Good article in this week’s New Scientist “Why supplements don’t work.” You cannot access the article online unless you subscribe to the unfortunately, so if you are interested best to buy the paper magazine.
Why supplements don’t work. - Atrial Fibrillati...
Why supplements don’t work.
56 Replies
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Can you give us a flavour of the piece?
in reply to Peddling
Difficult to summarise, but MarkS has provided an outline below.
Including the ones we need because our "health giving " food is grown in nutrient depleted soil lessening its efficacy?
in reply to Bagrat
I think the scientists would say in that case you should get the required vitamins etc. from food rather than supplements. Of course, if healthy food is not available then there may be a case for supplements. But the article points out that that is fairly rare in developed countries.
Since I know supplements empirically work for me given the right dosage is taken at the proper frequency/time-of-day, the title is probably designed to entice readers thus I have no interest in such article.
Supplements definitely work for me. Q10, magnesium, curcumin, potassium to name a few
in reply to noviceAFIB
I agree. I fail to understand the helpfulness of making such sweeping generalizations. All supplements? That's ridiculous.
I'm reading Metabolic Cardiology, by Dr. Stephen Sinatra, and was just reading that actually, we do not get enough of the particular supplements he suggests for heart patients from food alone.
Many of the details of cell biochemistry that he explains at length don't tend to stick in my brain, but nourishing the cells with the supplements he recommends (tailored to various heart conditions) makes sense to me. Of course, it's important to find the right doses for oneself and check with one's doctor.
heartmdinstitute.com/heart-...
He also spells out the context within the healthcare system (in the US, anyway) in which pharmaceutical companies have enormous influence on research and doctors. With such a strong profit orientation, nutriceuticals aren't likely to get the attention in research that the drugs get. Doctors are not trained to consider the efficacy of supplements.
Lately I have been taking Heart Calm and have been pleased to notice a difference in how I feel. It has magnesium, potassium, taurine, and CoQ10, all in rather small doses.
vitalbiologics.com/products...
I am happy to try out these supplements and keep educating myself so as to avoid having to take my FDA-approved PIP Flecainide, which may stop an episode or may well make it much worse, along with turning me into a zombie.
in reply to
The article in New Scientist was not referring to supplements for specific, known, vitamin or other deficiencies, but to the habit of taking supplements when there is no obvious reason to take them. The evidence doesn’t suggest that they are of any use beyond placebo. The article also suggests that in many case the deficiencies can be met more effectively by eating the appropriate foods. It is backed up with plenty of solid research.
in reply to
Here's something to consider, Samazeuilh....
You titled your post, "Why Supplements Don't Work," and shared nothing about the main idea of the article.
There may be folks here who are new to AF and are going through the mess of feeling awful and trying to figure out what to do to help themselves feel better. I don't know about you, but it's been rough figuring out who and what to trust and try along the way. And that includes Western docs with overpowering meds, in a health care system (in the US) that is strongly tilted toward these meds being the only answer for AF. Alternative approaches that can help quality of life are really not widely embraced.
This information I've recently discovered on the value of AF patients taking CoQ10, Magnesium, Potassium, and Taurine, and possibly L-Carnitine and D-Ribose has made a huge difference in how I feel in just a few days. My doctors never told me about this. It's common that cardiologists don't know about this.
There's enough misleading info out there to sort through; why add to it with such a broad pronouncement as you made when the audience here is highly specific? And the truth is that it's been scientifically proven that folks with AF become deficient in these substances.
I'm sure you meant no harm. Normally, I'd have just skipped the post, but I'm tired of alternative approaches being slammed or misrepresented. The very narrow approach of the cardiologists I've seen has at times done me more harm than good, while for the moment, as I sort out the dosage of these nutriceuticals, they are clearly helping me.
in reply to
Well, if you look back at the original post you will see that someone else provided a short summary, so a further one from me would have been redundant. I was simply directing people to an article which I thought they might find interesting. Anyone is, of course, free to ignore the research. The article by the way had nothing to do with alternative medicine, and I didn’t comment on that. I do think that people are entitled to criticise alternative medicine however as much of it is at best dubious. Homeopathy, for example, has no scientific support whatsoever.
