular" inositol?

A: Myo-inositol is one of eight naturally occurring forms that make up the nutrient inositol. Each one has a slightly different shape and are individually referred to as isomers. The myo-inositol isomer is the most abundant form found in the central nervous system, where it can be converted into phosphatidyl inositol, a second messenger neurotransmitters. Inositol is the term used to describe the entire group of isomers together.

Q. What is MSM?

A. Methylsulfonylmethane (MSM) is a highly biologically valuable source of sulfur. Sulfur is important for joint tissue support, however, other nutrients are also supportive of joint health. Along with MSM there are a number of supportive nutrients including glucosamine, chondroitin, vitamins C and E, and specific amino acids. While optimal joint support must start with a healthy and varied diet, nutritional supplements may be useful. However, it is important that your healthcare provider be aware of ALL supplements, herbs or medicines you are taking. (Find a practitioner near you.)

Q. What is the "glycemic index"?

A: The glycemic index (GI) is a ranking of foods on a scale from 0 to 100 according to the extent to which they raise blood sugar levels after eating. Glucose is given a relative number of 100 to provide a baseline to which all others can be compared. For example, an apple has a glycemic index of 38 which is less than half that of glucose, but higher than soybeans (which have a glycemic index of 18). Other common foods and their corresponding glycemic indices are Corn Flakes (84), dark rye bread (80), and bananas (54).

Q. What's the difference between indole-3-carbinol (I-3-C) and DIM?

A: Indole-3-carbinol (I-3-C) is the chemical name of a substance naturally occurring in cruciferous vegetables such as broccoli, brussel sprouts, cauliflower, and cabbage. Scientists have been studying the health benefits of I-3-C for a number of years, and believes it helps protect against certain types of cancers, such as breast and uterine because of its impact on the metabolism of estrogen in the body. Scientists now know that I-3-C is converted in the stomach to a different chemical called di-indolylmethane (DIM) when it comes in contact with digestive juices, and DIM is believed to be the major "active" metabolite, meaning that it has been shown to carry most, if not all, of the health-benefits ascribed to I-3-C.

The question might then be raised: "Why not just isolate and take a DIM supplement, if that's the active ingredient or metabolite? The answer is that, while DIM has shown interesting benefits, it is by no means the ONLY active ingredient converted from I-3-C; in fact, more than 20 metabolites of I-3-C have been identified; DIM is only one of them. These other metabolites have also been to shown to have potential benefits; one of them (called ICZ), for example is believed to enhance the body's fight against toxic substances that cause cancer by damaging DNA. Another similar example is the difference between mixed carotenoids and a single carotenoid like beta-carotene. It has been shown that taking all the carotenoids together as they would be naturally occurring in your diet, provides greater health benefits than taking beta carotene along

To recap, I-3-C is converted in the body to many substances, one of which is DIM. Taking a supplement containing only DIM would deprive you of the potential benefits of those other metabolites.

Q. When is the best time to take glutamine containing supplements, with food or without food?

A. Glutamine containing supplements can be taken with or without food.

Q. Why does N-acetylcysteine (NAC) have such a strong smell?

A. N-acetylcysteine is a sulfur-containing compound, and the sulfur gives it a very strong odor. Sulfur's characteristic "rotten-egg" smell is called that because eggs contain high amounts of sulfur which is freed and releases its odor as the egg decays.

Q. I am taking lithium, and have heard that myo-inositol might be good for control of depression as well. Is it safe to take them together?

A. Not without specifically discussing this question with your healthcare provider. In this case, myo-inositol may reduce or diminish the effects of lithium. You should always discuss any medications, nutritional supplements or herbs with healthcare provider to ensure maximum benefit to you. Be sure and bring up this and any other nutritional or medical question with your health care practitioner. (Find a practitioner near you.)

Q. Isn't it better to use glucosamine on its own without chondroitin?

A. Both glucosamine sulfate and chondroitin have been shown to beneficial for support of joints and connective tissue. The specific combination most suited to your needs may contain both together along with other nutrients, as recent research has shown that a mixture of glucosamine, chondroitin sulfate, and manganese ascorbate is more efficacious than taking glucosamine only. However, since every case is individual, it is important to discuss this with your practitioner in more detail. (Find a practitioner near you.)

