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Citrus Fruits, Dietary Fiber and Multivitamin News

November 3, 2009 Written by JP    [Font too small?]

Keeping up with medical news is a lot like keeping track of the stock market. New information is continuously being released and must be considered in order to have a well rounded picture of what’s really going on. I try to present an accurate assessment of each subject that I write about. However, the accuracy of the information is only current at the posting date. A week or two after I publish an article, there’s frequently something new that I could add. That’s why I regularly post updates on topics that I’ve already covered.

In September 2009, I wrote about a controversy pertaining to grapefruit consumption and the relative risk of breast cancer. Since grapefruit and other citrus sources contain similar phytochemicals, I thought I should also look at the most recent information about citrus intake in general and overall cancer risk. The most current study I found is published in the October 23rd edition of the journal Cancer Causes and Control. A group of Italian researchers carefully looked for a connection between citrus fruits in the diets of patients with cancer and those without. The patients with the highest (vs. the lowest) citrus consumption were found to have:

  • A 58% and 45% reduction in esophageal and laryngeal cancer.
  • A 31% and 18% lower risk of stomach and colorectal cancer.

With respect to hormonally influenced malignancies, “no consistent association was found with breast, endometrial, ovarian or prostate cancer”. The authors concluded that “citrus fruit has a protective role against cancer of the digestive and upper respiratory tract”. (1)

A new population study presented in the International Journal of Cancer discovered a significantly lower risk of gastric cancer in Iranians who ate large quantities of allium vegetables (garlic, leaks, onions, etc.), citrus fruits and fresh fish. In addition, an experiment conducted in an animal model suggests that hesperetin, a phytochemical found in citrus fruits, may be a potent agent in the fight against colon cancer. (2,3)

In August and September, I wrote a two part column about the role that dietary fiber can play in the development of cancer and heart disease. The most recent issue of the journal Diabetes Care provides yet another reason why roughage should be a focal point in most healthy diets. A group of 3,428 healthy senior volunteers were followed for a period of 7 years. During that time, 162 of the participants were diagnosed with type 2 diabetes. A team of London-based researchers examined whether there might be an association between fiber consumption and the incidence of diabetes. A significantly higher risk of diabetes was found in those with the lowest fiber intake. There were also indications of higher levels of inflammation and fatty liver in those with “low cereal and low vegetable fiber intake”. (4)

There is some evidence that suggests that a high fiber diet may reduce the risk of breast cancer. One of the proposed mechanisms is that dietary roughage may effectively lower “circulating estrogen concentrations” that are believed to contribute to the risk of breast malignancies. A new study in the American Journal of Clinical Nutrition offers hope to those who are concerned about breast cancer and gives pause to those who are hoping to become pregnant. (5,6,7)

The “BioCycle Study” involved 250 menstruating women over the course of 2 cycles. Fiber intake was assessed via “24 hour recall”. Hormone levels and “incident anovulation” (failure to ovulate) were measured 8 times per cycle. It was determined that higher fiber intake reduced the levels of estradiol (a form of estrogen), follicle-stimulating hormone, luteinizing hormone and progesterone. There was also an increased likelihood of anovulation. The risk of anovulation increased in accordance with elevating levels of dietary fiber. The authors of the study concluded that, “a diet high in fiber is significantly associated with decreased hormone concentrations and a higher probability of anovulation”.

The last stop on this fiber tour relates the important role that roughage plays in supporting healthy immune function. The October 28th issue of the journal Nature describes the importance of fiber in the colon. A group of Australian researchers explain that bacteria in the colon convert dietary fiber into short chain fatty acids (SCFA), which play a vital role in immune function and suppressing inflammation. They go on to state that the highly processed diets commonly found in modern societies may be contributing to disease due to a relative lack of fiber-rich foods. (8)

The Effects of Insoluble and Soluble Fiber
Source: J. Nutr. 138:439-442, March 2008 (link)

I make no secret about it – I strongly believe that a daily multivitamin/mineral is a valuable tool in the promotion of overall wellness. This is all the more true for women who are planning on becoming pregnant. Three new studies illustrate several reasons why the use of an appropriate prenatal supplement is essential to the good health of mother and child.

