Got Food? Recent Advances in Food Science and Technology docx

A low-carb diet should also include foods with healthy fats and protein University of Maryland Medical Center, 2007 Besides reducing fat in the body, a diet low in carbohydrates can imp

Got Food?

Recent Advances in Food Science and Technology

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An e-book co-authored by the Class of 2013

Massachusetts Academy of Math and Science

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Chapter 1 Diet and Nutrition 3

Ann Ming Samborski, Amanda Stevens, and Ingrid Marko

Barry Biletch, John deRivera, and Aniket Lachyankar

Patrick Aoude, Julia Knowles, and Derek Wegener

Nora Murphy and Jay McCowan

Arjun Tanguturi and Rebecca Stolarczyk

Dhroova Aiylam and Cameron Root

Emma Hewett, Sierra Harris, Angelica Heeney, and Divya Satishchandra

Ryan Thibodeau., Thomas Devlin, and Abigail Yu

Michael Andrews, Alexander Lee, and Sahit Mandala

Adam Carrier, Tony Trakadas, and Katherine McDonough

Rachel Maillet, Anish Athalye, George Han, and Osi Van Dessel

Dennis Giaya, Eric Williams, and Rohit Satishchandra

Chapter 13 Agriculture, Irrigation, Fertilization, and Pesticides 140

Ryan Fletcher and Aaron Hammond

Naveena Shanmugam, Jacob Grotton, Daniel Huang, and Jeeva Jacob

John Dymek, Deidre DiLiddo, and Mark Guertin

Chapter 1 Diet and Nutrition Ingrid Marko, Ann Ming Samborski, and Amanda Stevens

Diet Societal values intimidate individuals to obtain the ideal physique Often in order to achieve this, a healthy lifestyle must be implemented Unfortunately, such a simple solution is often taken to the extreme In fact, there are numerous diet plans on the market that may become a detriment to the lives of many Moreover, a sustainable way of life is without a doubt beneficial, but it is important to keep matters

in perspective

The ever-changing rules of what defines a ―good diet‖ confuse people to the point that they are uncertain of what foods to consume There are so many different meal plans in existence that it is almost impossible to decide on which one to follow Yet, with the technology and knowledge of today, it should

be relatively easy for nutritionists to plan out a healthy meal For instance, Dr Oz (2011) writes that in order to be healthy, people must abstain from diet soda and low fat foods because the present processed sugars are the main contributors to an overweight population Ultimately, the individual is the greatest influence because each body works differently due to the dissimilarity among DNA In fact, protein, carbohydrates, and lipids satisfy the body enough that it may not require the remaining components to sustain a healthy state (Liao, 2012)

When it comes to nutrients, the body regulates a certain amount that it needs each day Skipping any of these will result in over-consumption of another, which then leads to an unhealthy diet (Liao, 2012) Important substances to consume daily are eggs, nuts, lipids, and similar foods Even drinking whole milk and wine are a necessity according to Dr Oz It is overindulgence that leads to obesity Fats have unfortunately obtained a social stigma; however, in the correct amount, lipids are actually beneficial to an individual‘s health Monounsaturated fats, such as canola and olive oil, and polyunsaturated fats, such as omega-3, have great health benefits They can reduce the risk of developing atherosclerosis, heart disease, and inflammation However, trans fat does in fact cause complications if consumed too frequently

In moderation, sodium is a vital part of a good diet The human heart cannot function without it, and yet, too much will increase blood pressure (Oz, 2011) An increasing problem with salty foods is that the sodium (Na) binds to certain elements found in processed food and causes a reaction that leads to a stimulated appetite, meaning individuals consume more than what is necessary

Ingesting antioxidants can help increase human health because it can result in rejuvenated skin and lower dementia and resistance to Parkinson‘s disease and Type 2 diabetes (Oz, 2011) Good sources of food to induce this prevention are dark chocolate, wine, and coffee

Nutrigenomics have been linked to how the individual processes food Certain aspects of the DNA and the genes present in some people change how food is digested and how it affects the body Another important factor to staying healthy is exercise Dr Oz claims that there should be a balance between diet and exercise; in fact, calories consumed must equal calories burned to maintain a perfectly healthy body

If that scale is tipped so that there is an unequal balance, then the result will either be weight loss or weight gain Because the human brain is always looking for nutrients, not calories, eating a moderate amount from every food group is essential It is vital to eat in moderation, to ingest a certain amount of fruits and vegetables, and to exercise (Oz, 2011)

Another key nutrient is protein because it stimulates growth, repairs cells, and maintains tissue These are extremely important for athletes who often induce stress on the bones and muscles The proteins are broken down into amino acids and peptides Because they are so important for the function of the body, protein levels can become dangerously low if there is an inadequate intake of carbohydrates or fats The body often uses protein as a substitute for missing nutrients to produce energy, but a low level of any nutrient will lead to weakness and disease (Wilson, 2007)

Lipids, another source of energy, help maintain body temperature and are required for tissue growth and hormone production Too much of this group will lead to weight gain, as with any other nutrient In moderation, everything allows the body to function properly

Vitamins help the immune system fight infection and regulate bodily functions Minerals are similar to vitamins because they aid the daily functions of the body Water dissolves and carries nutrients;

it is not enough to consume nutrients alone because water is needed for transportation to every part of the body When all nutrients are present, their functions weave together in a seamless harmony

Economic Uncertainty

It is simply not enough to have a beneficial meal plan if one does not have the means to purchase the food Of course those with money have a clear advantage over the lower classes In general, people can afford what is required

Food availability and resulting levels of consumption have increased throughout the years The food supply showed that the average American was consuming 3,800 calories per day in 2000; the highest rate so far (USDA, 2001) The increase in calories directly means that there was a weight gain among the people Over 62 percent of the population was considered to be overweight; an increase of 46 percent since 1980 These shocking statistics are a result of supply and demand, the availability of food Other than the calorie intake, another cause of weight gain is lack of exercise

Increase in calories and food intake between 1983 and 2000

Food expenditures have risen in 2001 to $844.1 billion, a 3.8% increase then the 2001 counterpart (USDA, 2001) This rise was a result of a 5.5% income expansion from 2000 The cost of processing, transporting, and distribution from American farms rose to $121 billion This only represents 20% of the total food expenses (USDA, 2001)

What a dollar spent for food in 2000

Even given the strict diets followed by many consumers, America is on the path to having the most obese population The access Americans have to a sustainable food supply should result in a healthy population Yet, the opposite is true Other countries in the world have people that struggle to survive on what little food they can get Diseases and malnutrition have spread around the globe due to a lacking food supply in other countries

The main problem with access is the need to spend immense amounts of money Currently here is national debt, and promoting a healthy diet is often ignored The FDA is in charge of doing everything food and drug oriented Dr McClellan, a business man and doctor of economics, introduced the idea of efficient risk management where the FDA would only do things that have the most impact on society, because it cannot complete every single task available (―Business: Food, drugs and economics; face value‖ 2003) Challenges include how to inspect imports and medicine These have to be completed, but everything has a cost The amount of money the FDA can spend is limited After the most important task has been accounted for, the nutritional problem can be assessed Focusing on one aspect at a time will yield better results

Disease-Preventing Diets Nutrition is a vital component of a healthy lifestyle, and many people forget how important it actually is An unhealthy diet can lower a person‘s life expectancy by decades, while a healthy diet can extend a person‘s life above the average life expectancy This in mind, it is crucial that people recognize the nutrients that they are consuming and maintain a diet that will benefit their bodies

Low-Carbohydrate Diets People who have a low intake of carbohydrates are usually slimmer and have less fat Some foods containing this nutrient that are usually avoided and maintain body weight are white potatoes, rice, pasta, and bread Foods that are high in carbohydrates compel blood sugar levels to rise and, in result, insulin levels as well Eating foods that are composed of mainly carbohydrates leads to increased hunger levels, and the best low-carb diets comprise a variety of whole foods Although, crushed or refined fruits, beans, vegetables, or whole grains are healthier than most foods, they have higher Glycemic Load (GL) levels Whole foods, such as All-Bran and Cornflakes have low GL‘s A low-carb diet should also include foods with healthy fats and protein (University of Maryland Medical Center, 2007)