Q. Is glucosamine vegetarian?

A. No, glucosamine is derived from crab shell.

Q. What makes amino acid chelated minerals better than other types of minerals?

A: In order to be absorbed, minerals, whether from foods or in supplements, have to be combined with a "carrier" molecule. When this molecule is a fragment of protein (an amino acid), and the mineral-amino acid compound forms a stable molecule, it is referred to as an amino acid chelate. Because the body is very efficient at absorbing amino acids, chelated minerals are more easily transported across the intestinal wall than are non-chelated minerals.

Q. What does porcine mean?

A: Porcine means derived from pig.

Q. Where is the best source of bovine raw glandulars?

A. Glandular materials start out as healthy (or unhealthy) as the animals from which they are made. For this reason, all reputable processors of glandular concentrates will use only USDA-inspected animals as the original source. The highest quality glandular materials will be made from animals grown in a healthier environment. New Zealand beef cattle make the best source of bovine glandular concentrates, because they are free-range rather than lot-raised, and fed pasture grasses and hay rather than cattle feed. Additionally, New Zealand is one of the only countries in the world considered completely free of BSE (mad cow disease) and other transmissible spongiform encephalopathies (TSEs).

Q. What is BSE and how can I prevent exposure to it?

A. Bovine spongiform encephalopathy (BSE), also called "mad cow disease" is a fatal neurological disease in cows though to be caused by consuming contaminated animal feed. Some countries have included in the feed given to cattle, ground up animal parts including brains and nervous systems of animals killed for food. Some of these animals had early stages BSE, and the infectious agent was passed on to the animals who consumed the feed. There is now evidence that some people who ate the meat from animals infected with BSE became infected themselves. Nearly 100 people have now died from what are now called "transmissible spongiform encephalopathies" (TSEs) believed to have been caused by eating BSE-contaminated beef.

Although the only sure way to prevent TSE exposure is to avoid its source (contaminated beef), that does not mean you should become a vegetarian. For example, the United States is believed to be free of BSE-infected cattle, and New Zealand produces beef (and other animal meat) that is certified free of BSE. Selecting meat from New Zealand and other BSE-free countries would be wise for anyone concerned about BSE exposure. For more information about BSE, TSE and what can be done to prevent it, please refer to the "News" section of this Web site and click on the "Archives" section, where a more detailed discussion is posted.

Q. Will deglycyrrhizinized licorice (DGL) affect my blood pressure?

A. The active substance that can affect blood pressure, glycyrrhizic acid, has been removed from DGL. It will most likely not have an affect on blood pressure, but the question is important to raise because there is a possibility that certain herbs could interfere with medications you may be taking. You should be sure and discuss these questions with your healthcare provider on your next visit.

Q. Should supplements be taken with food or away from food?

A. Certain supplements are meant to support the digestive process itself, so of course they should be taken at or near mealtime. In those cases, your healthcare provider probably gave you specific instructions.

No scientific studies have been conducted to definitively answer whether absorption of vitamins and minerals is better when supplements are taken with meals or away from meals, and a case could be made for either position. Many people find that taking supplements with their meals has the benefits of convenience and a reduced potential for stomach upset, however.

Q What is microcrystalline hydroxyapatite concentrate?

A Microcrystalline hydroxyapatite concentrate (MCHC) is a highly absorbable, natural calcium source to support healthy bones produced from veal bone. It contains all the minerals naturally occurring in healthy bone in the right proportions, along with the other active and supportive constituents of bone. To preserve the delicate proteins and other active constituents, MCHC is carefully processed without heat, ensuring that the natural microcrystalline structure is not destroyed.

Q What is the difference between MCHC and calcium?

