Nutritional supplements for overall

health and development in humans

Importance of Nutrition
Nutrition is an input to foundation for health and development. Good nutrition
means stronger immune systems, less illness and better health. Healthy people
are stronger, more productive and more able to create opportunities. Better
1
nutrition is a prime entry point in achieving better quality of life. Nutrients play a
vital role in normal functioning of the body and are helpful in reducing the risk of
2
various diseases. An expert recommendation from World Health Organization
(WHO) and Food and Agricultural organization (FAO) says twenty essential
nutrients comprise the basis of all human nutrition. They include protein, energy,
vitamin A, vitamin D, vitamin E, vitamin K, thiamine, riboflavin, niacin, vitamin B , 6
pantothenic acid, biotin, vitamin B , folate, vitamin C, carotene, antioxidants, calcium, 12
3
iron, zinc, selenium, magnesium andiodine.
The worldwide acceptance of this fact has formed a recognition link between nutrition
and health and the concept of nutraceuticals has evolved.
A nutraceutical can be defined as a food or part of a food that provides medicinal and
2
health benefits, including the prevention and/or treatment of a disease. Different research
studies have revealed that nutraceuticals are efficacious to treat and prevent various disease
4
conditions.
This article outlines the benefits of different nutritional supplements that have a role in overall health
and development of humans.
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2013
Omega-3-fatty acids
Omega-3-fatty acids, specifically docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), have
received much attention in recent years. They are being increasingly promoted as important dietary
5,6
components for health and disease prevention. Alarge number of epidemiological studies, clinical trials
and experimental animal studies has shown that omega-3 polyunsaturated fatty acids (PUFAs) protect
against several types of cardiovascular diseases such as myocardial infarction, arrhythmia, atherosclerosis or
7
hypertension. A summary of the physiological roles and potential clinical benefits of very long chain omega-3
8
fatty acids are shown in table 1.
Micronutrients Trace elements andvitamins
Lactic acid Bacillus
Micronutrients include at least 14 trace elements and 13 vitamins which are required by humans in very small amounts.
The trace elements include As, B, Cr, Cu, F, I, Fe, Mn, Mo, Ni, Se, Si, Vand Zn. The vitamins inlcude thiamin, riboflavin,
26
niacin, pantothenic acid, biotin, folic acid, vitamins B , B , C, A, D, Eand vitamin K. 6 12
Zinc : Zinc is a cofactor for over 100 enzymes, whereas selenium is required in the form of selenocysteine within the
27
enzyme glutathione peroxidase. Zinc is widely required in cellular functions and abnormal Zn homeostasis causes a
variety of health problems that include growth retardation, immunodeficiency, hypogonadism and neuronal and sensory
28
dysfunctions.
Selenium : Selenium is of fundamental importance to human health. It is a vital component of several major metabolic
29
pathways, including thyroid hormone metabolism, antioxidant defense systems, and immune function.
VitaminB andVitaminB : Vitamin B is likely to benefit in treating premenstrual depression. Vitamins B and B are directly 6 12 6 6 12
involved in the synthesis of some neurotransmitters. Vitamin B delays the onset of signs of dementia (and blood 12
abnormalities). Supplementation with cobalamin improves cerebral and cognitive functions in the elderly; it frequently
improves the functioning of factors relatedto the frontal lobe, as well as the language function of those with cognitive disorders.
Iron : Iron is necessary to ensure oxygenation and to produce energy in the cerebral parenchyma (via cytochrome oxidase)
and for the synthesis of neurotransmitters and myelin. Iron concentrations in the umbilical artery are critical during the
development of the foetus and in relation with the IQ in the child; infantile anaemia with its associated iron deficiency is
linked to perturbation of the development of cognitive functions. Iron deficiency anaemia is common, particularly in
women and is associated with apathy, depression and rapid fatigue when exercising.
