Are there different kinds of vitamins? Do they impact us differently?

Dr. Clemens: “There are water-soluble and fat-soluble vitamins. The fat-soluble vitamins are A, D, E and K. The water-soluble vitamins encompass the classic ‘B’ vitamins, vitamin C and a few others.”

What is the most common vitamin deficiency?

Dr. Clemens: “The number one vitamin deficiency, on a global basis, is vitamin A, according to WHO. Frank vitamin A deficiency is presented by night blindness, compromised skin, increased infections and elevated mortality. Data from the NHANES suggest nearly 70% of the US population does not meet the vitamin A requirement established by the Institute of Medicine.”

According to Dr. Clemens, food processing technology and food fortification programs help to decrease the vitamin A deficiency to about 30%. He also shared that many people tend to be deficient in vitamin D, the sunshine vitamin. This deficiency leads to a condition called rickets, which is poor bone formation.

However, these vitamin A and vitamin D deficiencies in the United States tend to be rare. With respect to water-soluble vitamins, the NHANES survey data suggest significant deficiencies are unusual.

So, based on this information, are there any people who are more at risk for certain vitamin deficiencies?

Dr. Clemens: “Many at-risk populations, such as the elderly, may present nutrient insufficiencies of vitamins in the ‘B’ category, particularly vitamin B6 (needed for protein metabolism), vitamin B1 (needed for energy generation), vitamin B12 (needed for many processes, including blood cell formation) and choline (need for nerve cells).”

To help explain the commonality of vitamin deficiency, we found this graph from the Center for Disease Control.

Are there any foods that I should be eating to help prevent vitamin deficiencies?

Dr. Clemens: “Key to minimize nutrient insufficiencies is to follow a balanced, diverse dietary pattern. Those who avoid dairy products are likely to present insufficient vitamin A, vitamin D, and many other nutrients. Those who avoid grains are likely to present an array of gastrointestinal challenges.”

If you’re wondering what foods you should eat to help maintain vitamin levels, good foods to eat include:

• Mushrooms
• Dairy products such as milk, cheese and yogurt
• Carrots
• Sweet potatoes
• Spinach, kale and collard greens
• Apricots
• Grain breads and cereals
• Meat, fish, poultry and eggs
• Nuts and legumes

What are other ways, besides food, to get these vitamins?

Dr. Clemens: “There are several life-stages where nutrient insufficiencies are prevalent. The primary stages include infancy, adolescence, pregnancy & lactation and elderly. Each of these is unique with respect to needs and how vitamins are absorbed and utilized. For example, prior to pregnancy and throughout pregnancy, there is an increased need for folic acid. In fact, during each stage of pregnancy, the first two months are particularly critical for nutrient adequacy. Thus, many health professionals recommend the consumption of prenatal dietary supplements that are designed specifically for pregnant women.”

Are there health issues associated with vitamin deficiency?

Dr. Clemens: “The number of health-related issues with vitamin deficiency (and even insufficiency) is vast. For example, one of the initial injections administered to newborn infants is a form of vitamin K. Vitamin K is essential for maintaining blood clotting functions. Other health-related issues are noted above. Many organizations have compiled a simple chart of vitamins and their deficiency symptoms.

Each vitamin has an important role in keeping our bodies healthy. We are more susceptible to deficiencies at certain stages of life. Eating a diverse, balanced diet helps get all the vitamins you need.

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Nutrition is a simple word, but following a healthy, nutritious diet can sometimes be difficult to put into practice.

Noun. Nutrition, simply put, is the process of nourishing or of being nourished; the process by which organisms take in and utilize food.

The key to this definition is the word “nourishing.”

Used in a sentence:

Proper nutrition involves consuming a variety of foods that include fruits, vegetables, lean proteins and whole grains that provide essential vitamins and minerals for the body.

_{The image “Take Back Your Health Conference 2015 Los Angeles” by Take Back Your Health Conference is licensed under CC BY 2.0.}

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According to Dr. Dahl, infused water is a simple and healthy way to make tasteless water more appealing without adding any artificial ingredients or extra calories.

How is it made?

The general procedure involves using fruits, vegetables, or herbs to “infuse” or “permeate” water by sitting in or near the water for at least 4 hours. Infusing at room temperature often speeds up infusion rate and typical infused water lasts 3-4 days refrigerated. Rinds from citrus fruits can add a bitter taste, so if using citrus, you may want to cut off the rind portion of the fruit.

Are there any benefits to infused water besides taste?

Some benefits of infused water include the potential for nutrients, colors and flavors found naturally in the ingredients you use to seep into the water with little to no added calories. Water-soluble vitamins such as B vitamins and vitamin C may leak out in the infusion process and can be found in the water.

It’s getting easier to infuse water as more infusion products are available in stores. Big infusion pitchers or individual infusion water bottles with a place to put fruits or vegetables can be found at your local supermarket. If you don’t want to break the bank, you can use a mason jar and strain out the fruit and vegetable pieces left in the water.

Looking for some infused water recipes? Here are a few worth trying!

