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Health

From Wikipedia, the free encyclopedia

Health, as defined by the World Health Organization (WHO), is "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity."[1][2] This definition has been subject to controversy, as it may have limited value for implementation.[3][4][5] Health may be defined as the ability to adapt and manage physical, mental and social challenges throughout life.[6]

Contents

History

The meaning of health has evolved over time. In keeping with the biomedicalperspective, early definitions of health focused on the theme of the body's ability to function; health was seen as a state of normal function that could be disrupted from time to time by disease. An example of such a definition of health is: "a state characterized by anatomic, physiologic, and psychological integrity; ability to perform personally valued family, work, and community roles; ability to deal with physical, biological, psychological, and social stress".[7] Then in 1948, in a radical departure from previous definitions, the World Health Organization (WHO) proposed a definition that aimed higher: linking health to well-being, in terms of "physical, mental, and social well-being, and not merely the absence of disease and infirmity".[8] Although this definition was welcomed by some as being innovative, it was also criticized as being vague, excessively broad and was not construed as measurable. For a long time, it was set aside as an impractical ideal and most discussions of health returned to the practicality of the biomedical model.[9]

Just as there was a shift from viewing disease as a state to thinking of it as a process, the same shift happened in definitions of health. Again, the WHO played a leading role when it fostered the development of the health promotion movement in the 1980s. This brought in a new conception of health, not as a state, but in dynamic terms of resiliency, in other words, as "a resource for living". 1984 WHO revised the definition of health defined it as "the extent to which an individual or group is able to realize aspirations and satisfy needs and to change or cope with the environment. Health is a resource for everyday life, not the objective of living; it is a positive concept, emphasizing social and personal resources, as well as physical capacities".[10] Thus, health referred to the ability to maintain homeostasis and recover from insults. Mental, intellectual, emotional and social health referred to a person's ability to handle stress, to acquire skills, to maintain relationships, all of which form resources for resiliency and independent living.[9] This opens up many possibilities for health to be taught, strengthened and learned.

Since the late 1970s, the federal Healthy People Initiative has been a visible component of the United States’ approach to improving population health.[11][12] In each decade, a new version of Healthy People is issued,[13] featuring updated goals and identifying topic areas and quantifiable objectives for health improvement during the succeeding ten years, with assessment at that point of progress or lack thereof. Progress has been limited to many objectives, leading to concerns about the effectiveness of Healthy People in shaping outcomes in the context of a decentralized and uncoordinated US health system. Healthy People 2020 gives more prominence to health promotion and preventive approaches and adds a substantive focus on the importance of addressing social determinants of health. A new expanded digital interface facilitates use and dissemination rather than bulky printed books as produced in the past. The impact of these changes to Healthy People will be determined in the coming years.[14]

Systematic activities to prevent or cure health problems and promote good health in humans are undertaken by health care providers. Applications with regard to animal health are covered by the veterinary sciences. The term "healthy" is also widely used in the context of many types of non-living organizations and their impacts for the benefit of humans, such as in the sense of healthy communities, healthy cities or healthy environments. In addition to health care interventions and a person's surroundings, a number of other factors are known to influence the health status of individuals, including their background, lifestyle, and economic, social conditions and spirituality; these are referred to as "determinants of health." Studies have shown that high levels of stress can affect human health.[15]

In the first decade of the 21st century, the conceptualization of health as an ability opened the door for self-assessments to become the main indicators to judge the performance of efforts aimed at improving human health[16]. It also created the opportunity for every person to feel healthy, even in the presence of multiple chronic diseases, or a terminal condition, and for the re-examination of determinants of health, away from the traditional approach that focuses on the reduction of the prevalence of diseases[17].

Determinants

Generally, the context in which an individual lives is of great importance for both his health status and quality of their life[18]. It is increasingly recognized that health is maintained and improved not only through the advancement and application of health science, but also through the efforts and intelligent lifestyle choices of the individual and society. According to the World Health Organization, the main determinants of health include the social and economic environment, the physical environment and the person's individual characteristics and behaviors.[19]

More specifically, key factors that have been found to influence whether people are healthy or unhealthy include the following:[19][20][21]


Donald Henderson as part of the CDC's smallpoxeradication team in 1966.

An increasing number of studies and reports from different organizations and contexts examine the linkages between health and different factors, including lifestyles, environments, health care organization and health policy, one specific health policy brought into many countries in recent years was the introduction of the sugar tax. Beverage taxes came into light with increasing concerns about obesity, particularly among youth. Sugar-sweetened beverages have become a target of anti-obesity initiatives with increasing evidence of their link to obesity.[22]– such as the 1974 Lalonde reportfrom Canada;[21] the Alameda County Study in California;[23] and the series of World Health Reports of the World Health Organization, which focuses on global healthissues including access to health care and improving public health outcomes, especially in developing countries.[24]

The concept of the "health field," as distinct from medical care, emerged from the Lalonde report from Canada. The report identified three interdependent fields as key determinants of an individual's health. These are:[21]

  • Lifestyle: the aggregation of personal decisions (i.e., over which the individual has control) that can be said to contribute to, or cause, illness or death;
  • Environmental: all matters related to health external to the human body and over which the individual has little or no control;
  • Biomedical: all aspects of health, physical and mental, developed within the human body as influenced by genetic make-up.

The maintenance and promotion of health is achieved through different combination of physical, mental, and social well-being, together sometimes referred to as the "health triangle."[25][26] The WHO's 1986 Ottawa Charter for Health Promotion further stated that health is not just a state, but also "a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities."[27]

Focusing more on lifestyle issues and their relationships with functional health, data from the Alameda County Study suggested that people can improve their health via exercise, enough sleep, maintaining a healthy body weight, limiting alcohol use, and avoiding smoking.[28] Health and illness can co-exist, as even people with multiple chronic diseases or terminal illnesses can consider themselves healthy.[29]

The environment is often cited as an important factor influencing the health status of individuals. This includes characteristics of the natural environment, the built environment and the social environment. Factors such as clean water and air, adequate housing, and safe communities and roads all have been found to contribute to good health, especially to the health of infants and children.[19][30] Some studies have shown that a lack of neighborhood recreational spaces including natural environment leads to lower levels of personal satisfaction and higher levels of obesity, linked to lower overall health and well being.[31] This suggests that the positive health benefits of natural space in urban neighborhoods should be taken into account in public policyand land use.

Genetics, or inherited traits from parents, also play a role in determining the health status of individuals and populations. This can encompass both the predisposition to certain diseases and health conditions, as well as the habits and behaviors individuals develop through the lifestyle of their families. For example, genetics may play a role in the manner in which people cope with stress, either mental, emotional or physical. For example, obesity is a significant problem in the United States that contributes to bad mental health and causes stress in the lives of great numbers of people[32]. (One difficulty is the issue raised by the debate over the relative strengths of genetics and other factors; interactions between genetics and environment may be of particular importance.)

Potential issues

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A number of types of health issues are common around the globe. Disease is one of the most common. According to GlobalIssues.org, approximately 36 million people die each year from non-communicable (not contagious) disease including cardiovascular disease, cancer, diabetes and chronic lung disease (Shah, 2014).

Among communicable diseases, both viral and bacterial, AIDS/HIV, tuberculosis, and malaria are the most common, causing millions of deaths every year (Shah, 2014).

Another health issue that causes death or contributes to other health problems is malnutrition, especially among children. One of the groups malnutrition affects most is young children. Approximately 7.5 million children under the age of 5 die from malnutrition, usually brought on by not having the money to find or make food (Shah, 2014).

Bodily injuries are also a common health issue worldwide. These injuries, including broken bones, fractures, and burns can reduce a person's quality of life or can cause fatalities including infections that resulted from the injury or the severity injury in general (Moffett, 2013).[33]

Lifestyle choices are contributing factors to poor health in many cases. These include smoking cigarettes, and can also include a poor diet, whether it is overeating or an overly constrictive diet. Inactivity can also contribute to health issues and also a lack of sleep, excessive alcohol consumption, and neglect of oral hygiene (Moffett2013).There are also genetic disorders that are inherited by the person and can vary in how much they affect the person and when they surface (Moffett, 2013).

Though the majority of these health issues are preventable, a major contributor to global ill health is the fact that approximately 1 billion people lack access to health care systems (Shah, 2014). Arguably, the most common and harmful health issue is that a great many people do not have access to quality remedies.[34][35]

Mental health

The World Health Organization describes mental health as "a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community".[36] Mental Health is not just the absence of mental illness.[37]

Mental illness is described as 'the spectrum of cognitive, emotional, and behavioral conditions that interfere with social and emotional well-being and the lives and productivity of people. Having a mental illness can seriously impair, temporarily or permanently, the mental functioning of a person. Other terms include: 'mental health problem', 'illness', 'disorder', 'dysfunction'.[38]

Roughly a quarter of all adults 18 and over in the US are considered diagnosable with mental illness. Mental illnesses are the leading cause of disability in the US and Canada. Examples include, schizophrenia, ADHD, major depressive disorder, bipolar disorder, anxiety disorder, post-traumatic stress disorder and autism.[39]

Many teens suffer from mental health issues in response to the pressures of society and social problems they encounter. Some of the key mental health issues seen in teens are: depression, eating disorders, and drug abuse. There are many ways to prevent these health issues from occurring such as communicating well with a teen suffering from mental health issues. Mental health can be treated and be attentive to teens' behavior.[40]

 Many factors contribute to mental health problems, including:

  • Biological factors, such as genes or brain chemistry
  • Life experiences, such as trauma or abuse
  • Family history of mental health problems

Maintaining

Achieving and maintaining health is an ongoing process, shaped by both the evolution of health care knowledge and practices as well as personal strategies and organized interventions for staying healthy.

Diet

Percentage of overweight or obese population in 2010, Data source: OECD's iLibrary, http://stats.oecd.org[41]

Percentage of obese population in 2010, Data source: OECD's iLibrary, http://stats.oecd.org[42]

An important way to maintain your personal health is to have a healthy diet. A healthy diet includes a variety of plant-based and animal-based foods that provide nutrients to your body. Such nutrients give you energy and keep your body running. Nutrients help build and strengthen bones, muscles, and tendons and also regulate body processes (i.e. blood pressure). The food guide pyramid is a pyramid-shaped guide of healthy foods divided into sections. Each section shows the recommended intake for each food group (i.e. Protein, Fat, Carbohydrates, and Sugars). Making healthy food choices is important because it can lower your risk of heart disease, developing some types of cancer, and it will contribute to maintaining a healthy weight.[43]

The Mediterranean diet is commonly associated with health-promoting effects due to the fact that it contains some bioactive compounds like phenolic compounds, isoprenoids and alkaloids.[44]

Exercise

Physical exercise enhances or maintains physical fitness and overall health and wellness. It strengthens muscles and improves the cardiovascular system. According to the National Institutes of Health, there are four types of exercise: endurance, strength, flexibility, and balance.[45]

Sleep

Sleep is an essential component to maintaining health. In children, sleep is also vital for growth and development. Ongoing sleep deprivation has been linked to an increased risk for some chronic health problems. In addition, sleep deprivation has been shown to correlate with both increased susceptibility to illness and slower recovery times from illness.[46] In one study, people with chronic insufficient sleep, set as six hours of sleep a night or less, were found to be four times more likely to catch a cold compared to those who reported sleeping for seven hours or more a night.[47] Due to the role of sleep in regulating metabolism, insufficient sleep may also play a role in weight gainor, conversely, in impeding weight loss.[48] Additionally, in 2007, the International Agency for Research on Cancer, which is the cancer research agency for the World Health Organization, declared that "shiftwork that involves circadian disruption is probably carcinogenic to humans," speaking to the dangers of long-term nighttime work due to its intrusion on sleep.[49] In 2015, the National Sleep Foundation released updated recommendations for sleep duration requirements based on age and concluded that "Individuals who habitually sleep outside the normal range may be exhibiting signs or symptoms of serious health problems or, if done volitionally, may be compromising their health and well-being."[50]

Age and conditionSleep NeedsNewborns (0–3 months)14 to 17 hoursInfants (4–11 months)12 to 15 hoursToddlers (1–2 years)11 to 14 hoursPreschoolers (3–5 years)10 to 13 hoursSchool-age children (6–13 years)      9 to 11 hoursTeenagers (14–17 years)  8 to 10 hoursAdults (18–64 years)  7 to 9 hoursOlder Adults (65 years and over)  7 to 8 hours

Role of science

File:Nieuws uit Indonesië, het werk van de Nederlandse dienst voor Volksgezondheid Weeknummer 46-21 - Open Beelden - 16742.ogv

The Dutch Public Health Service provides medical care for the natives of the Dutch East Indies, May 1946

Health science is the branch of science focused on health. There are two main approaches to health science: the study and research of the body and health-related issues to understand how humans (and animals) function, and the application of that knowledge to improve health and to prevent and cure diseases and other physical and mental impairments. The science builds on many sub-fields, including biology, biochemistry, physics, epidemiology, pharmacology, medical sociology. Applied health sciences endeavor to better understand and improve human health through applications in areas such as health education, biomedical engineering, biotechnology and public health.

