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 Dietary Supplements: Supplements: Food, Special Formulas, Pills, and Intravenous Infusions 
 
Peggy Borum R. PhD ©
Supplement Information Is Confusing
Broadcast and print media, the Internet, product information, and scientific literature frequently contain statements concerning supplements. The audiences span the full spectrum of demographics, and yet their common reaction to these statements is that they are receiving mixed messages. The lack of data needed to address the issues being discussed is one of several sources of confusion that will require great effort to eliminate. However, one source of confusion could be greatly reduced today if each statement concerning supplements always defined specific parameters, which should be available from the study on which the statement is based. Elimination of this source of confusion requires that the creators of all types of information concerning supplements define these parameters or that their audiences ignore information that does not include the needed definitions.

Compounds Are Presented to the Body in Many Ways
The same chemical compound may be both a nutrient and a drug. Niacin has long been recognized as an important nutrient in the diet that has been added to fortified flour, has been a component of daily vitamin pills, and has been used as a medication in many patients. Although all these uses of niacin are often termed supplementation, their effects on the recipient are not the same.

At the beginning of this century, compounds were presented to the body in the form of food. With the discovery of the critical role of micronutrients in metabolism and the devastating deficiency diseases that result when the diet does not contain them in adequate quantities, vitamin supplements began to be presented to a large number of recipients. Complete liquid formulas for infants not receiving breast milk and complete liquid low-residue formulas for the space program were developed. Using this technology, researchers developed complete formulas and new enteral methods of presentation using tubes for patients who for medical reasons could not consume a diet in the usual manner. Today, messages from the public media suggest benefits for many healthy adults who consume some of these complete formulas as a supplement to their usual diet. During the last third of this century, special formulas and administration techniques were developed to permit total parenteral nutrition for many years in individuals whose gastrointestinal tract either was nonfunctional or had been surgically removed. Thus dietary compounds or nutrients are being presented to the body in many ways.

A growing body of data suggests that a compound required in the diet at a certain quantity to prevent well-described deficiency diseases may be presented to the body in higher quantities to prevent or to treat other undesired conditions. Therefore, the compound of interest has been added (in quantities greater then frequently consumed by healthy populations) to presentations known as functional foods, megadose vitamins, complete formulas for specific diseases, oral drugs, and intravenous drugs.

Table 1 lists the different modes of presentation used to "supplement" a recipient with compound C. Clearly the same compound is being presented by different routes, in different matrices, and in different quantities to recipients who are in different physiological states. However, each of these presentations has been termed C supplementation. It is not surprising that statements concerning C supplementation based on these different presentations of C and the accompanying different effects on the recipient do indeed give their audiences mixed messages.

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