Reprinted with permission of:
JOURNAL OF MEDICINAL FOOD
Volume 1, Number 3, 1998
Mary Ann Liebert, Inc.
AN EVALUATION OF LIQUID VITAMIN-MINERAL
SUPPLEMENT TECHNOLOGY
GERHARD N. SCHRAUZER, D.Sc. FACN, CNS
ABSTRACT
Liquid multivitamin-mineral preparations are gaining
popularity among those who believe that liquid (or colloidal) nutrients
are better absorbed from a liquid than when ingested in tablets or pills.
Critics have argued that this claim is not supported by any studies-but
is this really true? This article provides answers to this and other
frequently asked questions about these products.
INTRODUCTION
ALTHOUGH VITAMINS AND MINERALS are
customarily taken in solid (tabletted, capsuled, or chewable) forms,
liquid preparations have recently become available and have rapidly
found wide customer acceptance, based in part on the marketing argument
that supplements in solution are better absorbed than those taken in
solid form. Liquid supplements are as such are not new; the first were
developed decades ago but were prescribed mainly for elderly persons,
infants, and patients with digestive problems. They were not in general
use and did not become widely known. The recent upsurge of the popularity
of liquid supplements started 10 years ago with the promotion of products
designated as "plant-derived minerals" or "colloidal
minerals." Unlike the conventional supplements, which as a rule
use chemically defined compounds of single elements in solid form, the
plant-derived minerals are offered in solution. They are promoted as
being superior to conventional mineral supplements in that they contain
not just the usual elements, such as iron or zinc, but instead virtually
all elements, essential and nonessential, that are present in mineral-rich
humic shale deposits. They contain iron and a number of essential trace
elements at nutritionally significant amounts, but many of the other
elements listed on the labels are present at very low levels.
The popular acclaim of these preparations is difficult
to rationalize on the basis of their mineral content alone; if anecdotal
reports are believed, they appear to have additional healing or tonicizing
effects and act somewhat like elixirs, the possible reasons for which
will be discussed later. These liquid mineral extracts are also not
new products; they were claimed to have been used as remedies by Native
Americans for centuries in regions of Utah where such humic shale deposits
occur, and this is how they became known to white settlers in the region,
one of whom started to market them some 75 years ago. Their continuing
popularity among users is attributed primarily to the high bioavailability
of the elements present in these extracts. However, it has been charged
that this claim is unsupported by evidence; in addition, the chemical
nature, composition, and safety of the extracts have been called into
question (Schauss, 1997a, 1997b). Indeed, the various products that
were being marketed initially differed considerably in quality and composition.
After these criticisms, manufacturers standardized their products with
respect to composition and purity, but the general uncertainty as to
the nature and health value of these natural mineral extracts still
persists. In a broader sense, this uncertainty extends to liquid vitamin-mineral
supplements as a whole, and questions are still raised as to whether
vitamins or minerals are indeed better absorbed from solutions than
from tablets or whether any other advantages are offered by liquid preparations
compared with conventional solid supplements.
The present account was prepared to address these questions
without directly or indirectly promoting any specific line of products.
At first, the bioavailability and absorption of liquid and solid vitamins
and minerals is discussed on general principles. Then, studies are reviewed
in which liquid supplements were tested for against solid forms. Finally,
the nature of the plant-derived mineral extracts is disclosed and questions
regarding their apparent efficacy, mechanism of action, and safety are
addressed.
NUTRIENT BIOAVAILABILITY AND ABSORPTION
Bioavailability is defined as the proportion of a nutrient in food that
can be absorbed and made available for use and storage; absorption is
the physiological process that permits passage of a dietary nutrient
from the intestinal lumen to the body fluids and tissues (Bender, 1989).
Because bioavailability is a prerequisite of absorption, solid supplements
must be soluble in the stomach fluid. Most supplements are formulated
to meet this requirement, but their increasing complexity makes solubility
difficult to achieve.
The United States Pharmacopeial Convention, Inc. (USP)
has established manufacturing standards for vitamins and minerals with
regard to quality, purity, potency, and the dissolution and disintegration
properties of supplements. However, only a few manufacturers state on
the label that their products meet the USP requirements. It therefore
has been suggested (Blonz, 1996) that consumers test questionable pills
themselves, by placing them in half a glass of vinegar, to simulate
the acidic environment of the stomach. According to USP, calcium supplements
should dissolve in 30 minutes, magnesium supplements in 45 minutes;
for vitamin E tablets, a 45-minute disintegration is acceptable, and
for multivitamin and mineral combinations, a 60-minute dissolution.
