Tuesday, November 20, 2012

The Pros and Cons of Vitamin Supplementation, Part 1 of 3

Yesterday one of my students posted a question about vitamin supplementation on a forum for one of our courses. He suggested that by recommending that taking a low potency multivitamin and mineral supplement in one of my lectures I was taking a more reductionistic stance compared to the more holistic perspective that I usually espouse. I decided to provide an in-depth answer because it is a very important question that I am sure will come up for a lot of my students. Not only do I want to be very thorough in my explanation for the purpose of explaining the course material, it is also important to me to provide my students with the best information that I can to help them to make healthy choices in their own lives. Once I got into it, I realized that there are a lot of layers to this question and my response became quite lengthy. Since this is an important topic and I have been considering doing a post on it at some point, I decided to post my answer on this blog for the benefit of anyone who is interested. Due to the length I have decided to post it in three parts.

The first thing that I would like to say is that I don't believe in adhering rigidly to any particular ideological framework. It's a great big mysterious world out there and what we know has barely scratched the surface of what can be known, never mind what simply can't be known by the rational mind. It would be ignorant and/or arrogant for me to believe that the world is going to completely correspond to any particular human rational paradigm. As a practitioner of a healing profession, what matters the most to me is that something works. Although I acknowledge that approaching healing and herbalism from within the context of an holistic paradigm usually works best both in terms of clinical outcomes as well as supporting a healthier relationship with the world that we live in, that doesn't mean that a lot of useful information hasn't come from reductionistic medical science. I may often interpret it in a different way than most scientists do, but I won't deny it's value. If it works, it works!

Supplementation is very complex issue. There are a lot of opinions on this, but the research is very incomplete and what is available is often contradictory. There are probably going to be many people who disagree with me on this. That's fine! As with anything I've posted in this blog, the best I can do is offer what has worked for me in my life and in my practice. It's up to the readers to decide if they want to try it out and see if it works for them.

Supplementation: Good, bad or just a waste of money?

I agree that it is possible that for many people supplementation might not be necessary if they eat an ideal diet most of the time and live a healthy lifestyle. So lets start there. What exactly is a healthy diet? There are many traditional diets that have evolved around the world that represent what historically has worked best for a particular group of people, with a common genetic background, living a particular way, in a particular environment, in a preindustrial world. Presumably they will have over many generations developed a diet that worked well for them. It wouldn't necessarily have been the best diet in an ultimate sense, but the best diet based on what was available in the region where they lived.

Now let's fast-forward to the contemporary Western world. In North America we have a very diverse population who mostly come from other regions of the globe. We eat food that we purchase. It is mostly trucked in from other areas and isn't very fresh. The varieties of fruits, vegetables and animals that we eat have been extremely hybridized and a growing number will soon be genetically engineered. These varieties have been developed not based on their nutritional quality, but rather on characteristics demanded by industrialized agriculture, like the ability to resist "pests" and diseases, to ripen slowly in an artificial environment when harvested prematurely, not bruising easily, having a certain uniformity of appearance, etc. Most of our food is produced in dead soil that has been depleted of many of its trace minerals, using toxic pesticides, herbicides and fungicides. Most of the food we eat is also heavily denatured by food processing methods and has a lot of additives to preserve it and give it flavour. On top of this, we live an extremely sedentary lifestyle compared to our ancestors.

The good thing is that we can make positive health choices up to a point. So let's say we decide to do that. There are things we can do that will benefit everyone. We can eat exclusively fresh, organically grown, heirloom varieties of foods that we have grown ourselves or come from local organic farmers. We can eat everything in a whole, natural, minimally processed form and prepare all of our food ourselves. We can also do our best to eat a healthy, balanced diet. What does that look like? Well, there are many opinions out there but very few of them are backed up by the facts. The time-tested traditional diets don't necessarily apply because people in contemporary Western society will mostly be of different genetic stock, living in a different climatic and ecological region, and living a different lifestyle. Also, the foods associated with a particular traditional diet might not be available locally and therefore need to be transported long distances which could compromise their nutritional quality. Finally, the amount of variation in constitution, personal and family history, and lifestyle between different people living in our society will likely result in a greater diversity of individual nutritional needs than was typical in the past.

You've got to love that fresh, local produce!

If we look to the nutritional literature, mostly we are going to get confused. There are many authors and movements promoting various diets. Most of these are rationalistic diets. By that I mean that some person arrived at a set of nutritional principles through some combination of personal experience and rational deduction and has then extrapolated their conclusions and is advocating their particular dietary regimen as being the best diet for everyone. These diets are usually completely unsupported by the research literature or sometimes might seem to be partially supported if we selectively choose what research we want to accept.

Sometimes people who follow these diets do feel better for awhile. It is even possible that for a very small percentage of people some of them actually work. But usually people feel better because the diet is somewhat of an improvement over what they were eating before. Most of these diets are not healthy in the long run for most people. Nevertheless, they appeal to members of our society because we have been trained to live our life in our heads. We have forgotten how to listen to our body and the world around us. So if I can provide the right argument to a person with the right background, I can convince them that a particular diet is good for them and they will follow it based on a belief system rather than by listening to their body. Over the years I have met so many people who were obviously unhealthy but continued to rigidly adhere to some dietary philosophy.

