What is an appropriate price for a multivitamin?

[brimstoneSalad]

"The report focused on vitamin A, zinc and niacin because they are nutrients to which children are most over-exposed."

You realize you linked to EWG here, right? The fear mongering organization responsible for people eating fewer fruits and vegetables because they claim conventional produce is poison. Fox news would have been a more credible source.

I wonder if any credible organizations are raising concern of this.

There can be digestive issues for e.g. too much iron in cereals, but primarily for very young children -- it can cause constipation.

The more likely issue is that a serving size is comically small. Ever poured a bowl of cereal using the actual serving recommendations?
It's like a doll sized portion.

As to the orange juice: You may have a citric acid intolerance. This likely has nothing to do with the amount of vitamin C in it.
Licorice is an herb with very potent medicinal properties, yes it can be dangerous. Candy licorice rarely contains it, though.

The thing that I keep in mind is that serious malnutrition from lack micronutrients doesn't tend to occur unless they are completely absent from the diet for a long time.

"Serious" as in life threatening, maybe. But plenty of people do not feel well when being at sub-optimal status for many vitamins and minerals.

RDI is important because many of these nutrients are hard to absorb all at once. A once weekly dose isn't necessarily going to do it, and more importantly the large dose all at once is more likely to cause side effects than a gradual one.

Better to take half, or even quarter, of a multi daily if you're uncomfortable with the amounts it provides with a whole vitamin daily. And if you're taking less, you probably need another dedicated B-12 supplement.

[cornivore]

Yeah, that was food for thought. I was looking at the food safety news article because I was wondering if supplements had been involved in foodborne illnesses, and they linked to the EWG info about fortified foods. Other than that, since there's such a long list of vitamins for children, it seems possible that they could get too much from fortified foods in addtition to taking supplements. Wild guess? Well, considering that food fortification was implemented before there were all of those supplements on the market, they weren't intended to be combined, I suppose, and it's still strange to me that they are not typically discussed when the question of supplements is treated as a separate topic, as if they were unrelated to the vitamins in fortified foods (maybe people don't give it much thought). Here's something about it though: Overlapping vitamin A interventions in the United States, Guatemala, Zambia, and South Africa: case studies ... "Originally, supplementation was meant as a short-term solution until more sustainable interventions could be adopted. Currently, many countries are fortifying commercialized common staple and snack foods with retinyl palmitate. However, in some countries, overlapping programs may lead to excessive intakes."

Besides the juice, I don't seem to have a problem with citric acid as an ingredient otherwise, so the Vitamin C hypothesis sounded like a reasonable explanation for how orange juice tends to affect me. Here's one article specific to that: Diarrhea from vitamin C ... "Many runners have been advised that generous doses of vitamin C (1 g/day or more) will lessen musculoskeletal symptoms. Such doses of vitamin C frequently produce diarrhea, the source of which may be unrecognized for a long time". Here's more on that: ascorbic acid - FDA ... "Overdose with ascorbic acid may cause nausea, vomiting, diarrhea, facial flushing, rash, headache, fatigue or disturbed sleep". Also, I came across the licorice poisoning from reading medical case reports about people eating too much of the candy, so apparently it can be a problem. Like they say, anything can be a poison, and this includes any water soluble vitamin, and the water itself.

When I think about micronutrients, I don't picture them just flying out of the body on a daily basis, unless there's a fluid disturbance (and they are micro-nutrients after all, not necessarily needed at regular intervals like the energy from macronutrients, besides when one is sweating a lot, and such), so I don't feel at a loss for not taking vitamins or eating all the time (especially if I have extra body mass storing either kind of nutrient), but that's just me. I mean, I've read that micronutrient or macronutrient deficiencies don't tend to induce dieseases of malnutrition unless they are basically absent from the diet for an extended period of time, and then are usually reversible with supplementation in a short period of time. But if some people are uncomfortable when they don't get x-amount daily, then maybe that's what they need.

What kind of discomfort are they basing it on though? Physical discomfort isn't always an indication. You mentioned that it would be a fallacy to assume exponential improvements with more vitamins. It seems to be fallacy to assume that more vitamins would be harmless too. It may be misleading when no upper limit is set on a substance, but even the substance that constitutes most of a person's bodyweight can cause hyperhydration, or hypo-anything related to a fluid imbalance. So occasionally people die because they drink too much water, and have no idea that it is even a risk. They probably feel fine in the process of overdoing it, and then suddenly it becomes life threatening. The same goes for taking too much of any vitamin, or other substance, although the effects may be chronic too, from chronic overexposure, and go unrecocognized because of false assumptions, like how Vitamin C is suppposed to be harmless in any amount. Well, nothing is harmless in any amount, and sometimes less is more. The RDIs are not absolutely going to balance everyone's state of being, one way or the other, I presume (because they weren't supposed to be taken that literally).