Research from the Alcohol Research Group at the University of Berkeley, California examined “whether multivitamin supplements modify the relationship between alcohol consumption during pregnancy and the risk of miscarriage”. A total of 1,061 pregnant women participated in this analysis. The results showed that women who drank but did not use multivitamins were 67% more likely to have a miscarriage as compared to those who did not drink alcohol at all. However, women who consumed alcohol and took a daily vitamin supplement did not exhibit any increase in the risk of miscarriage. However, this information is preliminary and is obviously not a license to drink while pregnant. This is simply an illustration of the protective effect that vital nutrients can have in relation to a variety of dietary and environmental insults. (9)

Two other studies recently caught my eye. The first uncovered a long term benefit of folic acid supplementation during pregnancy and a reduced risk of “childhood behavioral difficulties” in “offspring”. Higher rates of hyperactivity and “peer problems” were noted in children born to mothers who consumed lower levels of folate during their pregnancies. These symptoms were noted in children with ages between 7 and 9. An objective measure of folate inadequacy was also detected – infants born to mothers lacking in folate exhibited a statistically smaller head circumference. The authors of the trial commented that, “lower folate status in early pregnancy might impair fetal brain development and affect hyperactivity/inattention and peer problems in childhood”. Finally, an antioxidant-rich prenatal supplement was found to provide long term heart and kidney protection for the offspring of lab rats. A particular benefit was found with regard to blood pressure regulation and a healthier circulatory system of the offspring whose mothers received key nutrients such as folate, selenium, Vitamin C and E. (10,11)

Earlier I mentioned that I’d be updating some of my previous blogs. I probably should have described my intent in a slightly different way. What I really hope to accomplish with these follow-ups is to reinforce positive habits and lifestyle choices. We all have a lot of helpful information at our fingertips these days. But with so many facts and figures swirling around, it’s very easy to misplace the very tips and concepts that we’d liked to incorporate into our daily routines. In reality, a gentle nudge and a friendly reminder is what I’m serving up today.

Be well!


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Posted in Nutrition, Nutritional Supplements, Women's Health

18 Comments & Updates to “Citrus Fruits, Dietary Fiber and Multivitamin News”

  1. Nina K. Says:

    Dear JP,

    great article, thank you šŸ™‚

    Nina K.

  2. Chris Says:

    Nice article JP.

    Just picking up on one comment, and going of on a slight tangent…

    “I strongly believe that a daily multivitamin/mineral is a valuable tool in the promotion of overall wellness”

    Have you read this,”Supplements Exposed: The Truth They Don’t Want You to Know About Vitamins, Minerals, and Their Effects on Your Health”:


    I think you may get a lot from it JP, it’s certainly made me rethink my supplementation strategy. Here’s a snippet from the book to give you an idea of what it’s about…

    “It is important to not that chemically derived nutrients (of which over 95% of multi-vitamins are) activate biochemical stimuli, which first gave the scientific community the impression that these substances where building health. What they were not aware of is that wars were waging between the immune system and these chemical substances, causing an over deterioration of health.”


  3. JP Says:

    Thanks, Nina! šŸ™‚

    Be well!


  4. JP Says:


    Thanks a lot for sharing the name of the book. I’ve heard of it but not read it yet.

    Dr. Brian R. Clement, who heads up the Hippocrates Institute, appears to favor more “food based” supplements (New Chapter and others) – though he does carry synthetic supplements in the HI online store as well.

    Here’s my basic P.O.V. (without the benefit of having read the book) … there is very little independent research published on these types of supplements. This makes it difficult to accept or refute claims of superiority made by companies, individual physicians and researchers, IMO.

    In the past, this is what I’ve often found when looking into this controversy:

    1) Food-based proponents generally use research conducted on actual whole foods to strengthen the case for food-based supplements.

    2) Negative studies on synthetic supplements are used to make the case against them. However, positive studies are generally dismissed … even though there’s not much in the way of food-based supplement research that can be used as a comparison.

    Both of these points are problematic, IMO. The trouble is, it’s highly unlikely that a fair, head-to-head comparison between food-based vs. synthetic supplements will take place any time soon. There really isn’t much of a financial incentive to instigate such studies – on either side of the issue or by an independent 3rd party.

    Ultimately, my position is as follows: Diet is king. Get as much as you can from whole food nutrition. Supplement-wise, follow the research and/or make the best educated guesses possible.

    I do recommend food-based supplements for those that who are very sensitive to more conventional supplements. I also mention them to those who may prefer them due because they’re more natural.

    I hope my reply doesn’t come across as combative or defensive in any way. I truly appreciate your recommendation and I’m only trying to reply based on my prior investigation of this topic.

    Be well!


  5. Chris Says:

    Hey JP,

    Excellent reply; not combative or defensive at all šŸ™‚

    I agree – diet is king. Like a lot of people I’m switching to raw foods to maximise vitamin/mineral intake. These seems to be a key factor to maximising nutrient intake.

