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Enriched Instructor’s Manual to Accompany Nutrition: Concepts and Controversies, 4Ce
7 The Vitamins
IF NOTHING ELSE, MY STUDENTS SHOULD LEARN…
1. That the structures and functions of vitamins differ from those of the energy-
yielding nutrients. Vitamins are much smaller in size and do not yield energy.
They assist the enzymes that release energy.
2. That the water-soluble vitamins are needed in frequent, small amounts. The fat-
soluble vitamins are important in growth and maintenance of the body.
3. That vitamin deficiencies and toxicities present problems. Toxicities are possible,
especially when supplements are used.
4. That there are eight different B vitamins, which carry out different functions
related to the support of energy metabolism.
5. That free radical production in the body is a major contributor to various diseases,
and that optimal nutritional practices are effective at combating the negative
health effects incurred by these molecules.
6. That the so-called antioxidant vitamins and minerals (vitamins A, C, and E, and
selenium) are effective agents at minimizing the harmful effects of free radicals.
7. The different dietary and nondietary sources for obtaining adequate amounts of
vitamin D and K.
LEARNING OBJECTIVES
Students should be able to:
• LO 7.1: List the fat-soluble and water-soluble vitamins, and describe how
solubility affects the absorption, transport, and excretion of each type.
[Remember/Understand]
• LO 7.2: Discuss the characteristics and functional aspects of fat-soluble

vitamins. [Remember/Understand]
• LO 7.3: Discuss the functional aspects, food sources, precursor, and effects of
deficiency and toxicity of vitamin A. [Understand/Apply]
Copyright © 2018 by Nelson Education Ltd. 7-1

• LO 7.4: Discuss the functional aspects, sources, and effects of deficiency and
toxicity of vitamin D. [Understand/Apply]
• LO 7.5: Discuss the functional aspects, food sources, and effects of deficiency and
toxicity of vitamin E. [Understand/Apply]
toxicity of vitamin K. [Understand/Apply]
• LO 7.7: Summarize the characteristics and functional aspects of water-soluble

vitamins. [Analyze]
toxicity of vitamin C. [Understand/Apply]
• LO 7.9: Discuss the collective functional aspects of B vitamins in metabolism and

the effects of their deficiencies. [Understand/Apply]
• LO 7.10 Discuss the functional aspects, the effects of deficiencies and toxicities,
and food sources of each of the eight B vitamins. [Understand/Apply]
• LO 7.11 Describe how to choose foods to meet vitamin needs.

[Understand/Apply]
• LO 7.12 List some valid reasons that vitamin supplements may be required by
some people and should not be taken by others. [Understand/Apply]
WHY IS THIS CHAPTER IMPORTANT TO SCIENTISTS AND

HEALTH-CARE PRACTITIONERS?
• Learning about the roles of the different vitamins in the body has been an
important pursuit of nutrition scientists. We now know that there are optimal
nutrient levels for vitamins and that too much or too little may have adverse
effects on one’s health. Scientists are continuously studying the effects of vitamin
supplementation and deprivation on the body.
• Nutrition scientists are gaining a better understanding of the biological roles that
vitamins play in maintaining health and preventing disease. It is now believed that
cardiovascular disease and cancer may be linked to low intakes of vitamins.
Scientists in genetics are studying the ways in which chronic deficiencies (or
some excesses) of vitamins and minerals may contribute to genetic damage that
can lead to the development of disease.
• Much of the information that we have on the role of vitamins (deficiency and
toxicity symptoms) in the body has been obtained from research using animal
7-2 Copyright © 2018 by Nelson Education Ltd.

models. These observations were then made on patients who experienced

deficiency and/or toxicity symptoms. Scientists continue to study the effects of
excess or deficiency in vitamin intake for each of the water- and fat-soluble
vitamins.
• Scientists have observed a relationship between oxidative stress (i.e., free radical
production) and the development of various diseases and are currently studying
the damage caused by free radicals. Health-care practitioners recognize the
importance of ensuring an adequate intake of vitamins A, C, and E, and selenium
to minimize the harmful effects of free radicals.
• Vitamin D insufficiency is relatively common in Canada due to its northern

geographical location, thereby affecting the magnitude of the sun’s energy in
stimulating the skin to begin the body’s synthesis of this vitamin. For this reason,
health-care practitioners regularly counsel patients/clients to make a conscious
effort, particularly during the winter months, to increase their vitamin D intake.
• Although vitamin K deficiencies are rare, scientists are trying to determine the
long-term effect on bone development and maintenance. Obtaining vitamin K, via
green vegetables and vegetable oils, is recognized by health-care practitioners
to be an important part of one’s diet, as vitamin K synthesis in the gastrointestinal
tract only supplies about half of our daily requirement.
• Vitamin C has always been recommended as a preventive measure against colds.

However, the theory that vitamin C prevents or cures colds or cancer is not well
supported by research. Scientists are studying the ways vitamin C may alter
cellular and molecular immune function in order to address this issue.
• There is some research to support the finding that vitamin B supplementation

(folate, vitamin B6, and vitamin B12) lowers circulating levels of homocysteine
and reduces the risk of heart disease. However, more research is needed to
confirm this benefit of vitamin B supplementation.
• Health-care practitioners should be aware of the problems associated with

vitamin B deficiencies or toxicities. Problems such as beriberi, ariboflavinosis,
pellagra, and neural tube defects in the developing fetus are known to result from
various B vitamin deficiencies. Although the B vitamins are water-soluble and
carry little risk of toxicity, taking excessive amounts of niacin, folate, and vitamin
B6 can lead to the development of various symptoms.
WHY SHOULD STUDENTS CARE?
• Students should be aware that vitamins are essential, non-Caloric nutrients; are
needed in tiny amounts in the diet; and help to drive cell processes in the body.

The fat-soluble vitamins are vitamins A, D, E, and K; the water-soluble vitamins

are vitamin C and the B vitamins. Students need to have an understanding of the
role of each of the fat- and water-soluble vitamins, as summarized below.
• Vitamin A is essential to vision, integrity of epithelial tissue, bone growth,

reproduction, and more. Vitamin A deficiency causes blindness, sickness, and
death and is a major problem worldwide. Overdoses are possible and may cause
many serious problems. Foods are preferable to supplements for supplying
vitamin A. The vitamin A precursor in plants, beta-carotene, is an effective
antioxidant in the body. Brightly coloured plant foods are richest in beta-carotene,
and diets containing these foods are associated with eye health.
• Vitamin D raises mineral levels in the blood, notably calcium and phosphorus,
permitting bone formation and maintenance. People exposed to the sun make
vitamin D from a cholesterol-like compound in their skin; fortified milk is an
important food source. A deficiency can cause rickets in childhood or
osteomalacia in later life. Vitamin D is the most toxic of all the vitamins, and
excesses are dangerous or deadly.
• Vitamin E acts as an antioxidant in cell membranes and is especially important

for the integrity of cells that are constantly exposed to high oxygen
concentrations, namely, the lungs and blood cells, both red and white. Vitamin E
deficiency is rare in human beings, but it does occur in newborn premature
infants. The vitamin is widely distributed in plant foods; it is destroyed by high
heat; toxicity is rare.
• Vitamin K is necessary for blood to clot; deficiency causes uncontrolled

bleeding. The bacterial inhabitants of the digestive tract produce vitamin K.
Toxicity causes jaundice.
• Vitamin C, an antioxidant, helps to maintain collagen, the protein of connective

tissue; protects against infection; and helps in iron absorption. Lack of vitamin C
has been associated with scurvy. Ample vitamin C can be obtained from foods.
• The B vitamins facilitate the work of every cell. Some help generate energy;
others help make protein and new cells. B vitamins work everywhere in the body
tissue to metabolize carbohydrate, fat, and protein. Historically, famous B
vitamin–deficiency diseases are beriberi (thiamin), pellagra (niacin), and
pernicious anemia (vitamin B12). Pellagra can be prevented by adequate protein
because the amino acid tryptophan can be converted to niacin in the body. A high
intake of folate can mask the blood symptoms of vitamin B12 deficiency but will
not prevent the associated nerve damage. Vitamin B6 is important in amino acid
metabolism and can be toxic in excess. Biotin and pantothenic acid are important
to the body and are abundant in food.

WHAT ARE COMMON STUDENT MISCONCEPTIONS/

STUMBLING BLOCKS?
1. Students often erroneously think that processed foods have the same nutrient
value as fresh foods (See Lecture Enhancement 7–1.)
2. Students have the misconception that taking vitamins is just as good as or even
better than eating regular, balanced meals. (See Lecture Enhancement 7–3.)
3. Students often do not pay enough attention to the inclusion of vitamins and
minerals in their diet, while focusing too much on the proportion of fats,
carbohydrates, and protein. Students should be aware that during periods of stress
or intense physical exercise, the body generates large amounts of free radicals,
which an adequate amount of vitamins C and E, as well as selenium, is successful
at neutralizing.
4. Many students think that taking large doses of vitamin C will prevent the common
cold. Students should be aware that there is a lack of scientific evidence
supporting this claim, and that even though this vitamin is water-soluble,
megadoses can result in the development of toxicity symptoms.
5. There is a common misconception that taking lots of vitamins is good for you.
Students often do not realize that the fat-soluble vitamins are stored in the body
and can potentially build up to toxic levels if they are taken in excess. With
respect to the water-soluble B vitamins, toxicity problems are possible with
niacin, folate, and vitamin B6.
6. Although remembering the role of each vitamin in the body can be overwhelming
to students, a discussion of each one separately, followed by an example of either
toxicity or deficiency symptoms, is helpful.
WHAT CAN I DO IN CLASS?

A variety of activities can be done in class. Described below are lecture enhancements
that can be integrated into your lecture. Classroom activities that will help introduce and
describe the features of vitamins are also included.
LECTURE ENHANCEMENTS
Lecture Enhancement 7–1: Food Processing and Nutrient Density
In general, food processing involves a trade-off: it makes foods safer and produces foods
with longer usable lifetimes than those of fresh foods, at the cost of some vitamin and
mineral losses. In some instances, however, processed foods have the edge over their

unprocessed counterparts, even in terms of nutritional quality. This section explains each
of the processing techniques and the effects they have on the nutrient content of food.
Canning. Canning is one of the better methods for preserving foods against the microbes
(bacteria, fungi, and yeasts) that might otherwise spoil them. Unfortunately, foods do lose
nutrients in the canning process. Like other heat treatments, the canning process depends
on time and temperature. Each small increase in temperature has a major killing effect on
microbes with only a minor effect on nutrients. By contrast, long treatment times are
costly in terms of nutrient losses. Therefore, the industry chooses treatments that employ
the high temperature–short time (HTST) principle for canning.
The extent of nutrient losses from canning depends, in part, on the characteristics of the
particular nutrient. The stability of the fat-soluble vitamins allows them to remain mostly
unaffected by canning. The inorganic character of minerals protects them from the
damages that heat processing inflicts on the vitamins. However, both minerals and
vitamins can be lost when they leak into water that is then thrown away. The extent of
losses closely relates to the extent food tissues have been broken, cut, or chopped, and to
the length of time the foods remain in water. In some cases, manufacturers add minerals,
such as sodium chloride, to foods during the canning process. Anyone who wishes to
control salt intake will want to use unprocessed food to the greatest extent possible and
foods labelled low-sodium when using processed foods.
Freezing. An alternative to canning, as a means of preserving food, is freezing. The

freezing process itself does not destroy nutrients, but losses may occur during the steps
taken in preparation for freezing, such as blanching, washing, trimming, or grinding.
People often wonder if frozen foods are less nutritious than fresh foods. In fact, the two
are usually quite close. In some instances, frozen foods may even be more nutritious.
Fresh foods are often shipped long distances, and to make the trip without bruising or
spoiling, they are often harvested unripe. Frozen foods are shipped frozen, so produce is
allowed to ripen in the field and develop nutrients to their fullest potential. If frozen foods
are prepared and stored under proper conditions, they will often contain more nutrients
when served at the table than fresh fruits and vegetables that have stayed in the produce
department of the grocery store even for a day.
Frozen foods have to be kept at a temperature colder than 0°C to retain their nutrients. In
general, the lower the temperature, the longer the storage life and the greater the nutrient
retention. Food may seem frozen at 2°C, but much of it is actually unfrozen, and enzyme-
mediated changes occur more rapidly than they would if the food item were solidly
frozen.
Drying. Drying foods eliminates microbial spoilage (because microbes need water to
grow), and it greatly reduces the weight and volume of foods (because foods are mostly
water). Conventional drying exposes foods to heat and oxygen, which can cause major
nutrient losses for specific vitamins, such as vitamins A and C. Vacuum puff drying and
freeze drying take place in cold temperatures and conserve nutrients especially well.

During the drying of fruits such as peaches, grapes (raisins), and plums (prunes), sulphite
additives are used to prevent browning. This helps to preserve vitamin C as well, but it is
highly destructive of thiamin. The overall effect of adding sulphites is probably
beneficial, because most sulphured, dehydrated products are not major sources of thiamin
anyway.
Extrusion. Some food products, particularly snack foods, have undergone a process
known as extrusion. In this process, the food is heated, ground, and pushed through
various kinds of screens to yield different shapes, usually bite-size or smaller, like pieces
of breakfast cereal or the “bits” you sprinkle on salad—so-called food novelties.
Considerable nutrient losses occur during extrusion processes, and nutrients are usually
added to compensate. Foods this far removed from their original fresh sources are still
lacking significant nutrients, and consumers should not rely on them as staple foods.
Enjoy them, but only as occasional snacks and as additions to enhance the appearance,
taste, and variety of meals.
Should everyone avoid all processed food? The answer depends on the food and on the
process. Consider the case of orange juice and vitamin C. Orange juice is available in
several forms, each processed in a different way. Fresh juice is simply squeezed from the
orange—a process that extracts the fluid juice from the fibrous structures that contain it.
The fresh-squeezed juice, per 100 Calories, contains 111 milligrams of vitamin C. If this
juice were condensed by heat, frozen, and then reconstituted, as is the juice in the freezer
case of the grocery store, 100 Calories of the reconstituted juice would contain just 88
milligrams of vitamin C—vitamin C is destroyed in the condensing process. Canning is
even harder on the vitamin C content of orange juice—100 Calories of canned juice has
82 milligrams.
These figures may seem to indicate that fresh juice is the superior food, and so it is—but
consider that the RDA for vitamin C is 90 milligrams for men and 75 milligrams for
women, an amount covered almost single-handedly by one serving of any of the above
choices. Consumers can consider the losses due to processing of orange juice tolerable,
especially in view of the convenience and distribution advantages of the processed
products. Fresh orange juice spoils. It cannot be stored indefinitely without
compromising nutrient quality. Shipping it to distant points would make it much more
expensive than frozen or canned juice. Without canned or frozen juice, people who have
no access to the fresh juice would be deprived of this excellent food.
Some processing stories are not so rosy. Processed foods are often loaded with sodium as
their potassium is leached away. A related mischief of processing is the addition of sugar
and fat—palatable, high-Calorie additives that reduce nutrient density. An example is
nuts and raisins covered with natural “yogurt.” This may sound like one healthy food
being added to another, but a look at the ingredient panel warns that generous amounts of
fat and sugar accompany the yogurt. About 75 percent of the weight of the product is fat
and sugar, and about 8 percent is yogurt.

