Role Supplementation Plays in Nutrition
Firstly let me say that supplementation in general is a heady issue and one that is hotly debated. And I've found that anytime an objective issue is hotly debated, there are probably some emotional components to the debate. And by "objective" I mean that conclusions should be based on hard-science and reality. But we are emotional beings, and some of us can't separate our emotional side from our logical side as easily as Mr. Spock can. Being as aware of this as I am, and wanting always to get to the truth of the matter (the reality of the situation), I make a concerted effort to use only logic, independent thinking, and (un)common sense when researching issues of health (which helps greatly when not wanting things like personal preferences and preferred beliefs to color otherwise sound judgment). So I employ the ethos of science in my thinking: open questioning, no authorities, no biases, honestly, transparency and reliance on evidence.
Secondly, the issue of supplementation is not as straightforward as some would think. There are many considerations, and if someone is subject to "subconscious selective consideration" their conclusions will probably not represent reality (I'm not going to discuss here those who employ "conscious selective consideration" i.e. hucksters, marketeers, and promoters who don't give a rat's rump about their customers' future health).
There's a popular notion that says, "Once you start eating enough fruits and vegetables you don't have to worry about nutrition", and although it's a lovely notion, I have found it to be incorrect, as have others. There is certainly a reason to be concerned about nutrition. Read on to find out why.
Some of my observations and conclusions
Just because there are no more instances (in the developed world) of scurvy, beriberi, or pellagra doesn't mean that those not suffering from these conditions don't have an insufficiency of one or more nutrients that is/will be a contributing factor (primarily or secondarily) to one of the serious degenerative diseases that are plaguing our society today (cancer, heart disease, mental illness, itis's, and other chronic conditions). And make no mistake about it, this is a plague, it's just a plague of very-slow-to-be-noticed illnesses, as opposed to acute conditions like the flu or hitting your thumb with a hammer.
So I disagree with the contention that most of the illnesses which people experience today are illnesses of excess. They are illnesses of both excess and insufficiency. And it does not help the situation to pin the blame mostly on one or the other; they both need to be addressed, and addressed dispassionately if robust health is the goal. And they are not mutually exclusive: One can be getting entirely too much ethyl alcohol and at the same time have a deficiency of a nutrient (and not because of the alcohol consumption, although alcohol does deplete the body of certain nutrients).
So it's safe to say that the vast majority of our modern maladies are caused by a combination of excess and insufficiency. And by-the-way, rickets (a bone disease caused by not enough vitamin D) was eradicated by fortifying the foods the public commonly consumed with vitamin D. But rickets is making a comeback! Why? When deciding how much D to fortify foods with, the objective was to add only the amount that would be needed to make rickets go away (why waste money on more D than necessary to accomplish the goal). But since we get vitamin D from sunshine, the amount of D that was added to food was an amount that, when combined with the D we made by being outdoors, was enough to end the occurrence of rickets. But now that kids are spending less time outdoors thanks to computers, Facebook, GameBoys, I-Pods and more "latch-key" kids, the amount of D added to processed, fortified foods is not cutting it in some cases. The answer? Simply up the amount of D added to foods. Sorry, to me, that's not the answer, especially when you consider that along with more indoor time comes more overweight children. (When I was in elementary school, there was only one overweight kid in the whole school. Today I was shocked to see how many kids are overweight and obese in elementary schools. Not a good trend.) Also, sunshine makes more than just vitamin D in the skin, so the taking of supplementary D to get enough D is not a good idea because D supplements (and foods) do not supply those other equally important sunshine-provided nutrients. A link to an article on D appears at the end.
And the same goes for iodine. When it was discovered that a common condition, goiter (enlarged thyroid) was caused by not enough iodine in the diet (because not enough was in the soil), iodine became the very first fortified nutrient, added to table salt, which everyone used at the time. When that was done, no more goiter. But only enough iodine was added to make goiter disappear from view (but not enough to saturate the body's tissues fully with iodine, so other conditions caused by not enough iodine remained). But fast-forward almost 100 years and goiter is making a comeback. Why? A double-whammy of less table salt being used and more iodine transport inhibitors in our environment. The answer? Pharmaceutical meds to the rescue instead of the medical industry embracing the use of iodine (as they did 100 years ago). Not the best answer in my book. (For more info on the iodine crisis, there's an article at the end.)