Besides reducing fat in the body, a diet low in carbohydrates can improve sleep disorders and the function of blood vessels People who suffer from sleep apnea can benefit from this type of diet Sleep apnea is a disorder that is a result of abnormal pauses in breathing or swallowing while sleeping, and it is

a leading cause in daytime fatigue This disorder is more common in people who are overweight and several researchers, from the Karolinska Institute, ran experiments which proved that low-carb diets have

a positive effect on sleep apnea (―Diet and sleep apnea‖, 2011.) In a similar way, a diet that is low in carbohydrates improves blood vessel function by reducing fat, according to a study completed by Johns Hopkins researchers Loss of stomach fat allowed arteries to expand and helped the blood flow more freely Several overweight participants helped the researchers refine their idea that low-carb diets that helped burn fat improved the overall health of the patient‘s vascular systems (―Improve blood vessel function‖,2012)

Heart-Healthy Diets Not only are fish tasty, but they are also important in lowering cholesterol levels Oily fish such as salmon, sardines, tuna, mackerel, and trout have omega-3 fatty acids that are very beneficial, unlike saturated fats Because of remarkable evidence from several studies on the subject, The Food and Drug

Administration announced that Omega-3 fatty acids lower triglycerides and slow down plaque growth in the bloodstream, as well as reduce inflammation Although fish are relatively high in calories, eating reasonable amounts will benefit the health A four-ounce serving of salmon provides 83% of the omega-3 acids a person needs a day (Griffin, 2005a)

A diet with oatmeal and oat bran also benefits the heart These two foods contain soluble fiber, which brings down low-density lipoprotein (LDL) cholesterol levels without reducing high-density lipoprotein (HDL) The fiber helps absorb cholesterol in the intestines and releases it as waste instead

placing it into the arteries Research published in 2005 the American Journal of Clinical Nutrition

suggests that a diet with oatmeal lowered cholesterol levels almost as much as cholesterol drugs Approximately five to ten grams of soluble fiber added to a person‘s diet can increase the strength of his

or her heart (Griffin, 2005b)

Diets containing soy and tofu also assist the heart by lowering blood pressure levels An important compound that lowers blood pressure, isoflavone, is present in soymilk, tofu, green tea, and peanuts Isoflavones increase the production of enzymes, nitric oxide (NO) that dilates the blood vessels The increased amount of NO reduces pressure from blood against the vessel walls A medical student at Columbia University, Safiya Richardson, completed research that suggests systolic blood pressure levels

in people with pre-hypertension could decrease as much as 10 mmHg with a diet of soy protein and other healthy foods This type of diet could reduce their chances of advancing to hypertension (―Soy reduces blood pressure‖, 2012)

Components of a diet that strengthen the heart

Fruits and Vegetables Although it is important to keep a balanced diet containing each component of nutrition, eating fruits and vegetables seems to provide the most superior benefits Consuming an adequate amount of these foods can prevent certain diseases, according to the United States Department of Health and Human Services‘ Healthy People 2010 objectives Fruits and vegetables fill important dietary needs and provide protection against chronic diseases such as hypertension, certain cancers, and Type Two Diabetes (―Eat your fruits and vegetables‖, 2011) Research completed by Paolo Boffetta and his colleagues suggests that

eating proper amounts of these foods can slightly reduce the overall risk of cancer Boffetta showed that there was a small inverse between eating many fruits and vegetables and reduced cancer risk, and several other studies supported this discovery While vegetables and fruits may have some ability to prevent cancer, other unhealthy lifestyle choices, such as smoking, can nullify the benefits that a healthy diet provides (―Cancer protective effects‖, 2010)

Unhealthy Diets Certain diets can improve health, while other diets cause negative effects Some factors that cause disease are out of a person‘s control, such as genetics, but eating well can provide your body with the proper nutrients to prevent diseases A diet low in nutrients is not able to protect the body against viruses that lead to chronic diseases such as the common cold or the influenza An unhealthy diet is a large factor

in obesity, disease, and decreased life expectancy (McLaughlin, 2011)

Negative Effects of Red Meat

A diet composed of red meat can have lasting negative effects According to Nicholas Bakalar in

the New York Times, there is a link between red meat and mortality Research conducted on 121,342 men

and women yielded interesting results; 5,910 people in the group died of cardiovascular disease and 9,464 people died from cancer Accounting for the people who lived sedentary or dangerous lifestyle, the researchers still found that a daily increase of three ounces of red meat was connected to a 12 percent greater risk of dying, a 16 percent increased risk of cardiovascular death, and a 10 percent greater risk of cancer-related death Scientists deduced that if the patients had lowered their red meat consumption by a half, mortality rates would have decreased 9.3 percent in men and 7.6 percent in women These results strongly suggest that consuming red meat is not only unhealthy, but can be deadly (Bakalar, 2012) Another peril of having a diet with too much red meat is that it can increase chances of contracting gout, a severely painful type of arthritis that causes joint inflammation Frank Bruni, who is a meat-lover and a frequent diner, once had a diet that included a surplus of red meat and alcohol After being diagnosed with gout, he had to quit eating most red meat and organ meat to avoid the excruciating burning and stabbing feelings caused by the disease (Bruni, 2012)

White Rice Research at the Harvard School of Public Health was conducted to determine the connection between intakes of white rice and Type Two Diabetes White rice is consumed worldwide and has a high glycemic index (GI) Increased GI diets are known to heighten chances of becoming diabetic The participants of the study were taken from Asian countries, whose population consumes up to 4 servings of white rice per day, and Western countries whose population eats much smaller amounts of white rice None of the participants were diabetic at the beginning of each study With each additional serving of rice, the study conducted separately on Asian and Western countries revealed that there is a 10 percent higher risk of developing Type Two Diabetes This research suggests that people in certain Asian countries who eat a large amount of rice will have a higher risk of this type of diabetes (―Diabetes and white rice‖, 2012)

An example of nutritional information printed on a box containing white rice

Soft Drinks Certain beverages also have the ability to affect a person‘s health in a detrimental way Research

on soft drinks suggests that drinking too much can lead to vascular diseases or gout Hannah Gardener and her colleagues discovered that diet soft drinks were less healthy than regular ones Her group studied 2,564 participants by inquiring how many soft drinks, diet and regular, that the people consumed and the number of vascular problems that they had over a ten year time period The study yielded surprising information: people who drank diet soft drinks every day were 43 percent more likely to have a vascular problem than people who drank none or people who chose regular soft drinks (―Soft drinks and vascular disease‖, 2012) Research on regular soft drinks that are high in fructose suggests that frequent

consumption leads to an increased risk of gout in men A study published in the British Medical Journal

investigates men 40 years or older with no previous history of gout They were assessed on the amount of regular soft drinks, diet soft drinks, and other fruit drinks high in fructose that they consumed over 12 years Other health factors were analyzed and after the 12 year period the researchers found that, in the group of men, 755 cases of gout arose Among the men, there was an 85 percent increased risk of gout in men who consumed five to six servings of soda per week Both of these studies display the effects of consuming any type of soft drink or drink high in fructose; the results are not desirable (―Sugary soft drinks and gout‖, 2008)

Soft drinks are a hazard to good health

Effect of Diet on Epigenetic Expression

In addition to affecting a person‘s own health, certain nutrition habits have the ability to influence future generations Environmental factors, such as diet, are able to alter DNA through epigenetic markings These marks reform the ways in which genes are expressed without changing the DNA sequence permanently by adding or subtracting methyl groups S-Adenosyl methionine, folic acid, and B vitamins are well-known nutrients that enter metabolic pathways, and when these nutrients are regularly consumed, gene expression can easily be altered The foods that people include in their diets have the capability to affect their epigenetic expressions either negatively or positively, and in response, these altered genes are passed on to the offspring (―Nutrition and the epigenome‖, 1969)