Strawberry, Basil and Cucumber from BudgetSavvyDiva.com

Blueberry Orange Water from ThePeachKitchen.com

Strawberry, Orange, Lemon and Mint from EatDrinkShopLove.com

_{“Fruit Infused Water” by Dave Leonhardt is licensed under CC BY 2.0.}

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_{“nom nom vitamins nom nom” by denAsuncioner is licensed under CC BY-ND 2.0}

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The Takeaway: Overall, nutrition experts say overdosing is a concern that we need to pay attention to, but vitamin and mineral supplements (that we take orally in a pill or chewable form) are much more likely to be the culprit for overdosing than fortified foods.

What can you tell us about this report?

Dr. MacDonald: “Historically, foods were fortified with vitamins and minerals to address deficiencies in the population. Examples include adding iodine to salt or vitamin D to milk. Enrichment of foods has also been done to put back nutrients that were decreased by processing, including adding B vitamins and iron to white flour. But today’s store shelves are full of products that contain added nutrients to improve the quality of the foods, and to encourage consumers to buy them. So being aware of how much supplements you are consuming may be a good idea. There is potential for over-fortification, especially for children, given the wide range of foods that are being fortified, and the fact that many parents are also giving them vitamin/mineral supplements. However, whether fortified foods alone can actually create toxic levels is questionable in my view. If fortified foods are taken with supplements, especially by kids, then there could be a concern.”

Dr. MacDonald suggested we reach out to Dr. Victor Fulgoni, a consultant with Nutrition Impact, LLC. Here’s what Dr. Fulgoni had to say:

Dr. Fulgoni: “Frankly, this report has not considered the issues with the estimated average requirements of certain nutrients, especially Upper Limits (the highest average daily nutrient intake level that is likely to pose no risk of adverse health effects to almost all individuals in the general population). The main issue is how to maximize meeting nutrient needs, while not having too many people exceed the Upper Limits. And, it’s important to note we do not know the risk of nutrient intake above the Upper Limits.”

The report says that nearly half of American kids age eight and younger consume potentially harmful amounts of vitamin A, zinc and niacin because of excessive food fortification, outdated nutritional labeling rules and misleading marketing tactics used by food manufacturers. Is this true?

Dr. MacDonald: “It’s a possibility. It’s a fact that there is more fortification of foods and beverages than there used to be, and people take more supplements that have a wide range of nutrients and other botanical/biologically active compounds.”

According to WebMD, Louise Berner, PhD, a professor of food science and nutrition at Cal Poly State University whose research is cited in the EWG report, questions the report’s conclusions.

Dr. Berner: “I agree that excessive or indiscriminate fortification, particularly along with the indiscriminate or unneeded use of supplements, is a potential issue of concern, but the EWG report is worrisome to me in several respects.”

Berner explained that the EWG report doesn’t address ‘tolerable upper intake level’ or UL. UL is the highest level of nutrients our bodies can take, without the risk of harm. Berner noted two additional challenges with the report: it “selects data and summarizes findings out of context” and “mischaracterizes the main message of our published data as I interpret them.”

Why do food companies fortify foods?

Dr. Berner’s research shows that fortified foods, mainly enriched grains, breakfast cereals, milk and juice, play an important role in ensuring that children get adequate amounts of many nutrients.

Is it possible to overdose on vitamins through fortified foods or supplements?

Per Dr. Berner, supplement use, and not fortification, seems to be “the major driver of potentially high [nutrient] intakes.”

Dr. MacDonald: “Yes, that is always a possibility, as some vitamins and minerals can be toxic in high doses. While overdosing is possible, people are much more likely to overdose by taking supplements than simply by eating fortified foods. As it relates to the specific vitamins and minerals cited in the EWG report,

• Vitamin A toxicity can occur if the vitamin is consumed in the active form of retinol or retinal, but not when in the pro-vitamin A form Beta-carotene (this form of Beta-carotene is found in carrots and orange vegetables, and has to be converted to be used as vitamin A in the body) – so you need to know what form is in the food by reading the ingredient label.
• Zinc is a mineral that is poorly absorbed, in general. Our bodies adapt the amount that is absorbed depending on how much is already present. For example, if we have low levels of zinc, our body will absorb more; if we have higher levels, our body will absorb less. So with zinc, overdosing from food is probably not likely, but overdosing could occur if there is a high dose taken in a supplement. The difference between food and supplement is the overall dose at one time – if you absorb 50% of 10 grams, that is less than 50% of 100 grams. Percent of absorption is the same, but the overall amount is more.
• Niacin is a water-soluble vitamin and is usually excreted in the urine when too much of it is in our bodies. It is important to note that if taken in high doses, for example, as a drug to regulate blood pressure, then it will have biological effects.

A good rule of thumb is to not consume supplements or fortified beverages/foods that contain greater than 200 times the recommended daily value of any nutrient. And to monitor supplement intake when consuming highly-fortified foods, such as energy drinks.”

To learn more about food fortification, please visit the FDA’s fortification policy site.

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