in reply to
I’ll be sure to tell my homeopath what you said next time I see her and next time I take a remedy that helps me! 😂 😂
in reply to
Dga5000 posted the New Scientist article a few hours ago. If you have not already read it I would suggest doing so. Surely, if good quality research shows that in many cases taking vitamins is ineffective, whilst eating certain foods (like fish, nuts etc .) *is*, that is important information which should be passed on to everyone, since it helps them make good health decisions and prevents them from wasting resources on things which don’t work.
in reply to
Thanks, Samazeuilh, but I'm not interested in reading this article, having done plenty of my own research, and having shared my thoughts already.
Quite happy to drop the conversation, as well. Best wishes to you.
...or do they, maybe in some cases not from the ingredients but because of the placebo effect; personally I am not bothered which as long as I feel an additional benefit.
I get New Scientist. In a very brief summary, in this article they say:
- fish oil is a waste of time, much better to eat fish
- supplementing with Vits A, B, C, D & E are similarly a waste of time
- we are deficient in fibre which you don't get in a pill!
- olive oil is good as it helps the body absorb essential nutrients
- calcium supplements increase kidney stones whereas calcium in food does not
- for the over 50's, extra B12 from food and Vit D supplements in the winter may be a good idea
Overall the gist is that people who eat a lot of fish, plenty of vegetables, whole grains and olive oils have a lower rate of heart disease and dementia. However extracting "super-nutrients" from those foods into a pill does not work.
Vitamin D supplementation works! My endocrinologist told me I’d got the highest and the best levels he’d ever seen. I’ve been taking them for five years after finding out I was deficient.
in reply to fortunata
If you have a specific deficiency then it’s another matter. The article is not referring to such a situation.
fortunata in reply to
Just thought I’d put my two pennorth in. ☺️
in reply to fortunata
Yes, that’s for a specific known deficiency which (possibly) could not be met by eating particular foods. The article is not referring to such a situation, but to taking supplements without any known deficiency.
fortunata in reply to
But I couldn’t read the article, could I? You mentioned that we can’t access the article online. I was merely saying that supplementation does work. The article headline says they don’t. And that’s all the info you gave. ☺️👍🏻
in reply to fortunata
Someone posted the article here (see dga5000’s post below) so you can now read it.
Originally, I simply referred to the scientific findings which people might or might not wish to follow up by buying the magazine. I think the research is important and helpful because it points out that obtaining vitamins from food is effective, whereas it generally is not when obtained from supplements (with some exceptions, for example when someone has a known vitamin deficiency). So this prevents people from wasting time and energy on things which don’t work and enables them to do things which will benefit them. If people don’t wish to heed the research, then that is, of course, entirely up to them.
I have six monthly blood tests on apixaban and they also test for vitD. The test in summer was ok but the one in winter showed D levels so low that the GP rang me and put me on a D supplement. Next test showed levels back to normal. I now take a supplement during winter months.
in reply to Dodie117
Yes, if there is a specific vitamin deficiency it’s another matter. The article is not referring to such a case, but to a situation where people are taking supplements because they think it will do them good.
Dodie117 in reply to
Agree. I have never previously believed in taking supplements.
I get 'industry fatigue' listening to the next slamming article about ineffectiveness of supplements or herbal remedies. The public is being asked to suspend their own reality and lived experiences because some 'expert' has determined supplements don't work. There is a concerted effort, actually an organized campaign, by big Pharma and their media allies to discredit alternative medicine in general. It doesn't matter that many (most?) people who use supplements or herbal remedies find these help (in this case the counter argument is "it's just the 'placebo effect'." While I readily admit there are some in the supplements industry who may be making unfounded health claims, the campaign to discredit alternative medicine in general should be enough reason for pause.
What is really going on is a pharma industry that manufacturers drugs that kill over 100,000 people in the U.S. when used exactly as directed by their physicians. What is really going on is many people have no confidence in the medical system and its therapeutic approaches - like the cancer industry which offers virtually nothing for people suffering with cancer while extorting billions worldwide in donations from people 'hoping for a cure'. Let's wake up and smell the coffee (in my case roses will do since I don't consumer caffeine). As AFers we all know the dangers of AADs and even ablation, which I have had, is not a cure - the 'experts' have no sound understanding of it's causes. Like the cancer industry, the alternative approaches are just 'quackery', right? Don't step on anyone's toes or expect any real progress when big money is being made.
