More Information on Coral Calcium Powder w/Vitamins
This product contains:
PANTOTHENIC ACID
Who is likely to be deficient?
Pantothenic acid deficiencies may occur in people with alcoholism but are generally believed to be rare.
How much is usually taken?
Most people do not need to supplement with pantothenic acid. However, the 10–25 mg found in many multivitamin supplements might improve pantothenic acid status. So-called primitive human diets provided greater amounts of this nutrient than is found in modern diets. Most cholesterol researchers using pantethine have given people 300 mg three times per day (total 900 mg).
Are there any side effects or interactions?
No serious side effects have been reported, even at intakes of up to 10,000 mg (10 grams) per day. Very large amounts of pantothenic acid (several grams per day) can cause diarrhea.
Pantothenic acid works together with vitamin B1, vitamin B2, and vitamin B3 to help make the fuel our bodies run on—ATP.
There is one report of a 76-year-old woman who developed a life-threatening condition (eosinophilic pleuropericardial effusion) while taking 300 mg of pantothenic acid per day and 10 mg of biotin per day.2 However, it is not clear whether the vitamins caused the problem.
Are there any drug interactions?
Certain medicines may interact with pantothenic acid. Refer to drug interactions for a list of those medicines.
VITAMIN B12
Who is likely to be deficient?
Vegans (vegetarians who also avoid dairy and eggs) frequently become deficient, though the process often takes many years. People with malabsorption conditions, including those with tapeworm infestation and those with bacterial overgrowth in the intestines, often suffer from vitamin B12 deficiency. Malabsorption of vitamin B12 can also result from pancreatic disease, the effects of gastrointestinal surgery, or various prescription drugs.5
Pernicious anemia is a special form of vitamin B12 malabsorption due to impaired ability of certain cells in the stomach to make intrinsic factor—a substance needed for normal absorption of vitamin B12. By definition, all people with pernicious anemia are vitamin B12-deficient. They require either vitamin B12 injections or oral supplementation with very high levels (1000 mcg per day) of vitamin B12.
Older people with urinary incontinence6 and hearing loss7 have been reported to be at increased risk of B12 deficiency.
Infection with Helicobacter pylori, a common cause of gastritis and ulcers, has been shown to cause or contribute to adult vitamin B12 deficiency. H. pylori has this effect by damaging cells in the stomach that make intrinsic factor—a substance needed for normal absorption of vitamin B12. In one trial, H. pylori was detected in 56% of people with anemia due to vitamin B12 deficiency. Successful eradication of H. pylori led to improved blood levels of B12 in 40% of those infected.8 Other studies have also suggested a link between H. pylori infection and vitamin B12 deficiency.9 10 Elimination of H. pylori infection does not always improve vitamin B12 status. People with H. pylori infections should have vitamin B12 status monitored.
In a preliminary report, 47% of people with tinnitus and related disorders were found to have vitamin B12 deficiencies that may be helped by supplementation.11
HIV-infected patients often have low blood levels of vitamin B12.12
A disproportionate amount of people with psychiatric disorders are deficient in B12.13 Significant vitamin B12 deficiency is associated with a doubled risk of severe depression, according to a study of physically disabled older women.14
A preliminary study found that postmenopausal women who were in the lowest one-fifth of vitamin B12 consumption had an increased risk of developing breast cancer.15
Although blood levels of vitamin B12 may be higher in alcoholics, actual body stores of vitamin B12 in the tissues (e.g., the liver) of alcoholics is frequently deficient.16 17
Low blood levels of vitamin B12 are sometimes seen in pregnant women; however, this does not always indicate a vitamin B12 deficiency.18 The help of a healthcare professional is needed to determine when a true vitamin B12 deficiency exists in pregnant women with low blood levels of the vitamin.
Hydroxocobalamin (a form of vitamin B12) has been recognized for more than 40 years as an effective antidote to cyanide poisoning. It is currently being used in France for that purpose. Because of its safety, hydroxocobalamin is considered by some researchers to be an ideal treatment for cyanide poisoning.19
How much is usually taken?
Most people do not require vitamin B12 supplements. However, vegans should supplement with at least 2 to 3 mcg per day.