Chemicals and additives also have the ability to affect epigenetic marks Bisphenol A (BPA), which is a compound in the polycarbonate plastic used in water bottles, causes negative health effects in offspring Epigenetic research showed that when pregnant yellow mice were given BPA, some of the mice gave birth to yellow, unhealthy mice When the yellow mice that were fed BPA were given a diet rich in methyl foods, the majority of their offspring were healthy and brown; they seemed to counter the detrimental effects of the BPA exposure (―Nutrition and the epigenome‖, 1969)

A woman‘s nutrition during pregnancy has a large impact on her children, but a man can also influence his offspring‘s health Research by a preventive-health specialist, Dr Bygren, aimed to discover how the switch in the amount of food available affected the offspring of that particular generation in both men and women This research yielded intriguing information The results revealed that boys who switched from famine to feasting in a single season later fathered children and grandchildren whose life spans were decreased from those who had not overeaten Further research suggested that changing nutrition also affected women‘s offspring in the same way (Cloud, 2012)

Knowledge of epigenetics has given scientists many new ideas on how to prevent and treat

diseases and genetic disorders A study published in the journal Clinical Epigenetics suggests that

vegetables are made up of compounds that might have the ability to prevent and protect people from diseases such as cancer The scientists leading the investigation say that this so-called epigenetic diet includes cauliflower, broccoli, cabbage, soybeans, kale, green tea, fava beans, thenspice turmeric, and grapes When mothers tell children to eat their vegetables, they‘re protecting them from fatal diseases The compounds in the vegetables that make up an epigenetic diet suppress gene abnormalities that cause horrible diseases such as cancer and Alzheimer‘s (Blanchard, 2012)

Malnutrition and Disease

A growing problem with natural disasters and tyrannical rulers has led to a renewed interest in malnutrition By its roots, the condition implies a state of poor nourishment (Jackson, 2008) According to John Saunders and his colleagues, ―the term malnutrition is used to describe a deficiency, excess, or imbalance of a wide range of nutrients, resulting in measurable adverse effects on body composition, function, and clinical outcome‖ (Saunders, Smith, & Stroud, 2011) Several recent polls have shown that approximately one in three people is suffering from malnutrition In fact, half of the adolescent deaths in underdeveloped countries are attributed to insufficient nourishment (Jackson, 2008) Malnutrition impacts the lives of approximately 3.5 million mothers and children, the elderly population, and those with chronic diseases It is a common assumption that malnutrition acts as a harbinger of oncoming death; however, it can also cause life-long effects such as growth stunting This phenomenon actually affects roughly 178 million children worldwide (Saunders, Smith, & Stroud, 2011)

The condition is mainly caused by an inadequate diet, difficulty or inability to absorb consumed nutrients, or particular medical conditions This is actually a secondary effect of a primary cause, namely

civil circumstance, natural disaster, impoverished conditions (NY Times 4, 2011), alcoholism, or addiction (Saunders et al., 2011) Other groups that are likely to develop a state of malnutrition are young children, pregnant women, those with diseases such as cystic fibrosis and liver disease, those taking appetite reducing medicine, and those living in low-income housing (Malnutrition, 2011) Additionally, the rise of malnutrition because of any circumstance is a risk factor for other diseases (Cathleen Samborski, personal communication, April 7, 2012) In fact, the prime contributor for this condition, in relation to disease, is neglecting to consume enough calories and nutrients (Saunders et al 2011)

Malnutrition results from multiple health problems

As the body begins to deteriorate because of malnutrition, fat, muscle, and organ mass also depart This visible change, technically referred to as cachexia, is often not observed in obese patients because they appear to be healthy rather than malnourished Nevertheless, if the correct amount

of nutrients is not being consumed, the body will suffer in numerous ways (Saunders et al 2011) Common symptoms of malnutrition include irritability, stunt in growth, rapid loss of weight, pain in

muscles and joints, abnormally colored hair and skin, broken nails, and loss of hair (Malnutrition, 2011) From an internal view, the muscle function will often deteriorate at a faster rate than the actual muscle mass Also, when calcium, magnesium, and vitamin D intake levels decrease, the bones become fragile and are difficult to strengthen

Without a proper diet, the digestive tract has difficulty performing its normal functions Organs such as the pancreas and intestines suffer, and often processes such as the pancreatic exocrine function or the intestinal permeability begin to break down Enzymes used to digest consumed food are less abundant, and this can even result in secondary lactose intolerance on certain occasions In addition, diarrhea is a leading cause in loss of water and electrolytes, which can result in death in severe cases

The immune response becomes less effective early in a state of malnutrition This causes the individual to be highly susceptible to infection especially respiratory tract viruses and bacteria and/or parasites Oftentimes, the common symptoms of these pathogens (such as fever) do not occur because of the suppressed immune system Also, wounds, particularly those caused by surgery, can take longer to heal than a normally functioning defense system

Effects of malnutrition affect every part of the body;

even psychological effects can occur

The endocrine complex fights to help the body preserve and use what nutrients it has This leads

to reduced levels of hormones because the materials needed to manufacture them are no longer present Hormones begin to disappear from the body, and sometimes, when production of insulin becomes severely stunted, a form of diabetes can occur

When the body is forced into pure starvation, with absolutely no sustenance, the membranes that transport sodium and potassium (which are dependent on energy metabolized by the body) stop functioning In a circumstance where nourishment is occasionally ingested, this process takes more time

to occur; however, in the meantime, other bodily functions and processes cease to operate in an attempt to allow the body to remain alive It is important to note that after an individual has been without proper nutrients for an extended period of time or the condition has become severe in a short time span, providing the afflicted with a balanced diet is complicated The new amount of food must be introduced

in a meticulous manner because too much can have a negative effect on the overall patient‘s health, even

if it is what he or she technically requires (Saunders et al 2011)

Malnutrition Globally Although a great deal of the world is modern, there still remain large portions that are developing

In addition, some populations are affected by malnutrition because they must flee their native countries For example, poor nutrition has been widely noted in the incoming population of refugee children It is a great relief that within 4 to 6 months of arriving in the U.S.A., the children have usually reached normal weight and growth rate However, an adverse affect to the dramatic change in culture often results in obesity Populations that arrive from low socioeconomic backgrounds tend to experience obesity within a few months of arriving in the U.S This is most prevalent in families from Latin America, Central Eastern Europe, the Caribbean, the Middle East, Northern Africa, Sub-Saharan Africa, and the once-lively Soviet Union The condition is common in both adults and children This new phenomenon is mainly attributed

to the length of stay in the country, different cultures, original cultural beliefs, and low quality of housing This new population is now at risk for both malnutrition that affects overall growth and for obesity that can cause further health problems such as diabetes Deficiency in vitamin B12, folate, and vitamin A may also contribute to iron deficiency (Center for Disease Control and Prevention, 2011)

Also, certain situations involving malnutrition occur because of political circumstance For instance, a sole leader has ruled North Korea for decades This form of government has not resulted favorably for majority of the population; one in three children in North Korea suffers from malnutrition Food is hard to obtain because the state stores are not properly stocked, and the remainder of goods is sold

in private markets In addition, the price of food is drastically inflated so many cannot afford what they can find (NY Times1, 2012) Similarly, Haiti suffers from severe economical and political stress In fact, riots occurred earlier in the year because of the inflated food and fuel prices (Klarreich, 2008) Another instance, Niger, an African country bordering the Sahara desert, is globally one of the poorest territories Due to civil unrest, it is not uncommon to find malnourished children in rural areas as well as settled cities (NY Times3, 2010)