A Calcium is a mineral involved in many different functions of the body, including muscle contraction, nerve impulse transmission, and helping your bones stay strong. Microcrystalline hydroxyapatite concentrate (MCHC) is a concentrate of whole bone. As such, MCHC contains calcium, but calcium is only one of many different components necessary to help build and maintain strong bones. MCHC also contains many other minerals, and even significant amounts of specific proteins. To elaborate, the calcium in your bones accounts for approximately 20% of the entire makeup of bone. The other 80% contains phosphorus, zinc, magnesium and many other minerals, as well as collagen protein. Collagen is also very important to the strength of your bones, by helping prevent them from becoming brittle.

Q What does it mean on a label when it talks of "elemental" calcium?

A Calcium in supplements (and in our diet) is always associated (in a chemical or molecular bond) with another substance. That substance may be carbon (forming calcium carbonate), citric acid (forming calcium citrate), or several others. Most labels will list the amount of calcium (without the other carrier substance) to allow consumers to compare one product with another based on the amount of calcium (called "elemental" calcium). This is somewhat misleading, however, as different forms of calcium (calcium carbonate, calcium gluconate, etc.) may have different effects on the body. For example, calcium carbonate (one commonly available form), may be poorly absorbed, especially by older people. Calcium carbonate interferes with the production of the very digestive juices required to prepare calcium for absorption. In contrast, calcium as found in MCHC or as calcium citrate, may be better absorbed by many people. Thus, 500 milligrams of "elemental calcium" from calcium carbonate may not provide the same health benefits as 500 milligrams of elemental calcium from MCHC or calcium citrate.

Q How much calcium is in MCHC?

A Whole bone is approximately 20% calcium. (As stated before, the other 80% is made up of other minerals such as phosphorus, zinc, copper, etc. and protein). Therefore, MCHC (which is a concentrate of whole bone) contains about 20% calcium. A product containing MCHC will list the amount of elemental calcium (which is the amount of calcium contained in the tablet, separate from the other components).

Q How is MCHC produced?

A Carefully selected New Zealand veal bones are the original source of the highest quality MCHC. New Zealand was chosen as the source because animals are free-range fed rather than feedlot raised, are completely free of BSE fear exposure and among the healthiest herds in the world. The pristine, unspoiled environment of New Zealand also ensures the world's lowest levels of contaminants such as lead (many times lower than the level determined safe by the US government guidelines). MCHC is processed without heat to preserve the delicate proteins and processed so that the microcrystalline structure is not lost. Stringent guidelines are followed to ensure purity and activity.

Q What is the difference between MCHC and bone meal?

A A great deal. Bone meal is heat-processed and produced from the bones of mature animals. The older the animal, the more time available for environmental contaminants such as lead to accumulate. MCHC is processed at -50 degrees Centigrade from young animals (veal) to preserve the delicate protein matrix and organic factors. (Studies have shown that when these organic factors are destroyed through heat processing, the benefits of MCHC are lost).

Q What about impurities such as lead in calcium supplements?

A Since our environment contains lead, every natural source of calcium will contain some lead. The key is to minimize exposure by selecting the purest possible natural sources of calcium. Since coastal waters are often highly polluted due to rain runoff and river outflow, oyster-shell calcium from these coastal waters would likely contain prohibitively high levels of lead and other contaminants. Bone meal from older animals would also likely contain higher amounts of lead. Selecting a source of MCHC from veal (young animals), grown in a pure, pristine environment such as New Zealand, would ensure a more pure starting material. Stringent testing during production and tableting ensures a high-quality calcium supplement. A reputable company will be able to supply assays upon request.

Q What is the best source of calcium?

A There are many sources of calcium available (calcium carbonate, gluconate, citrate, lactate, MCHC, etc. etc.), making it very difficult to know which to select. A better question to ask is "What is the intended application of the calcium supplement? In other words, "Why are you taking calcium?" Many people supplement with calcium to support muscle and nerve health, or because they read that calcium may be able to prevent leg cramps; others because they want healthy bones. As discussed in a previous question, bones are made up of much more than just calcium, so if your goal is healthy bones it makes sense to look for a comprehensive "bone health" supplement, which would contain more than just calcium alone.

Q How much calcium should I take?