It's like trying to define what fasting is. Is it a kind of metabolism, or is it an eating habit? Does everyone need three meals a day? No. Does everyone need a multivitamin everyday? No. One meal? Part of a vitamin? Not everyday. Because the fasting metabolism doesn't kick in until more than 24 hours without intake, usually. They may need or want to follow an eating habit, or supplement it for some reason, but that doesn't have much to do with fasting. If you take the RDIs literally, fasting would have no benefit, yet numerous studies show that it can help balance micronutrients better for some people. Then there's all kinds of fasting mimicry diets, and all kinds of supplements that mimic food, because people may respond to different things or there's more than one way to go about it. Naturally, not every animal has the luxury of choosing their diet or frequency of meals, and people can adapt to these situataions too. Sometimes it can be healthier, of course, when over indulgence is causing as much or more of the mortality. Looking at the reports in general, it seems that people tend to skip taking supplements entirely or take too many. So I think something in between could just as well be about playing it safe. About balance, that is. There are lots of variables to consider, besides giving RDIs all the weight, because some variables may contraindicate those values more or less, and supplements often far excede them in 'dosage'. I don't think it's safe to assume that nobody can have adverse reactions to a megadose especially, or that any dose must be administered daily for its absorption to be beneficial.

Relative to a swimmer who puts on extra body fat to swim the English Channel, it would be like saying this was only useful for the warm up, before they even stepped foot in the water, because fat people don't usually exercise more than such a warm up in a day. Conditioning is also a variable though, and people can adapt to using micronutrients efficiently, while fasting regularly too. Everyone knows that fasting can be overdone, but the same goes for eating or swimming. Putting on fat doesn't help the swimmer swim better, since they don't get fat for an olympic sprint, it's a trade off. Taking supplements more often could likewise be a trade off, like a triathlete who has to have some to sustain their race pace on land, but if you're not doing any exercise then maybe you don't need to chug sports gel all day, because it can work the opposite way, and you could get weaker or fatter for doing so (or get diarrhea, and lose more micronutrients anyway). You know what, fasting may be the one thing that doesn't have diarrhea or diuresis as a side effect, so it can't be entirely unhealthy. In that case, it could help with retaining more vitamins, so they have a longer time frame in which to be absorbed.

To put this in perspective, I think the "fasting" here is like a metaphor, for an interval, and the swimming is not really a metaphor, but likewise involves an interval. We don't say a swimmer is fasting when they utilize the nutrients that were stored for the event. Calling an interval between meals "breakfast" is like saying it amounted to fasting, but it doesn't really involve a fasting metabolism, so it's more like a metaphor. The difference is more extreme between swimming in a cold ocean for the amount of time between dinner and breakfast than it would be for not eating a day or two longer, as well. So the comparison of not eating or taking supplements for longer is more like doing a sport in slow motion, where you don't use the nutrients as fast, and the interval can be extended, but it isn't literally fasting (if the stored nutrients sustain the activity metabolically). The same interval may literally amount to fasting sometimes, metabolically, but it depends on more than the time involved between meals. Just as a swimmer could enter a fasting state if they didn't bulk up before a long ocean swim (except that would happen much faster). So I don't think it's anything but a metaphor to characterize taking multivitamins everyday as a necessity for the prevention of malnutrition (because starvation doesn't happen overnight).

If you look at it like sports nutrition, the nutrients have a counterpart, a sport. If you take supplements and eat all the time, and there is no sport involved, then eliminating what you ate becomes the sport, because the nutrients could cause an imbalance that has to be eliminated constantly (when a sporting activity doesn't utilize them). Likewise, if you eat or supplement before fasting (metaphorically), then utilizing the nutrients for that becomes the sport, instead of eliminating them (and it isn't really fasting, metabolically, it's just being sporty at a lower level of activity, but it takes longer). So I think that daily supplements or eating all the time can be counterproductive, if they don't have a counterpart, other than their elimination (because your body might never be able to keep up with such a pointless pace, of indigestion). To the extent it is excessive, over-eating or supplementing causes more elimination (in addition to storing an excess), which manufactures the problem of needing more nutrients, as if to correct the imbalance of getting too many in the first place (because you can lose more micronutrients in the process of excessive elimination). Okay, so it's literally a sport too, they call it an eating contest. Then there's sumo wrestling... it's like a metaphor for a bunch of nutrients throwing each other off balance (since they interact that way, when your mouth is like the black hole of calcutta). No offense, I'm not trying to say that everyone must fast if they aren't an athlete, just that eating less often isn't necessarily fasting, because it could be more optimal, like athletics, if the timing of nutrition corresponded to a lower level of activity, relative to how sports nutrition corresponds to a higher level.