Perfectly said. Thank you.
Exactly. When are we going to see articles about how for instance taking antidepressants is a waste of time as for many people they work little better than placebo? Or that taking Cipro for a UTI now can be little better than placebo for curing the UTI due to antibiotic resistance but could ruin your health for the rest of your life due to it's poisonous nature for some people? I do not think people should rely on supplements rather than a good diet but it is a fact that nutrient values in raw foods are not equivalent to what they were 50 or 100 years ago.
in reply to Plantwords
“ I get 'industry fatigue' listening to the next slamming article about ineffectiveness of supplements or herbal remedies. The public is being asked to suspend their own reality and lived experiences because some 'expert' has determined supplements don't work.”
It’s not a matter of an expert “determining” they don’t work , but of double -blind trials conducted by scientists showing they are ineffective beyond placebo. So, for example, if you take two matched groups (in terms of age, general health etc.) and one takes, say, an omega 3 supplement for 5 years, and the other doesn’t, there is no difference in the rate of heart disease between the two groups.
And doctors don’t recommend supplements on the whole- save where there is a known deficiency.
Plantwords in reply to
These are the same trials, I supposed, that certify the same dangerous medications approved by government agencies that cause serious and even fatal side effects? Look, I don't want to get into a back and forth on this - suffice it to say that there are very powerful vested interests that do not want the general public turning away from mainstream pharmaceuticals so they continually slam and denigrate alternative medicine. That is why, anyone who wants to use supplements and herbal products should do so under the supervision and advice of a qualified naturopathic doctor.
in reply to Plantwords
The trials described in the article were not conducted by scientists working for drug companies, so there is no reason to suppose that they were biased in any way.
Scientists do not condemn all alternative medicine. In fact it is known that some herbal medicines can be effective (and why they are effective can be explained by science). However, there is no evidence that, say, homeopathy is effective beyond placebo. And not much to support for acupuncture either. And, of course, many of the practitioners of such alternative medicine are making plenty of money out of it too. For verdict on homeopathy (as just one example) see:
in reply to Plantwords
Well said. My understanding is that in the States anyway much research is funded by the pharmaceutical companies. With such a strong profit orientation in the health care system, extensive research on anything that's not going to yield big profit isn't likely to happen.
Ooh, VERY well said, Plantwords!! 👍🏻💕
Well said! I couldn't agree more.
About 1 1/2 years ago I started faithfully taking supplements. I take about a dozen which I added on slowly after researching each one. One benefit I can say for sure is that my vision is now 20/40 whereas before it was 20/200. I had noticed I was beginning to see better. When I went to the ophthalmologist, she informed me that I didn’t need glasses because my vision was 20/40. I have been wearing glasses for 40 years and now I don’t wear them and can see fine, even at night. That was very miraculous to me and I know its credited to the supplements. The only problem is I don’t know which supplement caused it because of how many I take. Supplements work.
If you work out which supplement/s may have improved your eyesight, please let me know..
I’ll put a list here if you want to do any research because I have no idea. All I know is I couldn’t see and now I can see. I made that list at least a year ago when my brother was asking me the same question you just asked me.
This is what I take. I split the supplements as evenly as possible morning noon and night. When I say below 1x a day = 1 pill.
4 sprays (stomach) Sunfood super foods, pure and potent magnesium oil spray.
(3x a day) Garden of Life - RAW Probiotics Women 50 & Wiser - Acidophilus Live Cultures - Probiotic-Created Vitamins, Minerals, Enzymes and Prebiotics - Gluten Free - 90 Vegetarian Capsules (they have them for men also.
