Natural Truth: Dietary Supplements
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As you probably know, the use of nutritional supplements is widespread in modern life, and a part of many health promotion programs. Supplements provide concentrated amounts of one or more micronutrients (vitamins, minerals, or enzymes), macronutrients (proteins, fats, or carbohydrates), or probiotics (usually bacteria or yeasts). Typically, these supplements come in pill, powdered, or liquid form.
Overall, vast amounts and many types of nutritional supplements are sold and consumed each year around the world, and there are many passionate advocates and followers of various supplement regimes. In this Natural Truth post, we will consider whether dietary supplements are generally effective and health-promoting, if they are a wise use of our attention and resources, and if they are safe.
To answer these crucial questions, and before turning to applicable scientific research and other considerations, we need to consider at least three essential factors. First is the background diet of a person, and second is their overall health. After all, modern-day diets and health levels can vary widely, influencing a person’s nutrient intake, uptake, and outtake – or the scope and amount of nutrients entering, absorbed by, and excreted from our bodies. As you likely can imagine, each of these factors can greatly influence our need or the case for dietary supplements.
Beyond these two general or foundational considerations, a third and more specific factor involves evaluating how any supplement’s dosage level compares with recommended amounts – such as these widely used Daily Reference Intake (DRI) values – for the nutrients it contains. Popular multivitamin pills generally contain concentrations of vitamins and minerals at or near DRI or similar governmentally recommended daily values. On the other hand, single nutrient and other specialty supplements can provide one-dose concentrations far in excess of DRI levels or similar standards.
The Scientific Evidence
Though the use of dietary supplements is quite common today, and broadly informed and encouraged by significant enabling material from supplement advocates and providers, for HumanaNatura these social practices exist in sharp contrast to widespread and persistent scientific findings questioning the merits of supplementation generally. Simply put, for people in average health and following typical governmental dietary guidelines in the developed world, we believe there is sufficiently strong evidence – cataloged here and more briefly summarized here, among many available sources – to conclude that significant nutritional supplementation is generally unnecessary for most people (though a variety of potential exceptions are discussed below).
This broad body of evidence, even if counterintuitive for many people or unwelcome and actively discounted by others, explains why many national governments prohibit ascribing therapeutic value to supplements intended for non-medical use. Indeed, it is instructive that the prestigious Institute of Medicine’s approach to supplements almost exclusively involves safety considerations and research to guard against industry excesses, rather than added investigation of the health benefits of supplementation regimes. We will return to this important idea in a moment, and consider why national governments often permit supplement sales, despite poor evidence of significant health promotion from their use.
Of course, there are many of us who are not in average health, or do not or cannot follow typical governmental dietary guidelines, and we should distinguish these cases from more typical conditions. First, in the case of people in above average health and adhering to daily health practices superior to common governmental standards – including people following HumanaNatura’s Personal Health Program and OurPlate eating guidelines – the empirical case for supplementation further weakens. Here, we have good reason to expect that more than adequate daily intake, uptake, and retention of all needed nutrients will occur from our diets alone, and that the risks of abnormal or unusual physiological losses or deficiencies of nutrients will be low.
On the other hand, when we consider people in below average health or who regularly do not meet minimal national dietary guidelines, the case for supplementation does grow stronger, but is still quite nuanced or qualified. Potential reasons for people being in either or both of these latter categories are of course numerous. They include: 1) personal or collective poverty, 2) malnourishment due to social insecurity or disruption, 3) any number of chronic or acute diseases, 4) health indifference, low self-control, or other barriers to consuming a whole and diverse natural diet, and 5) strict veganism (where little or no animal foods are consumed, along with the essential human nutrients they contain and naturally provide).
As a general class, these many and varied situations can lead to very different conclusions regarding the relevance and desirability of supplement use, including the advisable types and amounts of supplements that should be considered. But overall, where supplements are available and relevant, at least some amount of dietary supplementation is likely to be beneficial. That said, the specific amounts and types of supplements will need to be determined by a treating physician, registered dietitian, or intervening public health official. And this is especially true in the case of supplement needs that are highly personalized or exceed daily recommended values for a particular nutrient (where medical or professional supervision is essential for safety reasons).
