Nutritional supplements… More harm than good?
“The value of those wild fruits is not in the mere possession or eating of them, but in the sight and enjoyment of them.” — Henry David Thoreau (American environmental scientist, philosopher and poet, 1817–1862).
Vitamins, minerals, fish oils… the list of nutritional supplements we are told to buy keeps growing. They are convenient, easy and cheap… but are they worth it. In 1911, Polish chemist Casimir Funk made an influential biomedical discovery that has changes the way we think of vitamins today. He learned that a disease called beriberi affected those who ate a diet of mainly white rice, but not those who ate mostly brown rice. He isolated a chemical from rice bran, showed it could prevent beriberi, and called it “vitamine“. We now call that compound vitamin B1. It is one of many essential nutrients that the human body cannot produce in sufficient quantities and that we must obtain from food. Casimir’s breakthrough led to similar discoveries, including vitamin C that prevent scurvy and vitamin D that prevents rickets. In 1920, the British chemist Jack Cecil Drummond proposed dropping the “e” and using the umbrella term “vitamin”. Early success at identifying, preventing and curing nutritional deficiencies naturally led to the idea that dietary supplements were good for everybody. Science now recognises around a dozen essential vitamins, as well as some 20 minerals considered essential in small amounts. Since then our awareness of vitamins has grown, and with it, a desire to take personal control of our health.
Despite the fact that most people believe, as the industry tells them, that supplements will make us healthier — there is little to no evidence that this is the case. Vitamin and mineral pills are a convenient way to plug specific gaps in your diet and they protect from diseases of deficiency (think scurvy, rickets and Beri Beri). But there is little-to-no evidence for them to make the immune system work better than it already does at baseline and they are not effective at mitigating risk of infection or risk of lifestyle related-ill health or chronic disease. What’s more, relying on supplements can be an excuse for a bad diet. Ensuring that your meals comprise a variety of fruits and vegetables, fibre and good fats most of the time will help make sure you have all the vital resources in place to keep your immune system functioning as it should. Plus, there are some unique nutritional aspects of our food that are vital for immunity which we cannot get from supplements alone.
Marketing magic & the dawn of a pill popping era.
One might ask then, given substantial evidence for lack of any health benefit for supplements in the majority of the adult population, why are these products so popular and so widely marketed? And why do over 40% of us regularly use them? The belief in the use of vitamins has deep roots. The immensely beneficial effects in preventing deficiency diseases of times gone by when overt nutritional deficiencies were common, has given supplements the halo of a magical panacea. Nowadays for some they are an insurance policy against a less-than-perfect diet. Others take them because they can’t – or won’t – eat certain foods. And not to forget the biology of belief - the very real placebo effect that can be unlocked by pill popping. Substantial misleading media and commercials coerce us into belief, which might be expected, given that supplements are big business. Relentless advertising and marketing of vitamins, herbs and other supplements that do not require a product to be is either safe or effective before selling it. Moreover, they can be legally marketed with vague claims such as “maintains immune function,” so long as they don’t specifically say that it actually treats or cures anything.
Ultimately, beliefs stay in place when they fulfill a need and strengthen our sense of identity, or what we aspire to be. Whatever the reasons, popping vitamin and mineral supplements can feel like a virtuous shortcut to a healthy life. But they can also be used as an excuse for a bad diet, an antidote to a day of disordered eating. whereas real food forces you to cook and possibly eat less. There are also absorption issues.
Supplements… more harm than good?
