Vitamin and Mineral Supplementation

Most studies involving vitamin or mineral supplementation in RA have focused on either the antioxidant nutrients (vitamin C, vitamin E, beta carotene, selenium) or B vitamins. Various studies have examined the effects of vitamins C, E, and selenium supplementation on the management of RA. In general, results from randomized controlled trials of vitamin E supplementation have been of relatively short duration and have led to conflicting results so that there continues to be a lack of concrete evidence to support vitamin E supplementation at a particular dosage. Nonetheless, patients with RA could certainly be encouraged to increase their intake of vitamin E-rich foods, including edible vegetable oils (sunflower, safflower, canola, olive), unprocessed cereal grains, and nuts. Similarly, the effect of dietary sources of other antiox-idant nutrients, such as selenium and vitamin C, on inflammatory symptoms in RA has also been ambiguous. It should be emphasized that providing individual nutrient supplements does not necessarily offer the same overall benefit as when nutrients are obtained from whole foods. It is possible that the combination of nutrients that are present in whole foods, or even some unidentified components of a food, are responsible for any observed beneficial effects, and that supplementing a typical diet with individual nutrients will not provide the same benefit.

We have studied vitamin B6 levels in patients with RA and healthy controls, and found that plasma levels of pyridoxal-5-phosphate (PLP), the metaboli-cally active form of vitamin B6, were lower in patients with RA compared to control subjects. Furthermore, plasma levels of PLP were inversely associated with TNF-a production by peripheral blood mononuclear cells, suggesting that abnormal vitamin B6 status may be contributing to inflammation in RA. However, there is no evidence to support the efficacy of oral vitamin B6 supplements for treating the symptoms of RA at this time. Furthermore, large doses of vitamin B6 can be toxic; therefore, as with the anti-oxidant nutrients, patients with RA would obtain the greatest benefit by increasing dietary sources of vitamin B6, consistent with the dietary reference intake (DRI) for this nutrient. If supplementation is considered, it should not exceed twice the DRI level.

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