Organized interventions to improve health based on the principles and procedures developed through the health sciences are provided by practitioners trained in medicine, nursing, nutrition, pharmacy, social work, psychology, occupational therapy, physical therapy and other health care professions. Clinical practitioners focus mainly on the health of individuals, while public health practitioners consider the overall health of communities and populations. Workplace wellness programs are increasingly adopted by companies for their value in improving the health and well-being of their employees, as are school health services in order to improve the health and well-being of children.

Role of public health

Postage stamp, New Zealand, 1933. Public health has been promoted – and depicted – in a wide variety of ways.

Public health has been described as "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals."[51] It is concerned with threats to the overall health of a community based on population health analysis. The population in question can be as small as a handful of people or as large as all the inhabitants of several continents (for instance, in the case of a pandemic). Public health has many sub-fields, but typically includes the interdisciplinary categories of epidemiology, biostatistics and health services. Environmental health, community health, behavioral health, and occupational health are also important areas of public health.

The focus of public health interventions is to prevent and manage diseases, injuries and other health conditions through surveillance of cases and the promotion of healthy behavior, communities, and (in aspects relevant to human health) environments. Its aim is to prevent health problems from happening or re-occurring by implementing educational programs, developing policies, administering services and conducting research.[52] In many cases, treating a disease or controlling a pathogen can be vital to preventing it in others, such as during an outbreak. Vaccination programs and distribution of condoms to prevent the spread of communicable diseases are examples of common preventive public health measures, as are educational campaigns to promote vaccination and the use of condoms (including overcoming resistance to such).

Public health also takes various actions to limit the health disparities between different areas of the country and, in some cases, the continent or world. One issue is the access of individuals and communities to health care in terms of financial, geographical or socio-cultural constraints to accessing and using services.[53] Applications of the public health system include the areas of maternal and child health, health services administration, emergency response, and prevention and control of infectious and chronic diseases.

The great positive impact of public health programs is widely acknowledged. Due in part to the policies and actions developed through public health, the 20th century registered a decrease in the mortality rates for infants and children and a continual increase in life expectancy in most parts of the world. For example, it is estimated that life expectancy has increased for Americans by thirty years since 1900,[54] and worldwide by six years since 1990.[55]

Self-care strategies

A lady washing her hands c. 1655

Personal health depends partially on the active, passive, and assisted cues people observe and adopt about their own health. These include personal actions for preventing or minimizing the effects of a disease, usually a chronic condition, through integrative care. They also include personal hygiene practices to prevent infection and illness, such as bathing and washing hands with soap; brushing and flossing teeth; storing, preparing and handling food safely; and many others. The information gleaned from personal observations of daily living – such as about sleep patterns, exercise behavior, nutritional intake and environmental features – may be used to inform personal decisions and actions (e.g., "I feel tired in the morning so I am going to try sleeping on a different pillow"), as well as clinical decisions and treatment plans (e.g., a patient who notices his or her shoes are tighter than usual may be having exacerbation of left-sided heart failure, and may require diuretic medication to reduce fluid overload).[56]

Personal health also depends partially on the social structure of a person's life. The maintenance of strong social relationships, volunteering, and other social activities have been linked to positive mental health and also increased longevity. One American study among seniors over age 70, found that frequent volunteering was associated with reduced risk of dying compared with older persons who did not volunteer, regardless of physical health status.[57] Another study from Singapore reported that volunteering retirees had significantly better cognitive performancescores, fewer depressive symptoms, and better mental well-being and life satisfactionthan non-volunteering retirees.[58]

Prolonged psychological stress may negatively impact health, and has been cited as a factor in cognitive impairment with aging, depressive illness, and expression of disease.[59] Stress management is the application of methods to either reduce stress or increase tolerance to stress. Relaxation techniques are physical methods used to relieve stress. Psychological methods include cognitive therapy, meditation, and positive thinking, which work by reducing response to stress. Improving relevant skills, such as problem solving and time management skills, reduces uncertainty and builds confidence, which also reduces the reaction to stress-causing situations where those skills are applicable.

Occupational

In addition to safety risks, many jobs also present risks of disease, illness and other long-term health problems. Among the most common occupational diseases are various forms of pneumoconiosis, including silicosis and coal worker's pneumoconiosis (black lung disease). Asthma is another respiratory illness that many workers are vulnerable to. Workers may also be vulnerable to skin diseases, including eczema, dermatitis, urticaria, sunburn, and skin cancer.[60][61] Other occupational diseases of concern include carpal tunnel syndrome and lead poisoning.

As the number of service sector jobs has risen in developed countries, more and more jobs have become sedentary, presenting a different array of health problems than those associated with manufacturing and the primary sector. Contemporary problems, such as the growing rate of obesity and issues relating to stress and overwork in many countries, have further complicated the interaction between work and health.

Many governments view occupational health as a social challenge and have formed public organizations to ensure the health and safety of workers. Examples of these include the British Health and Safety Executive and in the United States, the National Institute for Occupational Safety and Health, which conducts research on occupational health and safety, and the Occupational Safety and Health Administration, which handles regulation and policy relating to worker safety and health.[62][63][64]

See also

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Weight loss

From Wikipedia, the free encyclopedia

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Weight lossBefore and after comparison of weight loss 2015-06-25.pngA depiction of an individual's weight loss.

Weight loss, in the context of medicine, health, or physical fitness, refers to a reduction of the total body mass, due to a mean loss of fluid, body fat or adipose tissue or lean mass, namely bone mineral deposits, muscle, tendon, and other connective tissue. Weight loss can either occur unintentionally due to malnourishment or an underlying disease or arise from a conscious effort to improve an actual or perceived overweight or obesestate. "Unexplained" weight loss that is not caused by reduction in calorific intake or exercise is called cachexia and may be a symptom of a serious medical condition. Intentional weight loss is commonly referred to as slimming.

Contents

Intentional

Intentional weight loss is the loss of total body mass as a result of efforts to improve fitness and health, or to change appearance through slimming. Weight loss in individuals who are overweight or obese can reduce health risks,[1] increase fitness,[2]and may delay the onset of diabetes.[1] It could reduce pain and increase movement in people with osteoarthritis of the knee.[2] Weight loss can lead to a reduction in hypertension (high blood pressure), however whether this reduces hypertension-related harm is unclear.[1][not in citation given]

Weight loss occurs when the body is expending more energy in work and metabolismthan it is absorbing from food or other nutrients. It will then use stored reserves from fat or muscle, gradually leading to weight loss. For athletes seeking to improve performance or to meet required weight classification for participation in a sport, it is not uncommon to seek additional weight loss even if they are already at their ideal body weight. Others may be driven to lose weight to achieve an appearance they consider more attractive. However, being underweight is associated with health risks such as difficulty fighting off infection, osteoporosis, decreased muscle strength, trouble regulating body temperature and even increased risk of death.[3]

Low-calorie diets are also referred to as balanced percentage diets. Due to their minimal detrimental effects, these types of diets are most commonly recommended by nutritionists. In addition to restricting calorie intake, a balanced diet also regulates macronutrient consumption. From the total number of allotted daily calories, it is recommended that 55% should come from carbohydrates, 15% from protein, and 30% from fats with no more than 10% of total fat coming from saturated forms.[citation needed]For instance, a recommended 1,200 calorie diet would supply about 660 calories from carbohydrates, 180 from protein, and 360 from fat. Some studies suggest that increased consumption of protein can help ease hunger pangs associated with reduced caloric intake by increasing the feeling of satiety.[4] Calorie restriction in this way has many long-term benefits. After reaching the desired body weight, the calories consumed per day may be increased gradually, without exceeding 2,000 net (i.e. derived by subtracting calories burned by physical activity from calories consumed). Combined with increased physical activity, low-calorie diets are thought to be most effective long-term, unlike crash diets, which can achieve short-term results, at best. Physical activity could greatly enhance the efficiency of a diet. The healthiest weight loss regimen, therefore, is one that consists of a balanced diet and moderate physical activity.[citation needed]

Weight gain has been associated with excessive consumption of fats, (added) sugars, refined carbohydrates in general, and alcohol consumption.[citation needed] Depression, stress or boredom may also contribute to weight increase,[5] and in these cases, individuals are advised to seek medical help. A 2010 study found that dieters who got a full night's sleep lost more than twice as much fat as sleep-deprived dieters.[6][7]

Though hypothesized that supplementation of vitamin D may help, studies do not support this.[8] The majority of dieters regain weight over the long term.[9]

According to the Dietary Guidelines for Americans those who achieve and manage a healthy weight do so most successfully by being careful to consume just enough calories to meet their needs, and being physically active.[10] According to the U.S. Food and Drug Administration (FDA), healthy individuals seeking to maintain their weight should consume 2,000 calories (8.4 MJ) per day.[citation needed]

Techniques

The least intrusive weight loss methods, and those most often recommended, are adjustments to eating patterns and increased physical activity, generally in the form of exercise. The World Health Organization recommended that people combine a reduction of processed foods high in saturated fats, sugar and salt[11] and caloriccontent of the diet with an increase in physical activity.[12]

An increase in fiber intake is also recommended for regulating bowel movements. Other methods of weight loss include use of drugs and supplements that decrease appetite, block fat absorption, or reduce stomach volume. Bariatric surgery may be indicated in cases of severe obesity. Two common bariatric surgical procedures are gastric bypass and gastric banding.[13] Both can be effective at limiting the intake of food energy by reducing the size of the stomach, but as with any surgical procedure both come with their own risks[14] that should be considered in consultation with a physician. Dietary supplements, though widely used, are not considered a healthy option for weight loss.[15] Many are available, but very few are effective in the long term.[16]

Virtual gastric band uses hypnosis to make the brain think the stomach is smaller than it really is and hence lower the amount of food ingested. This brings as a consequence weight reduction. This method is complemented with psychological treatment for anxiety management and with hypnopedia. Research has been conducted into the use of hypnosis as a weight management alternative.[17][18][19][20] In 1996 a study found that cognitive-behavioral therapy (CBT) was more effective for weight reduction if reinforced with hypnosis.[18] Acceptance and Commitment Therapy ACT, a mindfulness approach to weight loss, has also in the last few years been demonstrating its usefulness.[21]

Permanent weight loss

In order for weight loss to be permanent, changes in diet and lifestyle must be permanent as well. Short-term dieting has not been shown to produce either long term weight loss or better health, and may even be counterproductive.[22]

Weight loss industry

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The examples and perspective in this section deal primarily with the United States and do not represent a worldwide view of the subject. You may improve this article, discuss the issue on the talk page, or create a new article, as appropriate. (December 2010) (Learn how and when to remove this template message)

There is a substantial market for products which claim to make weight loss easier, quicker, cheaper, more reliable, or less painful. These include books, DVDs, CDs, cremes, lotions, pills, rings and earrings, body wraps, body belts and other materials, fitness centers, clinics, personal coaches, weight loss groups, and food products and supplements.[23]

In 2008 between US$33 billion and $55 billion was spent annually in the US on weight-loss products and services, including medical procedures and pharmaceuticals, with weight-loss centers taking between 6 and 12 percent of total annual expenditure. Over $1.6 billion a year was spent on weight-loss supplements. About 70 percent of Americans' dieting attempts are of a self-help nature.[24][25]