A The USRDI (United States Recommended Daily Intake) for calcium has been determined by the FDA to be 1,000 milligrams. The average diet in America provides approximately 700 milligrams per day from all sources, Yours might be higher if you consume dairy as a regular part of your diet. You may have special needs that change that requirement, however. Such things as disease, injury, pregnancy, lack of exercise, etc. may cause your nutritional needs to change. It is always best to discuss these questions with your healthcare provider rather than relying on what a well-intentioned friend tells you.

Q How do I know how much calcium is in the product I am taking?

A Supplement labels in the US are regulated by the Food and Drug Administration. Supplement manufacturers are held accountable for the accuracy and reliability of the information they provide and the products inside the bottle. Reputable companies will follow Good Manufacturing Procedures (GMP's) for supplements, as established by the National Nutritional Foods Association (NNFA), so careful reading of the label of a reputable company should provide accurate information. For the amount of each mineral, look for "elemental" levels. This is the amount of that mineral, without its associated carriers (such as carbonate, gluconate, etc.).

Q Do I need to take magnesium to absorb calcium?

A No. Magnesium is required for many functions in the body, some of which also require calcium, so the belief has grown that the two must always be taken together. This is simply not supported by science. Studies done on a "bone support" product such as MCHC by itself (without additional magnesium) have shown dramatic benefits. While you may require both calcium and magnesium, there is no credible scientific evidence that everyone needs to take both of them together in a special ratio. It is always best to discuss your specific needs with your healthcare provider, since each person's nutritional needs are unique to them.

Q Is boron required for bone health?

A It is unclear whether boron is required to support healthy bones, but recent studies indicate that, at least in some people, it may help. Women who consumed a dietary supplement containing boron were able to maintain higher circulating levels of estrogen than women who didn't supplement with boron, according to some studies. Since loss of estrogen production at menopause is associated with accelerated bone loss, many believe that taking supplemental boron during menopause will help maintain healthier bones. You should discuss this with your healthcare provider to determine if you would benefit from boron supplementation, and if it would be wise to select a "bone health" product containing boron.

Q Do I need vitamin D for bone health?

A Yes. Vitamin D is considered an essential nutrient, meaning that for adequate health a certain amount of it must be consumed on a daily basis. Your body is able to store vitamin D, as it is a fat-soluble nutrient, and therefore some caution must be exercise, as too much of it may be harmful. Some people probably consume enough vitamin D in their diets so that they don't need additional supplements, but some notable exceptions include the elderly, those with compromised digestion, those who don't consume dairy products regularly, and others. As vitamin D can also be manufactured by your skin from direct contact with sunlight, those who live in northerly climates or who don't go out in the sun regularly may also be at risk. It is important to discuss with your healthcare provider your diet and lifestyle, and whether you would benefit from additional supplementation with vitamin D.

Q How can I protect myself from osteoporosis?

A Many factors contribute to osteoporosis, so it should come as no surprise that no one thing alone will prevent it. Many risk factors have been identified; some you can influence; others not. Risk factors you cannot control include your gender (women's loss of estrogen production at menopause is probably the single greatest risk factor), ethnic background (Asians and people from Northern European backgrounds are at greater risks) and family history (if your mother and grandmothers developed osteoporosis, your risks are higher). Some, however are under your control, including diet (calcium-rich foods include dairy and dark green leafy vegetables), exercise (especially weight-bearing) and limiting or eliminating alcohol and tobacco use. It is important to take stock of your current diet and lifestyle habits, and considering the risk factors outside your control, modify your habits to minimize your risk. Talking to your healthcare provider about tests that help you establish the health of your bones right now, would also be a good risk-reduction strategy.

Q I am taking estrogen right now. Doesn't that protect me enough?

A Maybe not. New studies have called into question the wisdom of long-term estrogen use due to increased risks to certain types of cancer. (Isn't it ironic that a strategy implemented to reduce one risk is now thought to increase another!) Since osteoporosis has many contributing factors (some of which you can control and others you cannot, as we discuss above), it is important that you speak with your healthcare provider to determine the healthiest way to reduce your risks to all diseases (including both osteoporosis and cancer).