Things that muddy the waters re: supplementation are:
1. Not all supplements are created equal. If you, the reader, wanted to come out with your own multivitamin (complete with your picture on the bottle), you can go to a supplement manufacturer (who actually makes the supplements for many of the well-known brands you see on the shelves in supermarkets and health food stores) and work with their product formulator to design one for yourself. Here's what happens when you sit down with the manufacturer's formulation scientist: he/she asks you what you want in the multi, giving you some suggested formulations depending on what you want to pay for a bottle (the wholesale amount) which will probably depend on what you want the bottle to retail for. If the price (to you) is too high, the formulator can do things like changing calcium citrate (the best form of calcium) to calcium phosphate or carbonate, and this will bring down the cost. In-other-words, the forms of the nutrients, the number and the amount of the nutrients themselves, and the quality of the excipients (binders, fillers, disintegrants) dictate the cost of the product, so the formulation depends on your market. If you want the bottle to sell in a regular supermarket for $12.95 for a 30 day supply, economics dictates that the formulation can NOT be as bioavailable and thus as efficacious as a product that costs you $20 and thus must sell for around $39.95. So there can be a HUGE difference between a worthless product (in my opinion) such as Centrum, One-A-Day, and Theragram, and a worthwhile product (but just because a supplement is expensive to buy isn't a guarantee it's a worthwhile supplement.)
2. The philosophy that says we can live in such a way where we shouldn't have to take supplements only works if we can live where humans were designed to live, and if we can eat the foods that humans were designed to eat, or if somehow we can get food that comes from nutritious soil. But the definition of "the foods that humans were designed to eat" cannot be defined by their names alone (i.e. kiwi, banana, papaya). It has been established that the nutritional value of a banana grown conventionally and a banana grown organically are different (monkeys can tell the difference between them). And there is likewise a difference in the nutritional quality of a food item that grows in the wild, and one that is grown by agri-industry that grows for yield, size, appearance, pest-resistance, shelf-life, growth-rate, and sugar-content, but not for nutritional content (except for potassium and phosphorous). So, yes, if I was living in a tropical environment and getting plenty of sun and eating the foods of my bio-physiological design from the wild, I would not need nutritional supplementation (unless I had a genetic defect that made this necessary, meaning that even though I now live in the wild, I wasn't born in the wild to parents who were born in the wild; I was born in Michigan to parents who were born in the U.S. and my Mom's diet wasn't all that good when she was pregnant with me and she was taking a medication that depleted her body of folate unbeknownst to the physicians of the time so that I was born with genetic defects that you can't see but interfere with my ability to utilize nutrients... see, I told you this issue wasn't straightforward).
And there are other non-serious health issues I experience when I haven't taken the supplement for a period of time. This scenario has also occurred with people I've counseled. A good example is when someone diagnosed (by an MD) with Type 2 Diabetes, who is taking insulin for it but who hears that Type 2 Diabetes can be resolved and wants to do this if at all possible, and they then come across someone like me who educates them on what they must do to eliminate the condition (fat content of the diet must come way down, eat a healthy diet, get enough exercise, etc) but who, after doing all that needs to be done, and doing it for a goodly amount of time, still needs some insulin. At first this was a head-scratcher, but it turns out that when I wondered if a sub-clinical nutrient insufficiency could have something to do with this, and then I put the person on a worthwhile supplement, no more insulin was needed. I know I said that I wasn't interested in which nutrient was responsible for my own issues, but in this instance I wanted to know what was going on. Turns out it was chromium (that was not sufficient enough in the diet); chromium plays a key role in blood sugar metabolism. Please see this short video for further explanation. (It should be noted that I don't have the person rely on a stand-alone chromium supplement to provide his chromium needs on an ongoing basis.)
What are the odds
of you consuming foods during a week's period of time that provided you
with exactly what you needed in the way of calcium, phosphorous,
magnesium, manganese, potassium, etc? The odds of you getting no more
or less than what you needed are astronomical, meaning, not possible.