Iodine : Iodine ensures the energy metabolism of the cerebral cells; the dietary reduction of iodine during pregnancy
induces severe cerebral dysfunction, actually leading to cretinism.
Copper, zinc, selenium and molybdenum are involved in many biochemical processes supporting life. The most
important of these processes are cellular respiration, cellular utilization of oxygen, DNA and RNA reproduction,
maintenance of cell membrane integrity and sequestration of free radicals. Copper, zinc and selenium are involved in
30,31
destruction of free radicals through cascading enzyme systems.
Probiotics are live microorganisms that provide health benefits to the host when ingested in adequate amounts. The strains
most frequently used as probiotics include lactic acid bacteria and bifidobacteria. Probiotics have demonstrated
significant potential as therapeutic options for a variety of diseases, but the mechanisms responsible for these effects have
not been fully elucidated yet.
Lactic Acid Bacteria (LAB) were used extensively as starter cultures in food fermentation. Some of the health benefits
which have been claimed for lactic acid bacteria as probiotics include the following: improvement of the normal microflora,
prevention of infectious diseases and food allergies, reduction of serum cholesterol, anticarcinogenic activity, stabilization
of the gut mucosal barrier, immune adjuvant properties, alleviation of intestinal bowel disease symptoms and improvement
32,33
in the digestion of lactose in intolerant hosts.
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Table 5. The recommended dietary intake of calcium and vitamin D in men and women
Use Dosage
References
1. 2. 3.
4.
5. 6. 7. 8.
9. 10. 11. 12.
13. 14.
15.
16. 17. 18. 19.
20. 21. 22.
23. 24. 25. 26.
27. 28.
29. 30. 31. 32.
33.
Nutrition for Health and Development. Accessed from website http://www.who.int/nutrition/nhd/en/index.html as on 22.02.2013. Ramaa CS et al. Curr Pharm Biotechnol. 2006;7(1):15-23. Dietary
recommendations / Nutritional requirements. Accessed from website http://www.who.int/nutrition/topics/nutrecomm/en/index.html as on 22.02.2013. Singh A et al. Int J Pharm Pharm Sci.2012; Vol 4, Suppl 4,
39-43. Schwellenbach LJ et al. J Am Coll Nutr. 2006;25(6):480-485. Surette ME. CMAJ. 2008;178(2):177-180. Hirafuji M et al. J Pharmacol Sci. 2003;92(4):308-16. Calder PC et al. Biofactors. 2009;35(3):266-272.
von Schacky C et al. Cardiovasc Res. 2007;73(2):310-315. Lavie CJ et al. J. Am. Coll. Cardiol. 2009;54;585-594. Kris-Etherton PM et al. Circulation. 2002;106(21):2747-2757. Cabrera C et al. J Am Coll Nutr.
2006;25(2):79-99. Tung NH et al. Evidence-Based Complementary and Alternative Medicine Volume 2012, Article ID 173297. Wee JJ, Mee Park K, Chung AS. Biological Activities of Ginseng and Its Application to
Human Health. In: Benzie IFF, Wachtel-Galor S, editors. Herbal Medicine: Biomolecular and Clinical Aspects. 2nd edition. Boca Raton (FL): CRC Press; 2011. Chapter 8. Available from:
http://www.ncbi.nlm.nih.gov/books/NBK92776/# as on 24.02.2013. Bruno G. Vitamin C & Bioflavonoids. Accessed from website http://vivavitamins.com/literature/Vitamin%20C.pdf as on 24.02.2013.
Sierpina VS et al. Ginkgo biloba. Am Fam Physician. 2003;68(5):923-936. Su X et al. Appl Environ Microbiol. 2011;77(12):3982-3987. Clifton PM. J Biomed Biotechnol. 2004;2004(5):272-278. Fernandez-
Mejia C. J Nutr Biochem. 2005;16(7):424-427. No authors listed. Diabetes Educ. 2004; Suppl:2-14. McCarty MF. Med Hypotheses. 1999; 52(5):401-406. Hazra Aet al. Indian Journal of Pharmacology. 2001; 33:
322-342. Gisondi P et al. J Dermatolog Treat. 2007;18(3):138-146. Prevention of neural tube defects. WHO document. Borges JL et al. Arq Bras Endocrinol Metabol. 2006;50(4):755-763. Welch RM.
