Tăng cường đề kháng
Bổ sung các dưỡng chất quan trọng như Vitamin C, Kẽm, Vitamin D và chiết xuất Elderberry để hỗ trợ và duy trì hệ miễn dịch khỏe mạnh, giúp cơ thể bạn có được sự bảo vệ tự nhiên trước những thay đổi của môi trường.
Hoạt chất khuyến nghị
Beta-glucans
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Copper
This section focuses on two diseases in which copper might play a role: cardiovascular disease (CVD) and Alzheimer’s disease.
Niacin
Very high doses of nicotinic acid—more than 100 times the RDA—taken for months or years are effective treatments for dyslipidemias. Nicotinamide does not have this effect because, unlike nicotinic acid, it does not bind to the receptors that mediate nicotinic acid’s effects on lipid profiles [11. Penberthy WT, Kirkland JB. Niacin. In: Erdman JW, Macdonald IA, Zeisel SH, eds. Present Knowledge in Nutrition, 10th ed. Washington, DC: Wiley-Blackwell; 2012:293-306.]. Studies conducted since the late 1950s show that these doses can increase high-density lipoprotein (HDL; good) cholesterol levels by 10%–30% and reduce low-density lipoprotein (LDL; bad) cholesterol levels by 10%–25%, triglyceride levels by 20%–50%, and lipoprotein(a) levels by 10%–30% [1212. MacKay D, Hathcock J, Guarneri. Niacin: chemical forms, bioavailability, and health effects. Nutr Rev 2012;70:357-66. [PubMed abstract]]. Together, these changes in lipid parameters might be expected to reduce the risk of first-time or subsequent cardiac events, such as heart attacks and strokes, in adults with atherosclerotic cardiovascular disease. However, despite dozens of published clinical trials, experts do not agree on the value of nicotinic acid to treat cardiovascular disease, especially given its side effects, safety concerns, and poor patient compliance [2525. Schandelmaier S, Briel M, Saccilotto R, Olu KK, Arpagaus A, Hemkens LG, Nordmann AJ. Niacin for primary and secondary prevention of cardiovascular events (review). Cochrane Database of Systematic Reviews 2017, Issue 6. Art. No.:CD009744. [PubMed abstract]]. In one large clinical trial from the 1970s, 8,341 participants age 30 to 64 years who had had one or more heart attacks were randomized to take one of five lipid-lowering medications, including 3,000 mg/day nicotinic acid, or a placebo for an average of 6.2 years [2626. The Coronary Drug Project Research Group. Clofibrate and niacin in coronary heart disease. JAMA 1975;231:360-81. [PubMed abstract]]. Those taking nicotinic acid lowered their serum cholesterol levels by an average of 9.9% and triglyceride levels by 26.1% over 5 years of treatment. During 5 to 8.5 years of treatment, these participants had significantly fewer nonfatal myocardial infarctions but more cardiac arrhythmias than those in the placebo group. Their overall rates of mortality and cause-specific mortality, including from coronary heart disease, did not decline. However, 9 years after the study ended, participants who had taken the nicotinic acid experienced significantly fewer (11%) deaths from all causes than those who had taken the placebo [2727. Berge KG, Canner PL. Coronary drug project: Experience with niacin. Eur J Clin Pharmacol 1991;40:S49-51. [PubMed abstract],2828. Canner PL, Berge KG, Wenger NK, Stamler J, Friedman L, Prineas RJ. Friedewald W. Fifteen year mortality in Coronary Drug Project patients: Long-term benefit with niacin. J Am Coll Cardiol 1986;8:1245-55. [PubMed abstract]]. Statin medications have become the treatment of choice for hyperlipidemia and lowering the risks of atherosclerotic cardiovascular disease. For this reason, clinical trials of nicotinic acid in the past several decades have examined whether it provides any additional cardiovascular protection to people taking statins [2929. Stone et al. American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults. J Am Coll Cardiol 2014;63:2889-934. [PubMed abstract]]. In the largest international, multicenter, clinical trial of nicotinic acid to date, 25,673 adults age 50–80 years (83% men) with cardiovascular disease who were taking a statin were randomized to take 2 g/day extended-release nicotinic acid with a medication to reduce nicotinic acid’s flushing effect and therefore improve treatment compliance or a matching placebo for a median of 4 years [3030. HPS2-THRIVE Collaborative Group. Effects of extended-release niacin with laropiprant in high-risk patients. New Engl J Med 2014;371:203-12. [PubMed abstract],3131. Lloyd-Jones DM. Niacin and HDL cholesterol—time to face facts. N Engl J Med 2014;371:271-3. [PubMed abstract]]. The nicotinic acid group had a mean reduction in LDL cholesterol (of 10 mg/dl) and triglycerides (of 33 mg/dl) and an increase in HDL cholesterol (of 6 mg/dl), but this group had no significant reduction in rates of major vascular events compared with the placebo (statin-only) group. Furthermore, the nicotinic acid group had a significantly greater risk of diabetes, gastrointestinal dyspepsia, diarrhea, ulceration, bleeding events in the gut and brain, and skin rashes and ulcerations. An earlier randomized clinical trial of 3,414 patients with established cardiovascular disease was stopped after 3 years when the researchers found that patients taking niacin (1,500–2,000 mg/day extended release) in