Friday, November 30, 2012

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

This is the third of three posts on this topic. Part 1 was posted on November 20th, Part 2 on November 22nd.

I would like to begin here by first clarifying some of the statements that I made in Parts 1 and 2 concerning manufacturers and retailers of natural health products. I referred to certain aspects of their formulating strategies as marketing gimmicks and also suggested that in some cases manufacturers were engaging in deceptive practices concerning the quality and forms of the ingredients in their products. Sadly, this is sometimes the case and it can be very difficult for consumers to discern the relative quality of products and information that are out there.

Before looking at some of the challenges for consumers who are looking for quality information and products, I would like to put this into a broader context. Natural healing practitioners and the natural health products industry have long been innovators in terms of challenging the status quo, developing effective therapeutic protocols, and making many excellent products available. Many of these very effective therapies and products have been ignored by mainstream medicine and often challenged as ineffective or even harmful. It is true that in some cases they were, but these challenges from reductionistic medical practitioners and scientists were largely based on a perspective that anything that is not backed up by clinical studies doesn't exist. The fact that a significant proportion of mainstream medical practices and uses of drugs are not supported by clinical studies doesn't seem to matter. What matters is that many proponents of mainstream medicine will attack anything that challenges their paradigm. Nevertheless, many of the medicines and methodologies that have been used by traditional peoples or developed by practitioners of natural healing have since been scientifically verified. When they are, the scientists who do the research often claim to have "discovered" these new treatments and don't acknowledge their origins or that they once vehemently denied their efficacy and the credibility of those who used them. That being said, just like any aspect of society where there is money to be made and ego gratification to be obtained, not everything out there in the natural healing and health products world is necessarily good for us.

Varro Tyler was a respected scientist considered to be one of the worlds leading authorities on medicinal plants. He once wrote that
mad-dog scullcap (Scutellaria lateriflora) is "a nearly worthless and essentially inactive plant". Recent research has begun to verify its
traditional uses. Any experienced herbalist that has ever used this herb knows that, stuck in his reductionistic, materialistic world view,
Tyler might have known a bit about the chemical constituents of plants, but he knew very little about medicinal herbs.

Back in the 60s and 70s, the natural foods and health products industry was largely made up of grassroots idealists who believed in what they were doing and tried their best to live it. Sure, there was still some questionable information and products out there, but most of it was pretty basic and sound. If we were to take a tour of the typical health food store at that time we would have found mostly staples, the essentials of a good diet: lots of unprocessed or minimally processed whole foods. The selection of supplements was for the most part pretty basic and uninteresting. What was sometimes lacking was a good variety of organic produce, meats and dairy products. Fortunately, organic agriculture has grown significantly since then and this is no longer the case.

In the late 70s and early 80s things began to change. The industry started growing at an incredible rate and the diversity of products increased similarly. On the food end, the shelves started filling with products that looked very similar to those on the shelves of regular supermarkets. On the positive side, this was an important indicator that natural products and healing modalities were becoming more mainstream and a growing segment of the population was starting to take their health more seriously. These products provided a lot more diversity and choices for consumers and they formed a very important bridge for people who were starting to change their diet, enabling them to purchase healthier products that were very similar to what they were already consuming. However, the downside was that the shelves of health food stores and eventually mainstream supermarkets as the momentum continued through the 90s were mostly filling up with slightly more natural and healthy junk foods. Although these products are better than their mainstream counterparts because they don't contain numerous additives and are usually made from mostly whole food ingredients, often organically grown, most of them are still for the most part processed foods. They are a healthier alternative but they are not whole, natural, unprocessed foods, which is ideally what our diet should consist of. You will find most of the real health foods in the bulk foods and produce departments of these stores, which of late tend to be taking up a smaller and smaller proportion of the floor space. I'm not saying that these products don't have any value. They are a step in the right direction and have lots of benefits over mainstream food products including those I mentioned above. I even eat some of them myself and recommend them to my clients to help them transition to a healthier diet. What I am saying is that many of these foods are not as "natural" as people tend to think they are.

Natural foods and health products are not on the fringe any more. They are mainstream and they are big business! In this industry it is almost impossible for small grassroots companies to survive these days. Most of the smaller companies have been swallowed up by medium sized companies or gone out of business. A growing number of the medium sized companies are being purchased by mega corporations. A significant portion of the industry is now owned by major food and pharmaceutical companies. This shouldn't surprise anyone because it is the same pattern that is unfolding throughout the global economy. These corporations aren't stupid. Natural foods and health products have been one of the fastest growing sectors and they want a piece of the pie, or all of it if they can get it! To this end, it's much easier to acquire an established company than to start from scratch. What this means is that natural foods and health products have arrived. They have been legitimized. In many ways this is a good thing, but what it means for this industry is that it is now infused with corporate values. Although many people that work in this industry still have a lot of the idealism that was characteristic of the past, a growing number of them aren't there because they believe in it. They are there because it's a good business.