In addition, overpopulation plays a large role in the high percentage of malnourished people Not only are certain countries struggling to feed its entire people, but also, it is the sudden rise in population that causes the country distress According to the latest Global Hunger Index, the levels of hunger in India have increased over the past two decades Out of the entire population, 42% of Indian children (who are five and under) are underweight (NY Times2, 2012) Also, approximately 30% of Pakistani children are malnourished, and 40% have been stunted in their growth; this, in turn, affects their future ability to learn (Jilani, 2012) One of the most prominent problems currently is the overpopulation of refugee camps, particularly in Kenya One of the most severe cases, Dabaad refugee complex contains four times as many occupants as it was originally intended to hold Numerous children are malnourished, and since January, the numbers have risen from 20 malnourished children to more than 130 This affliction accounts for 30%

of all children located in the outskirts of the camp Children as old as ten are malnourished, which is incredibly rare It is this phenomenon that truly displays the severity of the crisis in Kenya (Loewenberg

& Dadaab, 2011)

In short, many of these populations that suffer from malnutrition die because of diarrhea, pneumonia, or preventable diseases (NY Times4, 2011) This can easily be remedied by providing sufficient diet so that inability to absorb consumed nutrients may be avoided However, civil circumstance, natural disasters, and poverty contribute to the worldwide condition of poverty that is prominent in every nation

Diseases Caused as a Result of Malnutrition

As malnutrition becomes widespread across an area, multiple diseases become prominent shortly after Without the correct amount of nutrients, conditions develop because of a lack of vitamins, minerals, and/or amino acids Malnutrition causes myriad physical detriments; however, the onslaught of disease results in further complications to the human body

Vitamin Deficiencies Vitamin D deficiency is found in all areas of the world This condition can lead to further damage such as rickets and osteoporosis According to Saunders et al (2011), ―the etiology of vitamin D deficiency is multifactorial and heavily dependent on non-dietary determinants such as limited sun exposure (protective or religious clothing, moving to temperate climates, and the tradition of keeping infants indoors), increased skin pigmentation, reduced in-utero exposure, and reduced capacity to synthesize vitamin D with increasing age.‖ Those with dark skin, pregnant or nursing women, those living in mild climates, the elderly, and those with conditions such as celiac disease are particularly at risk (Saunders et al 2011)

Rickets is caused by poor diet and lack of fresh air and sunshine The main cause is a deficiency

in Vitamin D, calcium, or phosphorus Without enough of these minerals in the blood, the body removes stored minerals from the bone This, in turn, weakens bone structure Common symptoms are skeletal deformities such as bowed legs, bent spin, pelvic deformities, fragile bones, stunted growth, bone pain, and muscle fatigue Children usually stop growing, and adults develop osteoporosis Rickets is still found

in the US In fact, it seems to be reappearing in many areas In October 2008, American Academy of Pediatrics doubled the recommended amount of vitamin D for infants and children It can be produced when in direct sunlight; however, it can also be obtained through fish, milk, fortified cereal, and eggs

(Jackson, 2008)

Vitamin A deficiency is not commonly seen in developed countries but is relatively common in refugee populations It is the primary cause for blindness in children and approximately 500,000 lose their sight annually Vitamin A deficiency creates a myriad of visual changes that can include loss of night vision, Bitot spots, which according to Saunders, Smith, and Stroud (2011), are ―areas of abnormal squamous cell proliferation and keratinization of the conjunctiva, xerophthalmia, keratomalacia, corneal perforation, and permanent blindness.‖ It also retards bone growth as well as produces dry skin, fragile hair, and weakened humoral and cell-mediated immune response

Deficiency in Vitamin B12 occurs when animal products cease to be consumed in addition to inability to absorb the nutrient (i.e intrinsic factor deficiency) and malabsorption (which may be called by

the presence of Helicobacter pylori) Fatigue, unproductivity, memory loss, irritability, and depression are

often symptoms that are not recognized as official but are associated with it Essentially, this deficiency affects neurological functions Other symptoms include weakness, numb extremities, inability to smell, imbalance, and in the most severe instances, degeneration of the spinal cord

Vitamin C or ascorbic acid deficiency occurs in individuals with malnutrition, alcoholism, or diets that exclude fruits and vegetables The symptom is also known as scurvy and results in stunted collagen synthesis Ecchymoses, petechiae, bleeding gums, hyperkeratosis, and difficulty in healing wounds may occur as well as fatigue, malaise, pain in the joints, edema, anxiety, and neuropathy

Thiamine (vitamin B1) assists in energy metabolism and assembling tissues Deficiency occurs from lack of intake (such a excessive consumption of milled rice), sudden difference in metabolism (fever, pregnancy, liver disease, hyperthyroidism), severe diarrhea, or ingestion of food with anti-

thiamine compounds Deficiency can result in beriberi (Saunders et al 2011) The condition originated because a vitamin B1 was missing from processed rice, and therefore, whole populations were not receiving the proper dosages Thiamine is located in the outer layer of rice, which is often removed for products such as white rice as opposed to brown rice Also, foods such as tea and fish contain chemicals that render the thiamine useless to the body (Jackson, 2008) Symptoms include no appetite, constipation, tiredness, anger, amnesia, peripheral neuropathy, weakness, areflexia, foot drop, tachycardia, and heart failure However, there are multiple types of this disease (Saunders et al., 2011) Wet beriberi is caused by the lack of thiamine in the body (Jackson, 2008) and often leads to cardiac failure (Saunders, Smith, & Stroud, 2011) Common symptoms of Wet beriberi are swelling of the lower leg, fast heart rate, congestive heart failure, engorged heart, and shortness of breath (Jackson, 2008) Dry beriberi affects the multifocal peripheral/nervous system and is caused by the inability of the body to absorb the nutrient (Saunders et al 2011) Dry beriberi displays tingling of limbs, lack of feeling in hands and feet, vomiting, unnatural eye movement, disorientation, coma, and possibly death (Jackson, 2008) More severe cases occasionally become better diagnosed as Wernicke encephalopathy and Korsakoff syndrome (Saunders et al., 2011) Wernicke-Korasakoff is commonly seen in Europe; it is another form of beriberi and displays itself via irritability, confusion, and amnesia The condition can be easily remedied if a person is given thiamine via injection or orally within a reasonable amount of time (Jackson, 2008)

Pellagra is a deficiency in niacin or Vitamin B3 This was first observed in 1735 in Spain when a physician noticed symptoms in peasants eating a heavy corn diet However, Latin America appears to have avoided this condition because the tortillas were allowed to soak in lime juice before they were cooked The citrus released the niacin that is normally not accessible to the human digestive acids Pellagra was discovered to result directly from the lack of niacin or vitamin B1 and even the amino acid tryptophan If the body receives enough tryptophan, it can generate niacin The chemical is used in the body to release energy from carbs, fats, and proteins It is also used to make nucleic acids in RNA and DNA Symptoms involve diarrhea, dermatitis, and dementia In the West, this is rarely seen except for alcoholics because of their tendency to neglect nutrition India suffers from this especially because sorghum is consumed as a staple crop The product contains the amino acid leucine, which interferes with niacin absorption This disease is rarely seen in most developed countries because grain is fortified It does, however, occur in emergencies such as natural disasters or civil war Niacin is hard to access by the body, but if the grain is soaked in alkali, then it is capable of being absorbed Meat, poultry, yeast, fish, grain, flour, peanuts, lentils, milk, greens, and coffee/tea contain this vitamin (Jackson, 2008)

Mineral Deficiencies Iron deficiency is most prevalent in children This mainly affects infants and toddlers, but women of childbearing age are also at risk Iron deficiency anemia occurs from a lack of dietary iron The lack of ingestion of meat or frequent ingestion of tannins or phytates causes internal problems that results

in intestinal parasites, hemoglobinopathies, and chronic infections Lack of iron can lead to stunted psychomotor abilities in infants and cognitive impairment in youth Adults who are affected become fatigued, unproductive, and may lose the ability to reproduce Severe anemia is categorized once the Hb level falls below 80.0 g/L