However, for people with low stomach acid production, the in vitro dissolution
tests may be of little value.
In the liquid supplements, the vitamins and minerals are already dissolved
and therefore are immediately bioavailable. Furthermore, the liquid
supplements usually are acidic; specifically, they are formulated to
contain citric acid, ascorbic acid, and other substances that increase
the bioavailability of minerals, such as carbohydrates (glucose, lactose),
polyols (sorbitol), amino acids (arginine, lysine), vegetable gums,
peptides, and emulsifying agents. Solid vitamin-mineral preparations
instead contain inert excipients and are usually buffered so as not
to cause gastric discomfort on ingestion, although this may reduce mineral
bioavailability.
Active transport
The vitamins and minerals in foods are normally present
at low concentrations. Accordingly, active transport systems have evolved
to ensure their absorption. Active transport across the intestinal mucosa
may require specific carrier proteins and cofactors and is energy dependent
(usually adenosine triphosphatase dependent) (Serfaty-Lacrosnière
et al., 1995). Carrier proteins are often highly substrate specific,
although in the case of metals the same carrier can bind several different
metals with similar ionic radii and charges. Active transport is an
important mechanism of homeostatic control and may be subject to adaptation-that
is, it may increase in response to deficiency or decrease if a nutrient
is supplied in excess. However, active transport mechanisms are subject
to genetic damage and may change with age or in response to disease.
It therefore is difficult to predict, on a case-to-case basis, to what
extent a bioavailable nutrient is absorbed. As a general rule, the more
of an actively transported nutrient that is supplied, the less that
is absorbed. This situation favors liquid supplements because, if taken
as directed, they provide the nutrients in lower concentrations than
solid supplements do.
Facilitated absorption
The absorption of certain vitamins and minerals is facilitated
by endogenous carrier proteins or by exogenous factors acting as complexing
agents. The endogenous carrier proteins are located on the two faces
of the cell membrane and exist in two conformational states. Metal binding
occurs first at one and then at the other site on the membrane (Serfaty-Lacrosnière
et al., 1995; Stein, 1986). Facilitated absorption occurs mainly by
diffusion and is not an energy-dependent process; the driving force
is the concentration difference of the ion between the two sides of
the membrane. In general, facilitated absorption is more rapid than
simple diffusion, but it is limited by the carrier capacity and the
amount of binding factor available. If a specific endogenous carrier
or binding factor is not produced under pathological conditions, intestinal
absorption of the nutrient may be negligible. In order not to overwhelm
the available absorption capacity, vitamins and minerals should be supplemented
at low concentrations over a period of time rather than suddenly. These
conditions are more easily met with liquid than with solid supplements:
The former are ingested in comparatively high dilution, whereas the
latter on ingestion may release the vitamins and minerals at concentrations
much higher than those normally encountered in foods and in excess of
the available absorption capacity. Time-release supplements were developed
to obviate this problem.
Absorption by passive diffusion
Simple or passive diffusion represents the simplest possible
mechanism of absorption (Serfaty-Lacrosnière et al., 1995). It
is an energy-independent process and occurs best from isotonic solutions.
The degree of absorption depends on the concentration of the nutrient
on both sides of the membrane and its relative solubility in the lipid
bilayer. Liquid supplements readied for ingestion are, or should be,
near-isotonic solutions, so as to favor nutrient absorption by passive
diffusion. A solid supplement, in contrast, may dissolve in the stomach
to yield an initially hypertonic solution. When this solution is passed
into the small intestine, it is first diluted with body fluid, via osmosis
through the intestinal membrane, until isotonicity is reached. Because
of the attendant increase of intestinal content, peristalsis may be
activated, resulting in gastric discomfort, diarrhea, and diminution
of absorption. In elderly subjects or patients with intestinal disorders,
the normally spontaneous process of rendering an hypertonic solution
isotonic may be generally disturbed. For such subjects, special isotonic
liquid feeding mixtures have been developed.