In Western Europe, sales of weight-loss products, excluding prescription medications, topped €1,25 billion (£900 million/$1.4 billion) in 2009.[25]

Unintentional

Characteristics

Unintentional weight loss may result from loss of body fats, loss of body fluids, muscle atrophy, or even a combination of these.[26][27] It is generally regarded as a medical problem when at least 10% of a person's body weight has been lost in six months[26][28]or 5% in the last month.[29] Another criterion used for assessing weight that is too low is the body mass index (BMI).[30] However, even lesser amounts of weight loss can be a cause for serious concern in a frail elderly person.[31]

Unintentional weight loss can occur because of an inadequately nutritious diet relative to a person's energy needs (generally called malnutrition). Disease processes, changes in metabolism, hormonal changes, medications or other treatments, disease- or treatment-related dietary changes, or reduced appetite associated with a disease or treatment can also cause unintentional weight loss.[26][27][28][32][33][34] Poor nutrient utilization can lead to weight loss, and can be caused by fistulae in the gastrointestinal tract, diarrhea, drug-nutrient interaction, enzyme depletion and muscle atrophy.[28]

Continuing weight loss may deteriorate into wasting, a vaguely defined condition called cachexia.[31] Cachexia differs from starvation in part because it involves a systemic inflammatory response.[31] It is associated with poorer outcomes.[26][31][32] In the advanced stages of progressive disease, metabolism can change so that they lose weight even when they are getting what is normally regarded as adequate nutrition and the body cannot compensate. This leads to a condition called anorexia cachexia syndrome (ACS) and additional nutrition or supplementation is unlikely to help.[28]Symptoms of weight loss from ACS include severe weight loss from muscle rather than body fat, loss of appetite and feeling full after eating small amounts, nausea, anemia, weakness and fatigue.[28]

Serious weight loss may reduce quality of life, impair treatment effectiveness or recovery, worsen disease processes and be a risk factor for high mortality rates.[26][31]Malnutrition can affect every function of the human body, from the cells to the most complex body functions, including:[30]

In addition, malnutrition can lead to vitamin and other deficiencies and to inactivity, which in turn may pre-dispose to other problems, such as pressure sores.[30]

Unintentional weight loss can be the characteristic leading to diagnosis of diseases such as cancer[26] and type 1 diabetes.[35]

In the UK, up to 5% of the general population is underweight, but more than 10% of those with lung or gastrointestinal diseases and who have recently had surgery.[30]According to data in the UK using the Malnutrition Universal Screening Tool ('MUST'), which incorporates unintentional weight loss, more than 10% of the population over the age of 65 is at risk of malnutrition.[30] A high proportion (10-60%) of hospital patients are also at risk, along with a similar proportion in care homes.[30]

Causes

Disease-related

Disease-related malnutrition can be considered in four categories:[30]

ProblemCauseImpaired intakePoor appetite can be a direct symptom of an illness, or an illness could make eating painful or induce nausea. Illness can also cause food aversion.

Inability to eat can result from: diminished consciousness or confusion, or physical problems affecting the arm or hands, swallowing or chewing. Eating restrictions may also be imposed as part of treatment or investigations. Lack of food can result from: poverty, difficulty in shopping or cooking, and poor quality meals.

Impaired digestion &/or absorptionThis can result from conditions that affect the digestive system.Altered requirementsChanges to metabolic demands can be caused by illness, surgery and organ dysfunction.Excess nutrient lossesLosses from the gastrointestinal can occur because of symptoms such as vomiting or diarrhea, as well as fistulae and stomas. There can also be losses from drains, including nasogastric tubes.

Other losses: Conditions such as burns can be associated with losses such as skin exudates.

Weight loss issues related to specific diseases include:

  • As chronic obstructive pulmonary disease (COPD) advances, about 35% of patients experience severe weight loss called pulmonary cachexia, including diminished muscle mass.[32] Around 25% experience moderate to severe weight loss, and most others have some weight loss.[32] Greater weight loss is associated with poorer prognosis.[32] Theories about contributing factors include appetite loss related to reduced activity, additional energy required for breathing, and the difficulty of eating with dyspnea (labored breathing).[32]
  • Cancer, a very common and sometimes fatal cause of unexplained (idiopathic) weight loss. About one-third of unintentional weight loss cases are secondary to malignancy. Cancers to suspect in patients with unexplained weight loss include gastrointestinal, prostate, hepatobiliary (hepatocellular carcinoma, pancreatic cancer), ovarian, hematologic or lung malignancies.
  • People with HIV often experience weight loss, and it is associated with poorer outcomes.[36] Wasting syndrome is an AIDS-defining condition.[36]
  • Gastrointestinal disorders are another common cause of unexplained weight loss – in fact they are the most common non-cancerous cause of idiopathic weight loss.[citation needed] Possible gastrointestinal etiologies of unexplained weight loss include: celiac disease, peptic ulcer disease, inflammatory bowel disease (crohn's disease and ulcerative colitis), pancreatitis, gastritis, diarrhea and many other GI conditions.
  • Infection. Some infectious diseases can cause weight loss. Fungal illnesses, endocarditis, many parasitic diseases, AIDS, and some other subacute or occult infections may cause weight loss.
  • Renal disease. Patients who have uremia often have poor or absent appetite, vomiting and nausea. This can cause weight loss.
  • Cardiac disease. Cardiovascular disease, especially congestive heart failure, may cause unexplained weight loss.
  • Connective tissue disease
  • Neurologic disease, including dementia[37]
  • Oral, taste or dental problems (including infections) can reduce nutrient intake leading to weight loss.[28]

Therapy-related

Medical treatment can directly or indirectly cause weight loss, impairing treatment effectiveness and recovery that can lead to further weight loss in a vicious cycle.[26]

Many patients will be in pain and have a loss of appetite after surgery.[26] Part of the body's response to surgery is to direct energy to wound healing, which increases the body's overall energy requirements.[26] Surgery affects nutritional status indirectly, particularly during the recovery period, as it can interfere with wound healing and other aspects of recovery.[26][30] Surgery directly affects nutritional status if a procedure permanently alters the digestive system.[26] Enteral nutrition (tube feeding) is often needed.[26] However a policy of 'nil by mouth' for all gastrointestinal surgery has not been shown to benefit, with some suggestion it might hinder recovery.[38]

Early post-operative nutrition is a part of Enhanced Recovery After Surgery protocols.[39] These protocols also include carbohydrate loading in the 24 hours before surgery, but earlier nutritional interventions have not been shown to have a significant impact.[39]

Some medications can cause weight loss,[40] while others can cause weight gain.[41][42]

Social conditions

Social conditions such as poverty, social isolation and inability to get or prepare preferred foods can cause unintentional weight loss, and this may be particularly common in older people.[43] Nutrient intake can also be affected by culture, family and belief systems.[28] Ill-fitting dentures and other dental or oral health problems can also affect adequacy of nutrition.[28]

Loss of hope, status or social contact and spiritual distress can cause depression, which may be associated with reduced nutrition, as can fatigue.[28]

Myths

Some popular beliefs attached to weight loss have been shown to either have less effect on weight loss as commonly believed or are actively unhealthy. According to Harvard Health, the idea of metabolism being the "key to weight" is "part truth and part myth" as while metabolism does affect weight loss, external forces such as diet and exercise have an equal effect.[44] They also commented that the idea of changing one's rate of metabolism is under debate.[44] Diet plans in fitness magazines are also often believed to be effective, but may actually be harmful by limiting the daily intake of important calories and nutrients which can be detrimental depending on the person and are even capable of driving individuals away from weight loss.[45]

Health effects

Obesity increases health risks, including diabetes, cancer, cardiovascular disease, high blood pressure, and non-alcoholic fatty liver disease, to name a few. Reduction of obesity lowers those risks.

A 1-kg loss of body weight has been associated with an approximate 1-mm Hg drop in blood pressure.[46]

See also


References

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  2. ^ Jump up to:a b Institute for Quality and Efficiency in Health Care. "Health benefits of losing weight". Fact sheet, Informed Health Online. Institute for Quality and Efficiency in Health Care. Retrieved 27 June 2013.
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  28. ^ Jump up to:a b c d e f g h i Payne, C; Wiffen, PJ; Martin, S (Jan 18, 2012). Payne, Cathy, ed. "Interventions for fatigue and weight loss in adults with advanced progressive illness". The Cochrane Database of Systematic Reviews. 1: CD008427. doi:10.1002/14651858.CD008427.pub2. PMID 22258985.
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  30. ^ Jump up to:a b c d e f g h National Collaborating Centre for Acute Care (UK) (February 2006). "Nutrition Support for Adults: Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition". NICE Clinical Guidelines, No. 32. National Collaborating Centre for Acute Care (UK).
  31. ^ Jump up to:a b c d e Yaxley, A; Miller, MD; Fraser, RJ; Cobiac, L (February 2012). "Pharmacological interventions for geriatric cachexia: a narrative review of the literature". The journal of nutrition, health & aging. 16 (2): 148–54. doi:10.1007/s12603-011-0083-8. PMID 22323350.
  32. ^ Jump up to:a b c d e f Itoh, M; Tsuji, T; Nemoto, K; Nakamura, H; Aoshiba, K (Apr 18, 2013). "Undernutrition in patients with COPD and its treatment". Nutrients. 5 (4): 1316–35. doi:10.3390/nu5041316. PMC 3705350. PMID 23598440.
  33. Jump up^ Mangili A, Murman DH, Zampini AM, Wanke CA; Murman; Zampini; Wanke (2006). "Nutrition and HIV infection: review of weight loss and wasting in the era of highly active antiretroviral therapy from the nutrition for healthy living cohort". Clin. Infect. Dis. 42 (6): 836–42. doi:10.1086/500398. PMID 16477562.
  34. Jump up^ Nygaard, B (Jul 19, 2010). "Hyperthyroidism (primary)". Clinical evidence. 2010: 0611. PMC 3275323. PMID 21418670.
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  36. ^ Jump up to:a b Mangili, A; Murman, DH; Zampini, AM; Wanke, CA (Mar 15, 2006). "Nutrition and HIV infection: review of weight loss and wasting in the era of highly active antiretroviral therapy from the nutrition for healthy living cohort". Clinical Infectious Diseases. 42 (6): 836–42. doi:10.1086/500398. PMID 16477562.
  37. Jump up^ Massompoor SM (April 2004). "Unintentional weight loss". Shiraz E-Medical Journal. 5 (2).
  38. Jump up^ Andersen, HK; Lewis, SJ; Thomas, S (Oct 18, 2006). Andersen, Henning Keinke, ed. "Early enteral nutrition within 24h of colorectal surgery versus later commencement of feeding for postoperative complications". The Cochrane Database of Systematic Reviews (4): CD004080. doi:10.1002/14651858.CD004080.pub2. PMID 17054196. Lay summary.
  39. ^ Jump up to:a b Burden, S; Todd, C; Hill, J; Lal, S (2012). Burden, Sorrel, ed. "Pre‐operative Nutrition Support in Patients Undergoing Gastrointestinal Surgery" (PDF). The Cochrane Database of Systematic Reviews. 11 (11): CD008879. doi:10.1002/14651858.CD008879.pub2. PMID 23152265. Lay summary.
  40. Jump up^ Mariotti, KC; Rossato, LG; Fröehlich, PE; Limberger, RP (Nov 2013). "Amphetamine-type medicines: a review of pharmacokinetics, pharmacodynamics, and toxicological aspects". Current clinical pharmacology. 8 (4): 350–7. doi:10.2174/15748847113089990052. PMID 23342978.
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External links

Classification

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Vitamin

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VitaminDrug classB vitamin supplement tablets.jpg

A bottle of B-complex vitamin pills

PronunciationUK: /ˈvɪtəmɪn, ˈvaɪ-/
US: /ˈvaɪtəmɪn/[1]In Wikidata

A vitamin is an organic molecule (or related set of molecules) which is an essential micronutrient that an organism needs in small quantities for the proper functioning of its metabolism. Essential nutrients cannot be synthesized in the organism, either at all or not in sufficient quantities, and therefore must be obtained through the diet. Vitamin C can be synthesized by some species but not by others; it is not a vitamin in the first instance but is in the second. The term vitamin does not include the three other groups of essential nutrients: minerals, essential fatty acids, and essential amino acids.[2] Most vitamins are not single molecules, but groups of related molecules called vitamers. For example, vitamin E consists of four tocopherols and four tocotrienols. The thirteen vitamins required by human metabolism are: vitamin A (retinols and carotenoids), vitamin B1 (thiamine), vitamin B2 (riboflavin), vitamin B3 (niacin), vitamin B5 (pantothenic acid), vitamin B6 (pyridoxine), vitamin B7 (biotin), vitamin B9 (folic acid or folate), vitamin B12(cobalamins), vitamin C (ascorbic acid), vitamin D (calciferols), vitamin E (tocopherols and tocotrienols), and vitamin K (quinones).