Accessed from http://www.css.cornell.edu/FoodSystems/Micros&AgriMan1ref.html as on 24.02.2013. Shenkin A. Postgrad Med J. 2006;82:559567. Fukada T et al. J Biol Inorg Chem. 2011;16(7):1123-1134.
Brown KM et al. Public Health Nutr. 2001;4(2B):593-599. Bourre JM. J Nutr Health Aging. 2006;10(5):377-385. Chan S et al. Clin Lab Med. 1998;18(4):673-685. Bermudez-Brito M et al. Ann Nutr Metab.
2012;61(2):160-174. Kumari Aet al. Acta Biomed. 2011;82(3):177-180.
Summary
Micronutrients play a central part in metabolism and in the maintenance of tissue function. An adequate intake
therefore is necessary and clinical benefit is most probable in those people who are severely depleted and at risk of
complications. Much more research is needed to characterise better markers of micronutrient status both in terms of
metabolic effects and antioxidant effects, so that patients at risk can be identified and supplementation modified
accordingly. Large scale trials of different doses of micronutrients are warranted to optimise intakes in different groups
of patients as well as in the general population.
A combination of all the micronutrients and neutraceuticals discussed above can present as a valuable
support inimprovingoverall healthanddevelopment inhumans.
Product information : Each softgel capsule contains:
Omega 3 Fatty Acids (from Natural Source) 150 mg + Ginseng Extract Powder 42.5mg + Wheat Germ Oil 25mg + Citrus Bioflavonoids 20mg +Grape Seed Extract 15mg + Natural Mixed Carotenoids (10%
Dispersion) 11.33mg +Green Tea Extract eq. to Polyphenols 10mg + Ginkgo Biloba Extract 10mg + Piperine 5mg + Lutein 250mcg +Choline Bitartrate 25mg +Niacinamide 20mg+ Benfothiamine 1.5mg + Vitamin
B 1mg + FolicAcid 150mcg +Biotin 100mcg +Menadione Sodium Bisulphite (Vit K) 10mcg +Vitamin D 200I.U+Vitamin B 1mcg + Calcium Ascorbate 45mg + Ferrous Fumarate 30mg + Magnesium Oxide eq. to 6 3 12
Elemental Magnesium 30mg+ Dibasic Calcium Phosphate-eq. to Elemental Calcium 20mg + & eq . to Elemental Phosphorous 15.45mg + Zinc Oxide eq . to Elemental Zinc 15mg + Potassium Chloride eq. to
Elemental Potassium 4mg + & eq. to Elemental Chloride 3.6mg + Colloidal Silicon Dioxide eq.to Elemental Silicon 2mg + Manganese Sulphate eq Elemental Manganese 1.5mg +Copper Sulphate Pentahydrate Eq .
to Elemental Copper 0.5mg + Potassium lodide eq . to Elemental lodine 150mcg + Sodium Borate eq. to Elemental Boron 150mcg + Chromium Picolinate eq to Elemental Chromium 65mcg + Sodium Molybdate eq.
to Elemental Molybdonum 25mcg + Sodium Selenite Pentahydrate Eq to Elemental Selenium 20mcg + Stannous Chloride Dihydrate Eq. to Elemental Tin 10mcg + Sodium Metavanadate eq to Elemental Vanadium
10 mcg + Nickel Sulphate eq to Elemental Nickel 5mcg +LacticAcid Bacillus 500 Lacs+ Saturated fatty acids 0.20g + Polyunsaturated fatty acid 0.13g + Monounsaturated fatty acids 0.30g + Trans fatty acids Traces.