Inhibitors of absorption
The ingestion of solid supplements with foods is
sometimes recommended to increase bioavailability. However, foods may
actually diminish the bioavailability or absorption of nutrients. For
example, long-chain fatty acids from ingestion of lipids form insoluble
calcium and magnesium salts, which are poorly absorbed. In the liquid
vitamin-mineral preparations, the comparatively low solubility of the
citrates of calcium and magnesium compounds results in the formation
of suspensions. Bioavailability is not reduced, because these compounds
readily dissolve when added to orange juice. Phytic acid (inositol hexakis-dihydrogen
phosphate), a compound present in unprocessed whole grains and unleavened
bread, forms insoluble complexes with iron, zinc, copper, calcium, and
manganese and greatly reduces their bioavailability (Davies and Nightingale,
1975; Hallberg, et al, 1987; Navert et al., 1985). Copper forms an insoluble
sulfide when ingested with egg yolk (Schultze, et al., 1936). Dietary
fiber, oxalic acid in vegetables, and tannins in coffee and tea also
inhibit the absorption of iron and other minerals (Morck, 1983). Tannins
form poorly absorbable complexes with metals as well with vitamin B1
(thiamine) (Friedrich, 1987). Raw fermented fish contain an enzyme (thiaminase)
that inactivates thiamine; thiamine absorption is also inhibited by
alcohol. Naturally occurring antagonists of vitamin B2 (riboflavin),
vitamin B6 (pyridoxal), and biotin are known. The uptake of vitamin
K is inhibited by vitamin E (Friedrich, 1987).
Adverse interactions in supplements
Solutions of the B vitamins are more stable in acidic
rather than in neutral or alkaline solutions, which is one of the reasons
why citric and ascorbic acids are added to the liquid vitamin-mineral
preparations. However, the resulting mixtures are extremely oxygen sensitive.
To prevent loss of vitamins during manufacture and storage, liquid supplements
must be protected from air as much as possible; opened bottles should
be kept refrigerated. Destructive oxidation reactions may also take
place in powdered mixtures of minerals and vitamins and even in the
finished tablets, thereby reducing the shelf-life of the products. Accordingly,
special precautions are taken during manufacture of the supplements,
oxygen is excluded where necessary, and reactive ingredients either
are not combined or are prevented from interacting through microencapsulation
or the use of excipients. In some cases tablets with a layered structure
are produced; the vitamins typically form the central core, which is
surrounded by mineral salts and a protective layer of calcium carbonate.
Other manufacturers obviate this problem by offering packages of five
or more tablets or capsules containing water-soluble vitamins, fat-soluble
vitamins, and minerals separately.
BIOAVAILABILITY AND ABSORPTION OF VITAMINS
Many (but not all) of the water-soluble and fat-soluble
vitamins are absorbed by passive diffusion when they are present at
sufficiently high concentrations (Serfaty-Lacrosnière et al.,
1995) (Table 1). At low, physiological levels the absorption of vitamins
is often active, facilitated, and cofactor dependent, which provides
an argument against megadosing. As is well known, oral vitamin B12 is
absorbed regardless of oral dose only to the extent that it is bound
to intrinsic factor; impaired excretion of this factor by gastric mucosal
cells results in B12 deficiency. The absorption of vitamin C (ascorbic
acid) in humans is active and saturable. At dosages up to 180 mg/day,
80-90% of the vitamin is absorbed; at 2,000 mg/day, absorption drops
to 44%, and at 5,000 mg/day, to 20.9% (Horning et al., 1980). The human
organism can maximally absorb 1,160 mg of ascorbic acid per day. Vitamin
C is better absorbed in a natural citrus extract containing bioflavonoids,
proteins, and carbohydrates (Vinson and Bose, 1988). In therapeutic
applications, multiple smaller oral doses are in general preferable
to single large doses. This was confirmed for vitamin C in a study wherein
three divided doses per day caused a more significant increase of serum
ascorbate levels than the same amount given in one daily dose (Vinson
et al., 1998).
Selenium is included in Table 1 because it occurs
in foods, mainly in the form of seleno-methionine (i.e., an organic
rather than an inorganic form). Baker's or Brewer's yeast naturally
converts selenium into selenomethionine and is widely used in supplements,
although yeast-free selenomethionine-containing supplements are also
available. Selenomethionine is absorbed like methionine, by active transport;
its selenium is not immediately bioavailable but becomes so after enzymatic
degradation. In some products, selenomethionine is replaced by sodium
selenite or other inorganic selenium salts. Inorganic selenium salts
are also added to yeast, which is then offered as "organic"
even though it does not contain selenomethionine. Selenomethionine is
compatible with vitamin C, but selenite is reduced by it to the bio-unavailable
elemental selenium (Schrauzer and McGinness, 1979). The use of selenite
in solid or liquid nutritional supplements should therefore be discouraged;
also, the need for accurate labeling of supplemental selenium products
is apparent.