(3x a day) Enzymedica - Digest Gold with ATPro, High Potency Enzymes for Optimal Digestive Support, 240 Capsules (FFP)
(3x a day) Garden of Life mykind Organic Plant Calcium - Vegan Whole Food Supplement with D3 and K2, Gluten Free, 90 Tablets
(1x a day) Solgar - Ester-C Plus Vitamin C (Ester-C Ascorbate Complex) 1000 mg, 180 Tablets
(3x a day) Zahler Vitamin D3 3000IU, An All-Natural Supplement Supporting Bone Muscle Teeth and Immune System , Advanced Formula Targeting Vitamin D Deficiencies, Certified Kosher, 250 Softgels
(1x a day) Garden of Life Multivitamin for Women - Vitamin Code Raw One Whole Food Vitamin Supplement with Probiotics, Vegetarian, 75 Capsules (available for men)
(1x a day) Jarrow Formulas Colostrum Prime Life, Supports Gastroinestinal, Immune, Respiratory Health, 500 mg, 120 Caps
(4 pills a day-2 morning, 1 afternoon and 1 night)
Doctor's Best BenFotiamine with BenfoPure, Non-GMO, Gluten Free, Vegan, Helps Maintain Blood Sugar Levels, 150 mg, 120 Veggie Caps
(1x a day) Nature Made Coq10 200 Mg, Naturally Orange,Value Size, 80-Count
(2x a day) HPF Cholestene Red Yeast Rice, 120 Capsules
1 sublingual spray (under tongue) Garden of Life Mykind organic B12
I buy them all on Amazon and the ones that have automatic refills (subcription‘s), I have them automatically delivered monthly.
I stopped taking the first probiotics listed. But I’m still getting some probiotic in my multivitamin and taking digestive health. Also the benFotiamine, I believe that one got discontinued and they sent me a different brand that was close to the one I was taking
Jpan6,
Try a joint formula that contains hylauronic acid. I started taking it 6 years ago for athritic joints (works great!) and noticed after about 3-4 months that I could read again without my glasses. I can now read the very tiny print on a vitamin bottle at 5" away without difficulty. My distance vision is also much better. I use:
purityproducts.com/hyaluron...
I called them and negotiated a reduced price for "super saver" of $23.50/bottle.
Thank you for the link. I'll see if they are on a UK website
You are right in that I dare not stop one or other of my supplements just in case they are the essential ones which help me. There is no one size fits all in food, nutrition, supplements etc but what is for sure is that many big phama drugs do more harm than good.
in reply to Alfieros
You would a have to show that the supplement produces this effect systematically to be know that it was not something else which led to the improvement.
If you take hylauronic acid I can say that this is what worked for me. I took it initailly for joint pain which it DEFINITLY helps a great deal. I noticed after a few months that I could read again WITHOUT my glasses. Now, I can read the very tiny print on any medicine or vitamin lable from approx. 6" B4 my arm wasn't long enough. I don't need no stinking studies to let me know it's ok top take or not. Too many anecdotal positive results are out there for supplemnets. YEs, it would be great if our food had more nutrients and we could rely on food, but we can't. The results for me speak volumes.
Sorry, supplements DO work, but are not a magic bullet. Each of our chemical make ups is different so what works at a particular dose does not necessarily work for another. Think about it... it took perhaps years for your system to degrade (or be poisoned by chemicals/ over doing it (drinks, etc..)) to the point where a specific malady EG: AFIB occurs. It also correspondingly takes a while for supplements to do their work of undoing or fixing your condition. Be patient, make notes on how each supplement works for you. I am down to only 1 remaining prescription - diltiezem. I've eliminated warfarin, digoxin, linispril from my prescribed regimen and feel almost 100% normal again. Yes, I still have afib, but waaayyy better than before and I can do stuff again AND FEEL like doing it which under the drugs I didn't really feel like I could or wanted to do things.
in reply to solarjdo69
“Sorry, supplements DO work, but are not a magic bullet. Each of our chemical make ups is different so what works at a particular dose does not necessarily work for another. “
It’s possible that if you had, say, a specific vitamin deficiency a supplement would work for you, but scientific trials show that in general (there are a few exceptions like vitamin B12 for over 65s) they are ineffective beyond placebo. It’s better to eat healthy food with the required vitamin etc. An example here, is omega 3 (which I have taken myself): there is no evidence that it is effective against heart disease when taken as a supplement .
solarjdo69 in reply to
While I appreciate what you say, I have little faith in the "scientific" trials results. The established medical profession/industry has a vested interest in squashing alternative therapies. EG: colloidal silver. I've used it for over 36 years as an antibiotic as needed and have not used "normal" antibiotics with 1 or two exceptions to assist when I foolishly ran my health down by "burning the candle at both ends." Believe what you must. I have had too much positive effects from supplementation to believe otherwise. I am in agreement with you on the eating GOOD quality organic foods, our normal food system does not produce nearly enough nutrients due to our sorely depleted soils. Then there is the whole poison aspect of pesticides, et al in the food system.