Calcium
most men and women aged > 50 yr (adjust dosage according to dietary
calcium intake)
Vitamin D Supplementation recommended for Age 51 to 70 Yrs: 400 IU/day,
most men and women Age 70 yrs : 600 IU/day
In patients at risk for deficiency
because of inadequate sunlight
exposure: 800 IU/day
Supplementation recommended for Total intake 1,000 to 1,500 mg/day
Dosage : One softgel capsule daily after meals
Softgels of Omega 3 Fatty Acids, Green Tea Extract,
Ginkgo Biloba, Ginseng, Grape Seed Extract, Antioxidants,
Vitamis, Minerals & Trace Elements
Clifton et al., showed that polyphenols from GSEappear to be absorbed to influence endothelial nitric oxide production and
18
GSEhas the potential to favourably influence vascular function.
Biotin is a water-soluble vitamin that regulates gene expression and has a wide repertoire of effects on systemic processes.
Biotin has stimulatory effects on genes whose action favors hypoglycemia (insulin, insulin receptor, pancreatic and hepatic
19
glucokinase). Pharmacological doses of biotin appear to decrease plasma lipid concentrations andmodify lipid metabolism.
Chromium is an essential mineral that appears to have a beneficial role in the regulation of insulin action and effects on
carbohydrate, protein and lipid metabolism. It is an important factor for enhancing insulin activity. Chromium picolinate is
20
the most efficacious form of chromium supplementation.
Available data suggest that joint administration of supranutritional doses of Chromium Picolinate and Biotin (CPB) is likely
to combat insulin resistance, improve beta-cell function, enhance postprandial glucose uptake by both liver and skeletal
21
muscle and inhibit excessive hepatic glucose production.
Folic acid or folate is a well-known water-soluble vitamin of the B-complex group. Tetrahydrofolate, which is the active form
of this vitamin functions as a coenzyme in various metabolic reactions involving transfer of one-carbon moieties.
Folic acid is a critical vitamin in determining plasma homocysteine levels, which in turn is a major risk factor for
atherosclerotic cardiovascular diseases. Folic acid is essential for the integrity and function of DNA, normal cell growth and
replication. Human beings cannot synthesize this vitamin and must obtain preformed folate through dietary sources like
green leafy vegetables, cereals, fruits, organ meats and yeast. Folic acid supplementation appears as a reasonable therapeutic
option in patients affected by chronic inflammatory skin diseases, such as moderate to severe psoriasis.
The joint United Nations Food and Agricultural Organization (FAO) and World Health Organization (WHO) Expert Group
on vitamin requirements and the ICMR Expert Group in India have recommended folic acid intakes in terms of free folate as
22,23
given in Table 4.
Randomized trials, supported by many observational studies, indicate that periconceptional use of folic acid in multivitamin
supplements reduces the overall risk of birth defects, even after excluding NTDs. This includes reduced risk of cardiovascular
24
anomalies, orofacial defects, limb deficiencies, urinary defects, onphalocele and imperforate anus.
Adequate calcium intake is considered to be a most important factor that helps in the attainment and maintenance of bone mass.
Research studies have suggested that vitamin D is essential for the intestinal absorption of calcium. Serum concentrations of
25-hydroxyvitamin D decline with age, necessitating supplementation in the majority of older women. Combining vitamin D
supplementation with calcium has been shown to reduce risk of fracture. Table 5 lists the recommended dietary intake of
25
calcium and vitamin D in men andwomen.
Chromium Picolinate andBiotin
Folic acid
Calcium andVitamin D
Cardiac societies recommend the intake of 1 g/day of the two omega-3 fatty acids eicosapentaenoic acid (EPA) and
docosahexaenoic acid (DHA) for cardiovascular disease prevention, treatment after a myocardial infarction, prevention of
sudden death and secondary prevention of cardiovascular disease. These recommendations are based on a body of
9
scientific evidence that encompasses literally thousands of publications.