    But also off the back of reading Clement’s stuff, I’m switching my multi to a whole food source one. Reasons being (and these are just based on my intuition)…

    We function best when we live how we’ve evolved to – in this case we evolved to consume vitamins and minerals from natural food sources, not synthetic sources. Synthetics are a rather unknown quantity, we’re not entirely 100% of the positives and negatives. Whereas natural foods, well, we’ve consumed them since for ever. Basically, I’m erring on the side of caution.

    The only real downside of this approach is that it’s a tad more expensive. But for me worth the cost for that little extra peace of mind.


  6. JP Says:

    Thanks, Chris.

    I completely understand your P.O.V. I’ve often considered that position myself. It’s an interesting debate to be sure.

    I’m not sure what supplement you’ve decided on but I’ve noticed that Now Foods has a new food-based multi that looks pretty interesting (and it’s more economical than most).


    If you wouldn’t mind, I’d love to have your feedback on any differences you attribute to your supplement switch. Your feedback would be much appreciated!

    Be well!


  7. Chris Says:

    Great find JP, that product seems like very good value for money. This was the supplement I have on order, which can be had for $35 for 90 days supply:


    And I’ll probably give Now a go (I’m also a believer in variation of brands for supplements!)

    These supps are missing one or two things, like adequate magnesium and calcium, but there are also whole food supplements available for those too.

    Will report back in a few weeks šŸ™‚


  8. JP Says:

    Thanks, Chris. I’ll look forward to your report! šŸ™‚

    Be well!


  9. Randy Karp Says:


    Well done. Just want to make an important distinction for your readers between an RDA ( Recommended Daily Allowance), that the government has established to help us avoid deficiency, and an ODA ( Optimal Daily Allowance), based on what research shows we rquire to optimize our health. I spent years developing a super-mulitple, based on science, not headline news, to do just that. The point is that while an RDA can help you avoid disaser, and ODA can help you do more. The belief that supplements are meaningless if we just eat properly, is misinformed. As Dr. David Miller points out , we’d have to eat about 2 pounds of ground beef a day to get enough (anti-aging) carnosine, found in a simple supplement.

  10. JP Says:

    Thanks, Randy!

    I agree with your assessment of the RDA. Simply avoiding a deficiency state isn’t the same as promoting vibrant health.

    I appreciate your contribution. šŸ™‚

    Be well!


  11. Tom Says:

    A lot of western people are deficient in fiber to varying degrees, it is one of the key factors in becoming over weight, but it’s also a key factor in losing the weight too.

  12. Randy Karp Says:

    The key is to eat high fiber nutrient dense foods, like the right nuts, avocado’s and more ; that break down gradually, and feed your blood sugar on a slow roll. The key is balance, and purposeful eating helps get you there. Randy Karp -Author- Misinformed about Food . Good forum JP!

  13. JP Says:

    Thank you, Randy!

    I agree 100%!

    Be well!


  14. JP Says:

    Thanks. I hope you enjoy it.

    Be well!


  15. JP Says:

    Update: Diets rich in fiber reduce excessive inflammation in overweight adolescents …


    Pediatr Obes. 2015 Mar 2.

    Dietary fibre linked to decreased inflammation in overweight minority youth.

    OBJECTIVE: The objective of this study was to examine the relationship between diet and inflammation, and adiposity in minority youth.

    DESIGN AND METHODS: The study was designed as a cross-sectional analysis of 142 overweight (ā‰„85th body mass index percentile) Hispanic and African-American adolescents (14-18 years) with the following measures: anthropometrics, adiposity via magnetic resonance imaging, dietary intake via 24-h dietary recalls, and inflammation markers from fasting blood draws utilizing a multiplex panel. Partial correlations were estimated and analysis of covariance (ancova) models fit to examine the relationship among dietary variables, inflammation markers and adiposity measures with the following a priori covariates: Tanner stage, ethnicity, sex, total energy intake, total body fat and total lean mass.

    RESULTS: Inference based on ancova models showed that the highest tertile of fibre intake (mean intake of 21.3ā€‰Ā±ā€‰6.1ā€‰gā€‰d-1 ) vs. the lowest tertile of fibre intake (mean intake of 7.4ā€‰Ā±ā€‰1.8ā€‰gā€‰d-1 ) was associated with 36% lower plasminogen activator inhibitor-1 (Pā€‰=ā€‰0.02) and 43% lower resistin (Pā€‰=ā€‰0.02), independent of covariates. Similar results were seen for insoluble fibre. No other dietary variables included in this study were associated with inflammation markers.