When I was considering sports nutrition in the topic about intermittent fasting, I thought it seemed reasonable to supplement micronutrients daily based on some of that information. However, it was really between longer periodic fasting and athletics, or extremes in thermoregulation and fluid balance that the supplementation seemed most necessary. It depends on body composition and metabolism too. The thing about intermittent fasting is that it could just as well be characterized as intermittent eating, and there may be no actual fasting going on metabolically, so the meal and/or supplement prior to this interval could very well cover the nutrition for that activity, like how it covers the activity for a sport. The durations of each would typically be different, but the nutrition could balance out the activities either way, and in turn the activities could balance out the nutrition. As long as they correspond, the interval is arbitrary, except that perhaps the body can use nutrients more efficiently when eating is intermittent, and slows the process of elimination (but I think it's more like keeping pace with it, instead of falling behind a more constant digestive process or a flood of fluids and little solids to sort out, like some kind of eating machine). Such a process could be variable too, like the weather, especially if the weather is also a factor, so I wouldn't count on being a fasting machine in spite of that, trying to sweat it out for too long. It would be an average intake that mattered as a lifestyle. I think the same goes for supplements, and supposedly the shelf life of those can extend a few years past the date on the bottle, if stored properly. I rather not store them all internally in the meantime, only as needed (hmm, almost never so far). Fewer than I had anticipated at first (and it isn't about the price of those, mostly I don't find them appetizing), yeah they seem pretty nitty gritty. Some are more appealing than others though, perhaps it's no coincidence. Like how the basic tastes correspond to essential nutrients. I'd rather sort them out that way than getting the gummies or mixing up my own coating like that. Nah, there would have to be a more compelling reason for me to take any of them really. If it seems like I have the signs or symptoms of a vitamin deficit then it's worth a try. An ounce of prevention, not a ton!

That's just my impression, evolving slightly at times. Well maybe I've talked enough sense into myself, this time.

[brimstoneSalad]

and it's still strange to me that they are not typically discussed when the question of supplements is treated as a separate topic, as if they were unrelated to the vitamins in fortified foods (maybe people don't give it much thought).

Well, it's typically unhealthy foods that are fortified (refined grains and sugary cereals). If you're eating more healthfully, the only fortifications you're likely getting is from your plant-based milks. Which is likely B-12, calcium, and vitamin A; the last the only one with possible overdose.

Here's something about it though: Overlapping vitamin A interventions in the United States, Guatemala, Zambia, and South Africa: case studies ... "Originally, supplementation was meant as a short-term solution until more sustainable interventions could be adopted. Currently, many countries are fortifying commercialized common staple and snack foods with retinyl palmitate. However, in some countries, overlapping programs may lead to excessive intakes."

Interesting, and thanks for the link.
Programs in other countries may be more aggressive, but these slightly elevated levels probably aren't a significant public health concern (not compared to deficiency).

Keep in mind in the U.S. these elevated levels are probably related to obesity (where people are consuming inordinate amounts of high vitamin A foods, including fortified ones -- Obesity is at around 40%, which is more than the third which presented with high levels in autopsy) and meat consumption from which the vitamin A acts like a supplement (where overdose is possible). Vegetable consumption provides caratenoids which can optionally be converted into vitamin A but will not be converted if unneeded. Vegans are probably very safe since they will not have such variable dietary levels of preformed vitamin A to add to the supplement which would increase risk of clinically significant overdose.

Besides the juice, I don't seem to have a problem with citric acid as an ingredient otherwise, so the Vitamin C hypothesis sounded like a reasonable explanation for how orange juice tends to affect me.

Orange juice doesn't contain that much vitamin C. It does contain an inordinate amount of citric acid vs. other foods and is more likely to be consumed alone or accompanied by a smaller amount of food, and having bulk in your stomach when citric acid is part of some other food could mitigate the reaction.

"Many runners have been advised that generous doses of vitamin C (1 g/day or more) will lessen musculoskeletal symptoms. Such doses of vitamin C frequently produce diarrhea, the source of which may be unrecognized for a long time". Here's more on that: ascorbic acid - FDA ... "Overdose with ascorbic acid may cause nausea, vomiting, diarrhea, facial flushing, rash, headache, fatigue or disturbed sleep".

Those are absurdly high doses. 8 oz of orange juice has around 60 mg of vitamin c. That's 6% of those dosages which are causing issues.
In comparison, a red bell pepper contains over 200 mg. Do those give you diarrhea?

Also, I came across the licorice poisoning from reading medical case reports about people eating too much of the candy, so apparently it can be a problem. Like they say, anything can be a poison, and this includes any water soluble vitamin, and the water itself.

It's rare in candy, but yes it can happen. That's one of the only commonly used spices that can be deadly. Nutmeg is another. This is very uncommon.

With few exceptions, water soluble vitamins can usually only cause problems when administered in extremely large amounts all at once; because they are water soluble excess is easily removed from the body. It's more fat soluble vitamins like vitamin A that are likely to be problems.

Water itself is only an issue if consumed in very large amounts from sources that have low concentrations of some minerals because it can wash the necessary minerals out of your body (like potassium and sodium).

It's important to think about the mechanisms of action, the mechanisms by which overdoses are remediated or prevented, and the probability that these things occur.

