Editor’s Notes: In Defense of Supplementation

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supplementsIn the March/April issue of Nutrition Alert, I discussed three studies published in the December 16th issue of the Annals of Internal Medicine (AIM). Those studies concluded that taking supplements had little or no effect on lowering the risk for cardiovascular disease and cancer, cognition decline in men, or death and cardiovascular events in people who had already suffered a heart attack. I argued that these studies were not justification for tossing your supplement, as one editorial in the same journal concludes. Apparently, I was not alone. 

In the June issue of that same journal, a wealth of well-respected researchers (from Tufts University, Harvard School of Public Health, the Linus Pauling Institute at Oregon State University, the University of Pittsburgh, and more) responded to the statement in the December issue of AIM strongly disagreeing that the case on supplements is closed and that “…supplementing the diet of well-nourished adults with mineral and vitamin supplements has no clear benefits and might even be harmful.” 

In their rebuttal, the researchers remind us that most Americans do not meet even minimum standards of a balanced diet. More than 93%, 61%, and about 50% of adults in the U.S. do not get the Estimated Average Requirement for vitamins D and E, magnesium, and vitamin A and calcium, respectively. In addition, 98% and 71% do not meet the Adequate Intake level for potassium and vitamin K, respectively. Those percentages are even higher for certain subpopulations, including seniors, African Americans, and obese people. A moderate-dose, broad-range multiple vitamin and mineral fills in the gaps effectively, safely, and at a low cost. As the researchers remind us, “a high-quality multi vitamin and mineral supplement costs as little as 3 cents a day, and long-term use is not associated with any adverse health effects.” 

A multi is primarily meant to supplement (not substitute for) a good diet. But there also is evidence that it might help decrease the risk for certain chronic diseases. As the researchers point out, the largest and longest trial on supplementation is the Physicians’ Health Study II at Harvard, which followed almost 15,000 men for 13 years and found a statistically significant 8% reduction in total cancer incidence and up to a 13% reduction in cataracts. These findings are consistent with a wealth of other research spanning decades. If the statement that no one needs supplements was accurate, then every ophthalmologist who prescribes antioxidant supplements with lutein to treat cataracts and macular degeneration and every obstetrician who prescribes prenatal vitamins to prevent spina bifida and other birth defects is misinformed. Yet, these reasons to supplement are completely justified and backed by a large body of respected research. 

Supplement use has increased in the past few decades. Supplement users can rest assured they are doing the right thing for their health, as long as they follow some basic, commonsense guidelines: 1) Choose a multi that contains about 100% of the Daily Value for a broad range of nutrients, 2) compliment that multi with a calcium-magnesium in as close to a 2:1 ratio as possible, 3) take extra vitamin D if the multi doesn’t contain at least the Daily Value, if not more, for vitamin D, and 4) take an omega-3 DHA supplement if you don’t eat fatty fish at least twice a week. Other nutrients, such as lutein and zeaxanthin, are needed if you don’t eat dark greens daily.Elizabeth Somer, M.A.,R.D.

(For more information, see Nature 2014; 510, June 26, pages 462-464.)

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