addition to their cholesterol-reduction medications did not have fewer cardiovascular events than those taking medication alone, even though the niacin reduced triglyceride and LDL cholesterol levels further and raised HDL cholesterol levels further [3232. The AIM-HIGH Investigators. Niacin in patients with low HDL cholesterol levels receiving intensive statin therapy. E Engl J Med 2011;365:2255-67. [PubMed abstract]]. The results also showed that patients taking niacin had an increased risk of ischemic stroke. The authors of two 2017 systematic reviews examining the clinical trial data concluded that nicotinic acid therapy provides little if any protection from atherosclerotic heart disease, even though the therapy raises HDL cholesterol levels and lowers total cholesterol, LDL cholesterol, and triglyceride levels. One of these reviews examined 23 randomized controlled trials of moderate to high quality in 39,195 participants age 33–71 years (average 65 years; majority were male). Some had experienced a heart attack, and most were taking a statin. The doses used and treatment duration in these studies varied widely; the median dose of nicotinic acid was 2 g/day (range 0.5 to 4 g/day) for a median of 11.5 months (range 6 months to 6 years) [2525. Schandelmaier S, Briel M, Saccilotto R, Olu KK, Arpagaus A, Hemkens LG, Nordmann AJ. Niacin for primary and secondary prevention of cardiovascular events (review). Cochrane Database of Systematic Reviews 2017, Issue 6. Art. No.:CD009744. [PubMed abstract]]. Overall, use of nicotinic acid did not reduce overall mortality or cardiovascular mortality rates or the number of fatal or nonfatal myocardial infarctions or strokes. Eighteen percent of participants taking nicotinic acid discontinued treatment because of side effects. The second review examined 13 randomized controlled trials with 35,206 participants with, or at risk of, atherosclerotic cardiovascular disease [3333. Garg A, Sharma A, Krishnamoorthy P, Garg J, Virmani D, Sharma T, et al. Role of niacin in current clinical practice: A systematic review. The American Journal of Medicine 2017;130:173-87. [PubMed abstract]]. Overall, the addition of nicotinic acid supplementation (dose range not specified) to statin therapy taken for a mean of 33 months (with a broad range of 6 to 60 months) did not lead to significant reductions in rates of all-cause or cardiovascular mortality, myocardial infarction, or stroke. Nicotinic acid treatment was associated with a significantly higher risk of gastrointestinal and musculoskeletal adverse events. In addition, four of the studies that examined diabetes as an outcome found that the patients taking niacin had a significantly higher risk of developing the disease. A 2018 review of three randomized controlled trials with 29,195 patients found that all-cause mortality increased by 10% more in those who took 1 to 3 g/day extended release nicotinic acid in addition to a statin medication than patients taking the statin alone [3434. Jenkins DJA, Spence JD, Giovannucci EL, Kim Y, Josse R, Vieth R, et al. Supplemental vitamins and minerals for CVD prevention and treatment. Journal of the American College of Cardiology 2018;71:2570-84. [PubMed abstract]]. In their guidelines for lowering blood cholesterol levels, the American College of Cardiology and the American Heart Association advise that nonstatin therapies, compared with or in addition to statin therapy, do not provide atherosclerotic cardiovascular disease risk-reduction benefits that outweigh the potential harms of their adverse effects [2929. Stone et al. American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults. J Am Coll Cardiol 2014;63:2889-934. [PubMed abstract]]. When discussing the use of nicotinic acid supplements to reduce the risk of hyperlipidemia (for example, in patients unable to tolerate statin medications), the two professional societies recommend that patients take 500 mg/day extended-release nicotinic acid supplements and increase the dose to a maximum of 2,000 mg/day over 4 to 8 weeks or take 100 mg immediate-release nicotinic acid three times a day and increase the dose to 3,000 mg/day divided into two or three doses. (Their joint statement about monitoring supplement users who take niacin to reduce hyperlipidemia risk for adverse effects is described in the Health Risks from Excessive Niacin section below.) In their 2018 report, these two professional societies stated what although niacin may be useful in some cases of severe hypertriglyceridemia, it has only mild LDL-lowering effects. The societies therefore do not recommend using it as an add-on drug to statin therapy [3535. Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, et al. 2018 AHA/ACC/AACVPR/AAP/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the management of blood cholesterol. Circulation. Published November 10, 2018. [PubMed abstract]]. Overall, the evidence indicates that nicotinic acid supplementation improves blood lipid profiles but has no significant effects on risk of cardiovascular events. Although nicotinic acid is a nutrient, if very high doses (thousands of mg) are taken to treat hyperlipidemias, the supplement is being used as a drug. Such doses should only be taken with medical approval and supervision.