Vitamins have diverse biochemical functions. Some forms of vitamin A function as regulators of cell and tissue growth and differentiation. The B complex vitamins function as enzyme cofactors (coenzymes) or the precursors for them. Vitamin D has a hormone-like function as a regulator of mineral metabolism for bones and other organs. Vitamins C and E function as antioxidants.[3] Both deficient and excess intake of a vitamin can potentially cause clinically significant illness; although excess intake of water-soluble vitamins is less likely to do so.

Before 1935, the only source of vitamins was from food. If intake of vitamins was lacking, the result was vitamin deficiency and consequent deficiency diseases. Then, commercially produced tablets of yeast-extract vitamin B complex and semi-synthetic vitamin C became available. This was followed in the 1950s by the mass production and marketing of vitamin supplements, including multivitamins, to prevent vitamin deficiencies in the general population. Governments mandated addition of vitamins to staple foods such as flour or milk, referred to as food fortification, to prevent deficiencies.[4] Recommendations for folic acid supplementation during pregnancy reduced risk of infant neural tube defects.[5] Although reducing incidence of vitamin deficiencies clearly has benefits, supplementation is thought to be of little value for healthy people who are consuming a vitamin-adequate diet.[6]

The term vitamin is derived from the word vitamine, coined in 1912 by biochemist Casimir Funk, who isolated a complex of micronutrients essential to life, all of which he presumed to be amines. When this presumption was later determined not to be true, the "e" was dropped from the name.[7] All vitamins were discovered (identified) between 1913 and 1948.

Contents

List[edit]

Vitamin generic
descriptor nameVitamerchemical name(s) (list not complete)SolubilityUS Recommended dietary allowances
(male/female, age 19–70)[8]Deficiency diseaseOverdose syndrome/symptomsFood sourcesVitamin ARetinol, Retinal, and
four Carotenoids 
including Beta-caroteneFat900 µg/700 µgNight blindness, hyperkeratosis, and keratomalacia[9]Hypervitaminosis ALiver, orange, ripe yellow fruits, leafy vegetables, carrots, pumpkin, squash, spinach, fish, soy milk, milkVitamin B1ThiamineWater1.2 mg/1.1 mgBeriberi, Wernicke-Korsakoff syndromeDrowsiness and muscle relaxation[10]Pork, oatmeal, brown rice, vegetables, potatoes, liver, eggsVitamin B2RiboflavinWater1.3 mg/1.1 mgAriboflavinosis, glossitis, angular stomatitisDairy products, bananas, popcorn, green beans, asparagusVitamin B3Niacin, Niacinamide, Nicotinamide ribosideWater16 mg/14 mgPellagraLiver damage (doses > 2g/day)[11] and other problemsMeat, fish, eggs, many vegetables, mushrooms, tree nutsVitamin B5Pantothenic acidWater5 mg/5 mgParesthesiaDiarrhea; possibly nausea and heartburn.[12]Meat, broccoli, avocadosVitamin B6Pyridoxine, Pyridoxamine, PyridoxalWater1.3–1.7 mg/1.2–1.5 mgAnemia,[13]Peripheral neuropathyImpairment of proprioception, nerve damage (doses > 100 mg/day)Meat, vegetables, tree nuts, bananasVitamin B7BiotinWaterAI: 30 µg/30 µgDermatitis, enteritisRaw egg yolk, liver, peanuts, leafy green vegetablesVitamin B9Folates, Folic acidWater400 µg/400 µgMegaloblastic anemia and deficiency during pregnancy is associated with birth defects, such as neural tube defectsMay mask symptoms of vitamin B12deficiency; other effects.Leafy vegetables, pasta, bread, cereal, liverVitamin B12Cyanocobalamin, Hydroxocobalamin, Methylcobalamin, AdenosylcobalaminWater2.4 µg/2.4 µgPernicious anemia[14]None provenMeat, poultry, fish, eggs, milkVitamin CAscorbic acidWater90 mg/75 mgScurvyNone knownMany fruits and vegetables, liverVitamin DCholecalciferol(D3), Ergocalciferol(D2)Fat15 µg/15 µgRickets and osteomalaciaHypervitaminosis DLichen, eggs, liver, certain fish species such as sardines, certain mushroom species such as shiitakeVitamin ETocopherols, TocotrienolsFat15 mg/15 mgDeficiency is very rare; mild hemolytic anemia in newborn infants[15]Possible increased incidence of congestive heart failure.[16][17]Many fruits and vegetables, nuts and seeds, and seed oilsVitamin KPhylloquinone, MenaquinonesFatAI: 110 µg/120 µgBleeding diathesisDecreased anticoagulation effect of warfarin.[18]Leafy green vegetables such as spinach; egg yolks; liver

Sources[edit]

For the most part, vitamins are obtained from the diet, but some are acquired by other means: for example, microorganisms in the gut flora produce vitamin K and biotin; and one form of vitamin D is synthesized in skin cells when they are exposed to a certain wavelength of ultraviolet light present in sunlight. Humans can produce some vitamins from precursors they consume: for example, vitamin A is synthesized from beta carotene; and niacin is synthesized from the amino acid tryptophan.[19] The Food Fortification Initiative lists countries which have mandatory fortification programs for vitamins folic acid, niacin, vitamin A and vitamins B1, B2 and B12.[4]

Classification by solubility[edit]

Vitamins are classified as either water-soluble or fat-soluble. In humans there are 13 vitamins: 4 fat-soluble (A, D, E, and K) and 9 water-soluble (8 B vitamins and vitamin C). Water-soluble vitamins dissolve easily in water and, in general, are readily excreted from the body, to the degree that urinary output is a strong predictor of vitamin consumption.[20] Because they are not as readily stored, more consistent intake is important.[21] Fat-soluble vitamins are absorbed through the intestinal tract with the help of lipids (fats). Vitamins A and D can accumulate in the body, which can result in dangerous hypervitaminosis. Fat-soluble vitamin deficiency due to malabsorption is of particular significance in cystic fibrosis.[22]

Biochemical functions[edit]

Each vitamin is typically used in multiple reactions, and therefore most have multiple functions.[23]

On fetal growth and childhood development[edit]

Vitamins are essential for the normal growth and development of a multicellular organism. Using the genetic blueprint inherited from its parents, a fetus begins to develop from the nutrients it absorbs. It requires certain vitamins and minerals to be present at certain times.[5]These nutrients facilitate the chemical reactions that produce among other things, skin, bone, and muscle. If there is serious deficiency in one or more of these nutrients, a child may develop a deficiency disease. Even minor deficiencies may cause permanent damage.[24]

On adult health maintenance[edit]

Once growth and development are completed, vitamins remain essential nutrients for the healthy maintenance of the cells, tissues, and organs that make up a multicellular organism; they also enable a multicellular life form to efficiently use chemical energy provided by food it eats, and to help process the proteins, carbohydrates, and fats required for cellular respiration.[3]

Effects of cooking[edit]

The USDA has conducted extensive studies on the percentage losses of various nutrients from different food types and cooking methods.[25] Some vitamins may become more "bio-available" – that is, usable by the body – when foods are cooked.[26] The table below shows whether various vitamins are susceptible to loss from heat—such as heat from boiling, steaming, frying, etc. The effect of cutting vegetables can be seen from exposure to air and light. Water-soluble vitamins such as B and C dissolve into the water when a vegetable is boiled, and are then lost when the water is discarded.[27]

VitaminSoluble in WaterStable to Air ExposureStable to Light ExposureStable to Heat ExposureVitamin Anopartiallypartiallyrelatively stableVitamin Cvery unstableyesyesyesVitamin DnonononoVitamin EnoyesyesnoVitamin KnonoyesnoThiamine (B1)highlyno?> 100 °CRiboflavin (B2)slightlynoin solutionnoNiacin (B3)yesnononoPantothenic Acid (B5)quite stable?noyesVitamin B6yes?yes?Biotin (B7)somewhat??noFolic Acid (B9)yes?when dryat high tempCobalamin (B12)yes?yesno

Deficient intake[edit]

The body's stores for different vitamins vary widely; vitamins A, D, and B12 are stored in significant amounts, mainly in the liver,[15] and an adult's diet may be deficient in vitamins A and D for many months and B12 in some cases for years, before developing a deficiency condition. However, vitamin B3 (niacin and niacinamide) is not stored in significant amounts, so stores may last only a couple of weeks.[9][15] For vitamin C, the first symptoms of scurvy in experimental studies of complete vitamin C deprivation in humans have varied widely, from a month to more than six months, depending on previous dietary history that determined body stores.[28]

Deficiencies of vitamins are classified as either primary or secondary. A primary deficiency occurs when an organism does not get enough of the vitamin in its food. A secondary deficiency may be due to an underlying disorder that prevents or limits the absorption or use of the vitamin, due to a "lifestyle factor", such as smoking, excessive alcohol consumption, or the use of medications that interfere with the absorption or use of the vitamin.[15] People who eat a varied diet are unlikely to develop a severe primary vitamin deficiency. In contrast, restrictive diets have the potential to cause prolonged vitamin deficits, which may result in often painful and potentially deadly diseases.

Well-known human vitamin deficiencies involve thiamine (beriberi), niacin (pellagra),[29]vitamin C (scurvy), and vitamin D (rickets).[30] In much of the developed world, such deficiencies are rare; this is due to (1) an adequate supply of food and (2) the addition of vitamins and minerals to common foods (fortification).[15] In addition to these classical vitamin deficiency diseases, some evidence has also suggested links between vitamin deficiency and a number of different disorders.[31][32]

Excess intake[edit]

Some vitamins have documented acute or chronic toxicity at larger intakes. The European Union and the governments of several countries have established Tolerable upper intake levels(ULs) for those vitamins which have documented toxicity (see table).[8][33][34] The likelihood of consuming too much of any vitamin from food is remote, but excessive intake (vitamin poisoning) from dietary supplements does occur. In 2016, overdose exposure to all formulations of vitamins and multi-vitamin/mineral formulations was reported by 63,931 individuals to the American Association of Poison Control Centers with 72% of these exposures in children under the age of five.[35]

Government guidelines[edit]

In setting human nutrient guidelines, government organizations do not necessarily agree on amounts needed to avoid deficiency or maximum amounts to avoid the risk of toxicity.[33][8][34]For example, for vitamin C, recommended intakes range from 40 mg/day in India[36] to 155 mg/day for the European Union.[37] The table below shows U.S. Estimated Average Requirements (EARs) and Recommended Dietary Allowances (RDAs) for vitamins, PRIs for the European Union (same concept as RDAs), followed by what three government organizations deem to be the safe upper intake. RDAs are set higher than EARs to cover people with higher than average needs. Adequate Intakes (AIs) are set when there is not sufficient information to establish EARs and RDAs. Governments are slow to revise information of this nature. For the U.S. values, with the exception of calcium and vitamin D, all of the data date to 1997-2004.[38]

NutrientU.S. EAR[8]Highest U.S.
RDA or AI[8]Highest EU
PRI or AI[37]Upper limitUnitU.S.[8]EU [33]Japan[34]Vitamin A6259001300300030002700µgVitamin C75901552000NDNDmgVitamin D101515100100100µgVitamin KNE12070NDNDNDµgα-tocopherol (Vit E)1215131000300650-900mgThiamin (Vit B1)1.01.20.1 mg/MJNDNDNDmgRiboflavin (Vit B2)1.11.32.0NDNDNDmgNiacin (Vit B3)12161.6 mg/MJ351060-85mgPantothenic acid(Vit B5)NE57NDNDNDmgVitamin B61.11.31.81002540-60mgBiotin (Vit B7)NE3045NDNDNDµgFolate (Vit B9)32040060010001000900-1000µgCyanocobalamin (Vit B12)2.02.45.0NDNDNDµg

EAR US Estimated Average Requirements.

