The Pros and Cons of Vitamin Supplementation, Part 2 of 3

This is the second of three posts on this topic. Part 1 was posted on November 20th.

Let's continue this discussion by considering Walter Willett's recommendation that we take a low potency multivitamin and mineral supplement. I qualify that recommendation to mean a good quality low potency multivitamin. The first thing we need to realize is that pretty much the only thing that changes in potency between low, medium and high potency multivitamins is the amount of the B complex vitamins. These are among the most widely supplemented vitamins. They are often marketed as "stress" vitamins because our requirements for B vitamins increases when we are under greater stress – and people today experience a lot of stress! B vitamins are not easy to obtain in high doses from foods. There are a few foods, like liver and certain kinds of yeast, that are relatively high, but eating large quantities of these foods is not necessarily ideal. Firstly, the liver is an organ of detoxification and one of the most toxic organs in the body. Eating the liver of various mammals and fish was a good source of many important nutrients in the past, but these days I don't recommend eating liver or other organ meats on a regular basis or even at all due to their toxicity. Eating brewer's yeast or other kinds of nutritional yeast is also not necessarily the best solution. They need to be eaten in fairly large amounts to provide similar doses of nutrients to those found in supplements and are not a normal component of the human diet in these quantities. Also, many people have sensitivities to yeasts, and they don't necessarily provide B vitamins in the correct ratios that match our daily requirements. I'm not saying that we should never eat these foods, only that it probably isn't ideal to eat them in large quantities or too regularly. Also, if we do eat liver, we should only eat liver from healthy, organically raised livestock. Liver from wild animals is less desirable. Even in the remotest regions it has been known to contain significant quantities of mercury, PCBs and other toxins that come from the activities of the logging and mining industries or arrive in the air, rain and snow. Also, wild game tends to be contaminated with lead if it is killed using bullets that contain lead. Although traditional peoples used as much of an animal as possible to honour the spirit of the animal and because it makes practical sense, unfortunately it is no longer a good idea to eat the organs of wild game on a regular basis.

The flesh of wild game such as white-tailed deer (Odocoileus virginianus) can contain significant toxicity, even in remote areas.

Because consuming B vitamins in larger doses helps people to better deal with the affects of stress, B complex vitamins are very often supplemented, usually in medium to high potencies. This is not something that I recommend, and if we want to approach this from a "holistic" perspective, it is not very holistic. Most B vitamin supplements have the same dose of every B vitamin, usually 25, 50, 75 or 100 mg (mcg for a couple of them). However, our body doesn't use them all in the same amounts and these dosages are grossly in excess of what we need. A good quality B complex will have a range of doses of the individual B vitamins corresponding roughly to the relative amounts that we require. Ideally the dosage range should be between 5-10 mg (or mcg) for the lower dose B vitamins, and 15-25 mg (or mcg) for those required at a higher dose. It depends on the individual vitamin. Even at this dose, no matter how stressed out we are, our urine will still turn bright yellow after we take them. This means that the dose has exceeded our requirements and the excess is being flushed out by our kidneys. Technically, it is only riboflavin that produces this colour in our urine, but if the dose of riboflavin that we are taking is excessive enough to change the colour of our urine, we can be pretty certain that the dose of the others is similarly excessive. We don't want to exceed our requirements by too much because it puts stress on our kidneys to have to filter them out of our blood in large quantities on a daily basis.

Secondly, in order to be efficiently utilized, B vitamins need to be taken together with other nutrients, particularly vitamin C and some of the essential minerals. This is why it is much more "holistic" to take B vitamins in the context of a multivitamin and mineral supplement rather than on their own. In addition, there are probably other nutrient and nutrient-like substances in food that interact with B vitamins and all of the other nutrients in a multivitamin in ways that we haven't even begun to understand. For this reason vitamin supplements should always be taken with a meal so that they are taken together with their natural counterparts and all of the co-factors that work together with them. In particular, fat soluble vitamins like vitamins A, D and E can not be efficiently absorbed unless they are taken with a meal that contains some lipid (oil or fat).

The other rationale for taking a multivitamin and mineral supplement is that some of the most common nutrients that are deficient in our diet are trace minerals. This is because trace minerals are not replenished by the synthetic fertilizers used in commercial farming. Also, the soils of some regions are naturally deficient in certain trace minerals because they don't occur in the bedrock that underlies the soil, which is where most of the minerals in soil come from.

A multivitamin is not a replacement for a good diet. It is a supplement to a good diet. A good diet is essential. However, people in our society tend to experience chronic stress of a moderate to high intensity. This can significantly increase our nutrient requirements. A good quality, low potency multivitamin and mineral supplement is recommended to make sure that we are getting all of the nutrients that we need in sufficient, or preferably optimum amounts on a daily basis.