A generalization worth confirming here is that the more processed a food, the lower its
nutrient value. However, some processed foods provide more nourishment than others.
Consumers face the choice at the grocery store of selecting fresh whole foods or
minimally processed foods at one extreme, or at the other extreme, the so-called
partitioned foods that are constructed from fractions of plant and animal tissues—fats,
sugar, alcohol, and refined flour. Two-thirds of the food energy consumed in the North
American diet comes from the latter type, the partitioned foods, which are completely, or
almost completely, empty of nutrients (unless you count energy as a nutrient). Only one-
third of the food energy in the North American diet comes from relatively whole foods—
whole in the sense of being relatively unaltered from their original farm-grown state—
foods that contribute virtually all of our nutrients.
For an optimally nutritious diet, choose whole foods to the greatest extent possible.
Realistically, few people have the time to bake their own bread, to shop every few days
for fresh meats, or to plant, harvest, wash, peel, chop, and cook fresh fruits and
vegetables at each meal. Food processing can provide a valuable service. Commercially
prepared whole-grain breads, frozen cuts of meats, bags of frozen vegetables, and fruit
juices do no violence to nutrition and enable the consumer to eat a wide variety of lightly
processed foods.
This discussion has focused on processed foods, but has concluded that fresh foods are
still a good choice when they are available. A pointer on shopping for them: pick the
healthy looking ones. They don’t have to be shiny, artificially coloured, or even free of
the dirt from the field—you can wash them at home. But keep in mind that as food
quality (appearance, taste, and texture) deteriorates, nutrient content also declines. If your
common sense tells you that a food “doesn’t look quite right,” trust it.
While the kinds of foods you buy certainly make a difference, what you do with them in
your kitchen makes a major difference, too. These facts put the matter of food processing
into perspective: in modern commercial processing, losses of vitamins seldom exceed 25
percent. In contrast, losses in food preparation at home can be 60 to 100 percent.
Food Storage and Preparation

Once you have brought nutritious foods home from the store, you have the task of storing
and preparing them in such a way that they deliver the nutrients to you when you eat
them. Because vitamin C is one of the most vulnerable of the vitamins, it can be used to
demonstrate the principles involved, but remember, foods containing any of the water-
soluble vitamins deserve the same care as foods rich in vitamin C.
Vitamin C is an organic compound synthesized and broken down by enzymes found in

the fruits and vegetables that contain it. The enzymes work best at the temperatures at
which the plants grow, normally about 21°C, which is also the room temperature in most
homes. After a fruit has been picked, and the synthesis of vitamins (which has depended
on a continued influx of energy from sunlight) largely stops, degradation continues.
Chilling the fruit slows the degradation. To protect the vitamin C content, fruits and

vegetables should be vine ripened (if possible), chilled immediately after picking, and
kept cold until they are used.
Because it is an acid and an antioxidant, vitamin C is most stable in an acid solution,

away from air. Citrus fruits, tomatoes, and many juices are acidic enough to favour the
stability of the vitamin. As long as the skin is uncut or the can is unopened, the vitamin is
protected from air. If you store a cut vegetable or fruit or an opened container of juice,
cover it with an airtight wrapper and store it in the refrigerator.
Being water soluble, vitamin C readily dissolves into the water in which cut vegetables
are washed, boiled, or canned. If the water is discarded, as much as half of the vitamin is
poured down the drain with it. To minimize this kind of loss, steam vegetables over water
rather than in it, boil them in a volume of water small enough to be reabsorbed into them
by the time they are cooked, or cook them with a little water in a microwave oven. To
prevent losses during washing, wash the food before cutting it. To minimize the oxidation
of vitamin C, avoid high temperatures and long cooking times.
Manufacturers usually show the nutrient contents of canned foods as “solids and liquids.”
If you throw away the liquid from a canned food, you are throwing away some of the
nutrients that have leaked into that liquid. A bit of southern folk wisdom is to serve the
cooking liquid with the vegetable rather than throwing it away; this liquid is known as the
“pot liquor.” The user of canned vegetables who can think of a way to use the “liquor”—
for example, by saving it to make soups, cook rice, or moisten casseroles—is displaying
similar wisdom.
Lecture Enhancement 7–2: Resurgence of Rickets in North America1
Rickets seems to be on the rise because young children are consuming “health food”
beverages instead of milk, the primary dietary source of calcium and vitamin D. Young
children were reported to be suffering from undernutrition because their parents fed them
soy- or rice-based beverages that did not contain vitamin D instead of cow’s milk.
In addition to soy- and rice-based beverages, there is concern that children may be
drinking excessive amounts of soft drinks, juice, and juice drinks in place of milk. These
beverages don’t contain the nutritional profile of cow’s milk, and are increasingly being
substituted for milk. Even calcium-fortified juices and juice drinks do not contain
vitamin D.
This is a situation of nutrition ignorance rather than food deprivation in this country.
Today, there’s a renewed urgency for pediatricians to monitor rickets. The Canadian
Pediatric Society and the American Academy of Pediatrics have suggested overall
evaluation of a child’s diet along with detailed counselling and parental education with a
registered dietitian when necessary.
1
N. F. Carvalho and coauthors: Severe nutritional deficiencies in toddlers resulting from “health food”
milk alternatives. Pediatrics 107 (2001): 1–7.

Lecture Enhancement 7–3: Dietary Antioxidants: Best from Food or

from Pills?2
Dietary antioxidants have become household words. Consumers want to know which of
these metabolic busybodies might be beneficial and how much they need to obtain the
benefits. Knowledgeable people claim that eating foods rich in vitamin C, vitamin E,
beta-carotene and other carotenoids, and the mineral selenium, is the best path to disease
prevention. Others claim that supplements providing large doses are more reliable allies.
To tell who is right, consumers must weigh the evidence on both sides. This enhancement
offers a way to score foods versus supplements as sources of these beneficial compounds.
Most of the results presented here are preliminary. The roles some of these compounds
play in promoting health have not been fully defined, and research has provided only
mixed results for others. Much of the evidence is from epidemiological or observational
studies, which suggest interesting possibilities but have no specific implications for
individuals. So proceed with caution and demand rigorous, repeated testing before you
consider a finding confirmed—but do proceed. The evidence that lies before you holds
secrets that are quickly evolving into tomorrow’s nutrition concepts.
Free Radicals, Oxidative Stress, and Disease

The body’s cells use oxygen to produce energy. In the process, oxygen sometimes reacts
with body compounds to produce highly unstable molecules known as free radicals. In
addition to normal body processes, environmental factors such as radiation, pollution,
tobacco smoke, and others can act as oxidants and cause free-radical formation. The
trouble begins when free radicals in the body exceed its defences against them, a
condition known as oxidative stress.
A free radical is a molecule with one or more unpaired electrons.3 An electron without a
partner is unstable and highly reactive. To regain stability, the free radical finds a stable
but vulnerable compound from which to steal an electron. With the loss of an electron,
the formerly stable molecule becomes a free radical itself and steals an electron from
some other nearby molecule, setting off an electron-snatching chain reaction.
Free radicals are like sparks, starting wildfires that lead to widespread damage by
oxidative stress. Free-radical damage commonly disrupts unsaturated fatty acids in cell
membranes, damaging the membranes’ ability to transport substances into and out of
cells. Free radicals also cause damage to cell proteins and to DNA, disrupting all cells
that inherit the damaged DNA. Quantifying the body’s level of oxidative stress involves
2(Adapted from Controversy 7 from Nutrition: Concepts and Controversies, 3rd Canadian edition.)
3
Oxygen-derived free radicals are common in the human body. Examples are superoxide radical (O2•2),
hydroxyl radical (OH•), and nitric oxide (NO•). The dots in the symbols represent the unpaired electrons.
Scientists sometimes use the term reactive oxygen species (ROS) to describe all of these compounds.

testing the blood for increases of metabolic products of oxidized fatty acid or protein
molecules.4
Researchers have identified tentative links between oxidative stress and the development
of more than 200 diseases. Among them are age-related blindness, arthritis, cancers,
cardiovascular disease, cataracts, and kidney disease and other complications of
diabetes.5 Physical aging itself is thought by some to be the result of unrepaired free-
radical damage that accumulates over the years, although no evidence to date clearly
supports this idea.6 Still, antioxidants seem to be part of the answer, whatever the
question about nutrition.
While research focuses on damage caused by free radicals, they are not all bad. Their
destructive properties are put to good use by some cells of the immune system. These
cells stockpile free radicals to use as ammunition in an “oxidative burst” against the
viruses and bacteria that might otherwise cause diseases. Thus, infections cause a
detectable increase in free-radical activity all over the body.
The Body’s Defences against Free Radicals

The body’s two main systems of defence against damage from free radicals are its
reserves of antioxidants and its enzyme systems that oppose oxidation.7 These defence
systems try to handle all free radicals, but they are not 100 percent effective. If
insufficient radical-fighting agents are present in the body, if free radicals become
excessive, or if the body’s repair systems cannot undo all of the damage, health problems
can develop.
Antioxidant Nutrients. Vitamin E and vitamin C actively scavenge and quench free
radicals in the body, becoming oxidized themselves in the process. Once oxidized,
vitamin C and vitamin E can to some extent be regenerated to become active antioxidants
again, but some are dismantled and discarded. Free radicals attack the body continuously,
so to maintain defences, a person’s supplies of dietary antioxidants must be replenished
as rapidly as they are used up.
Vitamin E’s special antioxidant role includes protecting body lipids by breaking the free-
radical chain reaction at a rate 200 times as fast as BHT (butylated hydroxytoluene), a
commercial antioxidant added to baked goods to prevent rancidity from fat oxidation.
The fat-soluble vitamin E defends lipids in cell membranes to maintain optimal
functioning. Vitamin C is adept at neutralizing free radicals from polluted air and
4
Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, Food and Nutrition
Boards, Institute of Medicine, Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and
Carotenoids (Washington, D.C.: National Academy Press, 2000), pp. 45–46.
5
C. L. Rock, R. A. Jacob, and P. E. Bowen, Update on the biological characteristics of the antioxidant
micronutrient: Vitamin C, vitamin E, and the carotenoids, Journal of the American Dietetic Association 96
(1996): 693–702.
6
H. Hu and coauthors, Antioxidants may contribute in fight against ageing: An in vitro model, Mechanism
of Ageing and Development 121 (2001): 217–230.
7
Internal enzyme systems include an enzyme–selenium complex and the superoxide dismutase (SOD)
system.

cigarette smoke and restoring oxidized vitamin E to its active state. Though a water-
soluble compound itself, vitamin C may also protect blood lipids against oxidation by
maximizing the total antioxidant capacity of the tissues.
It may seem logical to conclude that if body tissues could be drenched in extra amounts
of antioxidants, then more free radicals could be quenched, and less damage to cells
would bring better health. This line of thinking is used to sell millions of dollars’ worth
of antioxidant supplements each year. However, current evidence does not support such
conclusions. Most positive findings come from antioxidants as they occur naturally in
foods, not in supplements, and so the protection may arise from other features of a diet
rich in antioxidant-containing foods or from some other unidentified lifestyle factor.8
Recognizing this uncertainty, we begin our tally of points for foods versus supplements at
zero points for both.
Internal Defence Systems. In addition to using antioxidant compounds from foods, the
body defends itself against oxidative stress by making a powerful set of cellular enzymes
that specialize in neutralizing free radicals.9 These enzymes are proteins whose
concentrations are controlled both by inherited genes and by influences affecting those
genes. One type of enzyme that contains the mineral selenium breaks down oxidizing free
radicals.10 Another radical-quenching enzyme is superoxide dismutase (SOD), which has
been purified for sale as an anti-aging supplement. Because these enzymes are proteins
made by the body, however, they are useless as dietary supplements. Enzymes taken by
mouth are digested in the stomach and small intestine long before they reach the
bloodstream. In our scoring of foods versus supplements, then, neither gains a point here.
Phytochemicals. Some phytochemicals have antioxidant activity although they work in

many other ways, too. One phytochemical filters incoming light, another slows blood
clotting, some act as hormones, others inhibit harmful chemical reactions, still others
stimulate immunity, and many act by mechanisms as yet unknown. Based on the
evidence, which is the better choice—foods or supplements? The complex combinations
of phytochemicals in foods score a major point in favour of foods: Foods, 1;
Supplements, 0.
Do Dietary Antioxidants Protect against Cancer?

Cancers arise when cellular DNA is damaged—sometimes by free-radical attacks. If
dietary antioxidants protect DNA from this damage, then they probably reduce cancer
risks. The strongest evidence that they do is found in studies showing that populations
with high intakes of vegetables and fruits, foods rich in antioxidants, most often have low
rates of cancer.11 Laboratory studies with animals and with cell cultures seem to support
such findings.
8
G. Cao and coauthors, Increases in human plasma antioxidant capacity after consumption of controlled
diets high in fruit and vegetables, American Journal of Clinical Nutrition 68 (1998): 1081–1087.
9
Proteins that bind the minerals iron and copper also help in controlling oxidation.
10
J. L. Groff and S. S. Gropper, Advanced Nutrition and Human Metabolism (Belmont, CA: Wadsworth
Thomson Learning, 2000), pp. 366–367.
11
M. P. Longnecker and coauthors, Intake of carrots, spinach, and supplements containing vitamin A in
relation to breast cancer, Cancer, Epidemiology, Biomarkers and Prevention 6 (1997): 887–892; World