The most commonly observed adverse effects of omega-3-fatty acids supplementation are nausea, gastrointestinal upset
10
and fishy burp. Some of the risks for adverse effects from ingestion of omega-3-fatty acids is listed in tables 2 and 3.
Safety of omega-3-fatty acids in humans

Ginseng
Citrus Bioflavonoids
Ginkgo biloba
Grape SeedExtract
Polyphenolic components have demonstrated antimutagenic and anticarcinogenic activity and inhibition of growth
of tumor cell lines andanimal tumor models, including cancer
Green tea is not only rich in polyphenols (catechins and gallic acid, particularly) but also contains carotenoids, tocopherols,
ascorbic acid (vitamin C), minerals such as Cr, Mn, Se or Zn and certain phytochemical compounds. These compounds
12
could increase the green tea polyphenols antioxidant potential.
Ginseng, an ancient and famous medicinal herb has been used as a valuable tonic and for the treatment of various diseases.
The pharmacological properties of ginseng are mainly attributed to ginseng saponins, commonly called ginsenosides, the
13
major and bioactive constituents. The pharmacological effects of ginseng have been demonstrated in cancer, diabetes,
cardiovascular diseases and have been used for promoting immune function, central nervous system (CNS) function,
14
relieving stress and for its antioxidant activities.
Ginseng is also known to have a beneficial role in the regulation of regular liver functions and the treatment of liver
13
disorders of acute/chronic hepatotoxicity, hepatitis, hepatic fibrosis/cirrhosis, hepatocellularcarcinoma.
Vitamin C has an extremely important role in relation to human health. It is necessary for the formation of collagen protein
found in skin, connective tissue, cartilage and bone; it is also an antioxidant nutrient. It is essential for wound healing, affects
immune responses, helps maintain strength in blood vessels, helps protect the body against infections, bacterial toxins,
viruses, influences formation of hemoglobin, absorption of iron from intestinal tract anddeposition of iron in liver tissue.
Bioflavonoids (citrus, hesperidin and rutin), sometimes called vitamin P, are substances that are found wherever vitamin C is
found in nature. Bioflavonoids have been shown to improve the therapeutic action of vitamin C. In particular,
bioflavonoids seem to have a synergistic role with vitamin C in strengthening capillary walls.
Vitamin C (and often bioflavonoids) has also been studied for its potential role in a number of different ailments and health
conditions. These include allergies, angina, atherosclerosis, stress, rheumatoid arthritis, asthma, cancer, herpes, cataract,
emphysema, the common cold, colitis, recurring ear infections, gingivitis, glaucoma, hemorrhoids, high cholesterol, high
15
blood pressure, lupus, macular degeneration, menopause andurinary tract infections.
Ginkgo biloba leaf extract is the most widely used to treat the symptoms of early-stage Alzheimers disease, vascular
dementia, peripheral claudication and tinnitus of vascular origin.
The mechanism of action of ginkgo is believed to be produced by its functions as a neuroprotective agent, an antioxidant, a
free-radical scavenger, a membrane stabilizer and an inhibitor of platelet-activating factor via the terpene ginkgolide B.
Studies have also shown that ginkgo is useful for sexual dysfunction secondary to the use of selective serotonin reuptake
inhibitors, mountain sickness and decreasing vasoactivity in response to cold, macular degeneration, asthma and hypoxia.
The World Health Organization has recommended the use of ginkgo in Raynauds disease, acrocyanosis and post-phlebitic
16
syndrome.
Grape seeds, which are by-products of wine and the grape juice industries contain large quantities of phenolic compounds
such as gallic acid and monomeric flavan-3-ols catechin, epicatechin, gallocatechin, epigallocatechin and epicatechin- 3-O-
gallate, as well as dimeric, trimeric and polymeric proanthocyanidins (PAC).