BIOAVAILABILITY AND ABSORPTION OF SELECTED MINERALS
Table 2 summarizes available data on the site and mechanism of absorption
of essential minerals and trace elements (Berthon, 1995). As may be
seen, the absorption of metals is often subject to endocrine control.
A separate discussion of several selected mineral elements and of the
so-called colloidal minerals follows.
Calcium
The most commonly prescribed calcium supplements
contain calcium carbonate. Although calcium carbonate is soluble in
acids and therefore should dissolve in the stomach, the solubilities
of calcium carbonate-based supplements vary considerably (Blanchard,
1989). Because the failure to dissolve is in some cases caused by the
compactness of the tablets, a disintegration test in simulated gastric
fluid under standardized conditions was introduced to assess calcium
bioavailability (United States Pharmacopoeia, 1985). However, because
this test measured only disintegration and not dissolution, it overestimated
bioavailability. Therefore, since 1987, the official USP requirement
for labeling of calcium supplements has included a dissolution test,
by which the tablets must dissolve in 30 minutes to at least 75% in
0.10 mol/L HCl at 37°C (Blanchard, 1989). Another test, the vinegar
disintegration test, has been developed to assess calcium bioavailability
(United States Pharmacopoeia, 1987; Kobrin et al., 1989). In this test,
a single tablet is placed into an Erlenmeyer flask containing 150 ml
of vinegar and is swirled vigorously every 5 minutes until the tablet
is completely disintegrated. In vinegar disintegration tests of seven
commercial calcium carbonate tablets, three were found to have low calcium
bioavailability. This result was confirmed by in vivo measurements of
calcium absorption and excretion.
Because stomach acid production diminishes with age, elderly
persons may be unable to utilize calcium as the carbonate. An effective
carrier for facilitated absorption of calcium is citric acid, which
may explain why calcium carbonate dissolved in orange juice shows generally
superior bioavailability (Whiting and Pluhator, 1992) and, under these
conditions, does not interfere with iron absorption (Mehansho et al.,
1989). Other calcium compounds that are well soluble and provide bioavailable
calcium include the orotate and the ascorbate. Calcium absorption and
the incorporation of calcium into bone are biochemically complex, hormonally
controlled processes in which several additional trace elements and
phosphate play contributory roles (Bucci, 1991). To this effect, more
sophisticated liquid and solid calcium supplements have been formulated
that contain calcium and magnesium as the citrates and orotates, microcrystalline
hydroxyapatite, and vitamin D, with boron and other trace elements believed
to be working synergistically to improve calcium absorption and incorporation
into bone.
Magnesium
Some studies indicate that soluble magnesium compounds
such as magnesium citrate are more bioavailable than magnesium oxide
(Lindberg et al., 1990). Magnesium absorption may be enhanced by the
addition of a glucose polymer solution (Bei, et al., 1986). Some studies,
however, indicate that the intestinal absorption of magnesium is the
same so long as it is free and in the ionized form (Lindberg et al.,
1990). Only about 21% of the magnesium is normally absorbed through
the intestine; excesses after storage compartments are filled are excreted,
about 70% via the intestine and 30% renally. The mechanism of intestinal
absorption of magnesium resembles that of calcium; physiological concentration
and excretion are hormonally controlled. Excess magnesium stimulates
calcium excretion, and excess calcium impairs absorption of magnesium.
Mineral waters containing magnesium and calcium as the bicarbonates
provide good sources of both elements. In some liquid vitamin-mineral
supplements, ocean-derived minerals, Dead Sea minerals, or minerals
from the Great Salt Lake are added to increase the magnesium content
and to add additional naturally occurring trace elements. The magnesium
is present in the form of the chloride, which is well absorbed from
dilute solutions but acts as a cathartic if ingested in larger amounts.
Iron
Subclinical iron deficiency is widespread in the
general population. In adults, migraine headaches, lack of appetite,
aversion to eating meat, breathlessness on exertion, heart palpitations,
brittle nails, constipation, cold sensitivity, sore tongue, and weak
or fragile bones can be caused by iron deficiency. In children, growth
retardation, pale complexion, unhealthy appearance, fatigue, depression,
dizziness, inability to concentrate or to think clearly, and irritability
are caused by iron deficiency.
For the treatment of simple iron deficiency anemias, pills containing
a high dose of iron, usually as the sulfate, are prescribed. Iron sulfate
taken in excess is toxic; in the home, it poses a serious health hazard,
and accidental ingestion of an overdose, especially by infants, can
be fatal. For some years, therefore, powdered elemental iron (Ferrum
reductum) was used to treat iron deficiency anemias. Elemental iron
is less toxic than ferrous sulfate, but because of its poor bioavailability
500 mg (approximately 7.5 grains) must be taken three or four times
daily after meals (The Dispensatory, 1995a). Even ferrous sulfate must
be taken daily for months because so little of the iron is absorbed.