Beta-Carotene and the Carotenoids. Populations with high cancer rates have been
found to consume few vegetables and fruits, especially those containing beta-carotene
and other carotenoids. This evidence is strengthened by the finding that people with the
highest concentrations of beta-carotene in their blood suffer less often from cancers of the
mouth, throat, cervix, ovaries, and lung than people with lower beta-carotene values.12
For a while, this evidence was touted as conclusive proof of beta-carotene’s protective
anticancer effect, and consumers across the nation bought and took beta-carotene
supplements in hopes of preventing cancer.
Support for beta-carotene supplements soon crumbled, however, as studies showed no

lessening of cancer incidence with the use of supplements.13 For example, a long-term
study reported no differences in disease rates between physicians who took beta-carotene
for 14 years and a matched group who took placebos.14 A similar study of almost 20,000
women detected no benefit or harm from taking beta-carotene supplements over two
years.15 And a disquieting result came from a study of beta-carotene supplements and the
incidence of lung cancer among smokers: major clinical trials of beta-carotene
supplements were immediately ceased upon finding a 28 percent jump in lung cancer
among the participants taking beta-carotene, but not among the controls taking
placebos.16
Subsequent research has been mixed in this regard, with some confirming an excess of
lung cancer among smokers who take beta-carotene and some finding no effect. At the
same time, several studies have provided evidence that beta-carotene from foods
correlates with a lower lung cancer risk, but there’s no telling whether the beta-carotene
Cancer Research Fund/American Institute for Cancer Research, Food, Nutrition and the Prevention of
Cancer: A Global Perspective (American Institute for Cancer Research, 1997), pp. 436–446.
12
E. R. Berton and coauthors, A population-based case-control study of carotenoid and vitamin A intake
and ovarian cancer (United States), Cancer Causes and Control 12 (2001): 83–90; Standing Committee on
the Scientific Evaluation of Dietary Reference Intakes, 2000, p. 346; Y. M. Peng and coauthors,
Concentrations of carotenoids, tocopherols, and retinol in paired plasma and cervical tissue of patients with
cervical cancer, precancer, and noncancerous diseases, Cancer, Epidemiology, Biomarkers and Prevention
7 (1998): 347–350; Y. Kumagai and coauthors, Serum antioxidant vitamins and risk of lung and stomach
cancers in Shenyang, China, Cancer Letters 129 (1998): 145–149; A. R. Giuliano and coauthors,
Antioxidant nutrients: Associations with persistent human papillomavirus infection, Cancer, Epidemiology,
Biomarkers and Prevention 6 (1997) 917–923.
13
S. T. Mayne, Beta-carotene, carotenoids, and disease prevention in humans, FASEB Journal 10 (1996):
690–701; E. R. Greenberg and coauthors, A clinical trial of antioxidant vitamins to prevent colorectal
adenoma, New England Journal of Medicine 33 (1994): 141–147.
14
K. Smigel, Beta-carotene fails to prevent cancer in two major studies; CARET intervention stopped,
Journal of the National Cancer Institute 88 (1996): 145; G. S. Omenn and coauthors, Effects of a
combination of beta-carotene and vitamin A on lung cancer and cardiovascular disease, New England
Journal of Medicine 334 (1996): 1150–1155.
15
I. Min Lee and coauthors, β-carotene supplementation and incidence of cancer and cardiovascular
disease: The Women’s Health Study, Journal of the National Cancer Institute 91 (1999): 2102–2106.
16
Smigel, 1996; Omenn and coauthors, 1996; O. P. Heinonen, J. K. Huttunen, and D. Albanes (and other
participants in the alpha-tocopherol, beta-carotene cancer prevention study group), The effects of vitamin E
and beta-carotene on the incidence of lung cancer and other cancers in male smokers, New England Journal
of Medicine 330 (1994): 1029–1035.

itself or some other constituent of the food deserves the credit.17 On the basis of such
findings, the DRI committee concluded that supplements of beta-carotene provide no
benefits and may cause harm to certain people.
Thus, we have an apparent contradiction: abundant beta-carotene from food and elevated
beta-carotene in the blood are associated with lower cancer incidence, but the taking of
beta-carotene supplements is not. These results lead to the conclusion that beta-carotene
itself is not responsible for an anticancer effect, but simply tags along as a marker for
another unknown factor that occurs along with it. Beta-carotene is just one of the dietary
antioxidants present in fruits and vegetables, and such foods also contain other disease-
fighting nutrients. These include vitamin A itself (which can arise from beta-carotene),
vitamin B6, folate, pantothenic acid, vitamin B12, zinc, iron, copper, selenium, and more.
In addition to all of these nutrients, hundreds of phytochemicals are present in fruits and
vegetables, too. Health effects attributed to beta-carotene may, in reality, be the work of
one or a number of phytochemicals or the fibre provided by these foods. In truth, it could
be an entire diet chosen by eaters of fruits and vegetables that makes the difference, or
even an entire lifestyle. Still, evidence leans in favour of consuming increased fruits and
vegetables for lowering disease risks. Population data link high intakes of fruits and
vegetables with low cancer incidence. Foods now have 2 points in their favour;
supplements still score 0.
Vitamins C and E. Research on vitamin C and cancer is mixed: many studies indicate
that when people’s diets include foods rich in vitamin C, they seem to develop fewer
cancers, but other studies detect no effect from dietary vitamin C. Like beta-carotene,
vitamin C occurs in foods together with other cancer-fighting constituents. For example,
broccoli and its sprouted seeds, leafy greens, and citrus fruits, which are all vitamin C–
rich foods, also contain beta-carotene, other carotenoids, and a host of other powerful
phytochemicals and nutrients thought to be active against cancer. These foods are also
fibre-rich and low in fat—two other dietary characteristics believed to reduce cancer risk.
Like beta-carotene, vitamin C may simply be a marker for a diet rich in fruits and
vegetables. If so, the taking of vitamin C pills alone will do nothing to prevent cancer.
Foods, 3; supplements, still 0.
What about vitamin E? Because cancer may result from DNA damage, and vitamin E
protects DNA, researchers have searched for an inhibitory effect of vitamin E on the
development of cancer. The great majority of studies demonstrate no effect, with the
exception of a single study showing a reduction of prostate cancer in heavy smokers
taking vitamin E supplements.18 More research is required to verify this finding before
conclusions can be drawn concerning vitamin E, smoking, and prostate cancer risk.
17
Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, 2000, pp. 342–343.
18
O. P. Heinonen and coauthors, Prostate cancer and supplementation with alpha-tocopherol and beta-
carotene: Incidence and mortality in a controlled trial, Journal of the National Cancer Institute 90 (1998):
440–446.

Diets high in fruits and vegetables, which are particularly good sources of beta-carotene
and vitamin C, are strongly associated with reduced risks of several types of cancer. At
this point, the score still stands: Foods, 3; Supplements, 0.
Selenium. The selenium content of food depends partly on the selenium content of the
soil, which varies from region to region. In low-selenium areas, people suffer from higher
rates of some cancers.19 Studies of animals confirm these results and suggest that
selenium may play roles in cancer prevention. In an experiment with more than 1,300
people with a history of skin cancer, half were given 200 micrograms of selenium over
several years while others received a placebo during the same period.20 The researchers
found that the incidence of recurrence of skin cancer was about the same between the two
groups. However, the selenium-treated group had fewer cancers of the prostate, colon,
and lung. In light of these seeming benefits, the researchers stopped their study to allow
all study participants access to the selenium treatment.
Selenium supporters hail this study as proof that selenium supplements prevent cancer,
but a problem remains. Though the selenium takers did indeed suffer fewer cancers of
some types, their rate of death from all causes was virtually identical to that of the
placebo group. Dr. Victor Herbert, a researcher famous for his vigorous antisupplement
stance, concluded that the selenium given in the study must have increased the rate of
deadly diseases other than cancer, thus equalizing the overall death rates between the two
groups.21 Evidence for this conclusion remains to be established.
An adequate intake of selenium is not to be neglected, however, especially by men. In

another study, men who tested low on selenium were reported as being more likely to
develop prostate cancer than men whose selenium stores were full.22 Future research may
reveal whether selenium affects cancer and how it may do so—through enzymatic
antioxidant activity, through improved immunity, or through some mechanism of direct
inhibition of cancer cell development.23
The DRI committee has set a Tolerable Upper Intake Level for selenium at 400
micrograms per day; doses somewhat above this amount may prove toxic to some
individuals. In animals grazing on selenium-rich pastures, toxicity has caused hoof loss
and nerve and muscle damage known as “blind staggers.” In people, toxicities have
caused nausea, loss of hair and fingernails, and nerve damage. Deaths from extremely
large doses have occurred. However, no harm can come from including in your diet
nutritious foods such as fish, vegetables, and whole grains, which provide forms of
19
J. C. Fleet, Dietary selenium repletion may reduce cancer incidence in people at high risk who live in
areas with low soil selenium, Nutrition Reviews 55 (1997): 277–286.
20
L. C. Clark and coauthors, Effects of selenium supplementation for cancer prevention in patients with
carcinoma of the skin, Journal of the American Medical Association 276 (1996): 1957–1963.
21
V. Herbert, Selenium supplementation and cancer rates, Journal of the American Medical Association
277 (1997): 880.
22
K. Yoshizawa and coauthors, Study of prediagnostic selenium level in toenails and the risk of advanced
prostate cancer, Journal of the National Cancer Institute 90 (1998): 1219–1224.
23
Fleet, 1997.

selenium that may be especially effective in the body.24 From the evidence so far, then,
give supplements another zero, but score another point for foods: foods, 4;
supplements, 0.
Evidence Concerning Age-Related Blindness

The leading cause of age-related blindness in North America is macular degeneration.
The macula, a yellow spot located at the focal centre of the retina, loses integrity, which
causes the loss of the most important field of vision, the area of central focus (peripheral
vision remains unimpaired).
This blindness has been untreatable and unpreventable, but a discovery about the yellow
colour of the macula offers some promise—the macular pigments derive from dietary
carotenoids other than beta-carotene, including lutein and zeaxanthin. These carotenoids
are believed to filter out damaging light rays before they can harm the macula and may
improve visual abilities.25 This protection may account for a doubled rate of macular
degeneration among people who consume diets low in carotenoids compared with people
whose diets are carotenoid-rich.26 Many of the same foods also provide vitamin C,
another protector of eye health.27 Evidence for the taking of supplements to support eye
health is lacking. Foods now have 5 points; supplements, still 0.
Do Dietary Antioxidants Protect against Heart Disease?

Antioxidant nutrients, especially vitamin E, may help protect against cardiovascular
disease.28 One theory suggests that vitamin E prevents oxidation of low-density
lipoproteins (LDL). Cholesterol carried in LDL in the blood correlates directly with
cardiovascular disease, and most of the cholesterol collected from damaged arteries has
turned out to be oxidized cholesterol. The theory suggests that once inside the artery wall,
LDL undergo oxidation by free radicals, thereby promoting the formation of artery-
clogging plaques.
Other theories pit vitamin E against heart disease in other ways. Vitamin E may act upon
cells to reduce the inflammation associated with arterial damage or reduce proliferation
of smooth muscle cells. It may also reduce the likelihood of heart attacks by interfering
with blood clotting or by dilating the arteries and allowing the blood to flow through
them.29 A high level of vitamin E in the blood correlates with a lower concentration of an
24
J. W. Finley and C. D. Davis, Selenium (Se) from high-selenium broccoli is utilized differently than
selenite, selenate and selenomethionine, but is more effective in inhibiting colon carcinogenesis, Biofactors
14 (2001): 191–196.
25
B. R. Hammond, Jr., B. R. Wooten, and J. Curran-Celentano, Carotenoids in the retina and lens: Possible
acute and chronic effects on human visual performance, Archives of Biochemistry and Biophysics 385
(2001) 41–46.
26
P. F. Jacques and coauthors, Long-term nutrient intake and early age-related nuclear lens opacities,
Archives of Ophthalmology 119 (2001): 1009–1019; J. T. Landrum and R. A. Bone, Lutein, zeaxanthin,
and the macular pigment, Archives of Biochemistry and Biophysics 385 (2001): 28–40.
27
R. C. Rose, S. P. Richer, and A. M. Bode, Ocular oxidants and antioxidant protection, Proceedings of the
Society for Experimental Biology and Medicine 217 (1998): 397–407.
28
J. E. Buring and C. H. Hennekens, Antioxidant vitamins and cardiovascular disease, Nutrition Reviews
55 (1997): S53–S60.
29
Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, 2000, pp. 211–212.

enzyme released when a heart attack damages heart muscle tissue. Researchers have
taken this to mean that a person with a high blood concentration of vitamin E may escape
from some of the usual heart damage from a heart attack.30 The following evidence
represents a large body of work that seems to indicate that vitamin E in amounts greater
than the DRI intake recommendation of 15 mg per day may offer some measure of
protection against heart disease.31
Vitamin E and Heart Disease. In one approach to studying vitamin E and heart disease,
scientists selected groups of men in 16 European regions where rates of death from heart
disease varied sixfold. The researchers compared the plasma vitamin E, cholesterol, and
blood pressure among the men from each region. The men with the lowest vitamin E
values were more likely to die from heart disease. The correlation of heart disease
mortality was stronger with low vitamin E than with high cholesterol or high blood
pressure, supporting the “antioxidant hypothesis” of heart disease.
In another approach, researchers inspected the arteries and blood lipids of young male
heart attack victims and found the arteries more severely narrowed when the men’s LDL
measured low for vitamin E.32 In women, a diet of foods rich in vitamin E has been
associated with fewer heart disease deaths.33 Such evidence is suggestive, but indirect:
was vitamin E actually protecting the heart? Or could it have been some other factor,
such as another dietary constituent that follows along with vitamin E into the diet?
To eliminate some of these factors, researchers focus on supplements and not on vitamin
E in the diet. Two classic large-scale studies reported a significant reduction in heart
disease in middle-aged men and women who took supplements of vitamin E for two or
more years.34 In a smaller study of elderly people, vitamin E supplements also seemed to
offer some protection against death from heart disease.35 An experiment called CHAOS
(Cambridge Heart Antioxidant Study) strengthened these findings. Researchers were so
impressed with the effect of taking 400 to 800 mg of supplemental vitamin E daily on the
risk of nonfatal heart attacks that they terminated CHAOS earlier than expected to allow
30
F. Carrasquedo, M. Glanc, and C. G. Fraga, Tissue damage in acute myocardial infarction: Selective
protection by vitamin E, Free Radical Biology & Medicine 26 (1999): 1587–1590.
31
E. K. Parkkala-Sarataho and coauthors, A randomized, single-blind, placebo-controlled trial of the effects
of 200 mg α-tocopherol on the oxidation resistance of atherogenic lipoproteins, American Journal of
Clinical Nutrition 68 (1998): 1034–1041.
32
J. Regnström and coauthors, Inverse relation between the concentration of low-density-lipoprotein,
vitamin E and severity of coronary artery disease, American Journal of Clinical Nutrition 63 (1996): 377–
385.
33
L. H. Kushi and coauthors, Dietary antioxidant vitamins and death from coronary heart disease in
postmenopausal women, New England Journal of Medicine 334 (1996) 1156–1162.
34
M. J. Stampfer and coauthors, Vitamin E consumption and the risk of coronary disease in women, New
England Journal of Medicine 328 (1993): 1444–1449; E. B. Rimm and coauthors, Vitamin E consumption
and the risk of coronary disease in men, New England Journal of Medicine 328 (1993): 1450–1456.
35
M. Meydani, Effect of functional food ingredients: Vitamin E modulation of cardiovascular diseases and
immune status in the elderly, American Journal of Clinical Nutrition 71 (2000): S1665–S1668; K. G.
Losonczy, T. B. Harris, and R. J. Havlik, Vitamin E and vitamin C supplementation use and risk of all-
cause and coronary heart disease mortality in older persons: The Established Populations for Epidemiologic
Studies of the Elderly, American Journal of Clinical Nutrition 64 (1996): 190–196.

