Studies show there are no benefits to taking supplements, and there may be harm. (Added 2017)
I’ve always been careful with recommending supplements, as the results of studies change over time. A new study finds that high doses of folic acid may increase the risk of developing precancerous colon polyp growths. Previous studies showed diets low in folic acid led to a higher risk of colon cancer.
Last month, a study linked heavy vitamin E use to fatal prostate cancer, and other research has shown beta-carotene pills can heighten smokers’ risk of lung cancer.
“I take vitamin C every day,” boasts a gentleman at my luncheon table. “I believe it’s good for me.” I ask him how much he’s taking. He doesn’t know. But he takes two to three pills. This is so common - someone believes something is good for him or her - they heard it somewhere - so they buy it but they don’t know how much they should take.
Billions of dollars are spent on nutrient supplements of all kinds each year. According to the Office of Dietary Supplements, in 2005 dietary supplement sales in the US approached 21.3 billion dollars.
Most of the supplements are going to those who need them the least. The people who buy the supplements are the well-to-do healthy population, not the malnourished population who really do need them.
THE MAGIC PILL
Everyone is looking for the “magic pill.” False advertising appeal to their insecurities. Messages such as “vitamins in fruits are destroyed when transported,” “a balanced diet is insufficient to maintain health,” “if you’re feeling tired, you lack....” and “when under stress you need extra nutrients.” If you buy into these, you may become another victim of the supplement industry.
With the craze for mega-dosing, it’s important that you know what you’re doing. A “little is good,” so you might assume a “lot is better.” This is not the case and can be downright dangerous. Don’t play games with supplements! (Even the scientific community is struggling to find the right amounts of nutrients that will improve health with no harmful side effects.) Instead use your knowledge to consume a variety of nutritious foods.
For example if you think you don’t have time to prepare vegetables, time yourself. It takes 15 seconds to open a bottle, take out a beta-carotene tablet, pour water and swallow the pill. Peeling a fresh and crunchy carrot takes only 20 seconds and you get so much more value. The carrot will not only supply you with beta-carotene, but hundreds of protective nutrients like other carotenoids, vitamin C and fiber. These substances in the carrot will supply many health benefits, so why limit yourself to only one?
Vitamin C - the perennial “flavor”’ of the month? - From 500 mg to 3000 mg and more. Who cares? It’s supposed to be good for us isn’t it? Next month it’s vitamin E. Again the public doesn’t know the amounts to be taken or why they should take it. With osteoporosis in the news, you self-prescribe calcium and vitamin D. What about ginseng and bee pollen? They’re hot in the media from time to time. I have clients who have brought in bags filled with 20 supplements. Many have overlapping nutrients, many don’t have ingredients listed, and many have very strange ingredients. What are the functions of the various ingredients? They can’t remember, although they sounded good at the time.
No one knows for sure if supplements are necessary. If they are, which ones and how much? Will there be toxic side effects at a later stage? Who knows? We can only work with what we know now. I prefer to be cautious. Eat well, and supplement only for certain conditions, and then under the care of a dietitian or physician.
“I FEEL GREAT AFTERWARDS” OR “THE PLACEBO EFFECT”
Most people don’t feel any different when they take supplements. But some take certain supplements and say they feel different. This may be the “placebo effect” working on them. In other words if you believe it makes a difference, it will. If the supplements are not harmful, I don’t object. But, if the total intake of some of the nutrients is excessive, I warn my clients that they can continue at their own risk, or slowly decrease their supplement intake, eventually stopping altogether. Remember, the contents of these supplements are present in nutritious foods, a more enjoyable way to get all your nutrients.
Some supplements, such as vitamin C, taken in large doses should be weaned slowly so that the body adjusts to absorbing vitamin C from food. This takes time due to the deprivation of its usual overload from supplements. Under these circumstances, scurvy can occur. Again, seek professional help.
With regard to pain and arthritis, studies with glucosamine chondriotin supplements found that some people feel better after three months, others had no change in pain. There are also quality issues, some supplements contain less than claimed or no chondroitin at all, some are good quality. Visit www.consumerlab.com for product reviews – well worth your investment.
Studies on chromium supplements have seemed positive. If your diet does not contain whole wheat bread and cereals, peanuts, prunes, apples, mushrooms, oysters or wine each week, speak to your dietitian.
A supplement salesperson once claimed, “Zinc is an essential vitamin you should take.” When I told her that zinc is not a vitamin, it’s a mineral, she said it’s not important, so long as we know it’s essential. She also told me that my clients should take supplements to prevent cancer. If I don’t recommend them, she insinuated, I’m contributing to their future ill health. As it turned out, she’d “studied” nutrition from a sales book on supplements. Wow, what kind of super salesman wrote that book? Unfortunately, she was passing on false information to her customers, who probably didn’t know better. It gave me pause to wonder what else she didn’t know that she was convincing the public to believe!