Fortunately, there is some excellent research out there on what constitutes a good diet for people of a diversity of genetic backgrounds living in the contemporary industrialized world. Most of the results of this research have only become available in the last decade or so because they are the results of studies that followed the diet and general health of tens of thousands of people over decades. By far the best book out there that summarizes the data from these studies is Eat, Drink and Be Healthy by Walter Willett. You can also find a more popularized and slightly different take on the literature in Michael Pollan's In Defence of Food. I strongly recommend both of these books to anyone who is interested in healthy eating. The latter is a bit more holistic, but the former is more comprehensive. Andrew Weil's Eating Well for Optimum Health is also pretty good, but it came out before a lot of the data was available and he has some definite personal biases that bleed through that are not necessarily supported by research. The great thing about Walter Willett is that he isn't just someone writing about this stuff. He is one of main scientists overseeing these studies and interpreting the data. He's also more open-minded than most scientists. He doesn't get into some issues like organic agriculture, presumably because he is a well-respected scientist with a distinguished reputation and he won't step outside of what is actually supported by research. However, unlike other scientists, he doesn't condemn things that are not supported by research. He just sticks to the facts that are available at this time. So if you want to know what the research says without a lot of personal bias and filler, his book is the best that I've come across.

The last thing I want to say about this is that the research tells us what works for most of the people most of the time. However, everyone's body and situation is unique. Walter Willett's recommendations are excellent guidelines and leave a lot of room for experimentation. They are a good starting point but we also have to learn to listen to our body, because what works best for us right now might not be ideal a month or a year or a decade from now. Everything in life changes. To stay healthy in a changing world we need to keep an open mind and heart, be vigilant and ready to adapt to change as it presents itself. There is no one static end point that we are striving to reach.

OK, so let's say we eat a good diet that works for us. It is organic, local as much as possible and we eat only whole foods that we prepare from scratch. We also need to minimize the amount of time we spend sitting in front of a computer, TV, or whatever, and be as active as possible: walk and bike instead of driving everywhere and get an intensive aerobic exercise on a very regular basis, if not daily. The truth is, living this way takes a lot of commitment and discipline and even the most dedicated among us aren't going to be able to live up to this standard 100% of the time. Regardless of our level of dedication, the time commitment alone makes this very difficult. So we have to acknowledge that this is an ideal to work towards but most of us probably won't be able to fully realize it. We don't want to beat ourselves up about it either. We need to do the best we can with the resources available to us and when things don't work out the way we want them to, learn from it and adapt. That being said, let's say that we are able achieve our ideal or even get close to it without stressing ourselves out in the process. Is there then any need of supplementation?

I believe that the answer to that question is yes for reasons that I will explain below. But first, getting back to the original question, I find the suggestion that recommending supplementation might be a more reductionistic approach very interesting. It's definitely a perspective that I have heard many times. What is interesting about it is that historically, it is primarily the reductionists who came from this point of view. In the past and to some extent in the present, most reductionistic medical practitioners and scientists have said supplementation is completely unnecessary as long as we eat a good diet with lots of variety. What they usually mean by a "good diet" is a typical North American diet with a bit more variety. "Just follow the Canada Food Guide" was a common response. In truth, most of the people who the public sought dietary information from knew almost nothing about nutrition. So what does Walter Willett say about supplementation? In recognition of the fact that we aren't always going to eat the perfect diet and that there are still a lot of unknowns concerning nutrition, nutrient availability and individual requirements, he recommends that everyone take a low potency multivitamin "for insurance". He also slams the American and Canadian food guides and explains the politics involved in how they are developed.

I think that based on Walter Willett's reasoning alone, it is probably a good idea to take a low potency multivitamin and mineral supplement. The truth is that we can never know exactly what our nutrient requirements are from moment to moment and whether or not what we are eating is fulfilling all of them. However, let's consider a couple of important factors that I haven't discussed yet that are also relevant to this issue. Firstly, people in contemporary Western society are living with some level of chronic stress throughout most of their lives. This is something that our hunter-gatherer ancestors didn't have to deal with except usually for short periods of time. The current situation began with the development of city states and empires and reached peak levels in the last century, particularly in the last four decades  and every year it is getting worse!

Today we are also living in a world that is becoming increasingly more toxic. On a daily basis we are exposed to thousands of chemicals most of which have only existed since World War II. They are chemicals that the human body never had to deal with over the course of our evolutionary history. Even if we live and grow our own food way out in the country and live in a building made of natural materials we can no longer avoid them. We've inherited them in our body from previous generations, both literally and via epigenetic influences that are passed down from generation to generation. No matter where we go they are in our air, water and soil. Even if we practice strict organic agricultural practices, they are still in our food because they are in the air, water and soil. They are in wild game even in the remotest regions of the world. We are also constantly being exposed to various forms of radiation that are broadcast around the globe. Every year as we overload the capacity of the frequencies that we are using we exploit additional frequencies. Pretty soon we will be bombarded with radiation from the entire electromagnetic spectrum!

These factors increase the various kinds of stress in our lives. It is my belief that even if we are able to accurately determine and follow the best diet and lifestyle for ourselves most of the time, some supplementation is probably necessary for optimum health.

This is the end of my first post on this topic. In Part 2 I will look at some specific issues concerning the quality of supplements, then in Part 3 I will explain what I personally recommend as a basic supplement regimen.

No comments:

Post a Comment