When I think about micronutrients, I don't picture them just flying out of the body on a daily basis, unless there's a fluid disturbance

If you're drinking any water that isn't your sweat or urine, then you're constantly disturbing your fluids by introducing liquid water without the ions you've lost.
Many other micronutrients are actually used up in cell growth and exit your body as waste through broken down cells etc.

There are some that you could consume less often, but you'd need to figure out which you need and don't need every day, and it's easier just to take everything every day and pee out the rest.

I mean, I've read that micronutrient or macronutrient deficiencies don't tend to induce dieseases of malnutrition unless they are basically absent from the diet for an extended period of time, and then are usually reversible with supplementation in a short period of time. But if some people are uncomfortable when they don't get x-amount daily, then maybe that's what they need.

The point is that there are clinical and subclinical levels of deficiency. Most people would just report symptoms of "blah" or other less critical concerns like poor skin or hair/nail health.

If some people are going to feel bad, but nobody would be harmed by taking them every day, then shouldn't we just recommend everybody take them every day so some people don't feel bad -- and as a consequence of feeling bad possibly blame veganism and start consuming animal products?

It seems to be fallacy to assume that more vitamins would be harmless too.

Not in unlimited amounts. But it takes a *lot* of some vitamins to do anything at all.
There are only a few vitamins which could actually be harmful in large amounts, like vitamin A. Most others are efficiently removed from the body OR the body just downregulates absorption of them (as with most minerals).
You can consume an enormous amount of non-heme iron and not get an overdose as long as you increase your dosage gradually. Your body is just going to stop absorbing it. The only likely effect is constipation.

Now you could make some speculative arguments about the microbiome; maybe having large amounts of iron available in the feces could cause issues because iron is a common limiting factor in the growth of certain bacteria and maybe there could be some imbalance or overgrowth of something... but at the same time, maybe having that iron available in the feces is beneficial because then the microbiome evolves to be bad at absorbing iron from the environment because it's been so plentiful thus becomes less virulent in the body? We don't really know.

The bottom line is that the gap between effective dose to basically eliminate risk of deficiency in 99.9% of people and the dose at which these things become potentially harmful is quite large. The body is pretty good at dealing with variability of nutrients within a plausible range, and for obvious reasons it's better at disposing of unneeded nutrients than scavenging them when they're barely present.

...You can also make the cancer argument (since cancer needs the same nutrients we do), but that's a more complicated issue. The whole point is that if WE are well nourished then so is cancer, so if you stay borderline malnourished cancer won't be able to grow quickly (none of your cells will). If you want to have minimal status of a host of nutrients that cancer needs to grow then you'd really just need a specially engineered diet and blood tests to balance on that razor's edge to minimize your risk. It doesn't make very much sense to put yourself at nutritional risk for speculative increases in resistance to cancer and I don't think that's something that's going to be appealing to most people unless they are already fighting cancer and want to pursue that approach as adjunct therapy under the supervision of their doctors.

like how Vitamin C is suppposed to be harmless in any amount.

How is it supposed to be harmless? Megadoses are known to cause diarrhea and over time promote the development of kidney stones. High vitamin C when people have cancer may also protect cancer cells and interfere with chemotherapy.

"What vitamin C does is protect the cancer cells from the chemotherapy mainly by protecting their mitochondria"

https://www.webmd.com/cancer/news/20081 ... ad-combo#1

It's not surprising to me that it causes diarrhea in large doses (a lot of things do). The other things I already knew and I think are fairly common knowledge in nutrition.

Well, nothing is harmless in any amount, and sometimes less is more.

It's about the amounts people are taking, not *any* amount. Less is almost never more.

The RDIs are not absolutely going to balance everyone's state of being, one way or the other, I presume (because they weren't supposed to be taken that literally).

It's about probability. You can prevent deficiency in 99.9% of people. The question of public health is doing more good than harm. Same thing when we make our own health decisions; we have to weigh the probability of something hurting us vs. potential benefit.

If you're fasting then you're treading kind of unknown ground in terms of nutrition. You probably don't need a vitamin on your fasting days and it may just upset your stomach. That would be my guess.
RDIs are for people eating every day, more or less normally (multiple meals). I don't know what you need. You might need a lot more on the days you eat because you're absorbing less when it's all at once.

If you take the RDIs literally, fasting would have no benefit, yet numerous studies show that it can help balance micronutrients better for some people.

It might help some people lose weight because they eat less. It may also be easier for some people to eat more healthfully and plan when they're not eating all the time.

I don't think there's much evidence on nutrient intake, though, or nutritional status. We're talking about a very small number of people.
If you're fasting regularly I'd suggest getting a blood test or something, because there are a lot of unknowns there.

Looking at the reports in general, it seems that people tend to skip taking supplements entirely or take too many.

Some supplements contain unnecessarily large amounts of nutrients, particularly single nutrient supplements. This is probably because people value shop and they buy the larger ones if they cost the same.
Multivitamins usually do not contain such high levels, because they would be enormous. And in the case of iron, because they'd cause constipation.