Balancing Freedom & Safety
As part of our exploration of dietary supplements, we would like to return for a moment to the important and instructive practice of supplement regulation, which we touched on before. As suggested, the safety of supplements, rather than their efficacy or health benefit, is the primary or overriding concern of many national regulatory and health research agencies. This approach reflects a general regulatory philosophy in many countries that broadly permits personal or private activity that is not immediately or significantly harmful, injurious, or unsafe – even when this activity is less than ideal, or even when patently irrational.
In practice, this general and broadly liberal approach avoids excessive social regulation, governmental paternalism or maternalism, and inhibition of potentially healthy private initiative and innovation – and thus seeks to balance social freedom and safety. This approach is not without its downsides, since it permits and ostensibly condones or even partly legitimizes many unhealthy or less than optimal behaviors (pick your favorite example from a long potential list, including legal recreational drug use, arcane hobbies and pastimes, and various idiosyncratic lifestyle choices).
With this background, it is thus perhaps more understandable why dietary supplements are often regulated quite lightly, or as foods rather than drugs, and thus tolerated or permitted even amid poor scientific support. As in many other areas of modern life, without obvious patterns of widespread harm, even ineffectual supplementation practices are often left largely unregulated and tolerated, and thus implicitly encouraged or sanctioned, by national governments. In our view, this ever-imperfect balancing of safety and freedom of choice considerations aptly describes the general context for supplement use, promotion, and regulation today – and explains the widespread use of supplements, despite their generally ineffective nature.
As evidenced in the research summary cited above and reprised here, a frequent compromise by public health agencies permits but discourages the use of supplements for people generally. In this approach, three common features typically recur: 1) treating daily multivitamin and mineral supplements that do not exceed recommended nutrient amounts per dose as a generally unnecessary but acceptable or benign practice, 2) permitting supplements exceeding recommended daily nutrient levels, or containing unusual active compounds, as long as strong therapeutic claims are not made and there is no significant evidence of poor safety, and 3) steering people with health complaints and limiting the therapeutic use of vitamins to treating or consulting physicians, registered dietitians, and other health professionals.
Supplements Amid High Quality Modern Diets
Let’s next review our major macronutrients, micronutrients, and probiotics. Overall, this discussion will explain and highlight their place in a healthy modern diet, and demonstrate why supplementation practices are often of low value, or needed only selectively or conditionally.
Below is a list of key human nutrients, links to information sources about them, comments regarding their intake adequacy and key sources in a healthy human diet, and points about specific nutrients we want to highlight. Overall, this information reflects and supports the idea that supplements are generally unnecessary for healthy people eating a diverse and whole modern diet.
In reviewing this list, please note that our comments generally assume a renaturalized modern diet based on HumanaNatura’s Personal Health Program and OurPlate guidelines – which notably include regular daily exercise and sun exposure – or an equivalent health regime. Our comments also assume that a person has no symptoms of reduced health, limited nutrient uptake, or unnatural nutrient losses.
> Protein – a natural diet provides all essential amino acids in adequate amounts via animal foods, nuts and seeds.
> Fat – a natural and especially whole, vegetable-rich pattern of eating provides all essential fatty acids, and sound balance of omega-3 and omega-6 fats, while moderating saturated animals fats (note that omega-3 fatty acid supplements are required for vegans, since limited vegetable sources of these fats are available to us – see vegan nutrition for a fuller discussion of vegan supplement needs)
> Carbohydrate – a natural diet also provides adequate but not excessive or undesirable carbohydrates, by emphasizing attentive consumption of fruits and starches, while de-emphasizing unnatural grains, cereals, legumes, beans, and processed foods derived them
> Vitamin A – adequate amounts via orange and yellow fruits, leafy vegetables including spinach, carrots
> Vitamin B1 – adequate amounts via meats, eggs, vegetables
> Vitamin B2 – adequate amounts via fruits and vegetables
> Vitamin B3 – adequate amounts via meats, fish, eggs, vegetables, tree nuts
> Vitamin B5 – adequate amounts via meats, broccoli, avocados
> Vitamin B6 – adequate amounts via meats, vegetables, tree nuts
> Vitamin B7 – adequate amounts via eggs, meats, vegetables
> Vitamin B9 – adequate amounts via leafy vegetables