In addition to a relatively low dose of B vitamins that are in ratios that approximate our daily requirements, a good multivitamin and mineral supplement should also contain the major trace minerals such as zinc, manganese, selenium, copper and molybdenum. The minerals should be in a form that is easily absorbed such as amino acid chelates, citrates and malates. Some forms such as carbonates and gluconates are not as well absorbed. Oxides are particularly not recommended because they promote tissue oxidation. Also, it is preferable to use a multivitamin that does not contain iron. This is because iron is a very powerful oxidizing agent and too much iron in our blood and tissues promotes oxidation and contributes to many chronic health problems. Most people in our society get too much iron because they eat too much meat. Many kinds of meat are very high in iron and it is in a form that is more absorbable than the iron in plant foods and water. Another issue with iron is that the forms of iron found in supplements are usually difficult to absorb. So, the iron in multivitamins isn't the best form to take. As a rule, I recommend iron-free multivitamins and, if there is reason to believe that someone needs an iron supplement, I give it to them separately in a highly absorbable form taken together with vitamin C, which also increases the absorption of iron. Fortunately, most companies offer iron-free alternatives these days.

The last point I would like to make about multivitamins is that many of the companies who like to market themselves as "higher quality" add herbs to their vitamins. This has become a common practice these days and it is bad news for consumers. It is getting very difficult to find decent multivitamins that don't contain herbs. Here I am not referring to concentrated plant-based antioxidant extracts like flavonoids, anthocyanins and carotenoids. These are excellent ingredients to include in a multivitamin and highly recommended. What I am referring to is the addition of popular medicinal herbs like ginseng, Ginkgo and Echinacea to vitamins. For the most part this is a gimmick. Usually the herbs are in forms and quantities that will not provide any medicinal benefit. They are included because they are popular. It is a selling feature that can increase sales and help justify charging higher prices for these products. Sometimes they are included in general multivitamins because the public (with the manufacturers help) will perceive some value to including them. In other cases they are used to give a product a more specialized function, like including traditional female reproductive herbs in multivitamins "for women". Unfortunately, most supplement manufacturers don't consult with experienced herbalists when developing their formulations. So, regardless of their intentions, they often end up including herbs in ways that are inappropriate.

Medicinal herbs such as common purple coneflower (Echinacea purpurea) should not be ingredients in vitamin supplements.

Although foods – especially plant foods – are medicinal to some degree, we have always made a distinction between plants that we eat and those that we reserve for specialized use when we need a more powerful medicinal action than what can be obtained from foods. Even though the herbs in these products are usually in quantities that will not provide any medicinal benefits, ingesting them in these small quantities can still cause our body, or microorganisms living in our body, to adapt to them so that when we really need their medicinal benefits they won't work as well even in the appropriate forms and doses. Medicines should never be abused. They can lose their effectiveness and in some instances they may even be harmful.

I have occasionally come across multivitamins that do contain concentrated extracts of herbs in therapeutic doses. This is still not desirable. Herbs are not meant to be used this way. We use them only when we need them and in the appropriate way. The moral of the story is that any vitamins that we purchase for use on a regular basis should not contain medicinal herbs.

Another issue concerning the use of vitamin supplements is that some vitamins in these supplements are in slightly different forms than those found in foods. In fact, the whole notion of "natural" vitamins is also for the most part an advertising gimmick. The only really natural vitamins are those in whole foods together with all of the other nutrients and co-factors with which they naturally occur. When you buy a "natural" vitamin, if it is a relatively good product the word "natural" really means "relatively complete, in more-or-less natural relative proportions with plant-based co-factors, a few ingredients from natural sources, mostly synthetic". There is a lot of misinformation out there about natural vitamins and manufacturers often go out of their way to promote it. For example, there are many products on the market called "Rosehips Vitamin C 500 mg". Most relatively educated consumers of natural foods have probably read that rosehips are very high in vitamin C. When they see a product called "Rosehips Vitamin C 500 mg" they tend to think that either each capsule contains enough rosehip powder to provide 500 mg of vitamin C or it contains 500 mg of vitamin C that was extracted from rosehips. What it really means is that it contains 500 mg of synthetic vitamin C with some amount of rosehip powder. It could be a very small amount, in which case the ingredient list will say something like "in a base containing rosehips". If it is a more substantial amount, it will specify some quantity, usually 50 or 100 mg. This is very different from how most consumers perceive the product. Although rosehips are a very rich source of vitamin C or ascorbic acid, they still only contain 0.03-1.3%, depending on the source. Therefore the amount of rosehip powder necessary to provide 500 mg of vitamin C is between 38 g (1.3 oz) and 1.67 kg (3.7 lb)! Even at the higher concentration it just wouldn't be possible for someone to eat that every day. It probably wouldn't be good for them either as rosehips have lots of other properties that are potentially problematic at this dose. Extracting vitamin C from rosehips is not practical either. Not only would it be prohibitively expensive, it would be extremely unsound from an ecological point of view to have to use that much rosehip powder to make every capsule of vitamin C. As it turns out, the ascorbic acid molecule is closely related to monosaccharides and can be manufactured very cheaply from glucose. The molecular form of synthetic ascorbic acid is identical to the natural form.