Iodine deficiency affects approximately 2 billion individuals It is the greatest cause of thyroid disease and is found in soil and seafood It regulates the metabolic process of the body If Iodine is not ingested, physical and mental growth can stop Hypothyroidism, goiter, and other conditions can also occur By iodizing salt, this deficiency has drastically dropped, but extremely high amounts of iodine have been found in refugee populations This can cause IIH (iodine-induced hyperthyroidism), which mainly occurs in females over the age of 40 after introduction to iodized salt The body is so accustomed

to lacking levels that the sudden surge causes further complications

Zinc deficiency is most common in areas where plants are a staple to the diet Zinc catalyzes more than 100 enzymes and helps fetus development during pregnancy and growth throughout adolescence Stunted growth, lacking appetite, and weakened immune system are all symptoms of the condition Hair loss, loose stools, stunted sexual maturation, infertility, hypogonadism, weight-loss, slow-healing wounds, skin and eye lesions, difficulty tasting, and fatigue are all more severe symptoms (Saunders, Smith, & Stroud, 2011)

Amino Acid Deficiencies Pellagra is a deficiency in niacin or tryptophan It is usually accompanied by a lack of amino acids and micronutrients The condition may occur because of severe diarrhea, cirrhosis, or alcoholism High-leucine diets are normally seen in cases of Pellagra Symptoms include photosensitive dermatitis (i.e Casal‘s necklace or face rash) in addition to diarrhea, stomatitis, and neurological abnormalities In children, symptoms differ and may appear as anorexia, irritability, anxiousness, and apathy

General Diseases Caused by Malnutrition Micronutrient deficiencies are also observed due to scarce resources Rare deficiencies are commonly seen because of the rapid change in diet that these individuals go through during a stay in refugee camps, etc (Saunders et al., 2011)

PEM (protein-energy malnutrition) or protein-calorie nutrition is a deficiency in macronutrients, proteins, and carbohydrates Another form of the deficiency, known as Kwashiorkor, refers to a lack of protein but a sufficient calorie intake Marasmus is the lack of calories in addition to protein The liver becomes enlarged, which makes the individual appear to be gaining weight Symptoms include edema, swollen stomach, enlarged liver, peeling, white skin, and reddish pigmentation of the hair These symptoms also result in fatigue, apathy, and irritability This condition occasionally accompanies AIDS

or other traumas It is most seen in undeveloped countries that suffer from natural disaster or lack of resources Majority of the cases are found in Asia, Africa, Latin America, and the Caribbean (Jackson, 2008)

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Chapter 2

Vitamins and Minerals

Barry Biletch, John deRivera, and Aniket Lachyankar

Introduction Organic molecules that are required in small amounts by organisms are called vitamins, and they can be divided into two groups: water soluble and fat soluble Water soluble vitamins include the B vitamins and vitamin C These vitamins are flushed out of the body through urine on a daily basis As a result, there are no known cases of water soluble vitamin toxicity Water soluble vitamins act largely as coenzymes in the body, allowing certain important enzymes to function properly The fat soluble vitamins, A, D, E, and K, are stored in the body for longer durations of time, and the accumulation of these vitamins in the body can cause serious side effects For example, Vitamin A is stored mainly in the liver When arctic explorers ate the livers of seals and polar bears, acute toxicity occurred because of the massive amounts of vitamin A that they were ingesting (Vitamin A, 2007) Not all vitamins need to be ingested in their final form because the body can synthesize some vitamins from other molecules Vitamin A is produced from beta-carotene and other carotenoids (Vitamin A, 2007), vitamin D is synthesized in the skin when in direct contact with UVB radiation (Vitamin D, 2007), and vitamin K is made by bacteria living in the intestines when insufficient doses are ingested orally (Vitamin K, 2007)

Vitamins to Combat Malaria Research being conducted at the University of Southampton might lead to the synthesis of malaria-combating drugs Malaria is a disease spread by parasites that affects approximately 250 million people annually and causes the deaths of approximately 1 million people each year Scientists hope to disrupt the production of vitamins in malaria-producing protists They hope to learn more about the enzymes that are used to manufacture vitamins in these parasites By targeting these particular vitamin-making enzymes, the production of these essential vitamins can be stopped, leading to deficiencies and the death of the parasite Drugs that target B9 production have been used very successfully in the past, but resistance to this particular drug in the parasites has increased, stimulating new research for a drug which

is as effective Scientists at the University of Southampton are currently researching the enzyme complex that produces vitamin B6- in malaria causing parasites If successful, a new drug to treat malaria could be made and millions of lives saved (University of Southampton, 2012)

Malaria parasites have become resistant to several types of malaria combating drugs

Vitamin Supplements

In many cases, whether it is due to dietary habit or location, people can have vitamin deficiencies Some vitamins, like vitamins C, B12, and D, are necessary for very important functions and can cause devastating effects for deficient individuals To combat these effects, people usually choose to take vitamin supplements There are many different forms of these supplements, the most popular being the pill Another difference between different vitamin supplements is the purpose that each one serves Today, companies have specifically targeted vitamin supplements to particular groups of people or deficiencies For example, One-A-Day Products markets vitamins that are targeted at specific stages of life and genders ranging from vitamins for teenage girls to vitamins for men over the age of 50 Vitamin supplements ensure that the consumer lives their life to the fullest without any vitamin deficiencies However, the process of accepting a supplement is very intricate and involves many organizations

One of the most involved parts of the supplement discovery and distribution process is the specification and regulation of the product itself Organizations like the United States Pharmacopeial Convention (USP) and the U.S Food and Drug Administration are highly influential in setting the standard for vitamin supplements; industrial companies that look to manufacture supplements utilize this benchmark The full list of standards can be found in the USP Dietary Supplements Compendium (DSC),

an amalgamation of different monographs that specify identity, strength, quality, and purity of various dietary supplements Again, manufacturers that hope to utilize these dietary supplements look to the DSC

to make sure that their product conforms to the standards set by the USP‘s compendium (Dietary Supplements Compendium, 2009)

Vitamins supplements, as previously stated, come in many different forms Some come for singular vitamins; supplements for simply vitamin C can be found on the shelf for those who do not think they consume enough of this essential vitamin However, the most popular vitamin supplement has quickly become the multivitamin This supplement variant is specifically designed to supply consumers with enough vitamins such that the consumer does not have any deficiencies These vitamins cannot completely substitute for the vitamins in food because they are usually created for the purpose of accommodating a healthy diet As noted above, companies like One-A-Day and Centrum are widely known for supplying multivitamins that serve very specific purposes Some of the specialized formulae that do not apply to sex or age include vision, heart, energy, and prenatal support Each multivitamin is specially formulated to ensure that the consumer is correctly treated (One-a-day Multivitamins, n.d.; (Centrum Multivitamins, n.d.)

Vitamin supplements can be beneficial, but their misuse can cause harm

The Dangers of Multivitamins and Supplements

It was long believed that vitamins were a cure-all supplement to healthy living, but recent studies have yielded results that contradict this While it is known that extreme doses of vitamins can have serious effects on the body, it has only recently been suggested that doses even slightly higher than the recommended amount (in the form of artificial vitamins present in supplements and multivitamins) can pose health risks It was found that men who took excess amounts of vitamin E had a 17% higher risk of developing prostate cancer than those who did not take the vitamin The study did not originally conclude this result when it was ended in 2008, but follow up research revealed this striking result A second study, in Iowa, on the effects of the use of multivitamins, folic acid, vitamin B6, magnesium, copper, zinc, and iron concluded that users of these supplements had an increased risk of death Other studies since then have yielded similar results (Parker-Pope, 2011)