> Vitamin B12 – adequate amounts via meats and fish (note that vitamin B12 supplementation is required for vegans, since no vegetable sources of this vitamin are available to us and humans are not evolved to produce it – again, see vegan nutrition)
> Vitamin C – adequate amounts via fruits and vegetables
> Vitamin D3 – adequate amounts via sunlight reaching our skin, fish, and eggs
> Vitamin E – adequate amounts via fruits and vegetables, nuts and seeds
> Vitamin K1 – adequate amounts via leafy green vegetables and eggs
> Vitamin K2 – adequate amounts via eggs, dairy, meats, and some fermented vegetables
> Calcium – adequate amounts via eggs, fish with bones (salmon, sardines), shellfish, green leafy vegetables, nuts, seeds, thyme, oregano, dill, cinnamon
> Chlorine – adequate amounts via a variety of plant and animal foods
> Copper – adequate amounts via leafy greens, tree nuts and seeds
> Iodine – adequate amounts via eggs, fish and shellfish, strawberries
> Iron – adequate amounts via eggs, meats, fish, dark leafy greens
> Magnesium – adequate amounts via fish, tree nuts, spinach, tomatoes, ginger, cumin
> Manganese – adequate amounts via fruits, spinach, thyme, cinnamon, turmeric
> Molybdenum – adequate amounts via tomatoes, onions, carrots
> Phosphorus – adequate amounts via meats, fish
> Potassium – adequate amounts via fish, fruits, tomatoes, avocados, dark leafy greens, turmeric
> Selenium – adequate amounts via wild fish, meats, tree nuts and seeds
> Sodium – adequate but not excessive amounts via a variety of plant and animal foods, and restriction on use of added salt
> Zinc – adequate amounts via meats, fish, dark leafy greens, tree nuts and seeds (note that zinc lozenges have been shown in research to reduce the severity and length of colds, if used at the onset of symptoms)
> Dietary Fiber – a natural diet will provide adequate fiber to promote the health of our bodies and its various microbiomes
> Microorganisms – a natural diet will similarly afford an adequate amount and diversity of needed microorganisms to ensure intestinal and other bodily microbiome health
Our Natural Truth Rating
Given this pattern of evidence, HumanaNatura rates the proposal that nutritional supplements are advisable for healthy people following a typical government recommended or (generally superior) renaturalized modern diet a 3/10 (Weak Evidence) in our Natural Truth rating system.
As summarized before, we base our rating on the broad body of evidence suggesting limited benefit and even potential harm to healthy people following a rich natural diet with adequate vegetables, animal foods, and fruit.
However, we would qualify this conclusion, and also highlight our reasoning for not assigning a still lower score to this proposal, by noting the following areas of supplementation advised in the HumanaNatura Personal Health Program:
1. Vitamin D3 – there is growing evidence to recommend that our circulating vitamin D3 levels be checked and steps taken to ensure adequate amounts of this vital sunlight-engendered compound – either via additional daily sunlight and outdoor exercise, dietary changes, or a daily vitamin D3 supplement (please note that the potential for a vitamin D3 shortfall may be greater for people with darker skin living in higher latitudes).
2. Vitamin K2 – as with vitamin D3, there is growing evidence that many of us may be deficient in this essential fat-soluble and calcium transporting vitamin, especially if we follow a low-fat diet or predominantly consume grain and legume-fed animal foods, and potentially with important health consequences. While supplementation usually will not be necessary, we encourage you to ensure you are meeting the recommended daily intake for vitamin K2.
3. Low-dose aspirin – owing to its low cost, often absent side effects, and potentially strong anti-inflammatory effects, we encourage, with your physician’s approval, a coated 81-milligram daily aspirin supplement for all adults.
4. ACV & lemon juice – as an often helpful and low-cost digestive aid, we encourage all people to take a tablespoon of apple cider vinegar (ACV) dissolved in a medium glass of water 1-2 times per day before meals, along with the addition of a tablespoon of unsweetened lemon juice for people who are eating in a very low-carbohydrate or ketogenic format – in the latter case, to reduce the natural but undesirable increases in uric acid that can accompany ketogenic eating.
5. Negative symptoms – people with health-related symptoms or complaints of any kind should seek medical assistance and follow any supplement instructions given to them by their treating physician, registered dietician, or other consulting health professional.
We hope this discussion of nutritional supplements is valuable to you, and that it helps you to make more informed and optimal decisions about how and where you focus your health-promotion efforts and resources.
You can click to learn more about our Natural Truth health information campaign and evidence-based 1-10 rating system. And we always welcome your comments and input on this or any other HumanaNatura Natural Truth review.
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