The vitamin wars.

Dietary supplements either keep you well, make you sick or just rip you off, depending on who you ask

Be comforted: You're not the only literate person who has never heard of echinacea. If you feel guilty because you ran out of antioxidants two months ago and still haven't replenished your supply, or you keep forgetting to take your chromium picolinate, relax.

Not every doctor or nutritionist thinks you should ingest a litany of supplements every day. Some think a basic multivitamin is enough of a boost; some, like Drs. Stephen Barrett and Victor Herbert in their book The Vitamin Pushers, say even that is unnecessary.

Other experts agree with Natural Health magazine, which points out in a July 1995 article that, since only nine percent of all Americans eat the recommended five daily servings of fruits and vegetables necessary for minimum wellness, we should take supplements regularly.

Only on one point will you find consensus: We should get our nutrients from food if at all possible. "Food always works better,"says Audrey Cross, associate clinical professor at Columbia University and President Carter's human nutrition policy coordinator. "Research bears this out over and over. It's important that you not give yourself a false sense of security by taking supplements."

Necessary or not, dietary supplements are big business. A Newsweek poll shows that seven in 10 Americans use vitamins at least occasionally, and supplement sales are expected to top $4 billion in 1996. We take vitamins, minerals and other supplements because we believe they will stop us from getting a chronic disease, give us energy, help us concentrate or lose weight.

Research supports some claims. In one study at West Virginia University in Morgantown, patients with bladder cancer were given a vaccine; half were also given high doses of vitamins A, B6, C and E. No one was cured, but 80 percent of those who did not take vitamins developed new tumors after two years of therapy, while only 40 percent of vitamin-takers got new tumors - and those who took vitamins lived nearly twice as long as the others.

Other studies have found similar, positive effects of taking vitamins: In one trial with 120,000 participants, vitamin E reduced the risk of heart disease by about 40 percent. Other studies show that B vitamins can help prevent birth defects and that a deficiency of vitamin D, which is produced when the skin is exposed to sunlight, contributes to osteoporosis (disabling bone decay), and breast, colon and prostate cancer. And a National Cancer Institute survey of 20 clinical studies showed a consistent link between high levels of beta carotene and a low incidence of lung cancer; similar, less-dramatic relationships appeared between beta carotene and cancers of the mouth, throat, stomach, bladder and rectum.

Last July, the respected Tufts University Diet and Nutrition Letter noted that people living in regions with low sunlight are more likely to suffer from a vitamin D deficiency and could potentially suffer broken bones. The remedy, the piece concluded, is a vitamin D-rich diet and supplements.

Some experts practice what they preach: Fitness guru Dr. Dean Ornish takes a multivitamin and 3,000 milligrams (mg) of vitamin C every day. Dr. William Castelli, director of the Framingham Heart Study, takes a multivitamin, 500 mg of vitamin C and 400 international units (iu) of vitamin E daily. But no one walked the walk like the late Linus Pauling, two-time Nobel Prize winner, who before his death at 93 took 18,000 mg of vitamin C daily. (The U.S. Recommended Dietary Allowance [RDA] is only 60 mg.)

But the voices of caution are just as clear. "Some of the vitamins weren't discovered until 50 years ago," says Ann C. Grandjean, director of The Center for Human Nutrition in Omaha. "We're talking about a real infant discipline here - a very new science."

Amy Subar, research nutritionist for the National Cancer Institute, agrees. "I think multiple vitamins don't hurt most people," she says, "but most people take extra doses...We can't just take these things and assume they're safe." Sounds like good advice - but with such disagreement among the experts, how can consumers make responsible decisions about supplements?

Counseling Moderation

Caution and moderation are the answers heard most often. With vitamins, for instance, consumers should be aware of the distinction between water-soluble vitamins (B and C) and those that are fat-soluble, such as A and D.

Water-soluble vitamins can be excreted quickly in urine, so the toxicity risk with these vitamins is low. But an excess of fat-soluble vitamins is stored in the body, so they can become toxic. Also, doses of vitamin C of more than 1,000 mg have been reported to trigger cramps and diarrhea, and more than 10 times the recommended RDA of vitamin A, or 50,000 iu, can cause dry skin, headaches, nausea, insomnia or joint pain.

It's important, too, to pay attention to interactions between vitamins and other substances - but if you follow that advice, count on becoming mightily confused. If one has a high level of body iron, vitamin C supplements might promote kidney stones, according to a brochure of the American Society for Clinical Nutrition. Coffee or tea with a meal reduces iron absorption by as much as 85 percent; caffeine saps calcium from the system, as does the thyroid medication Synthroid. And calcium hampers one's absorption of iron and zinc.

The U.S. RDA for iron is 10 mg; iron supplements are generally considered safe in doses up to several times that amount - but excess iron can contribute to cirrhosis of the liver and disturb the body's immune function. Individual tolerances to excess iron vary widely, however. If you feel you need an iron supplement, it's recommended that you do not take more than 10 or 20 mg, unless you've been diagnosed as anemic.

Calcium is another mineral that might be overused; some authorities believe that people taking calcium supplements to build bone density would get better results with extra vitamin D. Up to 2,000 mg of calcium per day is considered safe, best absorbed in maximum doses of 500 mg, taken with meals.

Zinc, too, is an essential mineral, especially for the elderly; a zinc deficiency diminishes one's ability to smell. One study of older persons showed a marked improvement in smelling ability after 90 to 120 days of taking zinc supplements.

The most common advice is to avoid supplements that provide more than 100 percent of the U.S. RDA for any mineral. Less clear are guidelines for some of the "hot" new supplements, including chromium picolinate, popular for its fat-burning claims, and the plant-based substances known as "botanicals."

Botanical Perils?

Of perhaps greater concern are the botanicals - an industry in themselves, with 1994 sales estimated at $1.5 billion. The danger with botanicals is the lack of standardization; there are neither U.S. RDAs nor manufacturing standards for such substances. In one study analyzing 54 ginseng products, 25 percent contained no ginseng at all.

And, even in small doses, some botanicals can be harmful. Ma huang, a product of the ephedra plant, is a medicinal herb used in China for more than 5,000 years, but in pill form it's reportedly caused vertigo, heart palpitations, insomnia and high blood pressure.

Some botanicals have positive effects. The University of Kansas Medical Center has documented the antioxidant properties of garlic supplements, for instance. "[Supplements] all have an effect," Audrey Cross says. "The question is, are they worth your money? The answer is, probably no, you'd be better off buying food."

To determine which supplements you might need, Ann Grandjean recommends that consumers look at the federal food pyramid and keep a food diary.

Cross says to take supplements if you will, but first learn all you can about what you're putting into your body, then use moderation. "I say the same thing about supplements that I say about drinking alcohol or eating steak: Don't go overboard."

MARY MIHALY is a freelance writer living in Cleveland.