A New Way to Ingest Vitamins Vitamins can be harmed by stomach acids, so it is necessary to provide protection to the vitamins when designing vitamin supplements Currently, pharmaceutical companies use materials such as cyclodextrin, which is a sugar molecule in the shape of a torus (see image) Scientists at Penn State did a series of experiments in which they developed cornstarch pouches which can hold oil soluble vitamins, such as A and C The starch protects the vitamins from the acid in the stomach so that it can remain unharmed when they reach and is absorbed by the small intestine The type of corn starch used forms coils with a hydrophilic outer surface and a hydrophobic inner surface The fat-soluble vitamins are attracted to the inner surface of the starch coil where they are protected This technique could lead to vitamin enriched starch foods, which would be a cheaper and more environmentally friendly way of manufacturing food supplements (Penn State, 2011)

This is the structure of cyclodextrin molecule

New technology is emerging to make getting a daily dose of vitamins easier David Edwards, a biomedical engineer at Harvard University, has invented a product he calls ―Le Whif.‖ The liver and intestinal tract can damage vitamins and are also slow to absorb the vitamins into the bloodstream To combat this, Le Whif grinds vitamins into aerosol particles that can be packaged into spray cans and then inhaled Inhalation provides a more direct route to the bloodstream without the altering effects of the liver or intestines (Dyer, 2011)

Vitamin D and Eyesight

A very recent study on the effects of vitamin D on mouse vision has yielded encouraging results Mice that were given vitamin D supplements showed less aging in their eyes, and older mice who were given the supplement exhibited improved vision This could lead to future drugs that slow the deterioration of the human eye and combat age-related macular degeneration The retina of the human eyes builds up debris and inflames as it ages, which can lead to a 30% decline in photoreceptor cells The study found that older mice which were given vitamin D supplements experienced an improvement in vision as well as a decrease in inflammation and the removal of some debris from the retina It is believed that the vitamin D reduced the number of macrophages, which can cause damage and inflammation in the retina, and also changed some of the macrophages‘ structure so that the cells actively decreased inflammation and debris buildup A second benefit seen in the mice was a decrease in the amount of amyloid beta present in the eye It is known that amyloid beta increases the risk of age-related macular degeneration (Biotechnology and Biological Sciences Research Council, 2012)

The history of humans suggests why poor eyesight becomes a problem as we age and why it is more common now than in human ancestors Vitamin D is ingested via certain foods, but the quantities found in most diets are insufficient for the body to function Human bodies manufacture vitamin D in the skin when hit by UVB rays from the sun This alternate form of production makes up the dietary gap in vitamin D consumption Human ancestors lived in Africa, where they were exposed to direct sunlight daily, prompting adequate vitamin D production Since then, humans have moved to less sunny areas of the globe and have clothed themselves in an attempt to block out the sun The changes have occurred so quickly that the human body has not yet adapted to reduced sunlight exposure, explaining the degeneration of the retina due to a lack of vital vitamin D (Biotechnology and Biological Sciences Research Council, 2012)

Vitamin D and Parkinson‘s Disease

Vitamin D is an essential component of life and its deficiency has very bad effects Deficiencies have been linked to various conditions, including asthma, cancer, and multiple sclerosis; these various effects show that vitamin D affects numerous facets of human life A study done by Paul Knekt at the National Institute for Health and Welfare in Finland attempted to connect the levels of vitamin D to Parkinson‘s disease This study took a population of Finnish men and women over the age of 50 and checked the levels of vitamin D in these people over a 29-year period In the group studied, 50 instances

of Parkinson‘s disease occurred, and with these instances, the vitamin D levels of each subject that contracted Parkinson‘s were significantly lower than that of those without The results suggest a peculiar relationship between the function of vitamin D in the nervous system and Parkinson‘s disease, which again strengthens the need for a healthy dosage of vitamin D in one‘s daily diet (Knekt et al., 2010)

Parkinson's disease can cause uncontrollable shaking, muscle stiffness, and movement issues among other things

Vitamin A and Osteoporotic Hip Fractures

One of the functions that Vitamin A affects is bone metabolism When taken in normal doses, the vitamin can promote healthy bone growth; however, excess amounts can cause adverse effects on bone structure Research at the Harvard Medical School, conducted by Diane Feskanich and colleagues, attempted to connect diets with high vitamin A values to osteoporotic hip fractures in older women The study consisted of over 30,000 postmenopausal females, some of which had sustained hip fractures with noticeable trauma After screening the levels of vitamin A in all of the women, the quartile with the highest dosage of vitamin A in daily diet had a significantly higher risk of hip fracture than those women with a normal vitamin intake With the transition to life after menopause, women will have to be careful

to strike a keen balance between a healthy dosage of vitamin A and a excess (Feskanich et al., 2002)

Increased vitamin A intake has been linked to increased risk of hip fracture

The Effects of Antioxidants on Pre-eclampsia

A condition known as pre-eclampsia can develop in women who are pregnant for the first time, causing hypertension and other negative effects This condition, which appears in approximately 5% of first-time pregnancies, is dangerous to both the mother and child Luckily, research conducted at a Mexico City hospital has yielded a possible method for preventing pre-eclampsia, thought to be caused by a deficiency

of L-arginine, an amino acid essential in blood circulation The study consisted of three groups of pregnant women The first group was given food bars containing L-arginine and antioxidant vitamins (Vitamin A, C, and E are all antioxidants) The second group was given bars containing just the vitamin supplements and the third group was given a placebo, which contained neither L-arginine nor vitamin supplements Of first group of women, only 12.7% were diagnosed with preeclampsia compared with the 22.5% of the second group and the 30.2% of the third group The results show that the best preventative procedure is to take both L-arginine and vitamins, although simply taking the vitamins can also have

beneficial effects (British Medical Journal, 2011)

Antioxidants such as vitamin C and E neutralize harmful free radicals

Vitamin B12 and Cancer

A study of patients in Norway pointed to an interesting pattern that connected vitamin B12 and cancer proliferation Previous studies that involved B12 and cancer had produced results towards the conclusion that B12 deficiencies were instrumental in cancer onset However, during the study done in Norway, where the government does not necessitate folic acid and B12 supplements, there was a difference between the amounts of people who contracted cancer after treatment with the vitamins when compared to those who were not treated with the B12 vitamins and folic acid There were 53 more B12

treated patients that were diagnosed with the cancer, a 21 percent increase from those who were not treated and still diagnosed with cancer Of those diagnosed with the cancer, 36 more died of that same cancer, which was a 38 percent increase in risk Of the forms of cancer that were diagnosed, scientists noted that lung cancer occurred most frequently in these subjects This study suggests an interesting relationship between the levels of B12 and certain stages of cancer It may be the case that low doses of vitamin B12 may cause early carcinoma onset, while on the other hand, higher doses of B12 later in life may cause cancer cells to proliferate

Minerals in Type II Diabetes

In an experiment done at the Shiraz University in Iran, scientists compared the levels of 4 minerals, zinc, copper, iron, and chromium, between normal children and children with Type II diabetes mellitus One characteristic of all of these minerals is that they are mainly found in trace amounts in the human body and are therefore not widely recognized for importance in nutrition Results showed that there was a significant decrease in 3 mineral levels for the diabetes patients: zinc, copper, and chromium This shows that each of these three may play a role in the onset of childhood diabetes Chromium is known to be a facilitator of insulin function in the human body This points to a more direct relation between the functions of the mineral and the onset of diabetes With more research, chromium may be used as a treatment for some forms of diabetes (Basaki et al., 2012)

Type II diabetes is caused by the inadequate production of insulin or the inability to use insulin

Magnesium Treatment for Migraines Magnesium is a commonly found ion and can be found in a supplemental form because it is an essential mineral for body functions In a study done by the New York Headache Center, scientists observed that magnesium levels of patients with migraine symptoms were significantly higher than those

of the controls Magnesium plays a part in migraine pathogenesis With this difference in magnesium levels, the scientists concluded that magnesium supplements could be used to treat migraine symptoms This connections proves to make a much simpler and more available treatment than a manufactured medicine because it is so accessible and usable (Mauskop & Varughese, 2012)

Migraine headaches are caused when arteries in the brain enlarge, causing the adjacent nerves to release chemicals that trigger adverse effects