RDA US Recommended Dietary Allowances; higher for adults than for children, and may be even higher for women who are pregnant or lactating.

AI US and EFSA Adequate Intake; AIs established when there is not sufficient information to set EARs and RDAs.

PRI Population Reference Intake is European Union equivalent of RDA; higher for adults than for children, and may be even higher for women who are pregnant or lactating. For Thiamin and Niacin the PRIs are expressed as amounts per MJ of calories consumed. MJ = megajoule = 239 food calories.

Upper Limit Tolerable upper intake levels.

ND ULs have not been determined.

NE EARs have not been established.

Supplements[edit]

Calcium combined with vitamin D (as calciferol) supplement tablets with fillers.

In those who are otherwise healthy, there is little evidence that supplements have any benefits with respect to cancer or heart disease.[6][39] Vitamin A and E supplements not only provide no health benefits for generally healthy individuals, but they may increase mortality, though the two large studies that support this conclusion included smokers for whom it was already known that beta-carotenesupplements can be harmful.[39][40]

The European Union and other countries of Europe have regulations that define limits of vitamin (and mineral) dosages for their safe use as dietary supplements. Most vitamins that are sold as dietary supplements are not supposed to exceed a maximum daily dosage referred to as the tolerable upper intake level (UL). Vitamin products above these regulatory limits are not considered supplements and should be registered as prescription or non-prescription (over-the-counter drugs) due to their potential side effects. The European Union, United States, Japan and some other countries each set ULs.[33][8][34]

Dietary supplements often contain vitamins, but may also include other ingredients, such as minerals, herbs, and botanicals. Scientific evidence supports the benefits of dietary supplements for persons with certain health conditions.[41] In some cases, vitamin supplements may have unwanted effects, especially if taken before surgery, with other dietary supplements or medicines, or if the person taking them has certain health conditions.[41] They may also contain levels of vitamins many times higher, and in different forms, than one may ingest through food.

Governmental regulation[edit]

Most countries place dietary supplements in a special category under the general umbrella of foods, not drugs. As a result, the manufacturer, and not the government, has the responsibility of ensuring that its dietary supplement products are safe before they are marketed. Regulation of supplements varies widely by country. In the United States, a dietary supplement is defined under the Dietary Supplement Health and Education Act of 1994.[42] There is no FDA approval process for dietary supplements, and no requirement that manufacturers prove the safety or efficacy of supplements introduced before 1994.[29][30] The Food and Drug Administration must rely on its Adverse Event Reporting System to monitor adverse events that occur with supplements.[43] In 2007, the US Code of Federal Regulations (CFR) Title 21, part III took effect, regulating Good Manufacturing Practices (GMPs) in the manufacturing, packaging, labeling, or holding operations for dietary supplements. Even though product registration is not required, these regulations mandate production and quality control standards (including testing for identity, purity and adulterations) for dietary supplements.[44] In the European Union, the Food Supplements Directive requires that only those supplements that have been proven safe can be sold without a prescription.[45] For most vitamins, pharmacopoeial standards have been established. In the United States, the United States Pharmacopeia (USP) sets standards for the most commonly used vitamins and preparations thereof. Likewise, monographs of the European Pharmacopoeia (Ph.Eur.) regulate aspects of identity and purity for vitamins on the European market.

Naming[edit]

Nomenclature of reclassified vitaminsPrevious nameChemical nameReason for name change[46]Vitamin B4AdenineDNA metabolite; synthesized in bodyVitamin B8Adenylic acidDNA metabolite; synthesized in bodyVitamin BTCarnitineSynthesized in bodyVitamin FEssential fatty acidsNeeded in large quantities (does
not fit the definition of a vitamin).Vitamin GRiboflavinReclassified as Vitamin B2Vitamin HBiotinReclassified as Vitamin B7Vitamin JCatechol, FlavinCatechol nonessential; flavin reclassified as Vitamin B2Vitamin L1[47]Anthranilic acidNon essentialVitamin L2[47]AdenylthiomethylpentoseRNA metabolite; synthesized in bodyVitamin MFolic acidReclassified as Vitamin B9Vitamin PFlavonoidsNo longer classified as a vitaminVitamin PPNiacinReclassified as Vitamin B3Vitamin SSalicylic acidProposed inclusion[48] of salicylate as an essential micronutrientVitamin US-MethylmethionineProtein metabolite; synthesized in body

The reason that the set of vitamins skips directly from E to K is that the vitamins corresponding to letters F–J were either reclassified over time, discarded as false leads, or renamed because of their relationship to vitamin B, which became a complex of vitamins.

The German-speaking scientists who isolated and described vitamin K (in addition to naming it as such) did so because the vitamin is intimately involved in the coagulation of blood following wounding (from the German word Koagulation). At the time, most (but not all) of the letters from F through to J were already designated, so the use of the letter K was considered quite reasonable.[46][49] The table nomenclature of reclassified vitamins lists chemicals that had previously been classified as vitamins, as well as the earlier names of vitamins that later became part of the B-complex.

There are other missing B vitamins which were reclassified or determined not to be vitamins. For example, B9 is folic acid and five of the folates are in the range B11 through B16, forms of other vitamins already discovered, not required as a nutrient by the entire population (like B10, PABA for internal use[50]), biologically inactive, toxic, or with unclassifiable effects in humans, or not generally recognised as vitamins by science,[51] such as the highest-numbered, which some naturopath practitioners call B21 and B22. There are also nine lettered B complex vitamins (e.g. Bm). There are other D vitamins now recognised as other substances,[50] which some sources of the same type number up to D7. The controversial cancer treatment laetrile was at one point lettered as vitamin B17. There appears to be no consensus on any vitamins Q, R, T, V, W, X, Y or Z, nor are there substances officially designated as Vitamins N or I, although the latter may have been another form of one of the other vitamins or a known and named nutrient of another type.

Promotion[edit]

Once discovered, vitamins were actively promoted in articles and advertisements in McCall's, Good Housekeeping, and other media outlets.[29] Marketers enthusiastically promoted cod-liver oil, a source of Vitamin D, as "bottled sunshine", and bananas as a “natural vitality food". They promoted foods such as yeast cakes, a source of B vitamins, on the basis of scientifically-determined nutritional value, rather than taste or appearance.[52] World War II researchers focused on the need to ensure adequate nutrition, especially in processed foods.[29] Robert W. Yoder is credited with first using the term vitamania, in 1942, to describe the appeal of relying on nutritional supplements rather than on obtaining vitamins from a varied diet of foods. The continuing preoccupation with a healthy lifestyle has led to an obsessive consumption of additives the beneficial effects of which are questionable.[30]

Anti-vitamins[edit]

Anti-vitamins are chemical compounds that inhibit the absorption or actions of vitamins. For example, avidin is a protein in raw egg whites that inhibits the absorption of biotin; it is deactivated by cooking.[53] Pyrithiamine, a synthetic compound, has a molecular structure similar to thiamine, vitamin B1, and inhibits the enzymes that use thiamine.[54]

History[edit]

The discovery dates of the vitamins and their sourcesYear of discoveryVitaminFood source1913Vitamin A (Retinol)Cod liver oil1910Vitamin B1 (Thiamine)Rice bran1920Vitamin C (Ascorbic acid)Citrus, most fresh foods1920Vitamin D (Calciferol)Cod liver oil1920Vitamin B2 (Riboflavin)Meat, dairy products, eggs1922Vitamin E (Tocopherol)Wheat germ oil, 
unrefined vegetable oils1929Vitamin K1 (Phylloquinone)Leaf vegetables1931Vitamin B5 (Pantothenic acid)Meat, whole grains, 
in many foods1931Vitamin B7 (Biotin)Meat, dairy products, Eggs1934Vitamin B6 (Pyridoxine)Meat, dairy products1936Vitamin B3 (Niacin)Meat, grains1941Vitamin B9 (Folic acid)Leaf vegetables1948[55]Vitamin B12 (Cobalamins)Meat, organs (Liver), Eggs

The value of eating certain foods to maintain health was recognized long before vitamins were identified. The ancient Egyptians knew that feeding liverto a person may help with night blindness, an illness now known to be caused by a vitamin Adeficiency.[56] The advancement of ocean voyages during the Renaissance resulted in prolonged periods without access to fresh fruits and vegetables, and made illnesses from vitamin deficiency common among ships' crews.[57]

In 1747, the Scottish surgeon James Lind discovered that citrus foods helped prevent scurvy, a particularly deadly disease in which collagen is not properly formed, causing poor wound healing, bleeding of the gums, severe pain, and death.[56] In 1753, Lind published his Treatise on the Scurvy, which recommended using lemons and limes to avoid scurvy, which was adopted by the British Royal Navy. This led to the nickname limey for British sailors. Lind's discovery, however, was not widely accepted by individuals in the Royal Navy's Arctic expeditions in the 19th century, where it was widely believed that scurvy could be prevented by practicing good hygiene, regular exercise, and maintaining the morale of the crew while on board, rather than by a diet of fresh food.[56] As a result, Arctic expeditions continued to be plagued by scurvy and other deficiency diseases. In the early 20th century, when Robert Falcon Scott made his two expeditions to the Antarctic, the prevailing medical theory at the time was that scurvy was caused by "tainted" canned food.[56]

During the late 18th and early 19th centuries, the use of deprivation studies allowed scientists to isolate and identify a number of vitamins. Lipid from fish oil was used to cure rickets in rats, and the fat-soluble nutrient was called "antirachitic A". Thus, the first "vitamin" bioactivity ever isolated, which cured rickets, was initially called "vitamin A"; however, the bioactivity of this compound is now called vitamin D.[58] In 1881, Russian medical doctor Nikolai I. Lunin (ru)studied the effects of scurvy at the University of Tartu .[59] He fed mice an artificial mixture of all the separate constituents of milk known at that time, namely the proteins, fats, carbohydrates, and salts. The mice that received only the individual constituents died, while the mice fed by milk itself developed normally. He made a conclusion that "a natural food such as milk must therefore contain, besides these known principal ingredients, small quantities of unknown substances essential to life."[59] However, his conclusions were rejected by his advisor, Gustav von Bunge, even after other students reproduced his results.[60] A similar result by Cornelius Pekelharing appeared in a Dutch medical journal in 1905, but it was not widely reported.[60]

In East Asia, where polished white rice was the common staple food of the middle class, beriberi resulting from lack of vitamin B1 was endemic. In 1884, Takaki Kanehiro, a British-trained medical doctor of the Imperial Japanese Navy, observed that beriberi was endemic among low-ranking crew who often ate nothing but rice, but not among officers who consumed a Western-style diet. With the support of the Japanese navy, he experimented using crews of two battleships; one crew was fed only white rice, while the other was fed a diet of meat, fish, barley, rice, and beans. The group that ate only white rice documented 161 crew members with beriberi and 25 deaths, while the latter group had only 14 cases of beriberi and no deaths. This convinced Takaki and the Japanese Navy that diet was the cause of beriberi, but they mistakenly believed that sufficient amounts of protein prevented it.[61] That diseases could result from some dietary deficiencies was further investigated by Christiaan Eijkman, who in 1897 discovered that feeding unpolished rice instead of the polished variety to chickens helped to prevent beriberi in the chickens.[29] The following year, Frederick Hopkins postulated that some foods contained "accessory factors" — in addition to proteins, carbohydrates, fats etc. — that are necessary for the functions of the human body.[56] Hopkins and Eijkman were awarded the Nobel Prize for Physiology or Medicine in 1929 for their discoveries.[62]

Jack Drummond’s single paragraph paper in 1920 which provided structure and nomenclature used today for vitamins