I don't think it's safe to assume that nobody can have adverse reactions to a megadose especially, or that any dose must be administered daily for its absorption to be beneficial.

Multis usually don't contain megadoses. Nobody recommends those doses except for people with deficiencies to correct them short term.
Not saying they all need to be daily, but some of them really do benefit from that in terms of absorption and tolerability (you don't need to take as much if you take it daily). To my knowledge nothing is harmed by being spaced out like that. In terms of nutrients it's always either the same or better to space it out in smaller daily doses rather than all at once.

Conditioning is also a variable though, and people can adapt to using micronutrients efficiently, while fasting regularly too.

Ability to upregulate absorption is limited.

You know what, fasting may be the one thing that doesn't have diarrhea or diuresis as a side effect, so it can't be entirely unhealthy.

That's because you're not eating anything...

In that case, it could help with retaining more vitamins, so they have a longer time frame in which to be absorbed.

That seems unlikely. Unless you're using fasting to treat chronic diarrhea? But the thing is, your body absorbs vitamins based on food contact time and there's probably going to be more absorption in the first hours. So whether you're holding poop in you for an extra day and eating less, or eating more and it's rocketing through you, seems you'd have about the same amount of contact time except the old poop may be depleted by the time you're excreting it, meaning you didn't absorb much from it at the tail end.

Microbiome may play a role, but I don't think we know enough about that to make any determinations on the benefits or drawbacks of various bowel transit times.

Maybe it's the same, maybe it's better, maybe it's worse. If it's working for you that's cool, but like I said maybe a blood test now and then just to make sure because this is again relatively unstudied territory.

[cornivore]

Thanks for those perspectives, I try to consider all perspectives. No, I don't have chronic diarrhea, it's just an acute response to foodborne issues occasionally, because I try not to repeat those mistakes often. Optimally, I eat before sleeping, which prevents other activities from interfering with digestion, and my intestinal transit time slows down when I only eat large meals intermittentlly. I've had good results with that, better digestion of things that would be too disturbing when I was moving around. But I try to avoid those kinds of foods anyway.

Obesity is at around 40%...
Less is almost never more...
That's because you're not eating anything...

Not to take things out of context there, but I am eating while fasting, because my body is metabolizing the nutrients between meals. I don't really consider it to be fasting in this case, even though it may be categorized that way as a dietary pattern. It all depends. I think there's a middle ground there.

[cornivore]

Interesting, and thanks for the link.
Programs in other countries may be more aggressive, but these slightly elevated levels probably aren't a significant public health concern (not compared to deficiency)...

I looked up a couple more articles, which were published recently. It would seem to be a public health concern (either way), as they are still questioning it. I'm just quoting some of their concerns about the excessive intake of fortified foods and/or supplements here.

Provision of micronutrients in coexisting public health programs and risk of excessive intake

"The chronic and acute adverse effects of excessive preformed vitamin A intakes during prolonged or short periods of time are well documented and include bone fragility, liver damage, skin disorders, increased intracranial pressure, and teratogenicity.

Excessive folic acid consumption has been associated with vitamin B12 deficiency, anemia, and cognitive impairment in certain population groups.

Adverse effects caused by a longtime exposure to iodine excess in pregnant women and particularly in children include hyperthyrotropinemia, increased risk of developing goiter, and impaired motor and verbal communication development.

Some of these negative effects can be permanent but others could be corrected or prevented when returning to appropriately lower micronutrient levels."

Weighing the risks of high intakes of selected micronutrients compared with the risks of deficiencies

"We focus primarily on VA [vitamin A], folic acid, iron, and zinc intakes...

Burden of excessive intakes

Vitamin A (retinol)
Retinol intakes above the UL [upper intake levels] among children have been reported in the United States and Canada, with prevalences ranging from 0% to 4% among children 4–8 years of age to 59% among children 24–47 months of age. Among adults, retinol intakes exceeding the UL were uncommon in the United States, Mexico, and several European countries, but there was some evidence of excessive intake among supplement users.

Folic acid
In the United States, folic acid intakes above the UL have been reported in preschool children, particularly in association with consumption of voluntarily fortified food, such as fortified breakfast cereal: 5–7% of children 1–8 years old in the highest quintile of fortified food intake had folic acid intake above the UL. Surveys in various countries have suggested that few adults would exceed the UL for folic acid from diet alone, but intakes above the UL were present among ready‐to‐eat cereal (RTEC) consumers in Canada (5.5%) and supplement users in Mexico (12.4%), and 3–6% of individuals in the general U.S. population (≥2 years old and ≥4 years old) would have intakes above the UL when fortification and supplementation are included.

Iron intakes above the UL were observed among supplement users in several countries, ranging from 7% among lactating women in China and U.S. women to ∼14% among Hawaiian men and Mexican women. In contrast, in Ethiopia, a high prevalence of total iron intake above the UL in the absence of iron supplements or other iron intervention programs was reported among women 15–49 years old (63.6% nationally, ranging from 1.1% in Somali region to 80.2% in Amhara region); the high iron levels in staple foods have been attributed to extrinsic iron in food (e.g., from soil).