The vast majority of calcium consumed by humans is distributed to the bones and teeth, but the 1% used by the rest of the body is very important to overall health Although it is widely accessible,

many people do meet the minimum recommended amounts This is partially due to lactose intolerance, because dairy is a good source of calcium

The main forms of calcium supplements are citrate and carbonate; however, the two forms are absorbed differently into the body Research conducted at the University of Texas Southwestern Medical School indicates that calcium citrate is absorbed approximately 25% better than carbonate, despite carbonate having more raw calcium

Researchers at the Jean Mayer USDA Human Nutrition Research Center on Aging have done research on the effects of nutrition on cancer rates They found that the B vitamins, especially vitamin B9, reduce the risks of colorectal cancer in mice However, this was not limited to the mice that ate the vitamins It also affected the offspring of the females of these mice Although increased consumption of these vitamins did not significantly reduce the frequency of cancer, it reduced the frequency of more severe forms by a factor of 300% The researchers attributed this phenomenon to the protection of the Wnt signaling pathway, which is a set of genes that is commonly mutated in patients with cancer At the moment, it is unclear whether or not the same conclusions

Bibliography

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Chapter 3 Food Supplements Patrick Aoude, Julia Knowles, and Derek Wegener

Introduction The desire to be healthy is the cause of many developments in medical science, chemical engineering, and the nutritional industry Both engineered and natural remedies have been labeled as cures for an unhealthy lifestyle The most widespread of these remedies belong to a category known as Food Supplements These products, also known as dietary supplements, are recognized as foodstuffs which supplement the normal diet and which are a concentrated source of nutrients or other substances with a nutritional or physiological effect Food supplements exist in the form of capsules, pastilles, tablets, pills and other similar controlled dosages (Eberhardie, 2005) Although these supplements are similar in purpose and form to prescription drugs, the regulations surrounding them are very loose In the United States, a doctor‘s prescription is not necessary for the acquisition of these drugs and informational labels on their packaging are more similar to those found on food products With these factors in consideration, it is necessary to question the safety of Food supplements as alternatives to a typical diet, and do these so-called supplements provide sufficient nutrition to support human lifestyle

The intended purpose of food supplements is, for numerous reasons, to replace the need to eat whole food for nutrition One benefit of this concept is the provision of nutrients to regions of the world that have limited availability to specific nutrition This characteristic benefits people living in extreme climates which cannot sustain crop production A lack of fruit and vegetables may result in a deficiency

of A and C vitamins for the population of these regions In many cases, food supplements carry a lower cost burden than whole foods This characteristic benefits impecunious or impoverished populations where a sufficient diet of whole food is not easily attainable (―The Fight for Food Supplements‖, 2005) Also, food supplements provide concentrated amounts of nutrients and thereby limit the need to consume unneeded volumes of nutrients provided by entire foods For example, a person may either consume one dietary fiber capsule, or a large bowl of fiber infused breakfast cereal that may contain amounts of carbohydrates, fat, and sugar as well This characteristic of food supplements may benefit people who are affected by obesity Many arguments can be made regarding the necessity of food supplements The benefits of replacing food in the human diet cannot be ignored when considering the viability of food supplements

Reasons for using food supplements; the most common reasons that a patient may use to justify taking a food supplement on a routine basis (Eberhardie 2005)

Patients' reasons for taking food supplements and herbal medicines

 A lack of faith in the food production, transport and storage system, meaning that nutrients are lost because fruit is harvested

too early or growth is forced

 A belief that more is better, for example, a large intake of vitamin A in the diet and supplements will prevent blindness

 With old age you do not metabolize vitamins and minerals and therefore you should take more

 Food supplements delay ageing

 Food supplements prevent cancer

 Food supplements are safer and healthier than prescribed medication

 Food supplements replace the deficiencies caused by a poor diet

 Food supplements save you from having to eat vegetables and fruit

 Food supplements are a good standby when waiting for a long time to be seen by a specialist doctor

The use of dietary supplements is a world-wide trend In the U.S., dietary supplement use has steadily increased since the 1970s However, the loose regulations surrounding these non-prescription products make it difficult to generate precise statistics Analyses of a representative population were conducted between 2003 and 2006 for the purpose estimating dietary supplement use Results were collected by means of a questionnaire and they indicated that 49% of the U.S population (44% of males, 53% of females) employs dietary supplements Multivitamin and multimineral use was the most frequently reported and between 28 and 30% of the surveyed population reported using dietary supplements containing vitamins B-6, B-12, C, A, and E; 18–19% reported using iron, selenium, and chromium; and 26–27% reported using zinc- and magnesium-containing supplements (Bailey et al., 2011) Although the safety of dietary supplements is in question, many people seem to be convinced of their effectiveness The following image is a graphical representation of food supplement use in the U.S

Food supplement use in the U.S An estimated majority of the population consumes at least on food supplement on a routine basis (Baily et al, 2011)

Different age groups also produced varying results in this survey Overall, botanical supplement use was more common in older than in younger age groups About one-half of the U.S population and 70% of adults ≥ 71 y use dietary supplements

Dietary supplement use in various age groups

↵ 2 Relative SE ≥ 40%; this estimate is not stable and is omitted.

Food supplements represent a multi-billion dollar industry, which indicates that people experience positive effects from these so-called food products Although the form and function of supplements is similar to pharmaceutical drugs, they are distributed in the same manner as grocery store items With public safety in consideration, is it necessary to be concerned with the nearly unregulated distribution of dietary supplements?

Production of Food Supplements The production of food supplements in the U.S is a highly controversial area that faces opposition from many people The main issue is lack of regulation in the production industry, which started in 1994 when the Dietary Supplement Health and Education Act (DSHEA) was passed The DSHEA states that supplements will be regulated as food products rather than drugs Furthermore, the safety and effectiveness of supplements are not monitored by the Food and Drug Administration (FDA)

so the health of consumers is left at risk (Kinariwala, 2003) It is the sole responsibility of manufacturers

to report health issues related to their supplements, and therefore, countless reports are never documented (Miller & Longtin, 2000) The FDA only interferes with supplement production once an unsafe supplement has already been marketed, and although the FDA can establish good manufacturing practices (GMPs), it has yet to do so effectively Also, companies do not need to ensure their product is safe even under the recommended conditions (Abebe 2003) Regulations need to change in order to improve the safety and quality of supplements Despite opposition, some organizations are working towards change, and coupled with support from the public and health-care companies, these organizations could persuade the FDA to change regulation laws for food supplements (Kinariwala, 2003)

The European Union also faces similar difficulties with food supplement regulations In the EU, supplements are also regulated as food without the enforcement of GMPs Once again, the quality and safety of supplements are in the hands of the manufacturers (Pravst & Žmitek, 2011) However, the EU is working to make improvements, and in 2002, the EU produced directives regarding the regulation of food and dietary supplements The EU 2004/24/EC directive recognizes the proven safety and efficiency of some herbal medicines Those that had been in use for over 30 years and at least 15 years within the European Union were recorded on an approved list, and in general, supplements had to conform to a so-called positive list of safe supplements and active ingredients However, companies could apply for clearance to sell supplements that did not appear on the positive list but were nevertheless approved as safe supplements There is still concern among medical and nutritional circles regarding the regulation of food supplements, and all agree that new directives will result in increased consumer safety (Eberhardie, 2005)

The contents of a so-called natural dietary

compounds are potentially harmful, the journal Food and Nutrition Sciences reported that the

concentration in which these carcinogens appear is harmless (―Some plant-based,‖ 2011)

Knowledge of supplements containing high levels of alkenylbenzenes has become essential in the push for stricter regulation and quality control An interest in botanicals and botanical preparations in the European Union has resulted in an expanding market for herbal and dietary supplements Researchers of Wageningen University have extensively monitored and analyzed the safety associated with plant-based

food supplements Thirty potential carcinogens were studied, and it was found that the majority of the compounds shared something in common They were part of the alkenylbenzenes group or the pyrrolizidine alkaloids group Awareness of the possible risks associated with some botanicals has created

a surge in improved quality control, so much that alkenylbenzenes estragole, methyleugenol and safrole (see figure below) being used as flavor additives have been prohibited in numerous EU member states (―Some plant-based,‖ 2011)