So there are only two real-world scenarios: You will either get more
than what you needed or less than what you needed. I don't
think I have to explain what can happen if you get less than what you
need of the "essential" nutrients (those your body can't manufacture,
that must come from food), so, hopefully, you will get more than what
you need. But this is not a problem for your body; it can use and store
what it wants and discard what it doesn't want to store. No one would
suggest that the differing amounts of the various nutrients you're taking
in that your body doesn't need somehow unbalances the body. So then why
would it be assumed that taking in some nutrients from a supplement that
result in an overage (not to be confused with an overdose) will upset
the body's balance in a detrimental way? Why do the opponents of supplements
say that taking in more of one nutrient than one of its co-factor nutrients
will unbalance the body when we eat such a varied diet that this "unbalanced
ratio" happens naturally? Could it be their dogmatic, philosophical
aversion to supplements colors their judgment? (Or maybe they run a fasting
center and know that they would lose business if more people would get
enough of all the nutrients their body required for optimal functioning.)
In economics we often hear about "Supply & Demand", but this also applies to health. As the supply of a nutrient goes down and the demand for that nutrient rises, there is an increased risk of ill-health due to the "perfect storm" effect. Many health educators focus on the Supply side of the issue when it comes to nutrition (depleted soils, early harvesting, transport & storage) but give little thought to the Demand side. Demand for nutrients, especially ones that play large roles in immune system function like iodine, can increase and be higher than what we needed 100,000 years ago due to things like environmental toxins (including things that compete with an essential nutrient), unnatural amounts of stress, existing ill-health, and genetics that have weakened over the generations. So when looking at fulfilling our nutritional needs, both Supply & Demand should be considered.
If your individual demand for a nutrient is higher than it would have been many millennia ago, relying on an amount of the nutrient that constitutes a "maintenance amount" will allow an insufficiency to persist or even deepen into an eventual deficiency. So in reality, some people may need, for example, more selenium, iodine, and chromium than they would have if they were in perfect health, and since these nutrients can be less available in the person's diet because of the way the foods of that diet are grown, the result can be a "perfect storm" that results in degenerative disease over time (the particular disease is largely dependent on the person's genetic weaknesses they were born with).
Category 1. The nutrients in this category are "acutely" essential, meaning, if you get low in them, you will know right away, and the warning won't be pleasant. Oxygen is a perfect example. You can't do without this nutrient for more than a few minutes. And there are others that will, if too low, cause imbalances that are quickly realized due to symptoms. It may take a few weeks or even a month or two, but there will be signs of an insufficiency, and with some unbiased thinking, you can realize this, and therefore correct it without drawing the wrong conclusion and abandoning your new diet.
Category 2. The nutrients in this category are also essential, but their lack will not be noticed for a very long time. These are nutrients that are needed for systems like your immune system. If the organs that comprise this system are not working at or near 100% all the time, your body can degenerate over time, and slow-growing degenerative disease can develop (like cancer). This is why it is not wise to believe that you feel "fine" just because you switched to a raw vegan diet and experienced greatly improved health, and now, a year or two latter, you believe that you are "fine". The stopping of detrimental dietary habits is a huge contributor to that initial improvement, but if you move from a diet that had been fortified with certain nutrients that are difficult to get enough of, to a diet of 100% unfortified fruits and greens that are also being grown in nutritionally sub-par soil, this perfect storm scenario is what contributes to the development of degenerative disease, and is why some long term raw vegans can and do get slammed with a diagnosis of something life threatening. And unlike the nutrients in the first category, here the symptoms you get don't appear for a very long time, after a lot of degradation has occurred, making it more difficult to turn things around, and even sometimes impossible (yes, there have been raw vegans who have died from cancer). So don't let anyone tell you that the proof that raw vegans don't need any supplementation is that they know some long term raw vegans who don't supplement and are "fine".