Unlike the case for drugs, human research is not required to prove that supplements are safe or effective. Only if the regulatory authorities find that supplements are unsafe, can they stop the distribution of the products. We are also waking up to the importance of the interactions between the different foods we eat and how these influences affect uptake of the nutrients they contain. It turns out it’s not what we eat, it’s how we eat it. Attributing broad health benefits to supplement pill popping is proving to be quite misguided. For example, vitamin E supplements repeated fail to show benefit in clinical trials and has even been linked to an increase in the risk of stroke, increased risk of prostate cancer, and when taken by pregnant women may increase the risk of congenital heart defects in their babies. Yet studies showing diets high in vitamin E are protective. Until more research is done, we should focus on assuming the fundamental unit of nutrition is food as the sum of its parts. Regular consumption of a variety of plant-based foods is reported to both reduce the risk of infections and certain diseases, such as cardiovascular disease and some cancers. This is attributed to the inclusion of varied combinations of phytonutrients together with microbiome nurturing fibres. Phytonutrients act as a natural pesticide which help protect plants from predators. So, it’s no surprise that they have been found to help keep us well too. It is important to note that a single phytonutrient in isolation won’t be responsible for having these powerful effects. With over 8000 different phytochemicals recorded across many foods - not only fruits and veggies but also beans & pulses, tea, coffee, red wine, cacao, herbs, spices, condiments & olive oil - their effects cannot be explained by just one or two select few. We are still discovering and learning more about phytochemicals, including identifying new ones. Evidence is also accumulating to show that different types of phytochemicals interact beneficially with each other, some effects are enhanced by cooking, others are destroyed. But rather it’s the combination of plant compounds that interact and synergise when eaten together. So, to get the full benefit from phytochemicals it is important to aim for variety. To allude to the orchestra analogy, it is like taking out the string section and expecting the same sound. When it comes to food, the whole emerges as greater than the sum of its parts. But that hasn’t stopped supplement companies from attempting to capture the properties of phytonutrients in pill form. But this is problematic, unregulated and unlikely to have the same benefits of consuming phytonutrients in a meal. Even if the package states a whole food supplement, they are unlikely to act the same way as the same food in a meal and in some cases might actually be detrimental to our health. Eating foods rich in beta-carotene were shown to reduce lung cancer risk but supplementing with did nothing to mitigate the risk and in some studies may actually increase cancer risk, as opposed to the whole carrot, which may lower our risk. Omega 3 studies show that eating fish has benefits beyond supplementing with fish oils and vitamin C capsules could be doing more harm than good, it's clear that when it comes to supplements, not everything is as it seems.
Know your reason.
If your diet in general is less than perfect, then improving your diet is where you want to start. No number of pills are going to negate that. But there may be certain circumstances whereby you need to supplement. For example, if you have or are at risk for osteoporosis, your doctor will likely recommend calcium and vitamin D supplements. Anyone over age 50 may need a vitamin B12 supplement because this nutrient becomes harder to absorb from food as we age, as do those following a vegetarian or vegan lifestyle. If you follow a diet that excludes food groups such as vegan it may be a good idea to consider adding vitamins and minerals to plug any gaps. It's often forgotten that the primary reason we take a multivitamin should be to prevent deficiencies or a lack of enough essential vitamins and minerals. In other circumstances, there are some nutrients it’s almost impossible to get in adequate quantities from food alone. Vitamin D is the most prominent – a particular problem in the UK and countries at similar latitude where, during the winter, the sun isn’t strong enough to allow your body to produce it naturally. Primarily known for its role in bone health, our immune cells actually contain receptors for vitamin D and it plays a key role in regulating our immune responses. As of 2016, official NHS advice is to take it in supplement form. BUT vitamin D only works well is you also have vitamin K2 – approximately half of which is produced by our microbiome. So already you start to see a complex picture emerge where we need a multi-pronged approach - take care of those gut bugs to help our vitamin D function properly. Other exceptions include vitamin B12 if you are vegetarian or vegan, omega 3, Zinc and vitamin C for hard training athletes, magnesium which according to the 2018 National UK Diet and Nutrition Survey is something we are all a little deficient in.
When it comes to food, the whole is often greater than the sum of its parts. And nutrition goes beyond just vitamins and minerals. Eating a diverse plant rich diet full of phytonutrients, fibre and good fats will help ensure you get your recommended vitamin and mineral needs covered but provide plenty of nourishment for your body in ways that pill popping just can’t. Always aim for a food first approach and supplement as necessary. Finally, nutrition is only one way of supporting your health - taking care of your overall general wellbeing with a sensible lifestyle, good quality sleep and regular exercise all lay the foundation for your health, helping you avoid getting sick and aiding a speedy recover if you do fall ill.