Grape Seed Extract (GSE) reportedly has many pharmacological and health benefits that include antioxidant,
cardioprotective, hepatoprotective, neuroprotective, anti-inflammatory, antidiabetic, anticarcinogenic and antiaging
effects. Recently, GSE has gained increasing attention in the food industry because of its associated antimicrobial
17
properties.
Up to 1 g/d Very low Very low Low Very low Very low
1 to 3 g/d Moderate Very low Moderate Low Moderate
> 3g/d Moderate Low Likely Moderate Likely
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Table 2. Risk for side effects from ingestion of omega-3 fatty acids
* Usually only in patients with impaired glucose tolerance and diabetes. Usually only in patients with hypertriglyceridemia.
Gastrointestinal Upset Clinical Bleeding Fishy Aftertaste Worsening Glycemia* Rise in LDL-C
Patients without documented CHD
foods rich in alpha-linolenic acid (flaxseed, canola and soybean oils; flaxseed
and walnuts)
Patients with documented CHD Consume ~1g of EPA+DHA per day, preferably from oily fish. EPA+DHA
supplements could be considered in consultation with the physician.
Patients needing triglyceride lowering Two to four grams of EPA+DHA per day provided as capsules under a
physicians care
Eat a variety of (preferably oily) fish at least twice a week. Include oils and
11
Table 3. Summary of American Heart Association recommendations for Omega-3 Fatty Acid intake
Population Recommendations
Greentea extract

Nowadays, green tea is considered one of the most promising dietary agents for the prevention and treatment of many
diseases and consequently, it is being studied extensively worldwide. Green tea leaves contain three main components which
act upon human health: xanthic bases (caffeine and theophylline), essential oils and especially, polyphenolic compounds.
Caffeine acts mainly upon the central nervous system, stimulating wakefulness, facilitating ideas association and
decreasing the sensation of fatigue
Theophylline induces psychoactive activity, has a slightly inotrope and vasodilator effect, causes a non-specific
relaxation on the bronchial smooth muscle and respiratory stimulation is also observed
Infants and children
0 - 6 months 40 25
7 - 12 months 60 25
1 - 12 years 100 30-70
Up to 18 years and over 200 100
Pregnancy 400 400
Lactation 300 150
22
Table 4. FAO/WHO and ICMR recommendations on daily free folate intake
Individuals / Age group
FAO/WHO
(mcg)
ICMR
(mcg)
Table 1. Summary of the physiological roles and potential clinical benefits of very long chain -3 fatty acids
Physiological role of very
long chain -3 fatty acids
Potential clinical benefit Target
CVD, cardiovascular disease.
Hypertension; CVD
CVD
CVD
Hypertriglyceridemia; CVD
CVD
CVD
Inflammatory diseases (arthritis, Inflammatory bowel
diseases, psoriasis, lupus, asthma, cystic fibrosis,
dermatitis, neurodegeneration. . ..); CVD
Compromised immunity
Osteoporosis
Type-2 diabetes
Some cancers
Poor infant visual development (especially pre-term)
Poor infant and childhood cognitive processes and
learning.
Regulation of blood pressure
Regulation of platelet function
Regulation of blood coagulation
Regulation of plasma triglyceride concentrations
Regulation of vascular function
Regulation of cardiac rhythm
Regulation of inflammation
Regulation of immune function
Regulation of bone turnover
Regulation of insulin sensitivity
Regulation of tumor cell growth
Regulation of visual signaling (rhodopsin)
Structural component of brain
and central nervous system
Decreased blood pressure
Decreased likelihood of thrombosis
Decreased likelihood of thrombosis
Decreased plasma triglyceride concentrations
Improved vascular reactivity
Decreased arrhythmias
Decreased inflammation
Improved immune function
Maintained bone mass
Improved insulin sensitivity
Decreased tumor cell growth & survival
Optimized visual signaling
Optimized brain development-cognitive
and learning processes