In 1910, the first vitamin complex was isolated by Japanese scientist Umetaro Suzuki, who succeeded in extracting a water-soluble complex of micronutrients from rice bran and named it aberic acid (later Orizanin). He published this discovery in a Japanese scientific journal.[63] When the article was translated into German, the translation failed to state that it was a newly discovered nutrient, a claim made in the original Japanese article, and hence his discovery failed to gain publicity. In 1912 Polish-born biochemist Casimir Funk, working in London, isolated the same complex of micronutrients and proposed the complex be named "vitamine". It was later to be known as vitamin B3 (niacin), though he described it as "anti-beri-beri-factor" (which would today be called thiamine or vitamin B1). Funk proposed the hypothesis that other diseases, such as rickets, pellagra, coeliac disease, and scurvy could also be cured by vitamins. Max Nierenstein a friend and reader of Biochemistry at Bristol University reportedly suggested the "vitamine" name (from "vital amine").[64][65] The name soon became synonymous with Hopkins' "accessory factors", and, by the time it was shown that not all vitamins are amines, the word was already ubiquitous. In 1920, Jack Cecil Drummond proposed that the final "e" be dropped to deemphasize the "amine" reference, after researchers began to suspect that not all "vitamines" (in particular, vitamin A) have an amine component.[61]

In 1930, Paul Karrer elucidated the correct structure for beta-carotene, the main precursor of vitamin A, and identified other carotenoids. Karrer and Norman Haworth confirmed Albert Szent-Györgyi's discovery of ascorbic acid and made significant contributions to the chemistry of flavins, which led to the identification of lactoflavin. For their investigations on carotenoids, flavins and vitamins A and B2, they both received the Nobel Prize in Chemistry in 1937.[66]

In 1931, Albert Szent-Györgyi and a fellow researcher Joseph Svirbely suspected that "hexuronic acid" was actually vitamin C, and gave a sample to Charles Glen King, who proved its anti-scorbutic activity in his long-established guinea pig scorbutic assay. In 1937, Szent-Györgyi was awarded the Nobel Prize in Physiology or Medicine for his discovery. In 1943, Edward Adelbert Doisy and Henrik Dam were awarded the Nobel Prize in Physiology or Medicine for their discovery of vitamin K and its chemical structure. In 1967, George Wald was awarded the Nobel Prize (along with Ragnar Granit and Haldan Keffer Hartline) for his discovery that vitamin A could participate directly in a physiological process.[62]

In 1938, Richard Kuhn was awarded the Nobel Prize in Chemistry for his work on carotenoids and vitamins, specifically B2 and B6.[67]

Etymology[edit]

The term vitamin was derived from "vitamine", a compound word coined in 1912 by the Polish biochemist Casimir Funk[68] when working at the Lister Institute of Preventive Medicine. The name is from vital and amine, meaning amine of life, because it was suggested in 1912 that the organic micronutrient food factors that prevent beriberi and perhaps other similar dietary-deficiency diseases might be chemical amines. This was true of thiamine, but after it was found that other such micronutrients were not amines the word was shortened to vitamin in English.

See also[edit]

References[edit]

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External links[edit]

Wikisource has the text of the 1922 Encyclopædia Britannica articleVitamine.

Vitamins (A11)

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Dietary supplement

From Wikipedia, the free encyclopedia

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As a pill

As a capsule


As a tablet

As a softgel capsule used for fish oil or large amounts of vitamin E

As a shake and bottled powder

Production of cod liver oil, one of the first dietary supplement products manufactured in the 18th century[1]

A dietary supplement is a manufactured product intended to supplement the diet when taken by mouth as a pill, capsule, tablet, or liquid.[2] A supplement can provide nutrients either extracted from food sources or synthetic, individually or in combination, in order to increase the quantity of their consumption. The class of nutrient compounds includes vitamins, minerals, fiber, fatty acids and amino acids. Dietary supplements can also contain substances that have not been confirmed as being essential to life, but are marketed as having a beneficial biological effect, such as plant pigments or polyphenols. Animals can also be a source of supplement ingredients, as for example collagen from chickens or fish. These are also sold individually and in combination, and may be combined with nutrient ingredients. In the United States and Canada, dietary supplements are considered a subset of foods, and are regulated accordingly. The European Commission has also established harmonized rules to help insure that food supplements are safe and properly labeled.[3] Among other countries, the definition of dietary supplements may vary as drugs or other classes of ingredients used in supplement products.

Creating an industry estimated to have a 2015 value of $37 billion,[4] there are more than 50,000 dietary supplement products marketed just in the United States,[5] where about 50% of the American adult population consumes dietary supplements. Multivitamins are the most commonly used product.[6] For those who fail to consume a balanced diet, the United States National Institutes of Health states that certain supplements "may have value."[7]

In the United States, it is against federal regulations for supplement manufacturers to claim that these products prevent or treat any disease. Companies are allowed to use what is referred to as "Structure/Function" wording if there is substantiation of scientific evidence for a supplement providing a potential health effect.[8] An example would be "_____ helps maintain healthy joints", but the label must bear a disclaimer that the Food and Drug Administration (FDA) "has not evaluated the claim and that the dietary supplement product is not intended to "diagnose, treat, cure or prevent any disease," because only a drug can legally make such a claim.[8] The FDA enforces these regulations, and also prohibits the sale of supplements and supplement ingredients that are dangerous, or supplements not made according to standardized good manufacturing practices (GMPs).

Contents

Definition

In the United States, the Dietary Supplement Health and Education Act of 1994 provides this description: "The Dietary Supplement Health and Education Act of 1994 (DSHEA) defines the term “dietary supplement” to mean a product (other than tobacco) intended to supplement the diet that bears or contains one or more of the following dietary ingredients: a vitamin, a mineral, an herb or other botanical, an amino acid, a dietary substance for use by man to supplement the diet by increasing the total dietary intake, or a concentrate, metabolite, constituent, extract, or combination of any of the aforementioned ingredients. Furthermore, a dietary supplement must be labeled as a dietary supplement and be intended for ingestion and must not be represented for use as conventional food or as a sole item of a meal or of the diet. In addition, a dietary supplement cannot be approved or authorized for investigation as a new drug, antibiotic, or biologic, unless it was marketed as a food or a dietary supplement before such approval or authorization. Under DSHEA, dietary supplements are deemed to be food, except for purposes of the drug definition."[9]

Per DSHEA, dietary supplements are consumed orally, and are mainly defined by what they are not: conventional foods (including meal replacements), medical foods,[10] preservatives or pharmaceutical drugs. Products intended for use as a nasal spray, or topically, as a lotion applied to the skin, do not qualify. FDA-approved drugs cannot be ingredients in dietary supplements. Supplement products are or contain vitamins, nutritionally essential minerals, amino acids, essential fatty acids and non-nutrient substances extracted from plants or animals or fungi or bacteria, or in the instance of probiotics, are live bacteria. Dietary supplement ingredients may also be synthetic copies of naturally occurring substances (example: melatonin). All products with these ingredients are required to be labeled as dietary supplements.[11] Like foods and unlike drugs, no government approval is required to make or sell dietary supplements; the manufacturer confirms the safety of dietary supplements but the government does not; and rather than requiring risk–benefit analysis to prove that the product can be sold like a drug, such assessment is only used by the FDA to decide that a dietary supplement is unsafe and should be removed from market.[11]

Types

Vitamins

Pharmacies and supermarkets in the U.S. sell a large variety of vitamin dietary supplements

A vitamin is an organic compound required by an organism as a vital nutrient in limited amounts.[12] An organic chemical compound (or related set of compounds) is called a vitamin when it cannot be synthesized in sufficient quantities by an organism, and must be obtained from the diet. The term is conditional both on the circumstances and on the particular organism. For example, ascorbic acid (vitamin C) is a vitamin for anthropoid primates, humans, guinea pigs and bats, but not for other mammals. Vitamin D is not an essential nutrient for people who get sufficient exposure to ultraviolet light, either from the sun or an artificial source, as then they synthesize vitamin D in skin.[13] Humans require thirteen vitamins in their diet, most of which are actually groups of related molecules, "vitamers", (e.g. vitamin E includes tocopherols and tocotrienols, vitamin K includes vitamin K1 and K2). The list: vitamins A, C, D, E, K, Thiamine (B1), Riboflavin (B2), Niacin (B3), Pantothenic Acid (B5), Vitamin B6, Biotin (B7), Folate (B9) and Vitamin B12. Vitamin intake below recommended amounts can result in signs and symptoms associated with vitamin deficiency. There is little evidence of benefit when consumed as a dietary supplement by those who are healthy and consuming a nutritionally adequate diet.[14]

The U.S. Institute of Medicine sets Tolerable upper intake levels (ULs) for some of the vitamins. This does not prevent dietary supplement companies from selling products with content per serving higher than the ULs. For example, the UL for vitamin D is 100 µg (4,000 IU),[15] but products are available without prescription at 10,000 IU.

Dietary minerals

Minerals are the exogenous chemical elements indispensable for life. Four minerals: carbon, hydrogen, oxygen, and nitrogen, are essential for life but are so ubiquitous in food and drink that these are not considered nutrients and there are no recommended intakes for these as minerals. The need for nitrogen is addressed by requirements set for protein, which is composed of nitrogen-containing amino acids. Sulfur is essential, but for humans, not identified as having a recommended intake per se. Instead, recommended intakes are identified for the sulfur-containing amino acids methionine and cysteine. There are dietary supplements which provide sulfur, such as taurine and methylsulfonylmethane.

The essential nutrient minerals for humans, listed in order by weight needed to be at the Recommended Dietary Allowance or Adequate Intake are potassium, chlorine, sodium, calcium, phosphorus, magnesium, iron, zinc, manganese, copper, iodine, chromium, molybdenum, selenium and cobalt (the last as a component of vitamin B12). There are other minerals which are essential for some plants and animals, but may or may not be essential for humans, such as boron and silicon. Essential and purportedly essential minerals are marketed as dietary supplements, individually and in combination with vitamins and other minerals.

Although as a general rule, dietary supplement labeling and marketing are not allowed to make disease prevention or treatment claims, the U.S. FDA has for some foods and dietary supplements reviewed the science, concluded that there is significant scientific agreement, and published specifically worded allowed health claims. An initial ruling allowing a health claim for calcium dietary supplements and osteoporosis was later amended to include calcium supplements with or without vitamin D, effective January 1, 2010. Examples of allowed wording are shown below. In order to qualify for the calcium health claim, a dietary supplement much contain at least 20% of the Reference Dietary Intake, which for calcium means at least 260 mg/serving.[16]

  • "Adequate calcium throughout life, as part of a well-balanced diet, may reduce the risk of osteoporosis."
  • "Adequate calcium as part of a healthful diet, along with physical activity, may reduce the risk of osteoporosis in later life."
  • "Adequate calcium and vitamin D throughout life, as part of a well-balanced diet, may reduce the risk of osteoporosis."
  • "Adequate calcium and vitamin D as part of a healthful diet, along with physical activity, may reduce the risk of osteoporosis in later life."

In the same year, the European Food Safety Authority also approved a dietary supplement health claim for calcium and vitamin D and the reduction of the risk of osteoporotic fractures by reducing bone loss.[17] The U.S. FDA also approved Qualified Health Claims (QHCs) for various health conditions for calcium, selenium and chromium picolinate.[18] QHCs are supported by scientific evidence, but do not meet the more rigorous “significant scientific agreement” standard required for an authorized health claim. If dietary supplement companies choose to make such a claim then the FDA stipulates the exact wording of the QHC to be used on labels and in marketing materials. The wording can be onerous: "One study suggests that selenium intake may reduce the risk of bladder cancer in women. However, one smaller study showed no reduction in risk. Based on these studies, FDA concludes that it is highly uncertain that selenium supplements reduce the risk of bladder cancer in women."[19]

Proteins and amino acids

Protein-containing supplements, either ready-to-drink or as powders to be mixed into water, are marketed as aids to people recovering from illness or injury, those hoping to thwart the sarcopenia of old age,[20][21] to athletes who believe that strenuous physical activity increases protein requirements,[22] to people hoping to lose weight while minimizing muscle loss, i.e., conducting a protein-sparing modified fast,[23] and to people who want to increase muscle size for performance and appearance. Whey protein is a popular ingredient,[21][24][25] but products may also incorporate casein, soy, pea, hemp or rice protein.

