Vitamins and supplements

If you use a supplement then you are one of around half of the population that does, and in fact Australians are some of the largest users of supplements in the world. We gals lead the way taking twice as many supplements than men with Vitamin C being our most popular ‘potion’ of choice followed by vitamin B (most likely as a way to cope in times of stress or lowered energy). While the majority of nutritional supplements sold in Australia and New Zealand are safe and can be effective, it is important to remember that they can’t beat eating a wide variety of wholesome foods. Research has shown us repeatedly that food has a better natural balance, variety of compounds and rate of absorption than most nutritional supplements.

‘Supplement’ is a broad term

Supplements are often referred to as ‘food supplements’, ‘nutritional supplements’ and ‘dietary supplements’. In Australia and New Zealand they are classified as food-type dietary supplements (FTDs). FTDs define a dietary supplement as ‘any amino acids, edible substances, foodstuffs, herbs, minerals, synthetic nutrients, and vitamins sold singly or in mixtures in controlled dosage forms as cachets, capsules, liquids, lozenges, pastilles, powders or tablets, which are intended to supplement the intake of those substances normally derived from food’¹. If you are thinking ‘that’s a long list’, you are right and it goes to show how extensive the industry has become and continues to be. Still, there is as yet no universally agreed definition, and so definitions change from one country to another.

Exactly what supplements contain has huge variation, ranging from a single vitamin or mineral to a long list of vitamins, minerals, herbs, amino acids, fibre, plant compounds and much more. You can buy two seemingly similar supplements of a nutrient and when you read the ingredients they may vary by the form of the nutrient, the level of the nutrient and the range of other nutrients combined to improve the uptake, and of course by cost and dose. Let’s take vitamin C for example: you can purchase it as ascorbic acid (straight vitamin C), or ascorbic acid mixed with buffers to make it easier on the stomach (and cheaper, supposedly) such as sodium (sodium ascorbate) or calcium (calcium ascorbate), you can also get vitamin C with bioflavonoids and so on. The seemingly endless options don’t make it easy to select what is best for you or your family.

Whether supplements are viewed as ‘foods’ or ‘drugs’ or ‘natural health products’, depends on the agency that controls food and drugs in your country. It can be easy to make the assumption that supplements are harmless because much of what is in a supplement is found in food. However, our laboratories aren’t in any way up to the rigorous standards of Mother Nature in the way she package nutrients, which is why food is always going to be our best source of nutrition.

Who is more likely to need a supplement?

For whatever reason, whether it be poor food production, illness, age, busy lifestyles or depleted soils we do know that some of us are more likely to require supplementation of certain nutrients. For example:

Folic acid is routinely prescribed for pregnant women and women who are planning a pregnancy. Folic acid is best taken prior to getting pregnant and continued for some months and can significantly reduce the risk of neural tube defects in babies.
Women who are breastfeeding their infants are often recommended a supplement, particularly if they are young mothers or have had pregnancies in rapid succession.
Cigarette smokers and people who drink alcohol, especially if it is at levels above what is considered a ‘safe’ level, often require increased nutrients.
Drug users may also be recommended nutrient supplements for a number of reasons, including poor diet.
People who are on very low calorie diets or who are restricting their diet for some reason, including allergies.
People who are very ill and also the frail and elderly, often due to poor diet, access and mobility issues.
People who are inactive and not able to get outdoors and people who cover the majority of their bodies, are commonly recommended vitamin D.
Individuals with malabsorptive disorders such as celiac disease are recommended supplements to counteract the loss of nutrients.

Nonetheless, if you fall into one of these categories it is ideal to talk with your healthcare professional about a supplement prior to commencing one so that you get the right dose and form for your situation.

Common nutrient concerns

Folic acid

As we know, women planning a pregnancy or in the early stages generally require folic acid supplementation. Interestingly though, this it is not due to a deficiency but rather a processing issue. Supplementation simply provides more folic acid to ‘push’ into the maternal system to overcome any potential error in processing folate.

Iodine

There is now considerable evidence that women and children are at greater risk of a deficiency of iodine, which is why iodine fortification programs are commencing in many countries and why standard pregnancy supplements now include iodine. However, iodine must not be taken in excess as it can have detrimental effects.

Calcium

Of course there is ongoing concern regarding calcium intake in relation to the adult population in terms of bone density. There is some concern for adolescent girls, many of whom don’t seem to be getting adequate calcium. The adolescent stage appears to be an important stage of bone density formation, hence calcium intake is critical.

Vitamin D

Vitamin D is also considered a nutrient of concern particularly in children, the elderly and those who aren’t exposed to sunlight. Again, fortification of our food sources is being discussed, in fact mushrooms containing vitamin D are a new addition to our vegie aisles. You are likely to see more foods with ‘added vitamin D’ noted on their labels on our shelves.

Is fortification the answer?

All this talk of fortification does bring up the question; is fortification the answer or is it a band-aid for a wound we are ignoring? For example, in the United States research suggests that some children are meeting nutrient requirements only as a consequence of consuming fortified foods. Does this suggest that something is going wrong with our food supply and our eating habits? Is it wise to rely on food manufacturers to ensure we cover our nutritional bases? Could this theme further complicate the way back to healthy eating for those who have lost their way? It’s probably good to also mention that fortification of our foods potentially impacts on our nutritional status, making the decision to supplement even more complex.

Are supplements safe?