Zinc
Numerous studies (but not all) have reported zinc intakes above the UL, particularly among young children, with many reported prevalences greater than 40%. In contrast, among adults, the prevalence of excessive zinc intakes from food appears to be low. However, prevalences of 7–13% have been observed among adult supplement users in the United States... for zinc, the benefits of addressing deficiency appear to outweigh the potential risks...

Although adult males have been considered an important target group for assessing the risk of excessive intake because their food intake is assumed to be greater than that of other age‐sex groups, the literature reviewed here suggests that excessive intakes of VA, folic acid, and zinc are more common among young children than among adults. Children may be more likely to exceed the UL if they tend to consume more RTECs and supplements compared to adults. However, the high prevalence of intakes above the UL among children may also reflect the fact that for many nutrients, the gap between the EAR [Estimated Average Requirements] and UL is narrower for young children than for adults...

Among adults in the U.S. National Health and Nutrition Examination Survey, males had a higher ratio of intake to UL than did females for iron, zinc, and folic acid, possibly reflecting greater food intake, since ULs are similar for men and women. In another U.S. study, pregnant women with folic acid intakes above the UL were more likely to be Caucasian or Hispanic...

In addition, data from high-income countries suggest that excessive intakes occur among self-prescribed supplement users and consumers of large quantities of fortified products (staple foods and/or processed foods)... Because excessive intakes are rarely observed from food sources of MNs [micronutrients] even in high-income countries, dietary diversification strategies may be particularly suited to address deficiencies while avoiding excessive intake."

I suppose there could be other nutrients of concern for excessive intake (since they were only considering fortified foods and supplements with the same substances overlapping). I'm not trying to dig up every study on the matter though, because I wasn't planning on eating a lot of fortified food or taking supplements frequently. Besides the fact that those have been considered necessary to the extent that they exist, I was looking into it for a perspective on whether nutritional supplements have been considered excessive, when taken in the usual ways. Apparently so. Risky amounts of overnutrition from micronutrients would seem to be involved more often than the people taking them might expect (in addition to more obvious forms of overnutrition from macronutrients).

Regardless of the price for multivitamins, those might work too well, and amount to overcompensation. But this is just my two cents worth (and the rest adds up to feud forethought, or stof til eftertanke, if you're hungry for a Danish)! Maybe I ate too much corn, anyway (check this out... a South American Purple Corn supplement, you can't make this stuff up).

[brimstoneSalad]

@cornivore as I expected, this is primarily in children (where required amount and upper limits are closer together) and due to fortified breakfast cereals of which they are consuming amounts difficult to meter.

I'm still not sure why you think this is an issue.

Symptoms of even pretty significant excesses here are also quite mild short of very large spikes in iron consumption (which can be fatal, but not what they're talking about).

They're talking about cases of certain segments of the population in different areas exceeding the UL by an unspecified amount but I don't see any epidemiological evidence of this being a problem.

[cornivore]

Like I said, I don't think they'd be continuing to study this if it weren't a public health risk (that's what they call it, so there you go). If it weren't risky to exceed the upper intake levels, there wouldn't be upper intake levels. They mentioned examples of adults being at risk as well, especially if they are taking supplements (which may be typical), and eating enriched food (such as pasta, which could also be typical in the adult diet, and has 10% iron and 25% folic acid added per 2 oz serving, which is a pretty small serving size). Did they say adults were not at risk? No, they didn't. They said that they expected men to be at higher risk, because they tend to eat more of these foods (or more food in general). Finding that it happens most often with children does not mean there is no risk for adults. The point is, it's more likely to happen when supplements and fortified foods are involved. This is comparable to what they said about Ethiopia, where the soil has too much iron. Eating fortified foods and supplements can be like enriching the soil, in effect. They don't know how much of a risk it is all together, because they are still studying these things, just that it is likely riskier to exceed the upper intakes (as they list some of the adverse reactions to excessive intakes).

The only one of those that they basically ruled out as riskier to be deficient in was zinc. The rest are potentially riskier if eaten in excess, than if they are otherwise deficient in the diet, as far as what they've determined.

This includes iron, which is said to require further studies, but here's a comment in an overview of those related to one organ, indicating that an excess can be risky for adults (including bleeding in the brain, causing headaches, etc.):

"Taken together, the data gathered with human subjects with results obtained with animal models, which show a clear association between increased iron and cognitive impairment, there seems to be some indications for a link between systemic iron status and cognition that needs to be studied in more detail"... Multilevel Impacts of Iron in the Brain

In the meantime, the other article above mentions that men and women using supplements exceed the UL for iron, somewhat frequently, ranging between 7-14% in the U.S., so there could be around 50 million of these people at risk for cognitive impairment, among other potential consequenses of iron excess and overload. It's a long list already, so I don't think it's safe to assume that there is no risk involved, just because the full extent of risk factors have yet to be determined.