It may cause stomach upset and constipation, and patient compliance
is often poor; children, especially, tend to refuse to take iron sulfate
pills for any extended period. To obviate the compliance problem in
an experiment with preschool children aged 2-6 years, iron-fortified
bread was given for 6 months; however, this regimen failed to produce
positive results. A significant increase of hemoglobin levels in the
children resulted only when a small amount of iron (20 ppm Fe as ferrous
sulfate) was added to the drinking water. At the conclusion of the test,
after 8 months of supplementation, hemoglobin levels increased from
10.661.1 to 13.061.1 g/dl, serum ferritin from 13.768.9 to 25.6610.5
mg/L (N531), and "no problems related to the (iron) salt addition
or to the children drinking the iron-enriched water" occurred (Dutra
de Oliveira et al., 1994). Iron is discussed further in the section
on colloidal minerals. Liquid vitamin-mineral supplements contain vitamin
C and vitamin A, which increase iron bioavailability and absorption,
respectively.
Zinc, copper, manganese, chromium
The bioavailability and absorption of zinc, copper,
manganese, and chromium are lowered by dietary components (e.g., phytic
acid, tannin, fiber, phosphate). Absorption is increased by certain
amino acids, decreased by others. The bioavailabilities of ionic forms
of these metals are mutually interdependent. Supplemental iron, for
example, impairs the absorption of zinc (Solomons and Jacob, 1981),
copper (Haschke et al., 1985), and manganese (Thomson et al., 1971),
whereas calcium may reduce chromium absorption (Seaborn and Stoecker,
1990). Ingestion of multiple minerals may provide assurance against
imbalances induced by single elements. In solid supplements, the presence
of calcium and magnesium may impair absorption of these metals. Vitamin
C may decrease gastrointestinal absorption of copper. More research
is required on both solid and liquid supplements to establish the optimal
concentration of these elements for supplementation.
Plant-derived liquid or colloidal minerals
Some of the liquid vitamin-mineral supplements contain
aqueous extracts of minerals found in deposits in humic shales. The
extracts contain predominantly the sulfates of iron, and aluminum; in
addition, zinc, silicon, nickel, manganese, magnesium, lithium, calcium,
boron, chromium, copper, and silicon and traces of 60 or more other
elements are present, or claimed to be present, depending on the sensitivity
of the analytical method employed. In some extracts, traces of organic
compounds such as humic or fulvic acids are detectable. The safety of
these extracts became a concern after it was suggested that some could
contain possibly radioactive or toxic elements such as strontium and
aluminum (Schauss, 1997a, 1997b). These concerns have since proved to
be unfounded with respect to radioactivity and the presence of unusually
high levels of strontium. In our own tests, using a scintillation technique
approved by the U.S. Environmental Protection Agency, none of 10 extracts
tested showed radioactivity above background, and a previously quoted
high value for strontium was actually that of sulfur.
The levels of aluminum in some of the
earlier, more concentrated versions of extracts could exceed 4,000 ppm,
but these have been lowered in most products to one third of that value
or less. At current levels, 1 ounce of extract provides 10-20 mg of
aluminum, which is within the nutritional range. Aluminum is widely
distributed in foods, from which a certain amount is absorbed, and the
absorption appears to occur in proportion with iron. Although iron is
retained, excess aluminum is excreted, causing the adult human body
invariably to contain only about 0.5 g of aluminum, compared with 4-5
g of iron. Several studies attest that aluminum may have beneficial
or essential physiological functions in animals; past postulated links
between oral aluminum intake and Alzheimer's disease have been discredited
(Watt, 1997).
Thus, recent comparisons of the levels of mineral elements in the subcortical
region and the frontal cortex of the brains of AD patients give no evidence
that Al is an etiological factor in AD. Instead, these studies revealed
significant accumulations of calcium and zinc in the frontal cortex
of AD brains, suggesting that mineral transport systems in the brain
cells of AD patients are defective (Kienzl et al., 1996).