The main problem with studies is that they are carried out by human beings. And human nature being what it is, some of these studies are "loaded", meaning, they are designed to prove something that the entity that commissioned the study wants shown (usually for reasons of financial gain). These tainted studies appear very credible to the naked eye, indeed many of them at first blush can rock your boat and make you think twice about something you thought you were sure about. And that is one of the intents of a loaded study. I have seen so many of these studies that I have felt ashamed to be a member of the human species.
There are studies that will show that a particular nutrient increases mortality, but when you dig through the data you can sometimes find the faulty premises, the missing info not considered, the skewed way the testing was carried out, the cherry-picking of data, and/or the inconsistent or unreliable way the data was collected, and you'll begin to see why not all study results are created equal.
The first thing to look at when considering a study is "who commissioned it". This may not always be an easy thing to determine. If the dairy industry wants to have a study done that refutes the data that milk consumption is a contributing factor to diabetes, cancer and osteoporosis, they would be crazy to fund the study directly, for this would make the study suspect. So what they do is create an organization (that often creates and funds another organization) to commission the study. This can make it difficult (but not impossible) to "follow the money". Yes, it's sad that we have to do this, but consider what's at stake.
So before you accept as the Gospel truth a study that seems to suggest that something you were taught is true isn't true, try to find the info that refutes the study in question. Yes, often it can come down to "I just don't know who or what to believe!" because you may lack the technical expertise to separate the sense from the nonsense and the fact from the fiction. And this is where logic and common sense need to come into play, because if you allow confusion to set in, it's unlikely you will end up adopting healthful info, because a confused mind does one of two things: it keeps the status quo and makes no decision (which is technically a decision in and of itself) or it turns to matters-of-the-heart to decide what to do if a decision is to be made, and the decisions that affect your physiological health are decisions best made not by your emotions, because those emotions have been influenced by industries and people who do not have your best interests at heart, or have been influenced by truly sincere, well-meaning people who are nevertheless miseducated.
With the above in mind, let's consider something: If it's true that by keeping your blood levels of vitamin D in the sufficient range we could reduce the risks of flu, colds, type 2 diabetes, osteosarcoma (bone cancer), melanoma, colon cancer, breast cancer, osteoporosis, inflammatory bowel disease like Crohn's disease and ulcerative colitis, mental illnesses like depression and psychosis, multiple sclerosis, heart disease, periodontal disease, macular degeneration, muscle weakness, chronic pain, bone fractures, autoimmune diseases including type I diabetes, lupus, and rheumatoid arthritis, kidney disease, and obesity, wouldn't there be some industries that wouldn't want you know about this fact? Of course there would. And yes, if you took over an industry that depended on ill-health for its survival, you might feel that people's health is more important than the profits of this industry and decide to shout out this news to the world, but unfortunately the big wheels of those industries are not as nice as you or I, and they will do whatever is necessary to keep this kind of information from affecting their financial bottom lines and their (huge) paychecks, including creating misinformation (disinformation) that refutes information which suggests that keeping up a decent D level is a healthful thing to do.
And if you don't think people would do something like this, just look at what those nice folks in the tobacco industry did when they discovered just how health-damaging cigarette smoking was. Did they take out public service ads to warn the population? No. Did they print warnings on each and every cigarette pack? No. In fact, when Congress decided to make them do that, the tobacco industry vigorously fought against it. Why? Because it would lower their profits, and that's the name of the game for corporations and industries. That's why the phrase, "Let the buyer beware" (and this applies to information too).
So don't think for one second that the truth about the benefits of having sufficient vitamin D levels will be disseminated by all parties to the issue. When the facts came out about the link between breast cancer and bra wearing, the garment industry (to name only one) launched a campaign to discredit the authors of the study. And in keeping with the media's policy of not biting the hand that feeds it, the media did what they are supposed to do, and made the authors look like nut cases even though the data is solid. Folks, this kind of stuff happens all the time, and there is no doubt in my mind that it is also occurring in the vitamin D arena (and in the nutritional supplementation conversation).