the placebo group to begin taking vitamin E if they wished. Interestingly, the rate of fatal
heart attacks and total deaths was about the same among those taking vitamin E and the
placebo.36
Recent clinical studies on vitamin E supplements and cardiovascular outcomes have been
disappointing. A large study of patients at high risk for heart attack, stroke, or
cardiovascular-related death revealed no fewer cardiovascular events among subjects
taking vitamin E supplements than among those taking a placebo.37 Other clinical studies
have also revealed no benefit on outcomes of heart disease.38
Because supplements of vitamin E may turn out to have side effects when taken over
many years and because despite early promise, research on vitamin E is mixed with
regard to efficacy, the rationale for taking supplemental vitamin E is crumbling. We give
zero points to vitamin E supplements but because vitamin E–rich foods are safe and may
be protective, they receive a point: foods, 6; supplements, 0.
Vitamin C and Heart Disease. Research results are mixed on vitamin C’s effect on
susceptibility to heart disease.39 Vitamin C and vitamin E work in tandem in defending
LDL against oxidation; both vitamins defend against free radicals in cells.40 Vitamin C
regenerates vitamin E from its oxidized form, making it available to act again as an
antioxidant.41 Some studies also suggest that vitamin C works with vitamin E to reduce
the damage from artery-clogging plaques.42 After measuring the vitamin C status of 1,600
men and tracking them for an average of five years, researchers observed that a mild
vitamin C deficiency increased a man’s risk of fatal heart attack by two and a half
times.43 However, two other factors measured in this study also correlated with both low
36
N. G. Stephens and coauthors, Randomized controlled trial of vitamin E in patients with coronary
disease: Cambridge Heart Antioxidant Study (CHAOS), Lancet 347 (1996): 781–786; A. Ness and G. D.
Smith, Mortality in the CHAOS trial (correspondence), Lancet 353 (1999): 1017–1018.
37
The Heart Outcomes Prevention Evaluation Study Investigators, Vitamin E supplementation in
cardiovascular events in high-risk patients, New England Journal of Medicine 342 (2000): 154–160.
38
Collaborative Group of the Primary Prevention Project, Low-dose aspirin and vitamin E in people at
cardiovascular risk: A randomized trial in general practice, Lancet 357 (2001): 89–95; E. A. Meagher and
coauthors, Effects of vitamin E on lipid peroxidation in healthy persons, Journal of the American Medical
Association 285 (2001): 1178–1182; N. J. Stone, The Gruppo Italiano per lo Studio della Sopravvivenze
nell’Infarto Miocardio (GISSI)-Prevenzione Trial on fish oil and vitamin E supplementation in myocardial
infarction survivors, Current Cardiology Reports 2 (2000): 445–451; S. Yusof and coauthors, Vitamin E
supplementation and cardiovascular events in high-risk patients. The Heart Outcomes Prevention
Evaluation Study Investigators, New England Journal of Medicine 342 (2000): 154–160.
39
R. A. Riemersma and coauthors, Vitamin C and the risk of acute myocardial infarction, American
Journal of Clinical Nutrition 71 (2000): 1181–1186.
40
D. Harats, Citrus fruit supplementation reduces lipoprotein oxidation in young men ingesting a diet high
in saturated fat: Presumptive evidence for an interaction between vitamins C and E in vivo, American
Journal of Clinical Nutrition 67 (1998): 240–245.
41
D. Kritchevsky, Antioxidant vitamins in the prevention of cardiovascular disease, Nutrition Today,
January/February 1992, pp. 30–33.
42
M. M. Mahfouz, H. Kawano, and F. A. Kummerow, Effect of cholesterol-rich diets with and without
added vitamins E and C on the severity of atherosclerosis in rabbits, American Journal of Clinical Nutrition
66 (1997): 1240–1249.
43
K. Nyyssönen and coauthors, Vitamin C deficiency and risk of myocardial infarction: Prospective
population study of men from eastern Finland, British Medical Journal 314 (1997): 634–638.

blood vitamin C and heart attack—a low intake of fruits and vegetables and low blood
carotene levels. In addition, an inverse relationship between consuming carotene-rich
vegetables and incidence of cardiovascular disease was noted among over 15,000 U.S.
physicians—the more of these vegetables they consumed, the lower their heart disease
risk.44 From these results, it is impossible to isolate vitamin C as the only factor at play.
Something else lacking from a diet low in fruits and vegetables could have elevated the
men’s risks. Or perhaps a healthy lifestyle that includes eating fruits and vegetables, as
well as exercising regularly and sleeping adequately, is the key.
Since fruits and vegetables supply adequate vitamin C, and these foods supply a host of
other nutrients and phytochemicals, a few servings a day of vitamin C–rich foods make
high-dose vitamin C supplements, along with any associated risks, unnecessary. Prudence
dictates that only foods receive a point: foods, now 7; supplements, 0.
Should We Take Supplements Anyway, Just to Be Safe?

Although supplement manufacturers have proclaimed antioxidant pills to be magic
bullets against aging, disease, and even death itself, our scientific reckoning has foods
beating supplements by a score of 7 to 0. Dr. Victor Herbert, the scientist introduced
earlier, energetically opposes the taking of supplements. He points to a host of side
effects that might endanger supplement takers’ health:
• Vitamin E supplements, taken over a period of time, may increase the risk of brain
hemorrhage (a form of stroke).
• Vitamin E supplements delay blood clotting.
• Vitamin E supplements may worsen autoimmune diseases, such as asthma or
rheumatoid arthritis.
• Vitamin C supplements enhance iron absorption, making iron overload likely in
some people.
• Vitamin C supplements may increase markers of oxidation in the blood.
• Daily supplements of vitamin E, beta-carotene, or both do not reduce the
incidence of lung cancer among smokers, and beta-carotene may increase it.
• Selenium supplements can be toxic (see the earlier section).
Besides, while orange juice and pills may both contain vitamin C, the orange juice
presents a balanced array of chemicals that modulate vitamin C’s effects. The pill
provides only vitamin C, a lone chemical. And although fruits and vegetables rich in
antioxidant nutrients have been associated with a diminished risk of many cancers,
supplements of beta-carotene and vitamins C and E have not always proven beneficial.
Most scientists agree that it is too early to recommend that people start taking antioxidant
supplements now, even those of vitamin E. The risks are real, and clinical studies to
quantify them and clarify the benefits have not yet been completed.
44
S. Liu and coauthors, Intake of vegetables rich in carotenoids and risk of coronary heart disease in men:
The Physician’s Heart Study, International Journal of Epidemiology 30 (2001): 130–135.

Should We Try to Eat More Antioxidant-Rich Foods?

You probably know our answer to this question. Every credible agency making
recommendations for chronic disease prevention includes advice to increase consumption
of fruits and vegetables, for the antioxidant nutrients, other nutrients, and phytochemicals
they supply. We conclude by recommending this personal strategy: don’t try to single out
a few magic nutrients to take as supplements. Instead, invest energy in eating a wide
variety of fruits and vegetables in generous quantities every day. This is one of the most
important favours you can do yourself, and the benefits are well backed by research.
Nutrient Enrichment of Foods Sold in Canada

Canadian policies about enrichment in foods differ from those in the United States. Thus,
the vitamin and mineral content of some Canadian foods may differ from the food
sources of nutrients listed in the text. This may also affect the results of nutrient analysis
of student food intakes. The Canadian Food and Drug Regulations45 specify the foods to
which nutrients may or must be added, and the amounts that may be added. Canadian
regulations are sometimes more restrictive than in the United States, and thus many
Canadian foods have lower amounts of some vitamins and minerals.
Nutrient values from some food composition tables and computerized nutrient analysis
programs do not accurately reflect Canadian foods and nutrient intakes. Breakfast cereals
are common examples of this variation. This is especially true for vitamins A and D,
which can be higher in U.S. cereal products. Vitamins A and D are not permitted to be
added to cereals in Canada. Annex 2, Section VI in Guide to Food Labelling and
Advertising46 provides detailed information about foods to which nutrients can be added.
Nutrient Value of Some Common Foods was revised and published by Health Canada in
2008. It is a quick reference for Canadian foods using the 2007b Canadian Nutrient Data
File.47
The Canadian regulations about addition of nutrients are being reviewed. Check the
Health Canada website for discussion papers and decisions about addition of nutrients to
foods.
CLASSROOM ACTIVITIES
Classroom Activity 7–1: Vitamin Flash Cards

Have students make index cards with the name of a vitamin on the front of each card. On
the back of each card have them list one important function of that vitamin. Then have
45 Health and Welfare Canada. Departmental Consolidation of the Food and Drugs Act and Regulations.
Ottawa: Ministry of Supply and Services, 2001. The current regulations can be found at http://www.hc-
sc.gc.ca/fn-an/legislation/acts-lois/act-loi_reg-eng.php.
46 Canadian Food Inspection Agency. 2003 Guide to Food Labelling and Advertising. Ottawa.
http://www.inspection.gc.ca/english/fssa/labeti/guide/toce.shtml.
47 Health Canada. Nutrient Value of Some Common Foods. Ottawa: Public Works and Government
Services Canada, 2008. http://www.hc-sc.gc.ca/fn-an/nutrition/fiche-nutri-data/nutrient_value-

valeurs_nutritives-tc-tm-eng.php.

them study these flash cards in pairs until they can tell from memory the functions of
each vitamin in the body.
Classroom Activity 7–2: What Vitamin Am I?

Before class, prepare sticky notes, index cards, or slips of paper by writing one water-
soluble vitamin on each. (You may also include other terms that appear in the chapter.)
Tape one on the back of each student. The goal of the activity is for students to find out
what vitamins are written on their backs.
To discover “What Vitamin Am I?” have students circulate through the room asking
other students questions about the vitamin or vitamin term written on their backs. They
are permitted to ask each student two “yes or no” type questions. After asking a student
two questions, they approach another student and ask two more. For example, one
question could be “Am I involved in energy metabolism?” After each student has
discovered what vitamin is on their card, they can tell the class how they figured it out
and what questions they asked during the activity. This activity works well for small class
sizes.
Classroom Activity 7–3: Vitamin Vocabulary Worksheets48

Ask students to write an original sentence using an assigned vitamin term. Then combine
all of the students’ sentences into a worksheet, removing the term used in the sentence,
and replacing it with a blank line. At the end of the worksheet list all of the terms used
alphabetically. Students have the fun of seeing their writing in print and are much more
likely to enjoy the process than they would filling in the blanks of a “canned” worksheet.
Example:
Vitamin Vocabulary Worksheet
1. A deficiency of _________ produces diarrhea, dermatitis, and dementia.
(niacin)
Classroom Activity 7–4: Vitamin Review

Have students keep their books and notes open. Start by asking a student to name one
vitamin. Then tell the next student to add some bit of information about that vitamin, and
so on, until you get four items of information about that vitamin. The next student names
another vitamin. Repeat until all of the nutrients covered in this section have been
reviewed.
Classroom Activity 7–5: Demonstration: Vitamin Supplement Dissolvability

Instruct students to bring nutrient supplements to the next class. Bring vinegar and clear
plastic cups.
The purpose of this activity is to demonstrate disintegration characteristics of

vitamin/mineral supplements. Supplements that do not disintegrate have little chance of
entering the bloodstream. To demonstrate how well or how poorly different
vitamin/mineral supplements dissolve in the stomach, conduct an experiment by filling
48
Activity provided by Penny Fredell, Yuba College, Marysville, CA.

several clear plastic cups with vinegar (to mimic the pH of the stomach). Place one
supplement in each cup and every 5 minutes stir or swirl the contents. Leave supplements
in the cups for approximately 15 to 30 minutes. Observe what happens. See if there are
differences between time-released supplements and others. Discuss the many
implications. This activity can be used as a vehicle for discussing many issues related to
supplementation, including appropriate and inappropriate reasons for taking supplements
and guidelines for supplement selection. Worksheet 7–3 can be used in conjunction with
this activity to provide an avenue for evaluating supplements.
Classroom Activity 7–6: Vitamin/Mineral Supplement Evaluation

Distribute Worksheet 7–3 (Vitamin/Mineral Supplement Evaluation Form). Instruct
students to select a vitamin supplement and evaluate it using the form. Issues that will be
covered include cost, completeness, percent of RDA (low amounts or dangerously high
amounts), presence of unnecessary nutrients or ingredients, and advertising terms such as
“natural,” “organic,” “chelated,” “no sugar,” or “stress-reliever.” Have students share
their evaluations with the class.
Classroom Activity 7–7: Examination of Nutrition Quackery via the Internet

Instruct students to obtain information about a questionable nutritional product such as a
nutrient supplement. To increase Internet skills, instruct students to obtain information
via the Internet. Next, have students evaluate the claims regarding the product using anti-
quackery sites on the Internet.
Critical Thinking Questions49
These questions will also be posted to the book’s website so that students can complete
them online and e-mail their answers to you.
1. Outline the differences between macronutrients (carbohydrates, fats, and proteins) and
vitamins.
Answer: There are many to discuss:

Structure: Vitamins are individual units, as opposed to macronutrients, which can be
broken down further into individual units that provide energy. Vitamins do not
provide energy per se but are involved in metabolic pathways that provide energy.
Vitamins are utilized for metabolic pathways and several other functions, and they are
available readily.
Function: Vitamins do not yield any energy but do help in metabolic pathways that
yield energy. Many of the B vitamins assist enzymes in their functions in the
metabolic pathways.
Amount in Food: Vitamins are needed in minimal amounts as opposed to the large
amounts of macronutrients required. While the water-soluble and fat-soluble vitamins
are very necessary, as are macronutrients, the absolute amounts are much less.
49
Contributed by Kathleen Rourke.