    CONCLUSIONS: These results suggest that increases in dietary fibre could play an important role in lowering inflammation and therefore metabolic disease risk in high-risk minority youth.

    Be well!


  16. JP Says:



    Stroke. 2015 Mar 31.

    Multivitamin Use and Risk of Stroke Mortality: The Japan Collaborative Cohort Study.

    BACKGROUND AND PURPOSE: An effect of multivitamin supplement on stroke risk is uncertain. We aimed to examine the association between multivitamin use and risk of death from stroke and its subtypes.

    METHODS: A total of 72ā€‰180 Japanese men and women free from cardiovascular diseases and cancers at baseline in 1988 to 1990 were followed up until December 31, 2009. Lifestyles including multivitamin use were collected using self-administered questionnaires. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) of total stroke and its subtypes in relation to multivitamin use.

    RESULTS: During a median follow-up of 19.1 years, we identified 2087 deaths from stroke, including 1148 ischemic strokes and 877 hemorrhagic strokes. After adjustment for potential confounders, multivitamin use was associated with lower but borderline significant risk of death from total stroke (HR, 0.87; 95% confidence interval, 0.76-1.01), primarily ischemic stroke (HR, 0.80; 95% confidence interval, 0.63-1.01), but not hemorrhagic stroke (HR, 0.96; 95% confidence interval, 0.78-1.18). In a subgroup analysis, there was a significant association between multivitamin use and lower risk of mortality from total stroke among people with fruit and vegetable intake <3 times/d (HR, 0.80; 95% confidence interval, 0.65-0.98). That association seemed to be more evident among regular users than casual users. Similar results were found for ischemic stroke.

    CONCLUSIONS: Multivitamin use, particularly frequent use, was associated with reduced risk of total and ischemic stroke mortality among Japanese people with lower intake of fruits and vegetables.

    Be well!


  17. JP Says:

    Update 05/27/15:


    Nutrients. 2015 May 19;7(5):3796-812.

    Improved blood biomarkers but no cognitive effects from 16 weeks of multivitamin supplementation in healthy older adults.

    Supplementation with vitamins, minerals and phytonutrients may be beneficial for cognition, especially in older adults. The aim of this study was to assess the effects of multivitamin supplementation in older adults on cognitive function and associated blood biomarkers. In a randomised, double blind, placebo-controlled trial, healthy women (n = 68) and men (n = 48) aged 55-65 years were supplemented daily for 16 weeks with women’s and men’s formula multivitamin supplements. Assessments at baseline and post-supplementation included computerised cognitive tasks and blood biomarkers relevant to cognitive aging. No cognitive improvements were observed after supplementation with either formula; however, several significant improvements were observed in blood biomarkers including increased levels of vitamins B6 and B12 in women and men; reduced C-reactive protein in women; reduced homocysteine and marginally reduced oxidative stress in men; as well as improvements to the lipid profile in men. In healthy older people, multivitamin supplementation improved a number of blood biomarkers that are relevant to cognition, but these biomarker changes were not accompanied by improved cognitive function.

    Be well!


  18. JP Says:

    Updated 12/18/16:


    Evid Based Complement Alternat Med. 2016;2016:3092828.

    The Effects of Four-Week Multivitamin Supplementation on Mood in Healthy Older Women: A Randomized Controlled Trial.

    Objective. Nutritional deficiencies have been associated with cognitive decline and mood disturbances. Vitamin intake can influence mood and randomized controlled trials have demonstrated that multivitamin supplements are capable of reducing mild symptoms of mood dysfunction. However, few studies have focussed on healthy older women. Methods. This study investigated the effects of four weeks’ multivitamin supplementation on mood in 76 healthy women aged 50-75 years. Mood was assessed before and after intervention in the laboratory using measures of current mood and retrospective experiences of mood over the past week or longer. Mobile phones were used to assess changes in real-time mood ratings, twice weekly in the home. Results. There were no multivitamin-related benefits identified for measures of current mood or reflections of recent mood when measured in the laboratory. In-home assessments, where mood was rated several hours after dose, revealed multivitamin supplementation improved ratings of stress, with a trend to reduce mental fatigue. Conclusions. Over four weeks, subtle changes to stress produced by multivitamin supplementation in healthy older women may not be detected when only pre- and posttreatment mood is captured. In-home mobile phone-based assessments may be more sensitive to the effects of nutritional interventions compared to traditional in-laboratory assessments.

    Be well!


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