High-powered people from multi-level marketing companies are out there selling supplements to their friends. These unnecessary supplements are more expensive than those in drugstores. Salespeople who boast about their large commission sell them to you. Fortunately, most of my clients, who have bought these, forget to take them.
I’ve been approached to endorse, or sell, their products but have declined. I would lose my professional status were I to do so. Dietitians may only recommend supplements if they are necessary. We certainly cannot sell them. The Nutrition Division of a local Public Health Department has been so concerned about pyramid sales or “network marketing”, that they have issued a pamphlet entitled “Caveat Emptor - Buyer Beware.” This issue warns the public about nutrition quackery, of which many of these supplement salespeople are guilty.
HEALTH FOOD STORES
Don’t feel you have to ingest grape seed extract, spirulina and echinacea to be healthy. I don’t consume them either. Our desire for perfect health compels us to seek products to replace our deficiencies. When we enter a health food store, a plethora of mixtures; herbs, seeds, powders and bars that seem to contain the precise remedy for our ailment confront us. With the claims to decrease aging, people are popping pills at an alarming rate. The prospect of lowering stress and preventing heart disease is naturally compelling, but without a sound scientific basis, you could be harming yourself.
My advice is to buy real foods, such as vegetables, fruits and whole grain products that are bursting with essential nutrients. The only time I go to a health food store is for interesting types of rice, seeds, herbs and spices. They’re quite expensive, but complement certain dishes. So if price is not an issue, buy interesting foods - not pills - at these stores.
THE DANGER OF SELF-PRESCRIBING
Before I plan any program with a client, I ask the following questions to assess their overall health:
• Are you taking supplements? Thankfully, most say no. But some are not certain if they should. I assure them that I’ll balance their food intake so that supplements can be avoided, unless necessary.
• If they say yes, I ask which supplements and what are the quantities taken? Most of my clients don’t know what is in each tablet or the amounts of vitamins and minerals they’re consuming.
• I then ask who recommended them? Many can’t remember - if they do, it’s either a relative, friend or health food supplier. It’s seldom a health professional.
• Why are you taking them? The answers vary: “It’s meant to be good for me,” “I heard our food supply lacks vitamins,” “for energy,” etc.
• Since taking the supplements, do you notice any difference in your condition? “No, but I’ll just finish these anyway,” “I think I’m feeling better, but I switched to a high fiber diet as well,” and more of the same.
• If a doctor has recommended a multi-vitamin and mineral tablet for a specific condition, for example, for pregnant women, I feel comfortable going along with this.
“NATURAL” VERSUS “SYNTHETIC”
“This is a ‘natural’ not a ‘synthetic’ type,” - Clive says smugly. How can he tell if it’s true? They look alike. And there’s no regulation at all to define “natural.” “Natural” is used to describe anything and everything. It does and always has meant nothing. In actual fact there’s no difference, except perhaps in price. The body can’t tell the difference.
If you are determined to take a supplement despite my advice, take the lowest dose and the cheapest all-purpose one. A better investment in health and education, and possibly cost saving, is to see a dietitian who helps you plan a healthy, nutritious eating program.
Supplements are regarded by the consumer as a food, not as a drug. But overdosing can occur. The dangers of toxicity far outweigh the hope for miracle effects. I need proof that a supplement is necessary for everyone before I recommend it across the board or even take it myself!
Pregnant women in particular need to be careful about self-prescribing supplements. The effects of vitamin megadoses on pregnant women can result in birth defects. More than 1 to 2 grams Vitamin C per day can destroy some vitamin B12 , cause stomach inflammation, diarrhea, over absorption of iron, oxalate kidney stones and possibly “rebound” scurvy.
Keep supplements away from children. Megadoses of vitamins and minerals are potentially harmful to children, damaging their livers and in some cases causing death.
Watch for other possible problems. The toxic effects of too much vitamin B3 can lead to liver damage, B6 leads to nerve damage, zinc leads to both copper deficiency and weakening of the immune system, and excess magnesium causes diarrhea. We have yet to discover all the toxic effects from overdosing.
Vitamins are organic compounds that are needed in small amounts in the diet for use in important metabolic reactions in the body. They promote growth, development and maintenance of the body. They promote good vision, form normal blood cells, create strong bones and teeth, and ensure the proper function of the heart and nervous system. They do not supply calories. They are found in minute quantities in animal and plant foods. The following is up-to-date information on the most popular vitamins being sold today:
• VITAMIN A AND BETA CAROTENE
Vitamin A is always present in a general multivitamin tablet. Excess intake as a supplement can be toxic so only take it under medical supervision. Beta-carotene is a precursor of Vitamin A and is present in dark colored fruits and vegetables. Picture spinach, carrots, tomatoes, broccoli, and green beans on your plate - plenty of color.