One other aspect is the FLU (fool) shots issue. I have never and WILL never get a fool shot. Liquid probiotics taken by mouth weekly during the flu season has protected my family. We don't get the FLU. Poison your system and take your chances on the shots if you must.
in reply to solarjdo69
The fact that your family did not get flu does not show that probiotics are effective preventers of flu. Maybe they just didn’t get exposure to the flu virus, or have built up resistance to flu over the years.
I agree with you regarding the dangers of pesticides in foods.
solarjdo69 in reply to
There are measurements and there measurements. the standard method is to see how much of something is in the blood which does NOTHING to tell you the degree of a substance at the sub-clinical TISSUE level which is what counts the most.
The difference between our beliefs appears to be fundamentally that you need scientific proof, while I do not. It's called faith. I feel you limit your range of choices if one requires full scientific proof which often takes many years to come to fruition. I don't know about you, but we have only so many years given us. When I read sufficient anecdotal evidence of people who have used something which helps, then I'll consider trying it without scientific proof. take cell phone and WIFI radiation. There are MANY anecdotal counts of people who have feel they have been affected by this radiation. If we wait for scientific proof, how many people will have suffered or perhaps died due to the wait for scientific proof. I know several people here personally that died of inoperable brain gliomas and guess what? It was on their preferred cell phone side of the head. Enough evidence for me. But hey! It's your life. Good luck with that.
You raise valid concerns about wifi radiation and cell phones. Studies have been done showing a linkage but immediately were deemed inconclusive and more studies were needed. AF has always been thought of as an older persons disease. Now, with the higher incidence of young people in their teens, twenties and thirties diagnosed with AF, what does this suggest? Society's proliferation of wireless communications, bombarding everyone with high frequency radio waves has some effect on human soft tissue. But don't hold your breath that any serious study of cell and related technology will be done that might disturbed the trillion dollar cell/wifi infrastructure. Years ago when I first took up amateur radio as a hobby I came across a US study which showed amateurs had a 5x higher cancer rate than the general population due to exposure to high frequency radio waves. Do I think you are going down the right path with cell technology - yes I do. The AF community spends a lot of time focusing on stress and anxiety factors in causing or triggering AF. What could be a bigger stressor on the human body than high frequency radiation? Some of us may be more sensitive to this radiation than others and get AF; others may not but I think there is indeed a connection.
What I am REALLY concerned with now is the forced 5G networks that they are building here in America. I feel I may need a 'tin foil" suit for protection.
I use Hair Tissue Mineral analysis to guide my supplementation and I owe a lot to supplementation guided intelligently in this way. All sorts of health issues are actually because of a deficiency. Very rapid improvement in health is possible from targeting the deficiencies. Gary Moller, a sportsmedicine doctor, swears that HTMA and intelligent supplementation is the secret weapon of some record-breaking athletes.
The truth about supplements. By: Geddes, Linda. New Scientist.
12/1/2018, Vol. 240 Issue 3206, p30-34. 5p. 3 Color Photographs.
The truth about supplements
Popping a pill to boost your diet feels like a no-brainer, but supplements often don't work - and
could even do you harm.
FOR some people, they are an insurance policy against a less-than-perfect diet. Others take them because
they can't - or won't-eat certain foods. Whatever the reasons, popping vitamin and mineral supplements
can feel like a virtuous shortcut to a healthy life.
But in recent months, serious doubts have been raised over whether they are actually any good for us.
