Vitamins Information
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Vitamin C: Tips For Increasing Your Intake
A new RDA?
According to a recent issue of the Journal of the American Medical Association (JAMA), the National Institutes of Health is taking another look at the Recommended Daily Allowance (RDA) for vitamin C. The current RDA for vitamin C is 60 milligrams per day—about the amount you get from one orange. Due to recent findings on the potential health benefits of this wonder vitamin, the NIH is now considering boosting the RDA to somewhere between 100 and 200 milligrams per day, two to three times the current recommendation.
Why all the hype?
Vitamin C has long been known for its value as an antioxidant. Antioxidants are natural compounds found in many of the foods we eat. The most well known antioxidants are vitamin C, selenium, beta carotene and vitamin E. Antioxidants work by inhibiting toxic substances in the body (also known as "free radicals") which may lead to the development of cancers, heart disease and the aging process. There has been a strong correlation between diets high in fruits and vegetables (which are rich in antioxidants) and reduced risk of chronic diseases. Vitamin C may account for much of this protection. However, we are also finding numerous other compounds within fruits and vegetables, collectively called "phytochemicals", that may also play a preventative role. Phytochemicals are defined simply as chemicals found in plants. They occur naturally in fruits, vegetables, grains, nuts and seeds. These substances, many of which also have an antioxidant effect, may protect our bodies from cellular damage that can lead to cancer and other chronic diseases.
Due to the strong correlation between diets abundant in fruits and vegetables and disease prevention, The National Cancer Institute launched the "5-A-Day" program. The basis of this campaign promotes the intake of a minimum of five fruits and vegetables daily as a good defense against cancer and other diseases. A specific recommendation of this program is to include vitamin C rich fruits and vegetables in the diet each day since vitamin C is a particularly well-researched antioxidant. The mainstay of the program, however, is that by eating five servings of produce daily we can easily take in not just a good dose of vitamin C, but the minimum amount of protective plant chemicals shown to be effective in reducing risk of chronic diseases. Remember, five is the minimum amount. In the case of fruits and veggies it's definitely a situation where more is better!
Plavix Less Effective in Some Patients
FRIDAY, March 12 (HealthDay News) -- The anti-clotting drug Plavix must now carry a "black box" warning on its label, alerting patients and doctors that some people don't metabolize the medication properly, U.S. health officials said Friday.
Patients with a certain genetic variation can't convert the blood thinner into its active form, which puts them at risk for heart attack and stroke, the U.S. Food and Drug Administration warned.
"If the patient makes less of the active form, there is less antiplatelet effect in the blood, and the patient may not receive the full benefit of Plavix treatment," Mary Ross Southworth, FDA's deputy director for safety in the division of cardiovascular and renal products at the Center for Drug Evaluation and Research, said during an afternoon press conference.
These patients are called poor metabolizers, she said.
Clopidogrel (Plavix) is generally prescribed after a heart attack, stroke or a procedure to open blocked coronary arteries. It usually makes platelets less likely to form blood clots, thus reducing the risk of heart attack, unstable angina, stroke and cardiovascular death in patients with cardiovascular disease.
For the drug to do its work, liver enzymes, especially one called CYP2C19, must convert the drug to its active form. In patients with low levels of the enzyme, the drug may be less effective in preventing heart attack, stroke and cardiovascular death, according to the FDA.
About 2 percent to 14 percent of people fall into this category, with the percentages varying by race. About 2 percent of whites have the variation, while 4 percent of blacks and 14 percent of Chinese people do, Southworth said.
But patients should not stop taking Plavix without consulting their doctor, the FDA said, noting a test to assess the CYP2C19 genotype can determine if a patient is a poor metabolizer.
In May 2009, the FDA required mention of the problem on the bottle label, but additional data from a recent study has caused the agency to call for the "black box" alert, its strongest warning.
That study, which the FDA asked Plavix's makers to conduct, found less antiplatelet activity in people who were poor metabolizers than in patients who had no problem converting the drug.
However, when Plavix was given at higher-than-usual doses, the poor metabolizers showed more active drug in their blood than when they received lower doses, the researchers noted.
Patients who cannot convert Plavix well should use another anti-clotting drug or try an alternate strategy, such as a dosage increase, the FDA advised. Anti-clotting drugs that might be substituted for Plavix include ticlopidine (Ticlid) and prasugrel (Efient), the FDA said.
>"Efient doesn't need this enzyme as much to form its active metabolite so it does not have the primary problem, and we know some people will consider using that," Dr. Robert Temple, director of the FDA's Office of Drug Evaluation, said during the press conference.
On the other hand, "ticlopidine was the first member of this class and has a fairly high frequency of some unpleasant hematologic problems, so it has lost popularity considerably," he said.
Another recent study found that heart attack patients taking Plavix plus a proton pump inhibitor, such as Prilosec or Nexium, may be at increased risk of death or another heart attack, because this combination also prevents Plavix from being fully metabolized. The FDA is conducting a safety review about potential interactions of these commonly prescribed medications.
Plavix is made in partnership by two pharmaceutical giants, Bristol-Myers Squibb and Sanofi Pharmaceuticals. A Bristol-Myers spokesperson told the Associated Press that the new labeling would be added to Plavix during the next two months.
More information
For more information on the new warning, visit the U.S. Food and Drug Administration.
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