Some supplements provide nutrients at dose levels similar to those found in food, these are known as ‘physiological doses’ and tend to be safer and more relevant to general use. Pharmacological doses, also referred to as ‘mega-doses’ or ‘therapeutic doses’, should be prescribed only after a consultation with a suitably qualified and experienced healthcare professional and in relation to your individual needs.

There is ongoing concern about the widespread use of supplements. One concern government agencies have is over whether we as consumers understand the potential for toxicity. There is concern that the view ‘more is better’ prevails and that supplements are used to compensate for poor eating habits. This old adage definitely doesn’t hold true of supplements; increasingly, research points to the deleterious effects of high doses of certain nutrients. Fat-soluble vitamins (A, D, E and K) can accumulate in the body and so are more likely to have toxicity effects. Even high doses of some water-soluble vitamins can have unwanted effects including, interfering with medication and interacting with other nutrients.

Arguments against nutrient supplementation

A number of arguments have been levelled against the regular use of nutritional supplements without confirmed requirement. Such arguments include:

Taking a supplement may give us a false sense of security and divert attention from maintaining a healthy diet and lifestyle.
Supplement marketing and advertising can confuse and mislead consumers given the complex nature of nutrients.
Nutrients interact constantly with each other; it isn’t clear as to what extent a supplement may interfere with our own nutrient balance.
Nutrients can help and hinder, for example, vitamin E may reduce the risk of cardiovascular disease, but may increase the risk of stroke.
Excessive intake of certain nutrients can be toxic and/or lead to other nutrient deficiencies or masking of nutrient deficiencies.
Some nutrient supplements have been found to interfere with some medications.
Results from research into supplements is difficult to evaluate, one reason being that supplements come in such a huge variety of combinations. There is much still to be learnt.
Many are expensive and the cost per dose is often unclear.

Some nutrient interaction examples:

Large doses of zinc can affect the uptake of iron and copper
Excessive fluoride can have negative effects on bone, particularly in children
High doses of fish oils can impair blood clotting
Excessive intake of calcium can inhibit iron uptake (common in children who drink large amounts of cows’ milk for example)
It’s very easy to overdose on iron, in fact iron is thought to be the most commonly overdosed nutrient
High doses of vitamin A can cause birth defects and even liver and other organ damage

What about using supplements to protect against cancer?

Few of us aren’t touched by cancer and there can be a tendency to believe that taking a supplement may protect us against cancer. However, most agencies don’t support the consumption of supplements to prevent cancer and other illnesses, suggesting that high-dose nutrient supplements, while they can protect against some cancers, may also be linked to others. Increasing your intake of nutrient-dense foods and beverages is the recommendation by most organisations.

Why not use food as our medicine!

The health benefits inherent in our plant foods, such as herbs from the garden or even supermarket, are often overlooked. For example, there is some great information coming to light about turmeric, which is used commonly in Indian meals, in regard to its benefits in food (over supplementation) in relation to cancer prevention. Numerous cancer societies note research conducted on foods and their preventative action against cancer.

Just a few examples of foods believed to reduce our cancer risk include:

Broccoli
Garlic
Vitamin C-rich foods such as red capsicum, guava, acerola, etc
Fish oils and plant oils such as those found in salmon or flaxseed and chia seeds
Probiotics and their link to improved immunity and intestinal health

There is an ever-increasing array of foods making their way onto the global food stage: goji berries, acai, camu camu, agave, Gubinge (Kakadu Plum) to name just a handful. Many indigenous societies have consumed what industrialised communities would call ‘exotic’ fruit and plant foods that, while known for thousands of years as having health benefits, are only just making their way into Western diets.

Be a discerning consumer

So if you choose to use supplements or believe your child needs a supplement then consider taking a targeted approach, where what you take is what you need:

Have your diet or your child’s diet assessed via a minimum three-day diet diary and computerised analysis.
Assess how the resulting nutrient levels compare to the appropriate RDI.
Discuss these results and your or your child’s overall health with a qualified person and design a diet and, if needed, supplement protocol based on this.
Ensure you have this reviewed regularly as life changes constantly.

Food first!

There is an extensive amount of research showing that the nutrients packaged in our food have a far more beneficial effect than synthetically made nutrients (although folic acid appears to be the exception, with a greater absorbency than natural folate). In fact a number of isolated nutrients appear to have different effects when they exist in a food. This may be due to the other nutrients and their levels inherent in a food or the compounds added to supplements.

We are still discovering compounds in food, and uncovering the effects and benefits of many of the nutrients we already know of, as well as the effect of how they work together. While there is some consensus that supplements have their place, better formulated supplements for specific users is needed. By far the best protector against disease and ill-health is a varied diet of healthy foods along with an appropriate level of activity.

Other sources of information and references

Australasian Nutrition Advisory Council’s (ANAC)* Codex Alimentarius, a collection of internationally recognised standards, codes of practice, guidelines and other recommendations relating to foods, food production and food safety.
Donaldson M. Nutrition and cancer: A review of the evidence for an anti-cancer diet Nutr J, 2004.
Food standards
The Food and Drug Administration (FDA) regulates dietary supplements as a category of foods, and not as drugs.
Nutrition and Physical Activity During and After Cancer Treatment: An American Cancer Society Guide for Informed Choices, 2009.

References:
1. http://www.foodstandards.gov.au/scienceandeducation/publications/evaluationreportseries/consumerstudyrelatedtofoodtypedietarysupplementlabellingjuly20036/

This information has been provided by Leanne Cooper from Sneakys baby and child nutrition. Leanne is a qualified nutritionist and mother of two very active boys.