To me it seems like iron deficiency in adults would tend to be mild (at least in men), compared to iron accumulation, because it can't be excreted. This could become complicated further, as it was said of an excess that "Damage to the cells of the gastrointestinal tract can also prevent them from regulating iron absorption, leading to further increases in blood levels". It was also said that "Many people have an undiagnosed genetic susceptibility to iron overload, and are not aware of a family history of the problem. For this reason, people should not take iron supplements unless they suffer from iron deficiency and have consulted a doctor".

Well, I'd rather err on the side of caution as far as taking fewer supplements goes (so as not be the human guinea pig in this ongoing experiment of people voluntarily taking too many, but I wish them well). Speaking of which, I don't want to experiment with staring at my computer screen too long either, so that's enough of that.

[brimstoneSalad]

Like I said, I don't think they'd be continuing to study this if it weren't a public health risk (that's what they call it, so there you go).

They haven't shown that it is, but as to the motivations there are plenty of possibilities. Academics are often required to publish research for consideration for tenure, or otherwise they may be taking the risk because if it turns out to be an issue they've won the lottery here and this will be a big payoff for their careers.

If it weren't risky to exceed the upper intake levels, there wouldn't be upper intake levels.

This is complicated, because UL is often determined from lab administration that saw short term adverse reaction from some people for some forms, or extrapolation from animal models for the same.
The thing is, downregulation for food absorption takes time. A gradual ramping up of dosage and particularly when buffered by a proportional amount of food is much less likely to cause any issues, particularly with most water soluble vitamins and minerals.

A person could potentially take an otherwise lethal dose of iron daily in food (an absurd amount, almost 4 grams) and be perfectly fine as long as the iron was in certain forms (e.g. like dirt, which would mean consuming almost 80 grams of iron rich soil) and this was what the body was accustomed to. I would be very surprised if the people with large iron doses because of local soil suffer any short term adverse reactions at all. This isn't a new issue, large doses of nutrients have been evolutionarily significant pressures for millions of years, and they're issues that threaten survival *before* reproduction which means they're meaningful pressures (as opposed to e.g. heart disease or cancers caused late in life at ages we rarely lived to and did not reproduce at).

They mentioned examples of adults being at risk as well, especially if they are taking supplements (which may be typical), and eating enriched food (such as pasta, which could also be typical in the adult diet, and has 10% iron and 25% folic acid added per 2 oz serving, which is a pretty small serving size).

Even adding 100% iron or folic acid from a food source over a day isn't likely to be an issue though.
Do you realize how much pasta would be required to reach 100% iron? It's 20 oz. how many calories is that? About 2,000. Interesting coincidence.
You meet your iron needs when you meet your calorie needs from the food. This is not an over consumption risk.

Even compounded with a modest supplement this isn't likely to be an issue assuming you didn't take up both habits at once, suddenly, from an otherwise low iron diet. And even if you did the most likely consequence is gastrointestinal issues which are going to be noticed.

The median dietary intake of iron is approximately 16 to 18 mg/day for men and 12 mg/day for women. The Tolerable Upper Intake Level (UL) for adults is 45 mg/day of iron, a level based on gastrointestinal distress as an adverse effect.

https://www.ncbi.nlm.nih.gov/books/NBK222309/

This is also based on large amounts of supplemental iron in pill form (60 mg), which is known to be less well tolerated, and even then only a small fraction of the study participants experienced serious GI problems from it (around 5%).
They add that to a guess of dietary iron and divide by an uncertainty factor to arrive at 45 mg.

They said that they expected men to be at higher risk, because they tend to eat more of these foods (or more food in general).

Which is even more dubious, since they're assuming the UL is the same for everyone and it isn't. The more people eat and the larger the body mass the higher the UL would be and indeed the higher the actual need for iron too.
Somebody who weighs 400 lb doesn't have the same need as somebody who weighs 100.

Most adults consuming over the UL are probably doing it as part of a very high calorie diet that's supporting an obese body mass.
I pointed out the correlation between this excess consumption and obesity; the fact they apparently didn't control for that or even notice it is concerning.

The point is, it's more likely to happen when supplements and fortified foods are involved.

The trouble is that this hasn't been established to be an actual risk, all they're showing is that a small segment of the population consumes more in fortified food and supplements than the current guess at UL based on taking a single supplement pill (which is known to be poorly tolerated).

The effects of large amounts of iron aren't exactly subtle. If such a large portion of the population were having GI symptoms like that it should be epidemeologically apparent.

They don't know how much of a risk it is all together, because they are still studying these things, just that it is likely riskier to exceed the upper intakes (as they list some of the adverse reactions to excessive intakes).

They really don't know, though. And other evidence doesn't seem to suggest it is.

The only one of those that they basically ruled out as riskier to be deficient in was zinc. The rest are potentially riskier if eaten in excess, than if they are otherwise deficient in the diet, as far as what they've determined.