On rare occasions I’ve seen excessive consumption of carrots, up to ten carrots per day, in eating disordered clients, resulting in yellowing of the skin, particularly the palms of the hands.
• VITAMIN C
Despite the Recommended Nutrient Intake for vitamin C being 60 mg per day, doses of over 500 mg per day have become very popular. “Since I’ve been taking vitamin C I haven’t caught a cold.” There is no scientific proof, to date, that this is true. But perhaps if you “believe” that vitamin C can stop colds, the placebo effect may spring into action. Besides, if you’re so concerned about catching a cold, you may already be taking good care of yourself and eating in a healthy manner. One research project did show that vitamin C taken when you already have a cold, can decrease the length of time of the cold. But then again, another study showed that exercise could decrease the length of time that you have a cold from ten days to five days. (Perhaps exercise is a better bet.)
You’re going to read somewhere that heavy smokers and drinkers should increase their vitamin C intake. Maintaining an unhealthy lifestyle as it stands is bad enough. It certainly doesn’t help you to supplement with vitamins. Instead, have an extra fruit a day.
Be warned: too much vitamin C appears to destroy vitamin B12, cause diarrhea, flushing, rapid heartbeat and kidney damage in children. Keep kids away from them!
• VITAMIN E
The rumors of vitamin E are much more exciting! For example: “Vitamin E improves your sex life dramatically” - unfortunately no proof. “Vitamin E slows down the aging process” - again no proof. “Vitamin E slows down the onset of heart disease and cancer” - not in recent studies. Rather include wheat germ, fruits, vegetables, vegetable oils and nuts in your diet.
Vitamin E is a fat-soluble vitamin and is not easily eliminated from our bodies so supplement intake can be toxic. The recommended intake is 8 - 10 mg per day. Excess intake - more than 250 mg per day (400 I.U.), can cause nausea, weakness, headache, diarrhea and fatigue. A recent study has shown earlier deaths as well. Scary thoughts!
• VITAMIN D
Vitamin D is essential for bone strength because it aids in calcium absorption. You can get it from food and a little sun. If it’s winter, be sure to include milk, eggs, canned salmon with bones, sardines, cheese, fortified margarine and fortified breakfast cereals. The RDA is 400 – 600 IU/day. A study found that higher daily doses of vitamin D—in the range of 700 to 800 IU—may reduce the risk of bone fracture by approximately 25%.
High intakes of vitamin D (from supplements) are toxic, leading to kidney stones, kidney failure, muscle weakness, excessive bleeding, bone weakness and overgrowth of bone.
• VITAMIN B12
Fortunately it is easy for us to get an adequate intake of vitamin B12, as it is present in all animal foods. I have heard of people injecting themselves with this vitamin for extra energy - how bizarre. Fatigue in healthy people is usually not due to the deficiency of this vitamin. It could be lack of sleep, hunger, overeating, iron deficiency and many other more obvious reasons. Only vegans, people who have chosen not to consume any animal products, need a vitamin B12 fortified food or supplement. Vegans should see a dietitian for a balanced healthy diet.
Minerals are present in organic and inorganic compounds and are essential for good health. Similar to vitamins, we need very small quantities of these nutrients for our body to function. The best way to get them is from food.
“Cows don’t drink milk after weaning, so why should we?” was the opening question asked of me by an obnoxious (but funny and likable) radio host. My reply was, “if you want to compare yourself to a cow, eat grass.” It’s illogical to compare a cow’s eating habits to ours. Cows have four stomachs with different enzymes to digest grass.
A lifetime intake of sufficient calcium is essential. We’ve all seen women and men practically bent over double with a humped back, and heard of elderly people falling and easily breaking their bones. This is due to osteoporosis, a crippling disease that causes bones to become porous and brittle due to loss of bone material. The incidence of osteoporosis is higher with women (25 - 30%) than men (12 - 15%) and bone fracture rates, which cost us millions of dollars annually, are related to calcium intake. If women over 65 receive adequate calcium intake, their bone loss is reduced by 12 to 25% over 2 years. So add up your calcium intake in your diet, and adjust where necessary.
As 99% of body calcium is found in our bones, this mineral is essential to keep our bones healthy and strong. Milk (including skim milk and 1% milk) is the best food source of calcium. (Notice that milk is enriched with vitamin D, which is essential for calcium absorption.) Other dairy products such as cheese and yogurt are equally good sources of calcium. Choose the low fat options - they contain no less calcium than the high fat types.
Research work has found that bone strength is increased until the age of 35 years. After that, calcium absorption is decreased.
Calcium is also present in other well-known foods. Although certain compounds (oxalates) in spinach and sweet potatoes, and other compounds (phytates) in legumes and grains reduce the availability of calcium in these foods, don’t be shy of eating them.