With the infusion of corporate values into the natural foods and health products industry comes a lot of sophisticated strategies aimed at increasing the bottom line. Sometimes this translates into cutting corners on product quality. It has also resulted in some unscrupulous marketing strategies such as greenwashing.

One of the things that tends to characterize people who are interested in improving their health is their hunger for information. Companies in this sector have used this to their advantage by flooding the market with information on various dietary strategies, nutrients, herbs, and other related topics and products. It is not an exaggeration to say that most health-related information that is available in magazines and a significant amount in books is essentially advertorial of one kind or another. Some of the information might still be useful, but it is very difficult to determine what is good quality information when most of it is at best very biased, and sometimes completely inaccurate. To make matters worse, the people who consumers rely on for information, natural health product retailers, typically get most of their information from sales representatives, product literature, and a lot of those magazines that are publishing advertorials. I'm sure the majority of the people working in health food stores sincerely want to help their customers, but most of the information that they have access to is dubious and they usually don't have the necessary training to be able to filter out the good stuff from the bad stuff. Even natural healing practitioners often buy into a lot of the inaccurate information that is out there. This is particularly true of practitioners who sell natural health products because they are obtaining a lot of their information from product literature as well.

Once more I want to emphasize that I am not suggesting that most natural health products are poor quality or that manufacturers, distributors and retailers are deliberately trying to deceive consumers. Although it is true that a lot of the dubious information out there ultimately comes from someone who is attempting to manipulate consumers in order to increase their profits, most of the people down the line really believe that this information is accurate and helpful to people  and some of it is! The challenge is that most people don't have the tools to be able to assess the quality of the information. As an herbalist, I can honestly say that most of the information out there on herbs is inadequate and often inaccurate. However, unless you are an experienced herbalist you aren't going to be able to recognize this. Everyone can't be an herbalist. That is why one of the most important roles of herbalists is as educators. We need to get good quality information out there to help people to be able to make informed choices.

Now let's get back to the original point. It can be very difficult to determine what constitutes a good supplement regimen. On the one hand, we have extreme supplement advocates who, whether for business or ideological reasons or both, would have everyone popping hundreds of pills per day. At the other end of the spectrum we have old school reductionists and food purists who believe that supplementation is unnecessary unless a deficiency is confirmed. In between we have just about every other possible opinion.

In considering a person's nutrient requirements there are basically four different ways of looking at it:
  1. Based on the minimum amounts required to prevent a deficiency disease. This perspective used to be common among medical doctors and dietitians. It is less so today as it is now clear that there are other negative health consequences that can be demonstrated when a person's intake of a particular nutrient is low well before the point where the symptoms of a deficiency disease will manifest.
  2. Based on the amounts that occur in a "normal" diet of a "healthy" population. This is more typical of medical doctors and dietitians today. It is problematic because what is average is not necessarily what is natural or ideal. What is currently considered "healthy" by practitioners and advocates of mainstream medicine is probably not as healthy as they would like to believe.
  3. Based on optimum requirements for overall level of health and well-being. This is difficult to determine and could vary considerably between different people.
  4. Based on therapeutic doses. This is not something that should be advocated for daily consumption. When the dose of an individual nutrient is increased beyond the range that it is utilized for nutritional purposes, its action becomes less nutrient-like and more drug-like. Taking nutrients in therapeutic doses can be an effective element of an overall treatment protocol, but it is not nutrition.
Many medicinal herbs and spices, such as rosemary (Rosmarinus officinalis), are loaded with nutrients and antioxidants.