But remember, even though I am of the considered opinion that a well-made supplemental vitamin D3 is safe to take in the proper dose (as determined by your blood level of 25-hydroxy-vitamin-D) when the sun isn't strong enough to enable your body to make enough D, and that keeping your blood level of 25-hydroxy-vitamin-D between 50-80 ng/ml can help prevent many of the conditions of ill-health that we see today, and can even help resolve certain conditions, I do not recommend a vitamin D supplement. For more info on the subject and what to do if you can't get strong enough sunshine all year 'round, see the article mentioned at the bottom.
My research over the last 45+ years suggests that there is more of a chance of ill-health from a dietary deficiency of nutrients than from getting more than you need, which is not to be confused with an overdose (which can be caused by taking way too much of individual nutrients in pill form). And I have seen firsthand how the food items we're supposed to eat, if coming from agri-industry, can be deficient in some nutrients that we need and can't manufacture ourselves. And I know full-well that all nutritional supplements are not created equal; probably 95% of them are garbage and don't do anything except give you expensive urine.
I also know that a high quality broad-spectrum, plant-based supplement can be of use by the body when the body is dealing with nutritional insufficiencies which are mostly caused by foods that are grown by the agri-industry (and of course by cooking foods). For me, this comes under the heading of empirical evidence, which is tough to argue with (but not impossible). And since my reasons for stating what I do are not motivated by preferred beliefs, dogmatic research, or financial gain, and are motivated by a vigorous desire for the truth and wanting to help people, this should hopefully say something about the credibility of the information.
The choice to supplement or not is, of course, a personal one. I am not the supplement police any more than I am the food or exercise police. But I firmly hope that whatever decision you make regarding nutritional supplementation is a well-thought-out and considered opinion, and one that will end up serving you well in the long run.
Here's a shorter, more concise take on
the issue. It does provide some additional information.
The Skinny on Nutritional
Humans, as with all animals, have certain nutritional requirements. Deficiencies of certain nutrients become very apparent very quickly (lack of vitamin C results in scurvy, insufficient thiamine/vitamin B1 results in beriberi), but certain nutritional inadequacies take a long time to manifest noticeable symptoms (insufficient B12 results in pernicious anemia).
In Nature, where our ancestors came from, we'd get our nutrition from our natural diet that grew "wild". We'd eat a variety of foods thus assuring that we got enough of all the nutrients our bodies need to thrive (not just survive). But in today's culture, most if not all of our food is agricultural-based and one of this industry's "movers" is financial profitability (as with most businesses). And as such, certain foods may be lacking in certain nutrients. If they contain less than they would in Nature, but still have enough to supply our needs, then it's not a problem, we simply store or excrete what we don't need at that moment. It's when there is not enough of a certain nutrient that we are put at risk of not thriving, and this can mean not dealing very well with degenerative disease thus allowing it to get ahead of our body's ability to handle it; there is a big difference between thriving and surviving.
The flip side of availability is need. In our modern society, our nutritional needs can be more than they were many centuries ago. This is due to degraded genetics and more stress and environmental toxins. Long ago, stress was momentary and infrequent. Today stress is pervasive; it has become part of most people's daily lives. Some stress is observable/noticeable, but a lot is not; it occurs in the "background", but it is just as health-damaging as the stress we can recognize. And dealing with stress requires nutrients, both to deal directly with the processes invoked by the stress, and for the repair work that stress necessitates.
Vitamins D and B12 are in a class by themselves. Firstly, they are not vitamins, but have been lumped into the vitamin category for expediency's sake. D and a few other nutrients are normally generated by the body from the action of sun on our skin; it is not present in food. But in many parts of the world, there is not enough sunshine during some parts of the year to produce enough D and those other nutrients. When we discovered this, we began fortifying commonly consumed foods with D (and with B12 and iodine and other nutrients that were difficult to get when eating foods that we are not designed to eat). But when we transition away from non-health-enhancing foods to foods that support a vital and disease-free life, we no longer eat fortified foods, making supplementation even more important for the reasons outlined in these articles. B12 is normally made by the body if the body has a perfectly healthy digestive tract which very few people have and we get enough cobalt in our diet. When we transition to a truly healthy diet which normally contains no meaningful amount of B12 many people need to take supplementary B12 to prevent a deficiency of this very important nutrient; and I say "very important" because a deficiency of this nutrient can result in irreversible neurological damage. And I know this because I've been counseling vegans and raw vegans for 16 years.