People with pernicious anemia are often treated with injections of vitamin B12. However, oral administration of 1,000 mcg per day can be used reliably as an alternative to vitamin B12 injections.20 21 22 23 24
Absorption of vitamin B12 is reduced with increasing age. Some research suggests that elderly people may benefit from 10 to 25 mcg per day of vitamin B12.25 26 27
When vitamin B12 is used for therapeutic purposes other than correcting a deficiency, injections are usually necessary to achieve results.
Sublingual forms of vitamin B12 are available,28 but there is no proof (nor is there any reason to expect) that they offer any advantage to oral supplements (i.e. a sublingual preparation is eventually swallowed).
Are there any side effects or interactions?
Oral vitamin B12 supplements are not generally associated with any side effects.
Although quite rare, serious allergic reactions to injections of vitamin B12 (sometimes even life-threatening) have been reported.29 30 Whether these reactions are to the vitamin itself, or to preservatives or other substances in the injectable vitamin B12 solution, remains somewhat unclear. Most, but not all, injectable vitamin B12 contains preservatives.
If a person is deficient in vitamin B12 and takes 1,000 mcg or more of folic acid per day, the folic acid supplementation can improve the anemia caused by vitamin B12 deficiency. The effect of folic acid on vitamin B12 deficiency-induced anemia is not a folic acid toxicity. Rather, the folic acid supplementation is acting to correct one of the problems caused by B12 deficiency. The other problems caused by a lack of vitamin B12 (mostly neurological) do not improve with folic acid supplements, and can become irreversible if vitamin B12 is not provided to someone who is vitamin B12 deficient.
Some doctors are unaware that vitamin B12 deficiencies often occur without anemia—even in people who do not take folic acid supplements. This lack of knowledge can delay diagnosis and treatment of people with vitamin B12 deficiencies. This can lead to permanent injury. When such a delayed diagnosis occurs in someone who inadvertently erased the anemia of vitamin B12 deficiency by taking folic acid supplements, the folic acid supplementation is often blamed for the missed diagnosis. This problem is rare and should not occur in people whose doctors understand that a lack of anemia does not rule out a vitamin B12 deficiency. Anyone supplementing 1,000 mcg or more per day of folic acid should be initially evaluated by a doctor before the folic acid can obscure a proper diagnosis of a possible B12 deficiency.
Are there any drug interactions?
Certain medicines may interact with vitamin B12. Refer to drug interactions for a list of those medicines.
VITAMIN A
Who is likely to be deficient?
People who limit their consumption of liver, dairy foods, and beta-carotene-containing vegetables can develop a vitamin A deficiency. Extremely low birth weight babies (2.2 pounds or less) are at high risk of being born with a deficiency, and vitamin A shots given to these infants have been reported in double-blind research to reduce the risk of lung disease.1 The earliest deficiency sign is poor night vision. Deficiency symptoms can also include dry skin, increased risk of infections, and metaplasia (a precancerous condition). Severe deficiencies causing blindness are extremely rare in Western societies.
Less severe deficiencies are more likely to occur with a variety of conditions causing malabsorption. A high incidence of vitamin A deficiency in people infected with HIV has also been reported. People with hypothyroidism have an impaired ability to convert beta-carotene to vitamin A.2 3 For this reason, some doctors suggest taking supplemental vitamin A (perhaps 5,000–10,000 IU per day) if they are not consuming adequate amounts in their diet.
Very old people with type 2 diabetes have shown a significant age-related decline in blood levels of vitamin A, irrespective of their dietary intake.4
How much is usually taken?
For most people, up to 25,000 IU (7,500 mcg) of vitamin A per day is considered safe. However, people over age 65 and those with liver disease should probably not supplement with more than 15,000 IU per day, unless supervised by a doctor. In women who could become pregnant, the maximum safe intake is being re-evaluated. However, less than 10,000 IU (3,000 mcg) per day is generally accepted as safe. There is concern that larger intakes could cause birth defects. Whether the average person would benefit from vitamin A supplementation remains unclear.
Are there any side effects or interactions?