Bioavailability: While macronutrients are generally stable in foods and relatively

easily absorbed and utilized by the body for energy, micronutrients have many issues
that impact their bioavailability. For example, heat and light can destroy many of the
B vitamins during food preparation or storage.
Precursors: Some of the water-soluble vitamins are precursors to reactions or are
provitamins. Macronutrients do not have this function. This again gets back to their
roles in metabolic pathways.
Organic Nature: Macronutrients are of course organic. Vitamins, however, can be
destroyed by light and many types of handling that the macronutrients are not
susceptible to. While proteins are susceptible to denaturing by high heat, vitamins,
particularly water-soluble vitamins, are very susceptible to heat, sunlight, and other
factors. Whereas macronutrients are normally broken down in the body for use, and
hence denaturing of proteins is a normal part of digestion, vitamins must retain their
chemical structures as they are absorbed or they cannot perform their functions.
Solubility: Water-soluble vitamins are hydrophilic. This differs from the lipids but not
from the proteins and carbohydrates.
Toxicity: While most water-soluble vitamins are not believed to pose a toxicity risk,
the body has some ability to store these vitamins. The macronutrients (proteins,
carbohydrates, and fatty acids), for the most part, cannot cause toxic effects to the
body (protein has limited ability to cause toxic effects). Toxicity, however, is more
common with the fat-soluble vitamins, which are stored extensively in adipose
tissues.
2. The B vitamins are very important in many critical functions of the body, yet many
clients negatively perceive B vitamins. How would you educate clients about the
importance of B vitamins and their critical functions without confusing them?
Answer: The B vitamins have many different roles in reactions within the metabolic
pathways.
Thiamin: This water-soluble vitamin is a vital part of thiamin pyrophosphate, a
coenzyme that is very important for energy metabolism. This vitamin is very heat
labile, and a deficiency causes beriberi. Thiamin is available in many foods, including
fruits, vegetables, and meats.
Riboflavin: This water-soluble vitamin also functions as a coenzyme in many
reactions in energy metabolism. Riboflavin is also very heat and sun labile and serves
many functions in maintenance of the integrity of the membranes of the skin, eyes,
and GI tract. Riboflavin is available in several foods, including dairy products and
meats.
Niacin: This is another important vitamin that functions as a coenzyme in many
metabolic reactions. Without niacin, many of these reactions could not take place.
Niacin deficiency is associated with pellagra, which is seldom seen in developed
nations. Tryptophan is a precursor to niacin. Sources include proteins, whole grains,
and nuts. Niacin has been prescribed for lowering cholesterol and can be quite
effective. However, too much niacin can result in a hot-flash-like reaction referred to

as “niacin flush” that causes considerable discomfort. Caution should be taken when
considering a niacin supplement.
Biotin: This B vitamin also plays an important role in carbohydrate metabolism
within the TCA cycle. While deficiencies are rare, there are instances where
consumption of egg whites can cause a deficiency of biotin. Biotin is found in protein
sources such egg yolks, liver, and soybeans.
Pantothenic Acid: Another important vitamin in metabolic pathways is pantothenic
acid. This vitamin is part of coenzyme A and thus part of the TCA cycle. While the
needs for this vitamin are not large, a deficiency can cause many issues in neurologic
function. Sources of pantothenic acid are proteins and whole grains.
Vitamin B6: This vitamin is very important as a coenzyme that helps metabolize urea.
Vitamin B6 also helps convert tryptophan to niacin and functions to activate
neurotransmitters. This vitamin is very heat labile and can be stored in the muscles,
making toxicity a possibility. Sources of vitamin B6 are protein sources as well as
potatoes, green vegetables, and fruits.
Folate: This vitamin is a coenzyme for some of the most important metabolic
functions, particularly with regard to DNA synthesis. Its importance has only been
recognized in the last couple of decades. This vitamin helps prevent neural tube
defects and (in some individuals) cancer. Sources include fruits and vegetables as
well as legumes.
Vitamin B12: This vitamin and folate are closely intertwined as vitamin B12 is
required to convert folate to its active form. Vitamin B12 is important for nervous
system function and nerve cell maintenance. The need for vitamin B12 is very small
and it can be recycled very effectively. Most deficiencies are related to absorption of
the vitamin rather than intake. Given that sources of vitamin B12 are all animal-
derived foods, vegans need fortified foods or supplementation of vitamin B12. Careful
selection of food products, such as fortified soy milk, miso, and yeast, can provide
enough vitamin B12 for an individual on a vegan diet.
Finally, it is important to understand the overall role of all the B vitamins within the
metabolic pathways. Collectively, they help to ensure that the metabolic pathways
function at an optimal level. As noted in Figure 7–11, the many B vitamins perform a
multitude of activities as coenzymes, and without them, energy metabolism would not
occur.
3. Suppose one of your friends comes up to you and asks what you are majoring in.
You tell them that you are majoring in nutrition and dietetics and are really
stressed about your upcoming biochemistry test! All of a sudden your friend
responds, “I thought you said you were majoring in nutrition and dietetics. Are
you planning to go to med school or something? Why would you need chemistry
when you are in a cooking major?” How might you best respond to your friend to
help him or her understand how important biochemistry is to the field of
nutrition and dietetics?

Answer: Taking a very different approach, this is one of my favourite questions to ask
my doctoral students. Of course, my question is, explain the role of vitamins in all the
biochemical pathways! Students, especially in the undergraduate years, don’t always
fully comprehend the importance of the role of their biochemistry classes in their
studies; here is where they can really comprehend its true importance.
All of the B vitamins play a critical role in energy metabolism, most as coenzymes or
cofactors. Without the B vitamins, energy metabolism would halt! Students simply
need to explain the following:
Thiamin: Thiamin functions as the coenzyme thiamin pyrophosphate in the reaction
that converts pyruvate to acetyl CoA. This conversion of a three-carbon to a two-
carbon compound is required for the TCA cycle.
Riboflavin: Riboflavin also serves as a coenzyme and functions as an electron donor
in FMN and FAD.
Niacin: The same holds true for niacin as NAD and NADP. Nicotinamide is very
active in several areas of the metabolic cycles, including glycolysis and amino acid
metabolism.
Vitamin B6: Vitamin B6 functions as a coenzyme as pyridoxal phosphate in critical
reactions in glycolysis and in amino acid metabolism.
Folate: Folate or tetrahydrofolate requires vitamin B12 to activate it and serves as the
coenzyme for one-carbon transfers. The result is the generation of the amino acid
methionine.
Vitamin B12: Vitamin B12 and folate are intimately involved in a coupled reaction that
involves the activation of folate, production of methionine, and synthesis of DNA.
Clearly, without B vitamins, energy metabolism as we know it would not exist;
therefore, the study of nutrition and dietetics is well beyond cooking food. This is a
field for research and education on the role of food in the body for energy production,
protein synthesis, tissue repair, growth and development, recovery from illness and
injury, and improvement of health, as well as many other areas. The student’s friend
learned even more than anticipated today from his or her encounter with a nutrition
and dietetics student, which, of course, always happens!
4. Differentiate between water- and fat-soluble vitamins and discuss how a diet that
is low in fat might impact vitamin absorption.
Answer: Water-soluble vitamins are vitamins that can be absorbed in an aqueous

environment. In general, they are not stored in the body; however, vitamin B6 appears
to have some ability to be stored in the muscle. There is little risk that the water-
soluble vitamins that cannot be stored in the body will reach toxic levels. Because the
body does not generally store these vitamins, water-soluble vitamins need to be
replenished on a regular basis. Excess is excreted by the kidneys into the urine.

Fat-soluble vitamins require ingestion of fatty acids in order for the vitamin to be
absorbed. Therefore, they are absorbed into the lymph before being transferred to the
bloodstream. Because of their association with fatty acids, fat-soluble vitamins can be
stored; as a result, they can reach toxic levels in the body, most particularly vitamin
A. To rid the body of excessive stores, the person should consume less so that stores
are reduced.
An individual that is consuming a low-fat diet may not be consuming enough fat to
allow for absorption of fat-soluble vitamins, though in general, a low-fat diet would
not preclude their absorption. The amount of fat in the diet can be very little; only two
tablespoons of added oil a day is enough to provide for the body’s needs. However,
suppose an individual is not consuming added fat and is avoiding all fat in his or her
diet, as well as perhaps taking a weight-loss medication such as Orlistat, which works
to excrete about 30 percent of the fat consumed. Then the dietitian may need to work
with this individual (who may have anorexia) to aid in fat-soluble vitamin absorption.
One tactic that can be taken is to rub monounsaturated or polyunsaturated fatty acids
into the skin of the client, which will allow some to be absorbed over a short time.
With vitamin supplementation, short-term results can be achieved for those clients
that do not require immediate hospitalization.
Long term, with a client that has avoided any fat, it will be a matter of nutrition
education, counselling, and patience to add a small amount of oil to the diet and
supplement with fat-soluble vitamins.
5. There is much debate regarding the need for consumers to take vitamin and/or
mineral supplements. As a nutrition professional, how would you advise a client
(female who is 60 years old and has no medical history, has no current medical
problems, and takes no medications) that believes in and therefore insists on
taking large doses of vitamin and mineral supplements to prevent disease?
Answer: A consumer’s desire to take a vitamin/mineral supplement is driven by many

factors, many of which have little scientific evidence for validation. For the nutrition
student, it is important to keep in mind that nutrition as a science is comparatively
young in relation to many of the other basic sciences, so much is still being
discovered. As a result, it is not unusual for foods such as broccoli or milk to be
reported as having differing, sometimes contradictory, benefits and disadvantages
over a decade. These facts can often be confusing to the consumer. As a result, the
vitamin and mineral supplement can be seen as a safe road in providing the necessary
nutrients to a person’s body and protection of health status without the confusion.
In addition to the above consideration, current lifestyles are faster paced, stressed, and
uncertain. Under these circumstances, an individual may find some security from
poor dietary choices and the impacts of stress on the body in the added protection of a
vitamin and mineral supplement.
Stressors of an active world but also environmental stressors are also a concern, given
their potential carcinogenic effects. Some individuals believe that diet alone cannot

protect the body from all the carcinogens that surround individuals, so they desire the
added protection of vitamin and mineral supplements.
Additionally, some individuals grow into a culture where vitamin and mineral
supplementation is part of their history and lifestyle. Supplementation is part of self-
care that was perceived as enhancing the longevity of parents and grandparents and,
therefore, is continued on as self-care for oneself.
Above are many considerations for the registered dietitian counselling a client that
insists on taking large doses of vitamin and mineral supplements. Clearly there can be
others that the students will discuss. The client may be afraid of illness or dying, have
different types of paranoia, etc. These should all be considered when counselling a
client such as this. In other words, what is the root of the desire or need for the
supplementation, beyond a regular diet?
Dietary assessment is required as well as physical and biochemical assessment to
acquire information on any physical illnesses or past histories. Medical background
and history should be acquired as well. The assumption is that the client is
asymptomatic and that this is simply a desire without physical rationale; therefore, the
registered dietitian must deal with the psychological/mental concerns and work to
have the client fill vitamin and mineral needs through diet.
The best approach here is to ask about the length of time this individual has been
taking the supplements, and in what doses, and to have a very clear understanding of
her diet and all medical information as well as the above information.
Given that she is not on any medications that would result in drug–supplement
interactions, that is not a concern here.
This individual is in good health and may be taking the supplements because of a
learned family history. Or, she may have begun this habit as she grew older or as her
dietary habits were changing and wanted to optimize her health status. All these need
to be explored. That being said, because she is in good health, is not taking
medications that would interact with the supplements, and has no medical history, this
is a client that would benefit from nutrition education as to where the various
vitamins and minerals can be found in foods and how foods can be prepared to
optimize the micronutrient viability. Nutrition education with the client as to the role
of the various vitamins and minerals would also be helpful. In this manner, the client
is empowered to understand the role and source of the numerous vitamins and
minerals in foods herself so that she is assured that she can provide her body with
adequate nutrients. Beyond that, the registered dietitian should recommend a general
multivitamin, thus working to move her client away from megadoses of vitamins.
Having worked with clients in private practice for many years, I know that it may not
always be realistic to stop clients from taking vitamin/mineral supplements. But,
when one can empower the client enough in the area of foods, generally, the client
will lower their dosage to a basic multivitamin supplement and avoid the megadosing.

6. Discuss the roles of vitamin C.
Answer: Vitamin C serves multiple roles within the body. It has long been known to
relieve the symptoms of scurvy, which was rampant in the British Navy when sailors
did not eat any citrus fruits. The role of ascorbic acid was later discovered. From that
time, scientists have been aware of the need for vitamin C.
For years, there has been a continued debate as to the need for additional vitamin C to
prevent illness and to cure the common cold. Data continue to be inconsistent, and
many individuals rely on anecdotal reports. The only consistent finding is the need for
additional vitamin C in smokers.
Another clearly defined role for vitamin C is that of an antioxidant. Vitamin C
defends the body against free radicals that are produced by the body as a result of
oxidative stress.
Vitamin C is a cofactor in the formation of collagen, an important material in
formation of bones and teeth. Vitamin C is also a cofactor in other reactions involving
transport of fatty acids for cell membrane synthesis, neurotransmitter transmission,
and hormone production.
Vitamin C is found in many citrus fruits and green leafy vegetables.
7. Vitamin A is a fat-soluble vitamin important for vision, cell differentiation, and

growth and development. Discuss the different forms of vitamin A and its
precursors and how they are activated. Then discuss the variety of roles that
vitamin A plays in the body.
Answer: There are two types of vitamin A: the active form, which is generally available
from animal sources and occurs as three different compounds, retinol, retinal, and
retinoic acid, and the precursor to active vitamin A, known as beta-carotene, which is
available from plant sources.
Active vitamin A compounds, collectively known as retinoids, are absorbed in the

intestine, transported to the liver, and carried throughout the body in the blood via a
protein carrier called retinol-binding protein. Of the three compound forms, retinal
and retinoic acid are the active forms of the retinoids. Beta-carotene must be
converted prior to its absorption and activation.
As noted, vitamin A plays some very critical roles in the body. They include a major
role in vision, another in cellular differentiation, and a role in the growth and
development of the fetus.
Retinal is important in supporting nerve transmission in the retina, which allows for
neurotransmission and communication to the brain, supporting vision.
Vitamin A is also important in supporting each cell’s ability to differentiate for its
appropriate function in the body. Beta-carotene, a photochemical, also protects the
skin from sun damage.

Growth and development of a growing fetus are also supported by the functions of
vitamin A, as is bone remodelling.
8. Taking too much vitamin E can cause significant problems in the body. Discuss
the physiological problems with ingesting too much vitamin E.
Answer: Vitamin E is important in keeping the blood “thin” or helping to keep the blood
from clotting. This could be another role it plays in its protection or prevention of
heart disease, as individuals that are more prone to heart disease are also more prone
to accumulate arterial plaque and develop blood clots.
Individuals that take large supplements of vitamin E will tend to bleed more easily. In
the event that they are also taking anticoagulant medications, this can be aggravated
even more.
In the event that an individual is taking supplements of vitamin E, he or she is clearly
gaining the benefits from the antioxidant properties of the vitamin E. The registered
dietitian should assess each client carefully regarding their use of supplements,
herbals, and medications and how they might interact with diet.
9. Taking too much vitamin K can cause significant problems in the body. Discuss
the physiological problems with ingesting too much vitamin K.
Answer: Vitamin K functions in the body to help the blood clot, through a complex
series of events. Some individuals have problems with blood clotting and may take
medication to assist their bodies in that activity. Should these same individuals also
take supplemental vitamin K, they may potentiate their medications significantly.

ANSWER KEY FOR WORKSHEETS
Worksheet 7–1 Answers will vary.

Worksheet 7–2: Bioavailability Concept
Minimal Effect on
Situations ↓ Bioavailability Bioavailability ↑ Bioavailability
Parboiling   
Microwaving   
Processed foods   
Fortified foods   
Medical condition of   
individual
Amount of food eaten   
Quality of food eaten   
Nutritional status of   
individual
Food composition of a   
meal
Worksheet 7–6: Fat-Soluble Vitamins’ Equivalent Measurements

1. Twice as much.
2. In the United States, milk is fortified with 10 µg/quart of vitamin D, and there are 4 cups in a
quart. If the glass holds 1 cup of milk, then 1 glass would contain 10 µg/4 = 2.5 µg = 100 IU
vitamin D. Vitamin D AI for ages 9–50 = 5 µg/day, so you would need to drink 2 cups of
milk to obtain the AI. In Canada, milk is fortified with 2.2–2.9 µg/cup of vitamin D, which is
approximately 100 IU. As the AI for vitamin D for ages 9–50 is 5 µg/day, 2 cups of milk
would provide the AI for the average Canadian.
3. Alpha-tocopherol is the only form of vitamin E that is active in the body, and the other forms
are neither able to perform the same functions as alpha-tocopherol nor easily converted to
alpha-tocopherol in the body.
4. Answers will vary; students may point out that about half of vitamin K needs are normally
met by production of the vitamin by GI tract bacteria.
5. Answers will vary.