According to US & Canadian Dietary Reference Intake guidelines, the protein Recommended Dietary Allowance (RDA) for adults is based on 0.8 grams protein per kilogram body weight. The recommendation is for sedentary and lightly active people.[26][27][28] Scientific reviews can conclude that a high protein diet, when combined with exercise, will increase muscle mass and strength,[29][30][31] or conclude the opposite.[32] The International Olympic Committee recommends protein intake targets for both strength and endurance athletes at about 1.2-1.8 g/kg body mass per day.[22] One review proposed a maximum daily protein intake of approximately 25% of energy requirements, i.e., approximately 2.0 to 2.5 g/kg.[27]

The same protein ingredients marketed as dietary supplements can be incorporated into meal replacement and medical food products, but those are regulated and labeled differently from supplements. In the United States, "meal replacement" products are foods and are labeled as such. These typically contain protein, carbohydrates, fats, vitamins and minerals. There may be content claims such as "good source of protein", "low fat" or "lactose free."[33] Medical foods, also nutritionally complete, are designed to be used while a person is under the care of a physician or other licensed healthcare professional.[34][35] Liquid medical food products - example Ensure - are available in regular and high protein versions.

Proteins are chains of amino acids. Nine of these proteinogenic amino acids are considered essential for humans because they cannot be produced from other compounds by the human body and so must be taken in as food. Recommended intakes, expressed as milligrams per kilogram of body weight per day, have been established.[26] Other amino acids may be conditionally essential for certain ages or medical conditions. Amino acids, individually and in combinations, are sold as dietary supplements. The claim for supplementing with the branched chain amino acids leucine, valine and isoleucine is for stimulating muscle protein synthesis. A review of the literature concluded this claim was unwarranted.[36] In elderly people, supplementation with just leucine resulted in a modest (0.99 kg) increase in lean body mass.[37]The non-essential amino acid arginine, consumed in sufficient amounts, is thought to act as a donor for the synthesis of nitric oxide, a vasodilator. A review confirmed blood pressure lowering.[38] Taurine, a popular dietary supplement ingredient with claims made for sports performance, is technically not an amino acid. It is synthesized in the body from the amino acid cysteine.[39]

Bodybuilding supplements

Bodybuilding supplements are dietary supplements commonly used by those involved in bodybuilding, weightlifting, mixed martial arts, and athletics for the purpose of facilitating an increase in lean body mass. The intent is to increase muscle, increase body weight, improve athletic performance, and for some sports, to simultaneously decrease percent body fat so as to create better muscle definition. Among the most widely used are high protein drinks, branched-chain amino acids (BCAA), glutamine, arginine, essential fatty acids, creatine, HMB,[40] and weight loss products.[41] Supplements are sold either as single ingredient preparations or in the form of "stacks" – proprietary blends of various supplements marketed as offering synergistic advantages. While many bodybuilding supplements are also consumed by the general public the frequency of use will differ when used specifically by bodybuilders. One meta-analysis concluded that for athletes participating in resistance exercise training and consuming protein supplements for an average of 13 weeks, total protein intake up to 1.6 g/kg of body weight per day would result in an increase in strength and fat-free mass, i.e. muscle, but that higher intakes would not further contribute.[30] The muscle mass increase was statistically significant but modest - averaging 0.3 kg for all trials and 1.0–2.0 kg, for protein intake ≥1.6 g/kg/day.[30]

As of 2010, annual sales of sport nutrition products in the United States was over US$2.7 billion according to a publication by Consumer Reports.[42]

Essential fatty acids

Fish oil is a commonly used fatty acid supplement because it is a source of omega-3 fatty acids.[43] Fatty acids are strings of carbon atoms, having a range of lengths. If links are all single (C-C), then the fatty acid is called saturated; with one double bond (C=C), it is called monounsaturated; if there are two or more double bonds (C=C=C), it is called polyunsaturated. Only two fatty acids, both polyunsaturated, are considered essential to be obtained from the diet, as the others are synthesized in the body. The "essential" fatty acids are alpha-linolenic acid (ALA), an omega-3 fatty acid, and linoleic acid (LA), an omega-6 fatty acid.[43][44] ALA can be elongated in the body to create other omega-3 fatty acids: eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).

Plant oils, particularly seed and nut oils, contain ALA.[43] Food sources of EPA and DHA are oceanic fish, whereas dietary supplement sources include fish oil, krill oil and marine algaeextracts. The European Food Safety Authority (EFSA) identifies 250 mg/day for a combined total of EPA and DHA as Adequate Intake, with a recommendation that women pregnant or lactating consume an additional 100 to 200 mg/day of DHA.[45] In the United States and Canada are Adequate Intakes for ALA and LA over various stages of life, but there are no intake levels specified for EPA and/or DHA.[46]

Supplementation with EPA and/or DHA does not appear to affect the risk of death, cancer or heart disease.[47][48] Furthermore, studies of fish oil supplements have failed to support claims of preventing heart attacks or strokes.[49] In 2017, the American Heart Association issued a science advisory stating that it could not recommend use of omega-3 fish oil supplements for primary prevention of cardiovascular disease or stroke, although it reaffirmed supplementation for people who have a history of coronary heart disease.[50]

Natural products

St. John's wort petals used in natural product supplements

Dietary supplements can be manufactured using intact sources or extracts from plants, animals, algae, fungi or lichens, including such examples as ginkgo biloba, curcumin, cranberry, St. John’s wort, ginseng, resveratrol, glucosamineand collagen.[51][52][53] Products bearing promotional claims of health benefits are sold without requiring a prescription in pharmacies, supermarkets, specialist shops, military commissaries, buyers clubs, direct selling organizations, and the internet.[52] While most of these products have a long history of use in herbalism and various forms of traditional medicine, concerns exist about their actual efficacy, safety and consistency of quality.[54][55][56] Canada has published a manufacturer and consumer guide describing quality, licensing, standards, identities, and common contaminants of natural products.[57] In 2016, sales of herbal supplements just in the United States were $7.5 billion, with the market growing at about 8% per year.[52] Italy, Germany and Eastern European countries were leading consumers of botanical supplements in 2016, with European Union market growth forecast to be $8.7 billion by 2020.[58]

Probiotics

In humans, the large intestine is host to more than 1,000 species of microorganisms, mostly bacteria, numbering in the tens of trillions.[59] "Probiotic" in the context of dietary supplements is the theory that by orally consuming specific live bacteria (or yeast) species, it is possible to influence the large intestine microbiota, with consequent health benefits. Although there are numerous claimed benefits of using probiotic supplements, such as maintaining gastrointestinal health, in part by lowering risk of and severity of constipation or diarrhea, and improving immune health, including lower risk of and severity of acute upper respiratory tract infections, i.e., the common cold, such claims are not all supported by sufficient clinical evidence.[60][61][62] A review based on interviews with dozens of experts in microbiome research expressed concern about "...how biomedical research is co-opted by commercial entities that place profit over health."[62] The concern is timely, as through 2021, probiotic supplements are expected to be the fastest growing segment of the dietary supplement market worldwide, while at the same time, the global health benefits market for probiotic-containing yogurt (a food, not a dietary supplement) is declining.[63][64]

As with all dietary supplements, in the United States inappropriate label health claims such as preventing or treating disease are opposed by the FDA and deceptive advertisements by the Federal Trade Commission. Probiotic foods and dietary supplements are allowed to make claims using Structure:Function vocabulary as long as human trial evidence is adequate. In 2005, the FDA issued a Warning Letter to UAS Laboratories for disease treatment claims (colds, flu, ulcers, elevated blood cholesterol, colon cancer...). The company revised label and website content and continued to sell the product.[65] In 2011 the company was found to have resumed the label and website claims, and the FDA seized product and stopped production.[66] In 2010 a FTC action was brought against a probiotic food company for exaggerated health claims, resulting in a multimillion-dollar fine and revisions to future advertising.[67] In the European Union a more restrictive approach has been taken by the EFSA. All proposed health claims were rejected on the grounds that the science was not sufficient, and no health claims are permitted. Foods with live microorganisms (yogurt, kefir) can be sold, but without claims.[60][63]

Probiotic supplements are generally regarded as safe. The greatest concern, evidenced by reviews reporting on case studies, is that for people with compromised gut wall integrity there may be a risk of systemic infection. For this reason, probiotic research is expected to exclude bacteria species that are antibiotic resistant.[68][69]

Industry

In 2015, the American market for dietary supplements was valued at $37 billion,[4] with the economic impact in the United States for 2016 estimated at $122 billion, including employment wages and taxes.[70] One 2016 analysis estimated the total market for dietary supplements could reach $278 billion worldwide by 2024.[71]

Controversy

Adulteration

Over the period 2008 to 2011, the Government Accountability Office (GAO) of the United States received 6,307 reports of health problems (identified as adverse events) from use of dietary supplements containing a combination of ingredients in manufactured vitamins, minerals or other supplement products,[72] with 92% of tested herbal supplements containing lead and 80% containing other chemical contaminants.[73] Using undercover staff, the GAO also found that supplement retailers intentionally engaged in "unequivocal deception" to sell products advertised with baseless health claims, particularly to elderly consumers.[73] Consumer Reportsalso reported unsafe levels of arsenic, cadmium, lead and mercury in several protein powder products.[74] The Canadian Broadcasting Corporation (CBC) reported that protein spiking, i.e., the addition of amino acids to manipulate protein content analysis, was common.[75] Many of the companies involved challenged CBC's claim.[76]

A 2013 study on herbal supplements found that many products were of low quality, one third did not contain the active ingredient(s) claimed, and one third contained unlisted substances.[77] In a genetic analysis of herbal supplements, 78% of samples contained animal DNA that was not identified as an ingredient on the product labels.[55] In some botanical products, undeclared ingredients were used to increase the bulk of the product and reduce its cost of manufacturing, while potentially violating certain religious and/or cultural limitations on consuming animal ingredients, such as cow, buffalo or deer.[55] In 2015, the New YorkAttorney General identified four major retailers with dietary supplement products that contained fraudulent and potentially dangerous ingredients, requiring the companies to remove the products from retail stores.[78]

A study of dietary supplements sold between 2007 and 2016 identified 776 that contained unlisted pharmaceutical drugs, many of which could interact with other medications and lead to hospitalization.[79] 86% of the adulterated supplements were marketed for weight loss and sexual performance, with many containing prescription erectile dysfunction medication. Muscle building supplements were contaminated with anabolic steroids, and multiple products contained antidepressants and antihistamines. Despite these findings, fewer than half of the adulterated supplements were recalled.[79]

Litigation against false health claims

The United States Food and Drug Administration, Office of Inspections, Compliance, Enforcement, and Criminal Investigations, monitors supplement products for accuracy in advertising and labeling, and when finding violations, warns manufacturers of impending enforcement action, including search and seizure, injunction, and/or financial penalties, such as for a Maine supplement company in 2017.[80] The United States Federal Trade Commission, which litigates against deceptive advertising,[67] established a consumer center to assist reports of false health claims in product advertising for dietary supplements,[81] and, in 2017, successfully sued nine manufacturers for deceptive advertising of dietary supplements.[82]

Adverse effects

In the United States, manufacturers of dietary supplements are required to demonstrate safety of their products before approval is granted for commerce.[83] Despite this caution, numerous adverse effects have been reported,[72] including muscle cramps, hair loss, joint pain, liver disease, and allergic reactions, with 29% of the adverse effects resulting in hospitalization, and 20% in serious injuries or illnesses.[72] By more than five-fold, the highest incidence of health problems derived from "combination products", whereas supplements for vitamins and minerals, lipid products, and herbal products were less likely to cause adverse effects.[72]

Among general reasons for the possible harmful effects of dietary supplements are: a) absorption in a short time, b) manufacturing quality and contamination, and c) enhancing both positive and negative effects at the same time.[56] The incidence of liver injury from herbal and dietary supplements is about 16–20% of all supplement products causing injury, with the occurrence growing globally over the early 21st century.[41] The most common liver injuries from weight loss and bodybuilding supplements involve hepatocellular damage with resulting jaundice, and the most common supplement ingredients attributed to these injuries are green tea catechins, anabolic steroids, and the herbal extract, aegeline.[41] Weight loss supplements have also had adverse psychiatric effects.[84]

Society and culture

Public health

Work done by scientists in the early 20th century on identifying individual nutrients in food and developing ways to manufacture them raised hopes that optimal health could be achieved and diseases prevented by adding them to food and providing people with dietary supplements; while there were successes in preventing vitamin deficiencies, and preventing conditions like neural tube defects by supplementation and food fortification with folic acid, no targeted supplementation or fortification strategies to prevent major diseases like cancer or cardiovascular diseases have proved successful.[85]

For example, while increased consumption of fruits and vegetables are related to decreases in mortality, cardiovascular diseases and cancers, supplementation with key factors found in fruits and vegetable, like antioxidants, vitamins, or minerals, do not help and some have been found to be harmful in some cases.[86][87] In general as of 2016, robust clinical data is lacking, that shows that any kind of dietary supplementation does more good than harm for people who are healthy and eating a reasonable diet but there is clear data showing that dietary pattern and lifestyle choices are associated with health outcomes.[88][89]

As a result of the lack of good data for supplementation and the strong data for dietary pattern, public health recommendations for healthy eating urge people to eat a plant-based diet of whole foods, minimizing processed food, salt and sugar and to get exercise daily, and to abandon Western pattern diets and a sedentary lifestyle.[90][91]:10

Legal regulation

United States

The regulation of food and dietary supplements by the U.S. Food and Drug Administration is governed by various statutes enacted by the United States Congress and interpreted by the U.S. Food and Drug Administration ("FDA"). Pursuant to the Federal Food, Drug, and Cosmetic Act("the Act") and accompanying legislation, the FDA has authority to oversee the quality of substances sold as food in the United States, and to monitor claims made in the labeling about both the composition and the health benefits of foods.