If you are a vegan and don’t drink milk, there are other sources of calcium equal to 1 cup of milk that can be chosen. Broccoli (8 cups), oranges (6), almonds (2/3 cup) or calcium-enriched tofu (1 cup) are all good sources. Unfortunately, I find it hard to get children to consume large quantities of broccoli, almonds and tofu at the best of times. Be very careful if you decide to have your children adopt this lifestyle.
“I didn’t manage to drink any milk or eat any yogurt or cheese today, I’d better take a calcium supplement.” Missing one meal or missing one food on a day is not cause for concern. Your food intake needs to be considered over a week and over a lifetime, not every meal in every day.
Be careful when prescribing a calcium supplement for yourself. Preferably, don’t supplement with bone meal or dolomite as these may contain lead. Over supplementing can lead to decreased absorption of iron and zinc as well as kidney stones.
There are two matters about this mineral that affect my female clients. Firstly, lack of energy due to anemia (lack of iron in the blood) and too much iron due to iron supplementation that causes constipation.
“I’m always tired. I was once diagnosed as anemic.” - say a few of my female clients. If lack of sleep is not the cause, they are often not eating foods high in iron. Certain foods enhance the absorption of iron such as meat, poultry, fish and vitamin C rich fruits and vegetables. Certain foods decrease the absorption of iron, such as oxalates in spinach, phytates in whole grains and ingredients in tea, coffee, bran and legumes. So even if tea is decaffeinated, it still contains tannin, and excess decreases the absorption of iron.
Iron deficiency is more common with women than men. It occurs in approximately 15% of women due to increased requirements for menstruation and pregnancy. Women are also inclined to eat less meat, either for “diet” or ethical reasons. Of course if they are athletes as well, they need sufficient iron to achieve peak performance. The result of an insufficient iron intake is weakness and shortness of breath, which may impair their work and activity performance. These people are frequently pale, have a poor appetite and an increased risk of infection.
Many of my clients are unaware of the fact that an iron supplement may cause constipation. Certainly, don’t prescribe it for yourself. If you have a blood test and discover that you have an iron deficiency, the physician will recommend the amount you need or, preferably, refer you to a dietitian who can make sure the amount you take is adjusted to suit your diet, increasing fiber and fluids and becoming more active to counteract the constipating effect.
Iron-rich foods from animal products (meat, liver, sausages and turkey) are better absorbed than from plant products (dried fruits, cereals, pasta, dark green vegetables and legumes). The good news is that, if you want to limit your meat intake, small portions of meat, poultry or fish, as well as foods rich in vitamin C (fruits and vegetables) increase the absorption of iron from plant foods. For example, add vegetables to iron enriched pasta or bean soup.
For children, iron is essential for rapid growth. Among teenagers it has become trendy to avoid beef. However, they replace meat with doughnuts and muffins - creating an iron deficiency. Teenage girls undergo a rapid growth phase, start menstruating and many go “on a diet” - three reasons that could lead to iron deficiency. If you decide to prescribe an iron supplement for your teenager, be aware that the toxic effects of excess iron intake include damage to the liver, pancreas, heart or immune system, hemorrhaging, decreased absorption of copper and even death. You’ll notice a warning on supplements, particularly high iron supplements, to keep from children. If they must take supplements, only a little is necessary.
In the 1940’s, when my dad started losing his hair, he heard that liver stopped baldness so he ate liver every day for six months. It didn’t help; he continued to lose his hair.
I’m not sure why, but zinc is a mineral everyone goes crazy supplementing from time to time. It seems that salespeople can always find something about you that needs improvement and say zinc can do it. But, as with other metals, ingesting too much can cause side effects such as vomiting, cramps and diarrhea. These symptoms, however, will subside once you stop taking it.
Rather, ensure that you are eating good sources of zinc, such as beef, lamb, pork, liver, the dark meat of chicken and/or whole-grain cereals, legumes, peanuts and peanut butter. You don’t have to have one of these foods in every meal, every day. Some days you’ll have plenty - cereal, a peanut butter sandwich and a hamburger. Other days you’ll have less. Deficiencies are rare - only vegetarian and low-protein diets can be low in zinc.
Should you take supplements? Not before an individual assessment of your diet by a dietitian. Don’t go to someone who sells supplements.
There are certain circumstances when I would consider supplementation. Women who are pregnant, vegans, lactose-intolerant people, osteoporotic women and men and people in a high-risk category for heart disease or cancer might need supplements, and then only if they run a risk of deficiencies in their diet. All the vitamins in the world won’t help if you have an unhealthy lifestyle.
If you intend to eat badly, or are insecure about your health, take a general, multi-purpose, tablet with less than 150% RDA for all nutrients. Just one. And a cheap one.