WORKSHEET ACTIVITIES
Worksheet 7–1: Vitamin History in Clinical Research
1. Perform a web-based search in PubMed or ScienceDirect for the following: thiamin vitamin
history, niacin vitamin history, and ascorbic acid vitamin history.
2. How many articles did you find on each vitamin?
3. Were you able to obtain any of the full articles or just the abstracts as a “free” source?
4. Now perform the same search using a nonscientific search engine such as Google or Ask.
5. How many “hits” did you find, and what types of information did you obtain?
Consider the following questions using a round-table approach:
• In terms of scientific evidence, do we have a long history of information with respect to

thiamin, niacin, or ascorbic acid?
• How have the discoveries of these vitamins led to influences in public health practices
throughout the world?
• How has the discovery of vitamins led to an increase in awareness of the need for clinical
research?
• Identify how each vitamin was discovered in terms of clinical research.
• If that research study were to be performed today, would the researcher be allowed to run the
study? Why or why not?

Worksheet 7–2: Bioavailability Concept
For the following situations, indicate whether or not the bioavailability of the nutrient content
would be affected related to vitamin content. (Choose all that apply.)
Minimal Effect on
Situations ↓ Bioavailability Bioavailability ↑ Bioavailability
Parboiling   
Microwaving   
Processed foods   
Fortified foods   
Medical condition of   
individual
Amount of food eaten   
Quality of food eaten   
Nutritional status of   
individual
Food composition of a meal   

Worksheet 7–3: Vitamin/Mineral Supplement Evaluation
Complete the supplement evaluation form about a selected supplement.
1. What is the name of the supplement?
2. What is the cost per pill?
3. Is the supplement complete (does it contain all vitamins and minerals with established DRI)?
If no, what is missing?
4. Are most vitamins and minerals present at or near 100 percent of the adult DRI? Exceptions
include biotin, calcium, magnesium, and phosphorus, which are rarely found in amounts near
100 percent of the DRI. List any vitamins or minerals that are present in low amounts or
dangerously high amounts.
5. Does the supplement contain unnecessary nutrients or nonnutrients? If yes, list them.
6. Is there “hype” on the label? Does the label use the terms “natural,” “organic,” “chelated,”
“no sugar,” “stress-reliever,” “immune formula,” etc.? List any terms used.

Worksheet 7–4: Vitamins in Your Diet
A diet that offers a variety of foods from each group, prepared with reasonable care, serves up
ample vitamins. The grains group delivers thiamin, riboflavin, niacin, and folate. The vegetables
and fruit group excels in folate, vitamin C, vitamin A, and vitamin K. The meat and alternatives
group serves thiamin, niacin, vitamin B6, and vitamin B12. The milk and alternatives group stands
out for riboflavin, vitamin B12, vitamin A, and vitamin D. Even the oils and fats group provides
vitamin E with its vegetable oils. Determine whether these food choices are typical of your diet.
Food Choices Frequency per Week

Citrus fruits
Dark green, leafy vegetables
Deep yellow or orange fruits or vegetables
Legumes
Milk and milk products
Vegetable oils
Whole- or enriched-grain products
1. Do you eat dark green, leafy, or deep yellow vegetables daily?
2. Do you drink vitamin A– and D–fortified milk regularly?
3. Do you use vegetable oils when you cook?
4. Do you choose whole or enriched grains, citrus fruits, and legumes often?

Worksheet 7–5: Antioxidants
Consider the following questions and use the following search methods in order to find
out information to discuss the answers: traditional library search, database search,
textbook search, and web-based search engine search. See how the information you have
gathered differs in both its amount and the quality of information.
1. Which vitamins are considered to have antioxidant properties?
2. Why does oxygen pose a threat to cell structures?
3. What is meant by the concept of free radical?
4. How does the body handle oxidative stress?
5. Are there differences in dietary antioxidants versus antioxidants found in dietary

supplements?
6. Is there clinical evidence that antioxidants improve health outcomes?
7. Do foods differ in their antioxidant composition?
8. Is there a recommended allowance for the daily intake of dietary antioxidants?
9. Which food sources are considered to have the highest amount of antioxidant
properties?
10. How do antioxidants function as stable entities in the body?

Worksheet 7–6: Fat-Soluble Vitamins’ Equivalent Measurements
Vitamin A = 1 RAE (retinal activity equivalent) = 1 microgram (μg) of retinol = 3.33 IU

(international units)
= 12 μg of dietary beta-carotene = 2 μg of beta-carotene supplements
= 24 μg of other vitamin A precursor carotenoids
Vitamin D = 1 IU = vitamin D3 = 0.025 μg, 1 μg of vitamin D3 = 40 IU
Vitamin E = 1 mg = 1 alpha-tocopherol unit
Vitamin K = DRI not defined but expressed as AI (Adequate Intake) = micrograms
There is so much discussion and confusion related to the measurements of fat-soluble

vitamins that it becomes difficult to explain what the measurements actually indicate. In
the table above are the common equivalent measurements for each of the fat-soluble
vitamins. Consider these equivalent measurements when answering the questions below.
1. If you obtained your daily vitamin A intake from a precursor carotenoid source, how
much would you have to consume as compared with obtaining your daily vitamin A
from a dietary source of beta-carotene?
2. How many international units (IU) of vitamin D are contained in a glass of milk, and
how many glasses of milk would you have to drink in order to get the DRI of
vitamin D?
3. When considering the fact that other tocopherols exist besides alpha-tocopherol in the
body, why can’t you just use a food supplement containing one of them to get your
daily recommended intake of vitamin E?
4. Since vitamin K does not have a specific equivalent measurement stated like the other
vitamins, does it mean that the relative proportion contained in foods is less
important?
5. Select one food item that you eat on a daily basis and then determine the relative
equivalent measurements for the fat-soluble vitamins indicated above. Note whether
or not the food items that you have selected meet the recommended dietary intakes
for that nutrient.

WHAT OTHER RESOURCES ARE AVAILABLE?
You can look up additional information about vitamins and health.
Listed below are a few useful websites in this area:
• Find out more about prenatal guidelines for folic acid supplementation at
http://www.hc-sc.gc.ca/fn-an/pubs/nutrition/folate-eng.php.
• Visit the National Council against Health Fraud (archived information) to learn
more about which claims about a vitamin are the truth and which are frauds:
http://www.ncahf.org.
• Learn more about Health Canada’s policies on the addition of vitamins and
minerals to foods at http://www.hc-sc.gc.ca/fn-an/nutrition/vitamin/index-
eng.php.
• Find information from the Dietitians of Canada regarding the role of antioxidants
in the diets of Canadians at http://www.dietitians.ca/Your-Health/Nutrition-A-
Z/Antioxidants.aspx?categoryID=2.
• To learn more about the prevention and treatment of osteoporosis, go to the

website for the Canadian Osteoporosis Society (http://www.osteoporosis.ca).
This site includes access to the most recent Canadian Medical Association
guidelines for osteoporosis.
• The following link describes the Canadian government’s position on vitamin D

and calcium intake: http://www.hc-sc.gc.ca/fn-an/nutrition/vitamin/vita-d-
eng.php.
• The nutrient values of some common foods are published online by Health
Canada: http://www.hc-sc.gc.ca/fn-an/nutrition/fiche-nutri-data/nutrient_value-
valeurs_nutritives-eng.php.
• A searchable version of the Canadian Nutrient File (CNF), which contains more
than 5,000 foods, is available electronically at http://www.hc-sc.gc.ca/fn-
an/nutrition/fiche-nutri-data/cnf_aboutus-aproposdenous_fcen-eng.php.