I appreciate that they at least ruled out Zinc as more useful for inclusion than exclusion, the problem is that the nature of the UL is vastly different from the sources people are getting this iron from.
However, I would bet that if you asked them about vegetarians and vegans specifically they would agree that the benefit of iron probably greatly exceeds the "risk" just as with Zinc.

That's likely to be the ultimate conclusion for the population at large once they do more research, but it's even more obvious for vegetarians.

"Taken together, the data gathered with human subjects with results obtained with animal models, which show a clear association between increased iron and cognitive impairment, there seems to be some indications for a link between systemic iron status and cognition that needs to be studied in more detail"... Multilevel Impacts of Iron in the Brain

An article that starts out spending many paragraphs talking about how iron deficiency is the most common deficiency in the world and results in cognitive impairment and expresses that vegetarian diets are lower in iron. It is a boon to vegetarianism to have such readily available fortified foods and supplements.
From that article I'm not really sold on a causative link between iron consumption and brain accumulation. Doesn't seem to be supported.

Being anti-iron supplementation/fortification ultimately makes it more difficult for people to be vegan. I just don't think we're really putting ourselves at risk with modest supplements.

To me it seems like iron deficiency in adults would tend to be mild (at least in men), compared to iron accumulation, because it can't be excreted.

It's excreted every single day. The excretion actually is variable (in overload cases it's higher), it's just not water soluble vitamin variable.
The bigger issue is that we only absorb tiny amounts from the diet. We should be sure to provide enough and let our bodies down-regulate how much we take in.

This could become complicated further, as it was said of an excess that "Damage to the cells of the gastrointestinal tract can also prevent them from regulating iron absorption, leading to further increases in blood levels". It was also said that "Many people have an undiagnosed genetic susceptibility to iron overload, and are not aware of a family history of the problem. For this reason, people should not take iron supplements unless they suffer from iron deficiency and have consulted a doctor".

There are conditions that can result in overload, but those are clinical and there are symptoms your doctor would be able to diagnose you based on.

This isn't like dietary cholesterol where there's no health reason to consume it and only a risk in doing so. Iron consumption can have benefits and virtually eliminate risk of deficiency.

Well, I'd rather err on the side of caution as far as taking fewer supplements goes (so as not be the human guinea pig in this ongoing experiment of people voluntarily taking too many, but I wish them well).

Why not supplement but just take under the UL if you're concerned?
We aren't mindless consumers unable to track our nutrient intakes.

[cornivore]

Okay, I wish you well in considering that what they call risky in the research is anything but that. It's just a wonder to me, if the people arguing for taking more vitamins think there is a risk of not getting enough, why they think it isn't likewise risky at the other end of the spectrum (personally I don't consider the upper limit to be somewhere in the middle). I guess it's comparable to people thinking the speed limit on a highway is the minimum speed at which they should be tailgating in the snow (and getting into 50 car pileups, time after time). It's nothing out of the ordinary... as long as they took the spiderman complete multivitamin with that, their reflexes should suffice.

[cornivore]

From that article I'm not really sold on a causative link between iron consumption and brain accumulation. Doesn't seem to be supported.

Not to harp on iron, but I was looking up info about whether dietary MSG affected the Japanese neurologically, and an article actually listed increased iron in their diet as a possible cause of Alzheimer's disease, which has become more prevalent there from Western influence. So I checked out a couple articles on about iron and Alzheimer's too...

Trends in diet and Alzheimer's disease during the nutrition transition in Japan and developing countries

"Mechanisms to explain the findings include increased obesity for the eight countries, and increases in cholesterol, saturated fat, and iron from increases in animal products and meat supply for Japan"

https://www.ncbi.nlm.nih.gov/pubmed/24037034

Neither too much, nor too little

"For decades, iron was the most common nutritional deficiency in the United States, so many foods are now routinely fortified with iron.

Baby foods, breakfast cereals, breads, even rice and pasta, have added iron.

Iron deficiency is now most likely in babies who are exclusively breastfed, as well as menstruating and pregnant women, strict vegetarians, and people who take medications that cause internal bleeding or interfere with iron absorption.

However, too much dietary iron has been associated with diseases such as diabetes, cancer, and heart disease.

A recent study from the University of California Los Angeles (UCLA) also linked high iron levels to Alzheimer’s disease.

The researchers there said the connection may be because excess iron can cause oxidative stress, a type of damage to which the brain is especially sensitive."

https://www.healthline.com/health-news/ ... rs-disease

Iron and Alzheimer's Disease: An Update on Emerging Mechanisms

"Iron dyshomeostasis has been strongly linked to the pathogenesis of Alzheimer's disease (AD), as well as other major neurodegenerative diseases."

https://www.ncbi.nlm.nih.gov/pubmed/29865061

Anyway, I'll have to harp on myself not staring at the screen too long, once again. It's interesting and all, but of course it isn't an appropriate price for my multivitamin, likewise it would be too much of a good thing to read about everything... I think I'm turning Japanese!