Take omega-3. For many people, these golden capsules are a way to get the essential fatty acids we are
told our bodies need without having to consume oily fish. Yet recent studies indicate that - unlike eating fish
- taking omega-3 or fish oil supplements does nothing to reduce your risk of heart disease, stroke or early
death.
It is a similar story for other nutritional supplements, including multivitamins: the results from a slew of
studies on their impact on our health has been underwhelming. In some cases, taking high doses of certain
nutrients may even be harmful.
We are also waking up to the importance of the interactions between the different foods we eat and how
these influence the uptake of the nutrients they contain. It turns out it's not what we eat, it's how we eat it.
So are supplements just a waste of money? And if not, which are the ones we should be taking-and how?
It is only in the past century that we have begun to identify and recognise the importance of the various
health-sustaining nutrients found in our food.
The word vitamin, derived from "vital amine", was coined by the Polish chemist Casimir Funk in 1913,
following observations that compounds called amines in rice husks could protect chickens from beriberi.
This serious condition, which also affects humans, can result in nerve damage or heart failure. We now
know that beriberi is caused by a deficiency in vitamin B1, also known as thiamine. Nutritional deficiencies
like this were common at the time, but their causes were poorly understood. It wasn't until 1926 that vitamin
B1, for example, was identified.
The following two decades saw many more vitamins discovered and a growing understanding of how their
deficiencies caused common illnesses. This led to the formulation of dietary strategies that cured ailments
such as scurvy, rickets and pernicious anaemia, caused by deficiencies in vitamin C, D and B12,
respectively. The onset of the second world war prompted the publication of recommended daily
allowances for various food groups, vitamins and minerals in many countries. Some nations also began
fortifying certain foods with nutrients, such as adding iron to flour and vitamin D to margarine.
However, as well as making populations healthier, this reductionist approach to nutrients has fuelled the
growth of what is now a multibillion-dollar supplements industry. This not only focuses on correcting
nutritional deficiencies, but also seeks to sell vitamins and minerals to the worried well. In the UK alone,
consumers spend £420 million on supplements each year, with multivitamin tablets the most popular,
followed by fish oil.
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On a superficial level, the evidence seems to suggest all this is a good idea. Epidemiological studies, which
look at the incidence of disease in specific groups or populations, show that people who eat a lot of fish, or
plenty of vegetables, whole grains and olive oil, have lower rates of illnesses such as heart disease and
dementia. Many of us have swallowed the notion that a handful of the super-nutrients found in these foods,
packaged up into neat once-a-day capsules, can provide the same benefits without the perceived hassle
and expense of preparing healthy meals.
The problem is that these benefits aren't necessarily found when the supplements themselves are tested.
Randomised controlled trials (RCTs) are used to examine whether and how a type of food or a supplement
works. In these studies, people are randomly assigned to take either a component of that diet, such as
omega-3 fatty acids, or a placebo. And here the results have been mixed. Some RCTs uncover a benefit;
others find none at all. "Industry has been attracted to the silver bullets of micronutrients because they are
very cheap and easy to formulate into tablets," says Andrew Prentice, head of the MRC international
nutrition group at the London School of Hygiene and Tropical Medicine. "If it had all worked that would have
been fine, but the trouble is that it hasn't. We need to understand why - and what to do about it."
Perhaps the biggest recent blow was a large study published in June by the highly regarded Cochrane
Collaboration. The meta-analysis - a statistical approach that combines the data from multiple RCTs to try
to get a more precise estimate of an effect - looked at 79 studies to assess the long-term impact of omega-
3 fatty acids or fish oil supplements on cardiovascular health. It concluded that they have little or no effect
on our risk of heart disease, stroke or early death. Other recent meta-analyses support this finding, and
have reached similarly disappointing conclusions for the effects of vitamins A, B, C, D and E on various
aspects of our health.
Yet some researchers question the relevance of meta-analyses to nutrition research. Unlike drug or surgery
trials, where you have a standard intervention and a fairly homogeneous group in which it is being tested,
nutrition research is much messier. With a supplement like omega-3 fatty acids, you are pooling together
widely disparate studies. They may involve different doses, formulations or even types of the nutrient.