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eyes, which seemed curiously dark; and a very brief inspection of
their abnormal appearance suggested one possible verdict.
“It looks as if she'd had a dose of one of these mydriatic drugs—
atropine, or something of that sort. The eye-pupils are markedly
dilated,” he pronounced.
Sir Clinton refrained from glancing at the Inspector.
“I suppose you couldn't make a guess at the time of death?” he
inquired.
Dr. Ringwood tested the stiffness of the limbs, but from his face
they gathered that it was almost a purely formal experiment.
“I'm not going to bluff about the thing. You know yourselves that
rigor mortis is only the roughest test; and when there's an unknown
poison to complicate matters, I simply couldn't give you a figure that
would be worth the breath spent on it. She's been dead for some
hours—and you could have guessed that for yourselves.”
“Congratulations, doctor! There are so few people in this world
who have the honesty to say: ‘I don't know,’ when they're questioned
on their own speciality. Now you might have a look at the wound, if
you don't mind.”
While Dr. Ringwood was carrying out this part of his examination,
Inspector Flamborough occupied himself in a search of the room. An
ejaculation from him brought Sir Clinton to his side, and the
Inspector pointed to a dark patch on the floor which had hitherto
been concealed by one of the displaced chairs.
“There's quite a big pool of blood here, sir,” he said tilting the
chair so that the Chief Constable could see it better. “What do you
make of that?”
Sir Clinton looked at him quizzically.
“Think you've caught me tripping, Inspector? Not in this, I'm
afraid. That's not the girl's blood at all. Unless I'm far out, it's young
Hassendean's. Now, while you're about it, will you have a good look
for empty cartridge-cases on the floor. There ought to be three of
them.”
The Inspector set to work, industriously grovelling on the floor as
he searched under the heavier articles of furniture in the room.
“Well, doctor, what do you make of it?” Sir Clinton asked, when
he saw that Ringwood had completed his examination.
“It's plain enough on the surface,” the doctor answered, as he
turned away from the body. “She must have been shot at quite close
quarters, just above the ear. Her hair is singed with the flame of the
powder. The bullet went clean through the head and then into the
padded ear-piece of the chair. I expect it's stuck there. You can see
for yourself that the shot didn't produce any twitch in the body; the
position she's sitting in shows that well enough. I'm quite prepared to
bet that she was dead before the shot was fired.”
“The P.M. will clear that up for us definitely, if the poison can be
detected,” Sir Clinton answered. “But these vegetable poisons are
sometimes the very devil to spot, if they're at all out-of-the-way
ones.”
He turned back to the Inspector, who was now on his feet again,
dusting the knees of his trousers.
“I've found three cartridge-cases sure enough, sir,” he reported.
“Two of them are under that couch over there; the third's in the
corner near the window. I didn't pick them up. We'll need to make a
plan of this room, I expect; and it's safest to leave things as they are,
so as to be sure of the exact spots.”
Sir Clinton signified his approval.
“On the face of things, judging by the way an automatic ejects its
cartridge, one might say that the single case near the window came
from the shot that killed the girl. The other two, which landed
somewhere near each other, might represent the two shots that
made the wounds in young Hassendean's lung. But that's mere
speculation. Let's have a look at the pistol, Inspector.”
Flamborough put his hand into his waistcoat pocket, stooped
down, picked up the pistol gingerly, and drew a rough outline of its
position on the floor with a piece of chalk.
“Try it for finger-prints, sir?” he inquired. “I've got an insufflator in
the car.”
Receiving permission, he hurried off to procure his powder-
sprayer, and in a few minutes he had treated the pistol with the
revealing medium. As he did so, his face showed deepening
disappointment.
“Nothing worth troubling about here, sir. Whoever it was handled
this pistol last must have been wearing gloves. There's nothing to be
seen but a few smears of no use to us at all.”
Sir Clinton seemed in no wise depressed by the news.
“Then just open it up, Inspector, and have a look at the
magazine.”
“It's three shots short of being full, sir, counting the cartridge that
must be in the barrel now,” Flamborough explained, after he had slid
the magazine from the butt.
“Then you've found all the empty cases corresponding to the
number of shots fired from this pistol, at any rate. We can leave
someone else to hunt for extras when the plan's being made. I don't
expect they'll discover any. Now we'll—H'm! What's this?”
He stepped swiftly across the room and lifted something which
had rolled under a little book-case standing on four feet. As he
picked it up, his companions saw that it was an amber cigarette
holder. Flamborough's face betrayed some mortification.
“I could have sworn I looked under there,” he declared.
“So you did, Inspector; but it happened to be close up to one of
the feet of the bookcase, and probably it was hidden from you in the
position you were when you lay on the floor. It just happened to be in
the right line from where I was standing a moment ago. Now let's
have a look at it.”
He held it out, handling it by the tip with the greatest precaution to
avoid leaving his finger-prints upon the tube. At first sight, it seemed
simply a cigarette-holder such as could be bought in any
tobacconist's shop; but as he rotated it between his finger and
thumb, the other side of the barrel came into view and revealed a fly
embedded in the material.
“One hears a lot about flies in amber,” Sir Clinton said, “but this is
the first time I've seen one.”
Dr. Ringwood bent over and examined the imprisoned insect.
“That ought to be easy enough to identify,” he commented. “I
never saw a fly in amber before; and that one, with its wings half-
spread, must be fairly well known to most of the owner's friends.”
“It may have nothing to do with the case, though,” Inspector
Flamborough put in. “It's quite on the cards that it was dropped there
at the time the house was open for the summer. Some visitor may
have lost it, for all one can tell. Or it may belong to either of the
Hassendeans.”
Sir Clinton twisted the little object into a vertical position and
peered into the cavity which had received the cigarettes’ ends.
“It's not a left-over from summer, Inspector. The tube's got quite a
lot of tarry liquid in it. That would have gone viscid if the thing had
been lying there for a couple of months. No, it's been used quite
recently—within the last day or two, certainly.”
He moved towards the window.
“Just bring that machine of yours, Inspector, and blow some
powder over it, please.”
Flamborough obeyed; but the application of the powder revealed
nothing except a few shapeless blotches on the stem of the holder.
“Nothing!” Ringwood exclaimed, with more than a tinge of
disappointment in his tone.
“Nothing,” Sir Clinton admitted.
He handed the holder to Flamborough, who stowed it away
safely.
“We've still to overhaul the body,” the Chief Constable suggested.
“You'd better do that, Inspector.”
“Not much help in these modern dresses,” said Flamborough,
eyeing the girl's evening frock with a disparaging glance. “But she
ought to have a bag with her, surely. . . . Here it is!”
He plunged his hand between the body and the chair and
withdrew a little bag, which he proceeded to open.
“The usual powder-box,” he began, enumerating the articles as
they came to hand, “Small mirror, silver-mounted, no initials on it.
Small comb. Lipstick—been used once or twice. No money. No
handkerchief.”
“You found Mrs. Silverdale's handkerchief in the car last night,”
Sir Clinton reminded him.
“Then I suppose this must be her body, right enough, sir. Well,
that seems to be all that's here.”
“What about these rings she's wearing,” the Chief Constable
suggested. “See if you can get them off. There may be some
inscriptions on the inside; some women go in for that kind of thing.”
Fortunately the hands of the body were relaxed, and it was
possible to remove the circlets from the fingers. Flamborough rose
with three rings in his possession, which he examined with care.
“You're on the mark there, sir, right enough. Here's her wedding-
ring. It's engraved ‘7–11–23’—that'll be the date of her marriage, I
suppose. Then on each side of the date are initials. ‘Y.S.’—that's for
Yvonne Silverdale, obviously; and ‘F.S.’—these'll be her husband's
initials. Then there's a diamond ring that she was using for a keeper.
Let's see. It's got the same pairs of initials on each side of the date
‘4–10–23.’ That'll be her engagement-ring, I expect. H'm! They don't
seem to have given themselves much time for second thoughts if the
engagement lasted only a month and three days.”
He passed the two rings to Sir Clinton and picked the last one
from his palm for examination.
“This is off the little finger. It's a plain gold signet with Y and S
intertwined on it. Evidently it's Mrs. Silverdale right enough, sir. The
inscription's inside . . . H'm! there's a variation here. The date's ‘15–
11–25’ here; but there's only a single letter at each end: a Y at one
side and a B at the other. That's a bit of a puzzle,” he concluded,
glancing at his superior to see if he could detect anything in his face.
“I agree with you, Inspector,” was all that he elicited for his pains.
“Now take off the bracelet, and that string of pearls round her neck.
Anything of note on the bracelet?”
“Nothing whatever, sir,” the Inspector reported after a glance at it.
“Well, you'd better put these in a safe place when we get back to
town. Now does that finish us here?”
He glanced round the room and his eye was caught by the
second window which looked out from the side of the bungalow. The
curtains were still undrawn, and he noticed a minute gap through
which the outer daylight could pass freely. A thought seemed to
strike him as he ran his eyes over the fabric.
“We'll just go outside for a minute,” he announced, and led the
way through the hall and out of the front door. “Let's see, that
window's round here, isn't it. Keep back for a moment.”
He halted outside the window and scrutinised the ground with
care for a few seconds.
“See that, Inspector?” he inquired. “There aren't any foot-prints
that one could make anything out of; but someone has put his foot
on the box edging of the path just in front of the window. It's quite
obviously crushed . . . and freshly crushed, too, by the look of it.”
Stepping softly on to the flower-bed which lay under the window-
sill, he bent down until his eye was level with the chink between the
curtains and peered through into the room.
“That's interesting,” he said, as he turned again to face his
companions. “One gets quite a good view of the room from here; and
it looks as if somebody had taken advantage of it last night. Nobody
would attempt to look into a shut-up house in the dark, so
presumably the lights were on when he took the trouble to put his
eye to the crack.”
The Inspector made no pretence of concealing his delight.
“If we could only get hold of him. Perhaps he saw the murder
actually done, sir.”
Sir Clinton seemed disinclined to rejoice too fervently.
“It's all pure hypothesis,” he pointed out, rather frigidly.
Flamborough's rectitude forced him into a semi-apology for past
doubts.
“You were quite right about Mr. Justice, sir. He's been a trump-
card; and if we can only get hold of him and find out what he saw
here last night, the rest ought to be as easy as kiss-your-hand.”
Sir Clinton could not restrain a smile.
“You're devilish previous, Inspector, in spite of all I can do. This
Peeping Tom may be Mr. Justice, or again he may not. There isn't
any evidence either way.”
He stepped back on to the path again.
“Now, Inspector, we'll have to leave you here in charge. It seems
to be your usual rôle in these days. I'll send a couple of men up to
relieve you—the fellow who makes our scale-models, too. You can
set him to work. And I'll make arrangements for the removal of Mrs.
Silverdale's body.”
“Very good, sir. I'll stay here till relieved.”
“Then Dr. Ringwood and I had better get away at once.”
They walked round the bungalow to the car. As he drove away,
Sir Clinton turned to the doctor.
“We must thank you again, doctor, for coming out here.”
“Oh, that's all right,” Ringwood assured him. “I got Ryder to look
after my patients—at least the worst ones—this morning. Very
decent of him. He made no bones about it when he heard it was you
who wanted me. It hasn't been a pleasant job, certainly; but at least
it's been a change from the infernal grind of Carew's practice.”
Sir Clinton drove for a few minutes in silence, then he put a
question to the doctor.
“I suppose it's not out of the question that young Hassendean
might have driven from the bungalow to Ivy Lodge with those
wounds in his lungs?”
“I see nothing against it, unless the P.M. shows something that
makes it impossible. People with lung-wounds—even fatal ones—
have managed to get about quite spryly for a time. Of course, it's
quite on the cards that his moving about may have produced fresh
lesions in the tissues. What surprises me more is how he managed
to find his way home through that fog last night.”
“That wouldn't be so difficult,” Sir Clinton rejoined. “This road runs
right from the bungalow to the end of Lauderdale Avenue. He'd only
to keep his car straight and recognise the turn when he came to it. It
wasn't a case of having to dodge through a network of streets.”
A thought seemed to occur to him.
“By the way, doctor, did you notice any peculiar coincidence in
dates that we've come across?”
“Dates? No, can't say I did. What do you mean?”
“Well,” the Chief Constable pointed out deliberately, “the date on
that scrap from the torn envelope we found in the drawer was 1925,
and the figures on that mysterious signet-ring were 5–11–25. It just
happened to strike me.”
His manner suggested that he had no desire to furnish any
further information. Dr. Ringwood changed the subject.
“By the way, you didn't examine the lever handle of the window
for finger-prints,” he said, with a note of interrogation in his voice.
“The Inspector will do that. He's very thorough. In any case, I
don't expect to find much on the lever.”
For a few moments Sir Clinton concentrated his attention on his
driving, as they were now within the outskirts of Westerhaven. When
he spoke again, his remark struck the doctor as obscure.
“I wish that poor girl who was done in at Heatherfield last night
hadn't been such a tidy creature.”
Dr. Ringwood stared.
“Why?” he inquired.
“Because if she'd shirked her job and left those coffee-cups
unwashed, it might have saved us a lot of bother. But when I looked
over the scullery, everything had been washed and put away.”
“Well . . . you don't seem to miss much,” the doctor confessed. “I
suppose it was what I repeated to you about Mrs. Silverdale looking
queer when she came out of the drawing-room—that put you on the
track? You were thinking of drugs, even then?”
“That was it,” Sir Clinton answered. Then, after a moment he
added: “And I've got a fair notion of what drug was used, too.”
Chapter VI.
The Nine Possible Solutions
The police machinery under Sir Clinton's control always worked
smoothly, even when its routine was disturbed by such unpredictable
events as murders. Almost automatically, it seemed, that big, flexible
engine had readjusted itself to the abnormal; the bodies of
Hassendean and the maid at Heatherfield had been taken into its
charge and all arrangements had been made for dealing with them;
Heatherfield itself had been occupied by a constabulary picket; the
photographic department had been called in to take “metric
photographs” showing the exact positions of the bodies in the two
houses; inquiries had ramified through the whole district as to the
motor-traffic during the previous night; and a wide-flung intelligence
system was unobtrusively collecting every scrap of information which
might have a bearing on this suddenly presented problem. Finally,
the organism had projected a tentacle to the relief of Inspector
Flamborough, marooned at the bungalow, and had replaced him by
a police picket while arrangements were being made to remove Mrs.
Silverdale's body and to map the premises.
“Anything fresh, Inspector?” Sir Clinton demanded, glancing up
from his papers as his subordinate entered the room.
“One or two more points cleared up, sir,” Flamborough
announced, with a certain satisfaction showing on his good-
humoured face. “First of all, I tried the lever of the window-hasp for
finger-prints. There weren't any. So that's done with. I could see you
didn't lay much stress on that part of the business, sir.”
The Chief Constable's nod gave acquiescence to this, and he
waited for Flamborough to continue.
“I've hunted for more blood-traces about the house; and I've
found two or three small ones—a track leading from the room to the
front door. There was less blood than I expected, though.”
He produced a blood-soaked handkerchief.
“This was picked up near the corner of Lauderdale Avenue, sir,
this morning after the fog cleared away. It has an H in one corner.
You remember we found no handkerchief on Hassendean's body.
Evidently he was using this one to staunch his wounds, and he
probably let it drop out of the car at the place where it was found.
The doctor said there might be very little external bleeding, you
remember; and the handkerchief's mopped up a fair amount of what
happened to ooze out.”
Sir Clinton again acquiesced, and the Inspector proceeded.
“I've taken the finger-prints from all three bodies, sir. They're filed
for reference, if need be. And I've had a good look at that side-
window at the bungalow. There's no doubt that someone must have
been standing there; but the traces are so poor that nothing can be
done in the way of a permanent record.
“One can't even see the shape of the man's boot, let alone any
fine details.”
“Anything more?” Sir Clinton inquired. “You seem to have been
fairly putting your back into it.”
Flamborough's face showed his appreciation of the compliment
implied in the words.
“I've drafted an advertisement—worded it very cautiously of
course—asking Mr. Justice to favour us with some further
information, if he has any in stock. That's been sent off already; it'll
be in the Evening Observer to-night, and in both the morning papers
to-morrow.”
“Good! Though I shouldn't get too optimistic over the results, if I
were you, Inspector.”
Flamborough assented to this. Putting his hand into his breast
pocket he produced a paper.
“Then I've got a report from Detective-Sergeant Yarrow. I sent
him down to the G.P.O. to find out about Mr. Justice's telegram. It's
impossible to get a description of the sender, sir. The telegram
wasn't handed in over the counter: it was dropped into a pillar box in
the suburbs in a plain envelope, along with the telegraph fee; and
when it was taken to the G.P.O. they simply telegraphed it to our
local office round the corner.”
“H'm!” said Sir Clinton. “There doesn't seem much likelihood of
your advertisement catching much, then. Mr. Justice is obviously a
shy bird.”
“He is indeed, sir, as you'll see in a moment. But I'll finish
Yarrow's report first, if you don't mind. When he heard this story at
the G.P.O., he asked for the postman who had brought in the
envelope and questioned him. It appears the thing was dropped into
the pillar-box at the corner of Hill Street and Prince's Street. That's
nowhere near the Lizardbridge Road, you remember—quite on the
other side of the town.”
“Five miles at least from the bungalow,” Sir Clinton confirmed.
“Yes, go on, Inspector.”
“The postman made his collection, which included this envelope,
at 7 a.m. this morning. The previous collection from the same box
was made at 8 p.m. last night, Yarrow elicited.”
“Then all we really know is that the thing was dropped into the
box between 8 p.m. and 7 a.m.”
“Yes, sir. Yarrow secured the original telegram form,”
Flamborough continued with a glance at the paper in his hand. “The
envelope had been torn open carelessly and dropped into a waste-
basket; but Yarrow succeeded in getting hold of it also. There's no
doubt about its identity, sir. Yarrow ascertained through whose hands
the envelope and the enclosure had passed while they were in
charge of the Post Office; and he persuaded all these people to let
him have their finger-prints, which he took himself on the spot. He
then brought all his material back here and had the envelope and its
enclosure examined for finger-prints; and the two documents were
photographed after the prints had been brought up on them with a
powder.”
“And they found nothing helpful, I suppose?”
“Nothing, so far, sir. Every print that came out belonged to the
postman or the sorter, or the telegraphist. There wasn't one of them
that could belong to Mr. Justice.”
“I told you he was a shy bird, Inspector.”
The Inspector put his paper down on the desk before Sir Clinton.
“He's all that, sir. He hasn't even given us a scrap of his
handwriting.”
The Chief Constable leaned forward and examined the
document. It was an ordinary telegram despatch form, but the
message: “Try hassendean bungalow lizardbridge road justice,” had
been constructed by gumming isolated letters and groups of letters
on to the paper. No handwriting of any sort had been used.
Sir Clinton scanned the type for a moment, running his eye over
the official printed directions on the form as well.
“He's simply cut his letters out of another telegram blank,
apparently?”
“Yes, sir.”
“Rather ingenious, that, since it leaves absolutely no chance of
identification. It's useless to begin inquiring where a telegraphic
blank came from, even if one could identify the particular sheet that
he's been using. He's evidently got one of these rare minds than can
see the obvious and turn it to account. I'd like to meet Mr. Justice.”
“Well, sir, it certainly doesn't leave much to take hold of, does it?
Yarrow's done his best; and I don't see how he could have done
more. But the result's just a blank end.”
Sir Clinton looked at his watch, took out his case and offered the
Inspector a cigarette.
“Sit down, Inspector. We're talking unofficially now, you'll note. I
think we might do worse than clear the decks in this business as far
as possible before we go any further. It may save time in the end.”
Inspector Flamborough thought he saw a trap in front of him.
“I'd like to hear what you think of it, sir.”
The Chief Constable's smile showed that he understood what
was passing in Flamborough's mind.
“I'd hate to ask a man to do something I didn't dare to do myself,”
he said, with a faint twinkle in his eye. “So I'll put my cards on the
table for you to look at. If the spirit moves you, Inspector, you can do
the same when your turn comes.”
The Inspector's smile broadened into something like a grin.
“Very good, sir. I understand that it's purely unofficial.”
“On the face of it,” Sir Clinton began, “two people got their deaths
at the bungalow last night. Young Hassendean didn't actually die
there, of course, but the shooting took place there.”
Flamborough refrained from interrupting, but gave a nod of
agreement.
“Deaths by violence fall under three heads, I think,” the Chief
Constable pursued—“accident, suicide, and homicide, including
murder. Now at the bungalow you had two people put to death, and
in each case the death must have been due to one or other of these
three causes. Ever do permutations and combinations at school,
Inspector?”
“No, sir,” Flamborough confessed, rather doubtfully.
“Well, taking the possible ways of two people dying one or other
of three different deaths, there are nine different arrangements. We'll
write them down.”
He drew a sheet of paper towards him, scribbled on it for a
moment or two, and then slid it across the table towards the
Inspector. Flamborough bent over and read as follows:
Hassendean Mrs. Silverdale