Substances which the FDA regulates as food are subdivided into various categories, including foods, food additives, added substances (man-made substances which are not intentionally introduced into food, but nevertheless end up in it), and dietary supplements. The specific standards which the FDA exercises differ from one category to the next. Furthermore, the FDA has been granted a variety of means by which it can address violations of the standards for a given category of substances.

Dietary supplement manufacture is required to comply with the good manufacturing practices established in 2007. The FDA can visit manufacturing facilities, send Warning Letters[80] if not in compliance with GMPs, stop production, and if there is a health risk, require that the company conduct a recall.[92]

European Union

The European Union's (EU) Food Supplements Directive of 2002 requires that supplements be demonstrated to be safe, both in dosages and in purity.[93] Only those supplements that have been proven to be safe may be sold in the EU without prescription. As a category of food, food supplements cannot be labeled with drug claims but can bear health claims and nutrition claims.[94]

The dietary supplements industry in the United Kingdom (UK), one of the 28 countries in the bloc, strongly opposed the Directive. In addition, a large number of consumers throughout Europe, including over one million in the UK, and various doctors and scientists, had signed petitions by 2005 against what are viewed by the petitioners as unjustified restrictions of consumer choice.[95] In 2004, along with two British trade associations, the Alliance for Natural Health (ANH) had a legal challenge to the Food Supplements Directive[96] referred to the European Court of Justice by the High Court in London.[97]

Although the European Court of Justice's Advocate General subsequently said that the bloc's plan to tighten rules on the sale of vitamins and food supplements should be scrapped,[98] he was eventually overruled by the European Court, which decided that the measures in question were necessary and appropriate for the purpose of protecting public health. ANH, however, interpreted the ban as applying only to synthetically produced supplements, and not to vitamins and minerals normally found in or consumed as part of the diet.[99] Nevertheless, the European judges acknowledged the Advocate General's concerns, stating that there must be clear procedures to allow substances to be added to the permitted list based on scientific evidence. They also said that any refusal to add the product to the list must be open to challenge in the courts.[100]

Research

Examples of ongoing government research organizations to better understand the potential health properties and safety of dietary supplements are the European Food Safety Authority,[3]the Office of Dietary Supplements of the United States National Institutes of Health,[7][101] the Natural and Non-prescription Health Products Directorate of Canada,[102] and the Therapeutic Goods Administration of Australia.[103] Together with public and private research groups, these agencies construct databases on supplement properties, perform research on quality, safety, and population trends of supplement use, and evaluate the potential clinical efficacy of supplements for maintaining health or lowering disease risk.[101]

Databases

As continual research on the properties of supplements accumulates, databases or fact sheets for various supplements are updated regularly, including the Dietary Supplement Label Database,[5] Dietary Supplement Ingredient Database,[104] and Dietary Supplement Facts Sheets of the United States.[105] In Canada where a license is issued when a supplement product has been proven by the manufacturer and government to be safe, effective and of sufficient quality for its recommended use, an eight-digit Natural Product Number is assigned and recorded in a Licensed Natural Health Products Database.[106] The European Food Safety Authority maintains a compendium of botanical ingredients used in manufacturing of dietary supplements.[107]

In 2015, the Australian Government's Department of Health published the results of a review of herbal supplements to determine if any were suitable for coverage by health insurance.[108]Establishing guidelines to assess safety and efficacy of botanical supplement products, the European Medicines Agency provided criteria for evaluating and grading the quality of clinical research in preparing monographs about herbal supplements.[109] In the United States, the National Center for Complementary and Integrative Health of the National Institutes of Healthprovides fact sheets evaluating the safety, potential effectiveness and side effects of many botanical products.[110]

Quality and safety

To assure supplements have sufficient quality, standardization, and safety for public consumption, research efforts have focused on development of reference materials for supplement manufacturing and monitoring.[111][107] High-dose products have received research attention,[101][112] especially for emergency situations such as vitamin A deficiency in malnutrition of children,[113] and for women taking folate supplements to reduce the risk of breast cancer.[114]

Population monitoring

In the United States, the National Health and Nutrition Examination Survey (NHANES) has investigated habits of using dietary supplements in context of total nutrient intakes from the diet in adults and children.[101] Over the period of 1999 to 2012, use of multivitamins decreased, and there was wide variability in the use of individual supplements among subgroups by age, sex, race/ethnicity, and educational status.[115] Particular attention has been given to use of folate supplements by young women to reduce the risk of fetal neural tube defects.[116][117]

Clinical studies

Research initiatives to improve knowledge of the possible health benefits of supplementing with essential nutrients to lower disease risk have been extensive. As examples, just in 2017 were reviews on

A 2017 review indicated a rising incidence of liver injury from use of herbal and dietary supplements, particularly those with steroids, green tea extract, or multiple ingredients.[122]

Absence of benefit

The potential benefit of using essential nutrient dietary supplements to lower the risk of diseases has been refuted by findings of no effect or weak evidence in numerous clinical reviews, such as for cardiovascular diseases,[121] cancer,[121] HIV,[123] or tuberculosis.[124]

Reporting bias

A review of clinical trials registered at clinicaltrials.gov, which would include both drugs and supplements, reported that nearly half of completed trials were sponsored wholly or partially by industry.[125] This does not automatically imply bias, but there is evidence that because of selective non-reporting, results in support of a potential drug or supplement ingredient are more likely to be published than results that do not demonstrate a statistically significant benefit.[125][126] One review reported that fewer than half of the registered clinical trials resulted in publication in peer-reviewed journals.[127]

Future

Improving public information about use of dietary supplements involves investments in professional training programs, further studies of population and nutrient needs, expanding the database information, enhancing collaborations between governments and universities, and translating dietary supplement research into useful information for consumers, health professionals, scientists, and policymakers.[128] Future demonstration of efficacy from use of dietary supplements requires high-quality clinical research using rigorously-qualified products and compliance with established guidelines for reporting of clinical trial results (e.g., CONSORT guidelines).[101]

See also

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About protein:

Protein is an essential macro-nutrient - one of three main chemical compounds consumed by humans in the largest quantities and which provide bulk energy (the two other macro-nutrients being fat and carbohydrates). Protein is required by the human body for a wide range of critical physiological functions. In other words, it is not just for athletes and bodybuilders - no one can function without it! This is because proteins are a component of each and every cell, tissue and organ in the body and they are constantly being broken down and replaced. Once ingested, food protein is broken down into amino acids (the building blocks of protein) and later used to replenish the body's own protein stores. There are 22 different amino acids required by the body in order to function properly and there are over 10,000 different kinds of protein in the body. Protein is involved in almost every biological process in one way or another and is used, for example, to: build and repair muscles and ligaments (whether as part of normal growth or following exercise or injury) provide the body with energy maintain organs balance blood sugar levels grow skin, hair, nails and bones produce haemoglobin in blood digest food make antibodies and support the immune system transfer messages between neurotransmitters in the brain make hormones, such as insulin and metabolism-regulators and the list goes on. Protein has an incredibly wide application in the body and can be used for anything from providing a physical structure to assisting in a biological process. This is why it is essential for all individuals to incorporate adequate levels of high quality, protein-rich foods into their daily diet. PROTEIN SUPPLEMENTS. 

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TIPS for HEALTHY WEIGHT LOSS!

Here are some simple tips, and recommendations for easy lifestyle changes, that can help you LOSE WEIGHT & KEEP IT OFF. The healthiest and most effective method for long-term weight loss combines a NUTRITIOUS DIET  with WEIGHTCONTROL SHAKES, and plenty of physical activity.

Getting out and about:

Jogging is an effective method of ridding your body of  EXCESS FAT.

CARDIOVASCULAR exercise like running, gets your heart rate up and keeps it elevated. It is best to do cardiovascular exercise for about 30 minutes, three or four times per week. Some people make the mistake of trying to tone up and increase muscle mass without doing any cardio. This is a mistake because the muscle that you build may remain hidden under  A LAYER OF FAT.

Using what you've got:

Body weight exercises are perfect because they do not require any gym equipment (and are therefore more affordable!). You can use your own body weight to build strength and INCREASE FLEXIBILITY.

Sit-ups, push-ups and pull-ups all use your own body weight to build strength in specific muscle groups. You can easily do these exercises for about 15 minutes each morning and evening. As a reminder, this type of exercise should be combined with cardiovascular exercise for maximum benefit.

You are what you eat:

Reducing your daily caloric intake and your consumption of saturated fat, cholesterol and sugar will help you LOSE WEIGHT. Try our WEIGHT CONTROL SHAKES!

Get your PROTEIN FROM HEALTHY SOURCES, such as plant-based foods which can offer lLEAN, COMPLETE & BALANCED PROTEIN Nutritious, ENZYME RICH FRUIT & VEGETABLES  should make up the bulk of your diet. They are generally low in fat and calories, yet high in DIETARY FIBE- ideal for both  WEIGHT LOSS and a HEALTHY DIGESTIVE SYSTEM.  Replace unhealthy, processed and chemical-laden foods with nutritious, NATURAL WHOLE FOODS.

Feel the burn:

When it comes to losing weight healthily and keeping it off, your  METABOLISM  plays a key role. Consider ways in which you can BURN SOME EXTRA CALORIES  each day. Walk the stairs instead of taking the lift. When out shopping, park your car at the far end of the parking lot instead of searching for the nearest parking space. Wear ankle weights while vacuuming and doing other household chores. Eventually all these extra burned calories will add up to a natural increase in weight loss.

Stay motivated:

Many people find that it is easier to stay motivated to exercise if they regularly attend a gym. Certain exercise classes can create a sense of healthy competition and obligation to attend classes regularly. Hiring a trainer at the beginning of your new lifestyle change may also help you to maintain your exercise and diet programmes. Find out what keeps you motivated and use it.

Get organised:

Plan your meals out a week in advance. Make a list to take to the shop and stick to it. Avoid walking through the aisles that are packed with sugary treats, processed foods and tempting unhealthy snacks.

Eating a balanced, healthy diet including WEIGHT CONTROL SHAKES to reduce your caloric intake and exercising to increase the calories you burn will lead to weight loss - it's as simple as that. Having said that, healthy lifestyle changes will not lead to fast weight loss so be patient. You can LOSE WEIGHT & KEEP IT OFF for the long-term, if you do it right! BUY NUTRI-GREEN ORGANIC SUPERFOOD POWDER & NUTR-HEMP ORIGINAL PROTEIN POWDER TODAY!

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