1. If the food
is grown in nutrient-poor soil
2. If the food
is grown from Genetically Modified seeds
3. If the food
is not allowed to remain on the tree/vine/bush long enough
quality diminishes over time
1. The "shotgun" approach to supplementation. Some natural health practitioners are aware that buying and taking vitamin supplements, every bottle from A to Zinc, is not considered an intelligent nutritional regimen. And some therefore simply dismiss out-of-hand all nutritional supplementation.
2. There is junk food and junk supplements. Some natural health practitioners are of the belief that most vitamin supplements sold in health food stores are not efficacious, and therefore worthless, giving consumers nothing more than expensive urine, so they dismiss out-of-hand all nutritional supplementation, but this is throwing the baby out with the bath water.
3. Personal opinion. Human beings have the capacity to filter information through our belief systems. If our closely held philosophies are based on correct information, this filtering process works for us. But what if we decide what to believe based on a philosophy not grounded in reality? What if it's instead based on what we'd like to believe or on what someone else would like us to believe. If we're a teacher, then what we teach may be inaccurate. Many natural health practitioners and laypeople are of the opinion that we simply do not need to take supplements if we're eating a healthy diet. In a perfect world, this would be true. But today even the seemingly healthiest of diets can be lacking in some nutrient(s) that prevents a person from having the healthiest (most efficient) maintenance/defense system ("immune system") they can have, which would give them less than the best odds of avoiding degenerative disease. I'd love to believe that we don't need to take supplementation, but I don't, because in reality, it's not true. Everyone is entitled to their own opinions, but everyone is not entitled to their own facts... I want the facts. My body exists in reality, so I want to know the reality of the issue at hand.
4. Some health educators are teaching what they've been taught. This is all well and good if what they've been taught is 100% accurate information. But what if your teacher/mentor is incorrect about something (maybe he is merely passing on incorrect information from his/her mentor not realizing that it's incorrect). You may be a very well-intentioned and well-meaning person, but if the person teaching you was taught incorrect info, and you don't question what you're being taught, you'll understandably have and pass along incorrect information.
Things you can consume whether they be food, supplements, or medications can be manufactured to one of two standards in this country: "Food Grade" or "Pharmaceutical Grade". These two standards have very different regulations and requirements that must be met, set by the FDA. Most (99%) of supplements are made to a "food grade" standard... to the same standard as a potato chip. What it says on the bottle does not necessarily have to be in the tablet, and the dissolution rate (what constitutes the product's bioavailability) is not overseen by the FDA. Supplements made to pharmaceutical grade standard are of a much higher quality by the very nature of the regulations they adhere to. But even some pharmaceutical grade supplements don't have the best formula (this is not part of the standard). Keep in mind this chilling thought: 78% of all the prescription prenatal supplements do not contain the recommended amount of folate; the supplement industry is surely aware that lack of folate in pregnant moms can and does often lead to neural tube birth defects (like spina bifida). So nutritional supplementation is a perfect example of "Let the Buyer Beware"; nowhere else is being an educated consumer more important than with nutritional supplementation. This is why I vet any nutritional supplement that I recommend to someone.
And to make absolutely sure you don't think that my being "pro supplementation" means that I think that all supplements are fine, here's a good summation of the current supplement industry by Michael Greger...
I've experimented with many supplements in my life, first the common store-bought varieties (worthless), then the "top-notch" health food store brands (some are not what they claim to be). When taking a truly efficacious supplement, certain "conditions" I had throughout my life resolved; things that wouldn't be considered serious, they were just there for as long as I can remember. One dealt with blood sugar regulation, and is the reason I mentioned chromium above (chromium plays a key role in the management of blood sugar). Another is iodine (here is a list of the things low iodine is associated with).
So, yes, there are so-called nutritional supplements that are worthless, and there are many of them. But don't throw the baby out with the bathwater; there are also effective, helpful, and not harmful ones, and thus worthwhile nutritional supplements. And if you, because of your circumstances, would benefit from their use, to avail yourself of this nutritional support would be in your best interest, health-wise.