Sweetbriar rose (Rosa eglanteria) is a common wild source of rosehips.

In the case of other vitamins, there are a couple for which the synthetic version is slightly different than the natural form. This usually means that the synthetic form partially or completely consists of isomers of the natural form. These are molecules that have the same chemical formula but are a different shape. In these cases our body, usually our liver, can sometimes convert the alternative isomers to the natural form so they can be used by our cells. In some instances they may need to be converted in our intestines before we can absorb them. These processes are not 100% efficient. That means that for a few vitamins the absorption and utilization of synthetic forms might not be as efficient as their natural counterparts. However, because the amounts found in supplements are significantly greater than those found in foods, even allowing for poorer utilization of some of them, they are still going to contribute significantly to our daily intake. Fortunately, the main vitamin for which this is a concern is vitamin E and most better quality vitamins contain the natural form, d-alpha-tocopherol or d-alpha-tocopherol succinate, rather than the synthetic form, dl-alpha-tocopherol. You will note that I said that some synthetic vitamins "might not" be as efficiently utilized. This is because natural nutrients are not always absorbed efficiently from our food either. In addition, due to common dietary and lifestyle habits, most people in our society suffer from some degree of digestive deficiency. For many of them it is actually easier to absorb and utilize vitamins from supplements than from food. The exception is timed release vitamins. These are intentionally made more difficult to digest so that water soluble vitamins will be absorbed more slowly, otherwise they tend to be flushed out of our body by our kidneys pretty rapidly. Timed release vitamins are not recommended because they are not always digested efficiently. It is better to take smaller amounts of vitamins more often than to take larger amounts in a timed release form.

Still on the natural vs. synthetic and bioavailability issues, there is another kind of supplement that you will sometimes come across that I will briefly discuss. These are usually called "food form" or "food matrix" supplements. The basic philosophy behind these products is that nutrients are better absorbed when they are part of an organic multi molecular matrix similar to how they occur in foods. Supposedly these kinds of supplements are made by force-feeding certain kinds of yeast large amounts of a particular nutrient in its synthetic form and forcing them to convert it to a more natural, organic form. An extract is then made of the yeast which includes these nutrients in a "food form" along with other cofactors found in the yeast. Although the basic idea sounds good, I do not recommend these kinds of supplements for several reasons. Firstly, it is difficult to guarantee that these products actually contain what they claim to contain. Some manufacturers have been know to simply mix synthetic vitamins with yeast or other food extracts, in which case the vitamins haven't really been converted to an organic form. This is particularly an issue in the U.S. where quality control standards are not as stringent as in Canada. So far I am not aware of any companies manufacturing these products in Canada and I have yet to see any of the American products with an NPN (Natural Health Product Number) indicating that they have met Canadian standards. Another concern is that sometimes nutrients of this kind are manufactured by genetically engineering yeasts or other organisms to produce the nutrient in large quantities as a metabolic by-product. Even for those products that are what they say they are, there is no independent research that I am aware of that indicates that this form of nutrient is more bioavailable. In fact, in order for nutrients to be absorbed they must be separated from any organic molecules to which they are attached. For this reason nutrients are usually better absorbed when they occur as closely as possible to their free form state. Finally, these nutrients tend to be a lot more expensive than standard vitamins and minerals even though they contain much lower doses of nutrients. The rationale for the lower doses is that they are supposed to be better absorbed. However, this isn't necessarily the case and even if it is, you are still going to absorb more from a standard supplement that contains a much higher dose - at a fraction the price! The bottom line is, even if some of these products contain what they claim to contain and work as well as they are supposed to, you will get a lot more value for your money purchasing other forms of supplements.

This is the end of my second post on this topic. In Part 3 I will continue this discussion and then explain what I personally recommend as a basic supplement regimen.

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 Harvard School of Public Health Healthy Eating Plate

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.

It's Never Too Late to Change!

Here's another interesting study that was recently published in the British Medical Journal:

http://www.sciencedaily.com/releases/2012/08/120830191036.htm?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+sciencedaily+%28ScienceDaily%3A+Latest+Science+News%29&utm_content=Google+Feedfetcher

The moral of this story is that, no matter how old we are, we can obtain significant health benefits by making positive lifestyle and dietary changes. Over the years I've heard many people say: "What's the point? It's too late for me to make positive change in my life. I've been living this way for too long." There is no doubt that the younger we make positive changes the greater the potential benefits. But, as this study demonstrates, even changes made very late in life can have a significant impact on our health and well-being. The choice is ours!

Aligning with the natural world.