1.—Accident ............... Accident
2.—Suicide ................. Suicide
3.—Murder ................. Murder
4.—Accident ............... Suicide
5.—Suicide ................. Accident
6.—Accident ............... Murder
7.—Murder ................. Accident
8.—Suicide ................. Murder
9.—Murder ................. Suicide
“Now, since in that table we've got every possible arrangement

which theoretically could occur,” Sir Clinton continued, “the truth
must lie somewhere within the four corners of it.”
“Yes, somewhere,” said Flamborough in an almost scornful tone.
“If we take each case in turn, we'll get a few notions about what
may have happened,” Sir Clinton pursued, unmoved by the
Inspector's obvious contempt for the idea. “But let's be clear on one
or two points to start with. The girl, so far as one can see at present,
died from poison and was shot in the head after death. Young
Hassendean died from pistol-shots, of which there were two.
Agreed?”
“Agreed,” Flamborough conceded without enthusiasm.
“Then let's take the cases as we come to them. Case 1: The
whole thing was accidental. To fit that, the girl must have swallowed
a fatal dose of poison, administered by mischance either by herself
or by someone else; and young Hassendean must either have shot
himself twice by accident—which sounds unlikely—or else some
third party unintentionally shot him twice over. What do you make of
that?”
“It doesn't sound very convincing, sir.”
“Take Case No. 2, then: A double suicide. What about that?”
“These lovers’ suicide-pacts aren't uncommon,” the Inspector
admitted. “That might be near the truth. And I suppose he might have
put a bullet through her head before shooting himself, just in case
the poison hadn't worked.”
He drew a notebook from his pocket.
“Just a moment, sir. I want to make a note to remind me to see
about young Hassendean's pistol license, if he had one. I think he
must have had. I found a box and a half of ammunition in one of the
drawers when I was searching the house after you'd gone.”
Sir Clinton paused while the Inspector made his jotting.
“Now we can take the third case,” he continued, as Flamborough
closed his pocket-book. “It implies that Mrs. Silverdale was
deliberately poisoned and that young Hassendean was shot to death
intentionally, either by her before she died or by some third party.”
“Three of them seems more likely than two,” the Inspector
suggested. “There's the man who opened the window to be fitted in
somewhere, you know, and there were signs of a struggle, too.”
“Quite true, Inspector. I suppose you can fit the shot in Mrs.
Silverdale's head into the scheme also?”
Flamborough shook his head without offering any verbal
comment on the question.
“Then we'll take Case 4,” the Chief Constable pursued. “Mrs.
Silverdale deliberately poisoned herself, and young Hassendean
came by his end accidentally. In other words, he was shot by either
Mrs. Silverdale or by a third party—because I doubt if a man could
shoot himself twice over by accident.”
Flamborough shook his head again, more definitely this time.
“It doesn't sound likely, sir.”
Then his face changed.
“Wait a bit, though,” he added quickly: “If that's what happened,
she must have had a motive for suicide. Perhaps someone was on
her track, somebody pretty dangerous; and she saw the game was
up. I don't profess to know how that could happen. But if the man on
her heels was the fellow who did the work with the tourniquet at
Heatherfield last night, she might have thought poison an easier way
out of things. It's a possibility, sir.”
“It leaves us hunting for the clue to a purely hypothetical mystery,
though, Inspector, I'm afraid. I don't say you're wrong, of course.”
“I daresay it's complicated enough already,” Flamborough
admitted without prejudice. “Besides, this Case 4 of yours has
another flaw in it—several, in fact. Unless you take the idea I
suggested, it's hard to see why the girl should have had a supply of
poison handy at all. It sounds a bit wild. And you've got to assume
that a third party shot young Hassendean twice by accident, if a third
party came into the business at all. To my mind, that won't wash, sir.
It's not good enough. Whereas if it was a case of Mrs. Silverdale
shooting him by accident, there was no need for her to commit
suicide because of that. No one knew she was here. She could
simply have walked out of the front door and got clear away with no
questions asked. And if she'd already taken poison, she wouldn't
need to shoot herself in the head, would she?”
“Grave objections,” Sir Clinton admitted. It amused him to see the
Inspector entering so keenly into the game. “Now we proceed to
Case 5.”
“Oh, Case 5 is just bunkum,” the Inspector pronounced bluntly.
“She gets accidentally poisoned; then she gets accidentally shot;
then young Hassendean suicides. It's too thick altogether.”
“I like the concise way you put it,” Sir Clinton answered with
simulated admiration. “So we go on to No. 6, eh? She was
deliberately murdered and he was accidentally shot. What about
that?”
“I'd want to see some motive for the murder, sir, before accepting
that as a possible basis. And if she was deliberately poisoned, what
was the good of young Hassendean dragging her off to the
bungalow? That would throw suspicion straight on to him if he
poisoned her. . . .”
Flamborough broke off and seemed to think hard for a moment or
two.
“That's a fresh line,” he exclaimed suddenly. “I've been assuming
all along that either she or young Hassendean used the poison. But
it might have been a third party. I never thought of it in that light, sir.”
He pondered again, while Sir Clinton watched his face.
“It might have been someone else altogether, if the poison was a
slow-acting one. Someone at Heatherfield perhaps.”
“There was only one available person at Heatherfield just then,”
Sir Clinton pointed out.
“You mean the maid, sir? Of course! And that might help to
account for her death, too. It might be a case of Judge Lynch, sir.
Somebody squaring the account without bothering us about it.”
New horizons seemed to be opening up in the Inspector's mind.
“I'll admit there's something in this method of yours, after all, sir,”
he conceded gracefully.
“I like your ‘after all,’ Inspector. But at any rate you seem to find
the method suggestive, which is something, at least.”
“It certainly puts ideas into one's mind that one mightn't have
thought about otherwise. What about the next case?”
“Case 7? That's the converse of the last one. He was shot
deliberately and she died by accident. What about it?”
“That would mean, sir, that either she took an overdose of the
drug by mistake or someone gave her a fatal dose, ditto. Then either
she or a third party shot young Hassendean.”
“Something of the sort.”
“H'm! It's no worse than some of the other suggestions. I wonder,
now. . . . She didn't look like a dope-fiend, so far as I could see; but
she might have been just a beginner and taken an overdose by
accident. Her eye-pupils were pretty wide-open. That wouldn't fit in
with her snuffing morphine or heroin, but she might have been a
cocaine addict, for all we know. . . . This method of yours is very
stimulating, sir. It makes one think along fresh lines.”
“Well, have another think, Inspector. Case 8: he suicided and she
was murdered.”
“That brings us up against the missing motive again, sir. I'd like to
think over that later on.”
“Case 9, then: He was murdered and she committed suicide.
What about that?”
“Let me take it bit by bit, sir. First of all, if he was murdered, then
either she did it or a third party did it. If she did it, then she might
have premeditated it, and had her dose of poison with her, ready to
swallow when she'd shot young Hassendean. That's that. If a third
party murdered young Hassendean, she might have suicided in
terror of what was going to happen to her; but that would imply that
she was carrying poison about with her. Also, this third party—
whoever he was—must have had his knife pretty deep in both of
them. That's one way of looking at it. But there's another side to the
thing as well. Suppose it was one of these suicide-pacts and she
took the poison as her part of the bargain; then, before he can
swallow his dose, the third party comes on the scene and shoots
him. That might be a possibility.”
“And the third party obligingly removed the superfluous dose of
poison, for some inscrutable reason of his own, eh?”
“H'm! It seems silly, doesn't it?”
“Of course, unlikely things do happen,” Sir Clinton admitted. “I'm
no stickler for probability in crime. One so seldom finds it.”
Flamborough took his notebook from his pocket and entered in it
a copy of Sir Clinton's classification.
“I'll have another think about this later on,” he said, as he finished
writing. “I didn't think much of it when you showed it to me at first, but
it certainly seems to be one way of getting a few ideas to test.”
“Now let's look at the thing from another point of view,” Sir Clinton
suggested. “Assume that young Hassendean and Mrs. Silverdale
were in the room of the bungalow. There were traces of somebody at
the side-window, and someone certainly broke the glass of the front
window. By the way, Inspector, when you went over young
Hassendean's clothes finally last night, did you find a key-ring or
anything of that sort?”
“He had a few keys—the latchkey of Ivy Lodge, and one or two
more.”
“You'll need to make sure that the key of the bungalow was
amongst them, because if it wasn't, then he may have had to break
in—which would account for the window. But I'm pretty certain he
didn't do that. He'd been up beforehand with these flowers in the
afternoon, getting the place ready. It's most improbable that he
hadn't the key of the front door with him.”
“I'll see to it,” the Inspector assured him.
“In the meantime, just let's assume that the broken window
represents the work of a third party. What do you make of things on
that basis?”
“What is there to make out of them except one thing?”
Flamborough demanded. “At the side window you had somebody
whom you christened Peeping Tom; at the front window was a
second person who got so excited that he broke into the room.
You're not trying to make out that these two characters were filled by
one person, are you, sir? There would be no point in Peeping Tom
leaving his window and walking round to the front one before
breaking in. Either window was good enough for that. He'd no need
to shift his ground.”
“No,” Sir Clinton assured him in a thoughtful tone, “I wasn't
looking at it from that angle. I was merely wondering where Mr.
Justice came in.”
“You mean whether he was Peeping Tom or t'other?”
“Something of that sort,” the Chief Constable answered. Then,
changing the subject, he added: “What bits of information are you
going to hunt for next, Inspector?”
Flamborough ran over some points in his mind and cleared his
throat before speaking.
“First of all, I want to know what this poison was, where it came
from, and how long it takes to act. I expect to get something from the
P.M. results, and we can always send some of the organs for
analysis.”
Sir Clinton nodded his agreement.
“I think we'll get two people on to that part of the thing
independently. Say a London man and perhaps one of the chemists
at the Croft-Thornton Institute here. We'll need to see this fellow
Markfield in any case, just to check the statements that Ringwood
gave us, and when we're doing that we can find out if there's anyone
capable of doing the analysis for us. Perhaps Markfield himself might
take it on.”
The Inspector, seeing that Sir Clinton was waiting for him to
continue, proceeded with his list of evidence required.
“I'll put Yarrow on to the matter of young Hassendean's pistol
license. That won't take long to look up, and it will help to clinch the
fact that it really was his pistol that we found on the floor. I don't
suppose for a moment that it was brought in from the outside. The
loose ammunition in the drawer seems convincing on that point.”
“I'm quite with you there,” Sir Clinton admitted.
“Then I want to look into the maid's affairs and see if she had any
grudge against Mrs. Silverdale. It's a pity the second maid's so ill.
We can't get anything out of her for a while, I'm afraid. And I want
her for another thing: to see if Mrs. Silverdale doped herself at all.
But I expect, if she did, that I'll be able to pick up some hint of it
somewhere or other. And of course, if the poison turns out to be a
non-dope kind, that line of inquiry drops into a subsidiary place.”
“Yes?” the Chief Constable encouraged him.
“Then I'll send a man up to try the keys we found in young
Hassendean's pocket on the lock of the bungalow door, just to clear
up the broken window matter. That won't take long.”
“And then?”
“Well, I suppose I'll need to make a try at finding out who Peeping
Tom was and also your Mr. Justice.”
“Quite a lot of suggestions you seem to have extracted from my
little list of possibilities, Inspector. I think you owe it an apology for
the rather contemptuous way you approached it at first.”
“Well, sir, it's been more suggestive than I expected, I admit.”
“One thing's certain, Inspector. The solution of the affair must lie
somewhere on that little table. It's simply a matter of picking out the
proper case. The odds at most are eight to one and they're really
less than that if one discards some of the very improbable
combinations.”
The desk-telephone rang sharply, and Sir Clinton listened to the
message.
“That interests you, Inspector. A report's come in that Mr.
Silverdale came home and has gone down to the Croft-Thornton. He
mentioned where he was going to the constable in charge at
Heatherfield, and he very thoughtfully suggested that as the Croft-
Thornton is quite near here, it would be easy for us to interview him
there if we desired to do so. The perfect little gentleman, in fact.
Well, what about it, Inspector?”
“I suppose I'd better go at once,” Flamborough proposed after a
glance at his watch.
“I think I'll include myself in the invitation,” Sir Clinton
volunteered. “And, by the way, you'd better take that fly-in-the-amber
cigarette-holder with you, if they've finished with it downstairs. Young
Hassendean was working at the Croft-Thornton and someone there
may be able to identify it for us if it was his. I'm not anxious to trouble
his relations in the matter.”
“Very good, sir,” Flamborough acquiesced. “You'll want your car.
I'll give the order for it now.”

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Organizational Behaviour Concepts Controversies

Organizational Behaviour Concepts Controversies

IF NOTHING ELSE, MY STUDENTS SHOULD LEARN…

Students should be able to:

• LO 7.2: Discuss the characteristics and functional aspects of fat-soluble

Copyright © 2018 by Nelson Education Ltd. 7-1

• LO 7.7: Summarize the characteristics and functional aspects of water-soluble

• LO 7.9: Discuss the collective functional aspects of B vitamins in metabolism and

• LO 7.11 Describe how to choose foods to meet vitamin needs.

WHY IS THIS CHAPTER IMPORTANT TO SCIENTISTS AND

7-2 Copyright © 2018 by Nelson Education Ltd.

models. These observations were then made on patients who experienced

• Vitamin D insufficiency is relatively common in Canada due to its northern

• Vitamin C has always been recommended as a preventive measure against colds.

• There is some research to support the finding that vitamin B supplementation

• Health-care practitioners should be aware of the problems associated with

WHY SHOULD STUDENTS CARE?

Copyright © 2018 by Nelson Education Ltd. 7-3

The fat-soluble vitamins are vitamins A, D, E, and K; the water-soluble vitamins

• Vitamin A is essential to vision, integrity of epithelial tissue, bone growth,

• Vitamin E acts as an antioxidant in cell membranes and is especially important

• Vitamin K is necessary for blood to clot; deficiency causes uncontrolled

• Vitamin C, an antioxidant, helps to maintain collagen, the protein of connective

7-4 Copyright © 2018 by Nelson Education Ltd.

WHAT ARE COMMON STUDENT MISCONCEPTIONS/

WHAT CAN I DO IN CLASS?

Lecture Enhancement 7–1: Food Processing and Nutrient Density

Copyright © 2018 by Nelson Education Ltd. 7-5

Freezing. An alternative to canning, as a means of preserving food, is freezing. The

7-6 Copyright © 2018 by Nelson Education Ltd.

Copyright © 2018 by Nelson Education Ltd. 7-7

Food Storage and Preparation

Vitamin C is an organic compound synthesized and broken down by enzymes found in

7-8 Copyright © 2018 by Nelson Education Ltd.

Because it is an acid and an antioxidant, vitamin C is most stable in an acid solution,

Lecture Enhancement 7–2: Resurgence of Rickets in North America1

Copyright © 2018 by Nelson Education Ltd. 7-9

Lecture Enhancement 7–3: Dietary Antioxidants: Best from Food or

Free Radicals, Oxidative Stress, and Disease

7-10 Copyright © 2018 by Nelson Education Ltd.

The Body’s Defences against Free Radicals

Copyright © 2018 by Nelson Education Ltd. 7-11

Phytochemicals. Some phytochemicals have antioxidant activity although they work in

Do Dietary Antioxidants Protect against Cancer?

7-12 Copyright © 2018 by Nelson Education Ltd.

Support for beta-carotene supplements soon crumbled, however, as studies showed no

Copyright © 2018 by Nelson Education Ltd. 7-13

7-14 Copyright © 2018 by Nelson Education Ltd.

An adequate intake of selenium is not to be neglected, however, especially by men. In

Copyright © 2018 by Nelson Education Ltd. 7-15

Evidence Concerning Age-Related Blindness

Do Dietary Antioxidants Protect against Heart Disease?

7-16 Copyright © 2018 by Nelson Education Ltd.

Copyright © 2018 by Nelson Education Ltd. 7-17

7-18 Copyright © 2018 by Nelson Education Ltd.