Finding an appropriate placebo is also fraught with difficulty. "If I do a study with a vitamin E supplement, I
have been exposed to vitamin E in utero, throughout my entire life and for the duration of the study-so there
is no such thing as a placebo control," says Jeffrey Blumberg, who studies antioxidants at Tufts University
in Boston.
KNOW YOUR VITAMINS
Vitamins can be separated into water-soluble and fat-soluble varieties. The water-soluble kind, such as
vitamin C, are absorbed from what you eat until you reach a saturation point, after which any excess is
urinated out. However, you can't store them, so if you stopped consuming these vitamins your levels would
quickly fall.
Fat-soluble vitamins, however, can be stored in the body, particularly the liver. But you can have too much
of a good thing, with the risk of certain stores reaching toxic levels. While most multivitamins limit the
amounts of fat-soluble vitamins they contain, if people take multiple supplements at once they might
unknowingly be having too much.
Nor do RCTs of supplements often record what else participants are eating, or measure background levels
of the nutrient in their bodies. This is important, because supplementing someone who already has
adequate levels of a vitamin or mineral is very different to giving it to someone who is deficient in it.
And whereas drug companies will invest large sums of money in high-quality studies because of the
regulatory hurdles they must jump to get their drugs approved, there is less incentive for supplement
companies to do so. Supplements are generally regulated in the same way as food, rather than medicines.
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They must be safe for consumption and correctly labelled, but they don't have to prove that they improve
health. "The studies tend to be smaller. They tend to be of a shorter duration," says Simon Dyall at the
University of Roehampton in London. "But nutritional supplements are not drugs, so you're unlikely to see
an effect on people's health after taking them for 10 weeks, or even four or five months. You're looking at a
minimum of a year, and supplement companies are less likely to fund those kinds of studies."
Meta-analyses often try to account for some of this variability, but the basic problem remains, says Dyall.
Still, randomised controlled trials are the best approach we have tried so far. Where does that leave us?
Most nutrition researchers agree that for people who find it harder to eat a balanced diet, either because of
allergies or lifestyle choices such as being vegetarian or vegan, taking supplements may be a good
insurance policy. There are also other groups in the population who should consider them (see "Who
should be taking what?", right).
However, on the issue of whether healthy and well-nourished individuals should take food supplements,
expert opinion is divided. "I think we have to be aware that, especially at high doses, dietary supplements
may not be entirely free of risk," says JoAnn Manson, an epidemiologist at the Harvard T.H. Chan School of
Public Health in Boston. Too much beta-carotene, for instance, seems to increase the risk of lung cancer in
smokers, while excessive vitamin E has been linked to a greater risk of haemorrhagic stroke, and possibly
prostate cancer.
Manson recently published guidance for clinicians on what to tell their patients about nutritional
supplements. Her conclusion: "Routine micronutrient supplementation of the general population is not
recommended."
Prentice agrees. "My view is very strongly that people shouldn't take supplements unless there is a specific
indication - and in a country like Britain, most people don't need supplements."
Hidden hunger
Yet Blumberg at Tufts University argues that a country's wealth is a poor indicator of people's nutritional
status: you can have plenty to eat, but still be malnourished. "Sixty-six per cent of Americans are
overweight or obese - and the reason is because they are eating energy-dense, nutrient-poor foods," says
Blumberg.
This "hidden hunger" doesn't only affect people who are overweight or obese. In a joint publication, the US
departments of agriculture, and health and human services identified vitamins A, C, D and E, together with
choline, calcium, iron, magnesium, potassium and fibre, as "under-consumed" by many people in the US.
Those taking a daily multivitamin have intakes that are much closer to the recommended daily allowances,
according to work by Blumberg.
"We know that people in the UK, the US and around the globe are not eating the way they should," says
Blumberg, who led the study. "We should try to change that, but I think it is also a prudent and reasonable
thing to tell you to take a multivitamin."
Blumberg, who acts as a consultant for several supplement companies, points to the Physicians' Health
Study II - one of the largest randomised trials of supplements conducted so far, led by researchers at
Brigham and Women's Hospital in Boston. It tracked the health of more than 14,000 men in the US aged
over 50 for more than a decade and concluded that those taking a daily multivitamin had a modest but
significant 8 per cent fall in the incidence of all cancers.