Since a 1995 report from the New England Journal of Medicine,5 women who are or could become pregnant have been told by doctors to take less than 10,000 IU (3,000 mcg) per day of vitamin A to avoid the risk of birth defect. A recent report studied several hundred women exposed to 10,000–300,000 IU (median exposure of 50,000 IU) per day.6 Three major malformations occurred in this study, but all could have happened in the absence of vitamin A supplementation. Surprisingly, no congenital malformations happened in any of the 120 infants exposed to maternal intakes of vitamin A that exceeded 50,000 IU per day. In fact, the high-exposure group had a 50% decreased risk for malformations compared with infants not exposed to vitamin A. The authors noted that some previous studies found no link between vitamin A and birth defects, and argued the studies that did find such a link suffered from various weaknesses. A closer look at the recent study reveals a 32% higher than expected risk of birth defects in infants exposed to 10,000–40,000 IU of vitamin A per day, but paradoxically a 37% decreased risk for those exposed to even higher levels. This suggests that both "higher" and "lower" risks may have been due to chance.
Excessive dietary intake of vitamin A has been associated with birth defects in humans in fewer than 20 reported cases over the past 30 years.7 8 Presently, the level at which vitamin A supplementation may cause birth defects is not known, though combined human and animal data suggest that 30,000 IU per day should be considered safe.9 Women who are or who could become pregnant should consult with a doctor before supplementing with more than 10,000 IU per day.
Vitamin A supplements can both help and hurt children. Many people have heard that vitamin A supplements support immune function and prevent infections. This is true under some circumstances. However, vitamin A can also increase the risk of infections, according to the findings of a double-blind trial.10 In a study of African children between six months and five years old, a 44% reduction in the risk of severe diarrhea was seen in those children given four 100,000–200,000 IU applications of vitamin A (the lower amount for those less than a year old) during an eight-month period. On further investigation, the researchers discovered that the reduction in diarrhea occurred only in children who were very malnourished. For children who were not starving, vitamin A supplementation actually increased the risk of diarrhea compared with the placebo group. The vitamin A-supplemented children also had a 67% increased risk of coughing and rapid breathing, signs of further lung infection, although this problem did not appear in children infected with AIDS. These findings should be of concern to American parents, whose children are not usually infected with AIDS or severely malnourished. Such relatively healthy children fared poorly in the African trial in terms of both the risk of diarrhea and the risk of continued lung problems. Vitamin A provided no benefit to the well-nourished kids. Therefore, it makes sense to not give vitamin A supplements to children unless there is a special reason to do so, such as the presence of a condition causing malabsorption (e.g., celiac disease).
In a study of people with retinitis pigmentosa (a degenerative condition of the eye), participants received 15,000 IU of vitamin A per day for 12 years with no signs of adverse effects or toxicity.11 For other adults, intake above 25,000 IU (7,500 mcg) per day can—in rare cases—cause headaches, dry skin, hair loss, fatigue, bone problems, and liver damage.12 At higher levels (for example 100,000 IU per day) these problems become more common.
A controlled clinical trial showed that people who took 25,000 IU of vitamin A per day for a median of 3.8 years had an 11% increase in triglycerides, a 3% increase in total cholesterol and a 1% decrease in HDL cholesterol compared to those who did not take vitamin A.13 Although the significance of these findings is not clear, people at risk for cardiovascular disease should use caution when considering long-term vitamin A supplementation.
One study found that increasing the intake of vitamin A in the diet was associated with bone loss and risk of hip fracture, possibly due to a vitamin A-induced stimulation of cells that break down bone.14 In this study, a vitamin A intake greater than 5,000 IU per day, when compared to a lower intake, was associated with a reduction in bone mineral density that approximately doubles the risk of hip fracture. Beta-carotene (which can be used by the body to make vitamin A) has not been linked to reduced bone mass. Until more is known, people concerned about osteoporosis may consider taking beta-carotene supplements rather than supplementing with vitamin A.
Data from test tube, animal, and human studies show that excessive vitamin A intake can accelerate bone loss and inhibit formation of new bone, increasing the risk of osteoporosis.15 In humans, small studies have found these effects at about 85,000–125,000 IU per day. 16 17
Taking vitamin A and iron together helps overcome iron deficiency more effectively than iron supplementation alone.18 Supplementation with zinc, iron, or the combination has been found to improve vitamin A status among children at high risk for deficiency of the three nutrients.19
Are there any drug interactions?
Certain medicines may interact with vitamin A. Refer to drug interactions for a list of those medicines.
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