Probiotics
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Selenium
This section focuses on six diseases and conditions in which selenium might play a role: cancer, cardiovascular disease (CVD), cognitive decline and Alzheimer’s disease (AD), HIV infection, male fertility, and thyroid disease.
Vitamin A
People should get most of their nutrients from food and beverages, according to the federal government’s Dietary Guidelines for Americans. Foods contain vitamins, minerals, dietary fiber, and other components that benefit health. In some cases, fortified foods and dietary supplements are useful when it is not possible to meet needs for one or more nutrients (for example, during specific life stages such as pregnancy). For more information about building a healthy dietary pattern, see the Dietary Guidelines for Americans.
Vitamin C
Because vitamin C acts as an antioxidant and plays a role in immune function, it has been promoted as a means to help prevent and/or treat numerous health conditions. This section focuses on the following diseases and disorders in which vitamin C might play a role: cancer (including prevention and treatment), CVD, age-related macular degeneration (AMD) and cataracts, and the common cold.
Vitamin D
The FNB committee that established DRIs for vitamin D found that the evidence was inadequate or too contradictory to conclude that the vitamin had any effect on a long list of potential health outcomes (e.g., on resistance to chronic diseases or functional measures), except for measures related to bone health. Similarly, in a review of data from nearly 250 studies published between 2009 and 2013, the Agency for Healthcare Research and Quality concluded that no relationship could be firmly established between vitamin D and health outcomes other than bone health [6969. Newberry SJ, Chung M, Shekelle PG, Booth MS, Liu JL, Maher AR, et al. Vitamin D and calcium: A systematic review of health outcomes (update). Evidence Report/Technology Assessment No. 217. (Prepared by the Southern California Evidence-based Practice Center under Contract No. 290- 2012-00006-I.) AHRQ Publication No. 14-E004-EF. Rockville, MD: Agency for Healthcare Research and Quality. September 2014.]. However, because research has been conducted on vitamin D and numerous health outcomes, this section focuses on seven diseases, conditions, and interventions in which vitamin D might be involved: bone health and osteoporosis, cancer, cardiovascular disease (CVD), depression, multiple sclerosis (MS), type 2 diabetes, and weight loss. Most of the studies described in this section measured serum 25(OH)D levels using various methods that were not standardized by comparing them to the best methods. Use of unstandardized 25(OH)D measures can raise questions about the accuracy of the results and about the validity of conclusions drawn from studies that use such measures and, especially, from meta-analyses that pool data from many studies that use different unstandardized measures [55. Sempos CT, Heijboer AC, Bikle DD, Bollerslev J, Bouillon R, Brannon PM, et al. Vitamin D assays and the definition of hypovitaminosis D. Results from the First International Conference on Controversies in Vitamin D. Br J Clin Pharmacol 2018;84:2194-207. [PubMed abstract],99. Sempos CT, Binkley N. 25-hydroxyvitamin D assay standardisation and vitamin D guidelines paralysis. Public Health Nutrition 2020;23:1153-64. [PubMed abstract],7070. Sempos CT, Carter GD, Binkley NC. 25-hydroxyvitamin D assays: Standardization, guidelines, problems, and interpretation. Pages 939-57 in Feldman D, Pike JW, Bouillon R, Giovannucci E, Goltzman D, Hewison M, eds. Vitamin D, Volume 1: Biochemistry, Physiology and Diagnostics, Fourth Edition. Elsevier, 2018.]. More information about assay standardization is available from the Vitamin D Standardization Program webpage.
Zinc
This section focuses on the following diseases and disorders in which zinc might play a role: the common cold, pneumonia in children, HIV in children and adults, acute childhood diarrhea (which often results from infections), age-related macular degeneration (AMD), and type 2 diabetes. For information on zinc and COVID-19, see Dietary Supplements in the Time of COVID-19.
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Câu hỏi thường gặp
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