Further studies are ongoing to see if its results can be replicated, and if the findings also apply to women.
"As an ageing, older man, I am happy to take modest benefits in any of my physiological systems," says
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Blumberg.
For those with a poor diet, then, topping up with supplements can bring them closer to the recommended
daily dose. But that doesn't always translate into the health benefits you might expect. For one thing, foods
contain much more than the nutrients you would find in a typical supplement. This may be another reason
why the results from trials of supplements don't match observational studies of populations who eat large
quantities of foods containing those nutrients.
Not in a pill
"One of the main things that is deficient in the UK diet is fibre, and you don't get fibre from a pill," says
Richard Hoffman at the University of Hertfordshire, UK.
Then there are phytochemicals, compounds found in plants, such as carotenoids and flavonoids, that are
thought to work in the body to minimise damage to cells caused by free radicals, unstable and highly
reactive molecules released by normal body processes. "These would certainly be missing if you are eating
a diet of processed foods supplemented with a multivitamin pill," says Hoffman.
The balance of these nutrients also seems to matter. For instance, the body uses omega-3 oils from oily
fish to make substances that dampen inflammation. But closely related omega-6 fatty acids, found in meat,
make molecules that promote inflammation. This may be one reason why eating too much red meat is bad
for us, and why populations that consume a lot of fish seem to be healthier.
But it isn't only important to eat an overall balanced diet - eating a mixture of foods at each meal also
matters. "How much food you eat, when you eat it and the combination of foods you eat it with can have a
huge impact," says Julian McClements at the University of Massachusetts.
In an as-yet-unpublished study, McClements and his colleagues gave people fresh fruit and vegetables to
eat either on their own or in combination with emulsions containing various fats or spices, or both. Far more
of the nutrients entered the bloodstream when the fruit and vegetables were consumed with an emulsion.
When emulsions were combined, the impact was higher still. "It suggests that we can design foods to
increase the amount of beneficial nutrients absorbed by the body," says McClements. But it also has
implications for the design of clinical trials to test nutritional supplements. "If you don't control for this 'foodmatrix'
effect, then people could eat the same amount of, say, carotenoids, and one person might absorb a
lot, while another would absorb very little," he says.
Outside of the lab, a good example of this effect is olive oil. It increases the amount of a carotenoid called
lycopene that we absorb when we eat tomatoes, because carotenoids must be dissolved in fat to be
transported into the blood. A similar principle applies to the fat-soluble vitamins A, D, E and K.
"The combination of food you eat and when you eat it can have a huge impact"
Such findings are important for supplement-takers, says Blumberg. "If you don't take a supplement with
food then many of those nutrients are going to be less than optimally absorbed," he says.
In some situations, these effects could even undermine your health. For instance, calcium supplements
have been linked to an increased risk of kidney stones, whereas dietary calcium seems to reduce people's
risk.
Clearly, we still have a lot to learn about how different foods interact. As we discover more, it may be
possible to boost the nutritional value of the foods we eat, as well as design better supplements.
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Food, then, is the best source for the nutrients we need. But for those who aren't able to get all their
nutrition from what they eat, there are some simple things you can do to ensure you get the most out of a
supplement: always take it with food, including a little fat, and follow the instructions on the container to
avoid overdosing on certain nutrients. And ask your doctor about any supplements you are taking, as some
vitamins have been shown to interfere with drugs, such as the blood-thinning medication warfarin, and lab
tests.
Most of all, don't assume that taking nutritional supplements can compensate for eating an otherwise
unhealthy diet. There are thousands of active ingredients in foods - some of which we are only starting to
become aware of. They taste a lot better, too.
PHOTO (COLOR): Omega-3, or fish oil, supplements were thought to help protect our heart health, but a
recent study found they have little effect
~~~~~~~~
By Linda Geddes
Copyright of New Scientist is the property of New Scientist Ltd. and its content may not be copied or
emailed to multiple sites or posted to a listserv without the copyright holder's express written permission.
However, users may print, download, or email articles for individual use.
Certain medications deplete the body of essential vitamins & minerals, which is why they can have a place with some people, & can provide a boost along with a healthy diet
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