Chemical structures of alkenylbenzenes present in several plant-based food supplements

Although dangerous carcinogens have been found in dietary supplements, they have not been banned Even supplements that have basil, fennel, nutmeg, sassafras, cinnamon, or calamus as a main ingredients are high in alkenylbenzenes Several recent studies revealing hazardous herbal supplements have created a surge in risk management actions being taken Although researchers report the occurrence

of liver cancer in animals after consumption of high concentrations of pure alkenylbenzenes, there are numerous supplements which contain negligible amounts of potential carcinogens in them When testing the effects of alkenylbenzenes, the experimental animals were administered only the pure concentrations rather than the dietary supplements combined with regular feed Even if the studies are not indicative of the level of risk present when consuming plant based supplements, it is appropriate to raise concern over the lack of regulation and quality control (―Some plant-based,‖ 2011)

Step 1 Herbs are checked for pesticides or hazardous chemicals

Step 2 A microbiological analysis is conducted in order to test for contaminants such as fungi

Step 3 A phytograph is done in order to ensure that the identity and quality of each herb are

legitimate

Step 4 Pills are made based on appropriate dosages

Step 5 The final product is quality tested

The production process of herbal supplements (based on Barrett, 1999)

Permissible Claims Several recent studies have focused on the true benefits of certain herbal supplements such as gingko, Echinacea and Saint John‘s Wort These herbs have been reported to be cures for several illnesses while studies have shown that they are ineffective Despite the negative results from studies done on herbal remedies, $14.8 billion was spent on herbal supplements in 2007 According to the Government Accountability Office (GAO), those who market supplements continue to inform consumers incorrectly, sometimes advising hazardous usage techniques This was uncovered by incognito GAO employees who posed questions as if they were elderly clients Furthermore, it was found that salesmen advised customers that herbal supplements were capable of preventing and curing Alzheimer‘s disease and that prescription medication could be replaced with supplements Gregory Kutz, managing director of Forensic Audits and Special Investigations at the GAO revealed during a testimony to the U.S Senate Special Committee that the FDA and FTC had labeled the marketing approaches to be ―improper and likely in violation of statutes and regulations.‖ Even though herbal supplements do not require pre-market testing because they are sold as food, the GAO tested 40 commonly purchased supplements and found that over 80% contained traces of lead, mercury, cadmium, and/or arsenic

The FDA and U.S Environmental Protection Agency considered the results to be hazardous but stated that the levels of contaminants found were not high enough to put a consumer at risk In general, the Americans who purchase herbal supplements are cautious in choosing a reliable brand, and are advised by the president of the Council for Responsible Nutrition that the GAO research should be of no

―concern to consumers.‖ Consumers buy herbals supplements to improve their health and lifestyle but are

at the mercy of marketers who fail to give valid information The FDA regulates all dietary supplements but give the responsibility of determining their benefits and dosages to the manufacturing company Also, the marketers are not required to present the means in which they determined the effectiveness and safety

of products to the FDA The FDA checks to see that all manufacturing processes are valid, but no tests are done on the claims made by manufacturers If a faulty claim is revealed, the FDA must show that consumers are at risk before actions can be made to remove the product from stores Though it is illegal to claim that a supplement can cure or prevent illnesses, the manufacturers are allowed to make general claims about improving everyday bodily functions A disclaimer is required which says that the claims

have not been evaluated by the FDA, but the majority of consumers are still mislead Although administrations like the FDA and the FTC are responsible for preventing false advertisements, there is not enough attention given to inappropriate marketing techniques (Harmon, 2010)

Professor Edzard Ernst at the Department of Complementary Medicine at the University of Exeter advises that herbal remedies should be sold by pharmacists He has written before that herbs such

as ginkgo, St John‘s wort, saw palmetto and horsechestnut seed extracts are viable for use as natural remedies, but at the moment, they lack quality control because they are sold as food supplements rather than drugs Interested consumers are constantly referring to Professor Ernst to answer questions concerning the efficacy and side effects of food supplements Information supplied to these consumers is limited though due to legal restrictions Despite the regulatory process being inadequate, there is a growing interest in herbal supplements Salesmen should be allowed to provide appropriate advice if a consumer is questioning the accuracy of information present on a label (Freeman, 2000)

Although herbal supplements cannot be claimed to treat disease, recent studies have shown that there are potential benefits involved in the use of plant-based dietary supplements The majority of clinicians consider the use of herbal supplements to be disadvantageous, but people who use herbal supplements do not need to consult their physician first It has been tested to see how beneficial herbal supplements are to the gastrointestinal health of a person These studies have shown that herbal supplements do not aid in the treatment of liver disease, but can help in the alleviation of gastrointestinal symptoms (Lipman, n.d.)

Herbal supplements can benefit a person‘s entire diet but are commonly used for specific purposes For example, ginseng has been known to improve the overall health of the body, while echinacea is used specifically to improve one‘s immune system Other examples of herbal supplements that have been used for specific purposes are spirulina, bee pollen, royal jelly, psyllium seed husks, wheat germ, wheat grass, shiitake mushrooms, and reishi mushrooms (Dupler & Fundukian, 2011)

Side Effects of Food Supplements The side effects of many food supplements remain unevaluated The long term side effects are particularly problematic, and although health reports may provide some insight into more immediate effects, no major studies have been conducted on the extensive side effects This is because food supplements are regulated as food so broad studies are not required (Johnson, Haley, & Ward, 2007) However, research shows that the side effects of many supplements may be harmful and interfere with medical drugs

Many protein supplements are taken as forms of ergogenic aid despite their documented adverse effects These supplements make up part of a multi-billion dollar industry that is based on a marketing strategy that involves using mostly unproved claims Additionally, many of these protein supplements can have harmful side effects including decreased liver function, dehydration, and worsening of gout A more extensive list of these side effects can be found in table 1, which includes popular protein supplements such as Creatine Fuel Chews, Muscle Milk, and Hydroxycut (Johnson et al., 2007).For example, studies conducted on creatine show an increase in body mass and lean body mass In reality however, this increase is mainly a result of increased water retention in muscles, which does not actually benefit the user‘s physical performance Also, the protein supplements may not provide any additional benefits for athletes in need of protein because sufficient amounts of protein are already provided in a normal diet (Clarkson & Rawson, 1999) It is important to consider the costs and benefits of consuming protein supplements

Agent Active Ingredient(s) Trade Names Documented Adverse

Effects

Creatine  Creatine Monohydrate  Creatine Fuel Chews

(Twinlab Inc NY, NY)

 Creatine Monohydrate 100% (Higher Power, Boise, ID)

 Cell Tech (MuscleTech, Mississauga, Canada)

 Micronized Creatine (AST Sports Science, Golden, CO)

 Electrolyte disturbances29-31

 Renal Damage29,32

 Transient elevation in transaminase31,33

 Increased post-exercise compartment

 Muscle Milk (CytoSport, Benicia, CA)

 Ripped Fuel (Twinlab Inc NY, NY)

 ProBURN (Prolab, Chatsworth, Ca)

 Acute Myocardial Infarction36-37

Interactions of herbal supplements with dental drugs based on (Abebe, 2003)

Increase bioavailability and effects of drugs

Dong quai(Angelica sinesis) For painful menstrual cramp; general tonic;

antispasmodic; for cardiovascular health and liver support

Corticosteroids

Cardiac arrythmias Cardiac arrythmias and other cardiovascular complications Decreased steroid effect

Ginkgo

(Ginkgo biloba)

To improve memory and brain function; for claudication and general cardiovascular health; antioxidant

Aspirin Acetaminophen plus caffeine plus enfotamine

Increased risk of bleeding Brain hemorrhage

Increased CNS depression