In my clinical practice I have found that what works best is to strive for optimum nutrient requirements. This should primarily be accomplished through eating a good diet as I discussed in the first part of this series. In particular, it means eating lots of vegetables and moderate amounts of fruit. However, for reasons that I stated previously, namely variations in individual requirements and the high levels of stress and toxicity that are endemic in contemporary Western society, I have also found that some level of supplementation is preferred if one wants to achieve some level of optimum health and well-being. The basic regimen that I recommend is as follows:
  1. A low potency multivitamin and mineral supplement as I discussed in part 2 of this series, taken once a day with breakfast. This helps to ensure that we are getting what we need on a daily basis. The higher levels of B complex vitamins and certain minerals also help to address increased nutritional requirements due to stress, as well as provide some level of support for immune function.
  2. To help protect our body from the harmful affects of toxicity and support immune function, I recommend some degree of supplementation with antioxidants. I primarily recommend vitamin C, 400-600 mg once or twice a day. If only taken once a day it should be taken with dinner to separate it from the vitamin C taken at breakfast as a component of the multivitamin. It is best to take vitamin C in the form of mineral ascorbates rather than ascorbic acid because the diet of most people in our society tends to be acidic and ascorbic acid will increase our acid load. Mineral ascorbates are not acidic. Calcium, magnesium or mixed mineral ascorbates are best. Sodium ascorbate is not recommended because we already tend to consume way more sodium than is good for us. It is also important that a vitamin C supplement contain a decent dose of antioxidant polyphenols, such as flavonoids, anthocyanins and proanthocyanidins. These are mutually synergistic with vitamin C. I also recommend vitamin E. 200 IU is sufficient for most people. It should be natural vitamin E, preferably in the form of mixed tocopherols. Vitamin E works best if taken together with 50-100 mcg of the mineral selenium. The vitamin E and selenium are best taken once per day with dinner. They must be taken with a meal that contains fat.
  3. For people who live in the temperate regions of the northern and southern hemisphere, I recommend supplementation of vitamin D. Typically, I recommend 2,000 IU per day from October to March (April to September in the southern hemisphere), and 1,000 IU in April and September (March and October in the southern hemisphere). Anyone who does not spend much time outdoors should take 1,000 IU in the summer as well. However, anyone who wants to implement a healthy lifestyle should try to spend as much time as possible being active outdoors  in a natural setting as much as possible. For vitamin D production and many other reasons, it is best not to wear sunglasses all of the time when outdoors during the summer. Sunglasses aren't good for our eyes anyway. Of course, these recommendations are reversed for people living in the southern hemisphere where the seasons are opposite. Also, keep in mind that requirements of vitamin D supplementation is going to be lower at high altitudes and higher for darker skinned people. It's also going to be lower for people who traditionally eat foods that are high in vitamin D such as fish liver.
  4. In the contemporary Western diet, the fat content of our diet tends to be high in saturated fats of animal origin and plant-based oils that are high in omega-6 fatty acids. Ideally we need to reduce these and increase the proportion of monounsaturated and omega-3 fatty acids. Traditionally, animal fats in our diet came from seafood or wild game and livestock that ate a natural grass-based diet. Today, livestock are primarily fed an unnatural diet designed to speed up their growth rate and fatten them up. They are also a lot less active. The result is that their tissue contains more fat and it is primarily saturated with very little omega-3. Consumption of large amounts of fish and wild game is no longer recommended due to environmental contamination and ecological issues. As a result, the easiest way to increase omega-3 consumption is through the use of plant-based vegetable oils. By far the best source is organically grown, raw flax seed oil that has been processed without exposure to heat or oxygen, stored in dark bottles and refrigerated. Other plant sources tend to have lower levels of omega-3 relative to omega-6, monounsaturated and saturated oils. Consuming nuts and other foods that contain them is still good in moderation. Olive oil, which is a mostly monounsaturated oil, has been found to have many health-promoting benefits as well. Nevertheless, we still need to increase the omega-3 oils in our diet and flax seed oil is the best option. I don't recommend fish oils because they are subject to environmental contamination and because of the way they are processed they tend to be rancid. Although the negative health consequences of consuming rancid oils has been given less attention than trans-fats and animal source saturated fats, it is almost certain that rancid oils pose almost as much of a health threat as trans-fats. The other issue with fish oils is that several major studies that have looked at the amount of fish and other marine animals that are being harvested from the ocean have unanimously concluded that commercial fishing at anything close to current levels is completely unsustainable. The omega-3 issue has been given a lot of attention in recent years and many foods are now claiming to be "fortified" with omega-3 oils. This is another marketing gimmick. Omega-3 oils are extremely unstable in the presence of light, heat and oxygen, and adding them to various processed foods means that they will be rancid. As a result, I recommend a dietary supplement of 1-2 teaspoons of good quality flax seed oil per day. This should never be cooked but can be added to cooked foods on our plate as long as they are consumed right away. It is important to recognize that consumption of polyunsaturated oils increases our daily requirements for vitamin E and selenium.
This is the basic supplement regimen that I recommend. In my life and my practice I have found it to be a very useful adjunct to a good diet and healthy lifestyle. It is not going to meet everyone's needs exactly, and I sometimes recommend additional supplements or higher doses for specific issues. For example, anyone suffering from chronic auto-immune or inflammatory conditions will benefit from higher doses of vitamin D and antioxidants, especially ascorbate and polyphenols.

Blueberries are a very rich source of polyphenols such as anthocyanins.

We can also increase the antioxidant content of our diet by increasing consumption of leafy green vegetables, and fruits and vegetables that have a deep orange, red, blue or purple colour. It is not necessary to consume exotic "superfoods". This is also a marketing gimmick. All plants are anti-oxidant to some degree. It's true that some are considerably more antioxidant than others, but pretty much no matter where we live their are fruits and vegetables that are very high sources of antioxidants. For instance, it doesn't get much better than dark blue and purple berries like black raspberries, blackberries, blueberries and bilberries, which grow and are cultivated throughout the temperate regions of the northern hemisphere. It doesn't make sense to consume exotic plants from foreign countries where we don't know for sure whether they are destroying the environment when growing or wild-harvesting them, they must be transported long distances, and they are usually a lot more expensive.

That is my take on supplementation. It's not going to be perfect for everyone, but it's a good basic template which we can work with and fine-tune in order to meet our individual needs. Of course, there are lots of other opinions out there. All I can say is that these recommendations are supported by the limited research that is available, and more importantly, I have found that they work in my life and my practice.

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