Because the humic shale extracts contain sulfates of iron and aluminum,
they are weakly acidic and contain equilibrium amounts of free sulfuric
acid and traces of colloidal metal hydroxides. It was the presence of
the latter that led to their marketing name, "colloidal minerals,"
although most of the elements are actually present in ionic forms. An
extract may typically contain 300 ppm of iron, predominantly as ferrous
sulfate. One ounce of extract in 8 ounces of orange juice provides almost
10 mg of iron at a dilution that makes it both well tolerable and highly
bioavailable. This fact provides a basis for the disputed promotional
claim that the plant-derived minerals are 10-12 times more bioavailable
than in their elemental form. The fact that elemental iron has a low
bioavailability is well known; the literature lists it as ranging from
0.5% to 2%. In contrast, the bioavailability of iron in the form of
ferrous sulfate is given as 12-16% (Auterhoff, 1968).
The presence of iron in the extracts
could be responsible for some of their claimed beneficial effects: Iron
supplementation in cases of subclinical iron deficiency often results
in striking improvements of the general condition. However, the extracts
also provide nutritionally significant amounts of several other essential
elements. The extracts bear a close chemical resemblance to the iron
sulfate-containing mineral springs or "vitriol waters" found
in Europe. These have been described as possessing astringent, tonicizing,
and antiseptic properties. They were widely recommended at the turn
of the 20th century for treatment of iron deficiency anemias and especially
of chlorosis, the then common form of anemia occurring in young girls,
because it was already known that dissolved iron is more bioavailable
than that in conventional iron preparations (Tilenius, 1925). Vitriol
waters were prescribed as tonics after acute diseases or blood loss;
to treat exhaustion and fatigue; and for diseases of the spleen, liver,
and kidneys, various chronic diseases, nervous disorders, "sciatica,"
disorders of the thyroid gland, diseases of the mucous membranes, and
so on (Tilenius, 1925). These claims may appear excessive or difficult
to rationalize, but they were based on empirical observations made over
the years by the local balneologists.
Today, similar claims are made by users of the "colloidal
minerals" products. If one is willing to accept them as true, these
apparent healing effects cannot be attributed solely to the iron present.
To rationalize them, it must be considered that the preparations contain
sulfates of iron and other metals, which causes them to be acidic as
a result of the presence of equilibrium amounts of sulfuric acid. Dilute
sulfuric acid, Acidum sulfuricum dilutum, was used for hundreds of years
internally as a tonic and medicine for a wide variety of conditions-to
promote convalescence from protracted fevers, to reduce fatigue, to
stimulate the appetite, to improve digestion, and to treat gastric hypoacidity,
menopausal hot flashes, thyroid diseases, and so on. The administration
of dilute sulfuric acid was recommended still relatively recently as
a "constitutional agent" (Aschner, 1995). In U.S. pharmacies
it was available in flavored alcohol solution known as Elixir of vitriol
or Acidum sulfuricum aromaticum (The Dispensatory, 1995b), and in Europe
as Elixir acidum halleri or Aqua rabelii (Schulz, 1903). The plant mineral
extracts or colloidal mineral preparations therefore may owe their apparent
efficacy also to the presence of sulfuric acid. They could be regarded
as natural versions of "elixirs of vitriol." Sulfuric acid,
or sulfate, is the terminal product of the metabolism of sulfur amino
acids. Sulfate is required for biosynthesis of the all-important chondroitin
sulfates and for detoxification of physiological metabolites, natural
products, and pharmaceuticals, including adrenaline, thyroid hormones,
phenols, and a wide variety of drugs. Sulfate may also detoxify heavy
metals such as lead and barium.
SUMMARY AND OUTLOOK
Because the industry is now offering both solid and
liquid vitamin-mineral preparations, health professionals have a wider
choice in searching for the right supplements for their patients. Solid
vitamin and mineral preparations have the obvious advantage that single
or multiple nutrients can be prescribed and dispensed at accurate dosages.
They are also easier to ship and store, but, as we have seen, they may
cause problems with respect to bioavailability and compliance. Liquid
supplements contain the nutrients in a more highly bioavailable form,
are gentler to the stomach, and sometimes are more suitable than solid
supplements, especially for children and elderly patients, as was shown
specifically for iron. The liquid mixtures containing numerous vitamins
and minerals are probably better suited for routine general supplementation
than for treatment of a defined deficiency. Those containing humic-shale
or plant-derived minerals are tonics as well as supplements and therefore
belong in a special category. In general, the preparation of any supplement
poses a challenge, and some of the newer liquid products need to be
further refined and improved. However, the liquid technology is here
to stay and offers opportunities for numerous new products. It is hoped
that further development of the liquid supplement technology will ultimately
lead to a more balanced and economical use of vitamins and minerals.
REFERENCES