Sunday, April 25, 2010

Week 17: Should you take Vitamins & Supplements?

Distribution Source: iTunesU
Content Source: University of California TV (UCTV)
Format: Audio
Length: 2 hours 52 minutes

I've wondered for a long time about vitamins, minerals and supplements. Grocery stores and pharmacies have rows and rows of bottles of VM&S, all of which implicitly or explicitly suggest some health benefit. Fish oil - good for your heart, calcium - good for your bones, vitamin C - keeps away colds. You name an ailment and one of those tinted bottles has the preventative solution. Obviously, there are rows and rows of these bottles for a reason. The biggest reason of course is that people buy them. But why? Are the health benefits real? Or are these wonder pills just another example of America's failed have-everything-for-free approach to life?

I'll start with what VM&S I currently take, and will end with how this might change going forward. Prior to this week's research, each day I took one multi-vitamin, one vitamin C pill, one calcium pill and at least one Omega 3 fish oil supplement. The vitamins I never gave much thought to, the calcium I take because unfortunately I became lactose intolerant in college (making drinking milk less straightforward than I'd like it to be), and the fish oil I began taking recently because I heard a few smart people say it's probably the right thing to do.

So what did the experts I listened to say about the subject? There are two very straightforward and uniform themes. First, absolutely nothing can replace a healthy, diverse diet consisting of in my case 2.5-3.5 cups of fruits and vegetables per day (click here to determine how much you need). Why not? In spite of recent advancements in science, it is still not known how all of the components of your nutritional intake react to each other, and to your body. Thanks to many studies it is known, however, that simply isolating the compounds found in foods (e.g. vitamin C) and taking a dose or pill of these underlying compounds does not offer the same health benefit as the food itself. In fact, the isolation of these compounds has in many cases shown net negative health benefits! The second theme is that each person is very different; nutrition needs vary greatly from age to sex to health conditions to genetics. In other words, you can't just say "this is the best regiment, take x,y and z."

So we clearly have a scientifically confusing and complex assessment to make. Adding to the uncertainty is the fact that unlike other drugs, vitamins, minerals and supplements do not have to be tested before being sold. There are not requirements that guarantee safety, purity or effectiveness. The FDA is only now implementing regulations concerning the quality of manufacturing. While these regulations will force companies to keep records of their manufacturing process, the actual quality of the product will remain unverified, at least by the government. If you really care about what you're putting into your body you can pay the ~$30 yearly subscription to, a site that independently tests the composition of various brands of VM&S.

So let's assume that we can vouch for the safety of these products. Why are they so important (either in pill form or through a healthy diet)? Vitamins serve as co-factors in many essential reactions that occur in our cells. Our bodies need them to function. And even though vitamins are needed only in small amounts, if there is a deficiency the required reactions literally will not happen. One only needs to read the history of pirates to learn about scurvy, one of the many ailments that could result from a vitamin deficiency.

While I listened to almost three painful hours of lectures on the specifics of each type of vitamin, mineral and supplement, I will summarize only those that stuck out as particularly meaningful or those for which scientific clarity exists. The scientific research is clear that free-radicals (molecules with an extra electron) are basically bad and can lead to many types of cancer and make you age prematurely. It is also clear that antioxidants neutralize free-radicals. If you don't like spinach or tea (which I of course love), vitamin C is an antioxidant rich option. While there is no research to support the theory that vitamin C prevents colds, it is crucial to producing collagen (the main protein of connective tissue). The other uniformly praised vitamin was vitamin D3. New studies show that vitamin D's benefits and necessity may extend to all major organs in the body. It has also been proven to be helpful in fighting many forms of cancer. Surprisingly, almost one billion people worldwide are estimated to be vitamin D deficient, in large part due to our fear of sun exposure. The sun triggers a reaction in our skin that allows the body to naturally produce vitamin D. But because we now wear sunscreen and in many cases work and live indoors, many of us are simply not creating the levels of vitamin D required for proper health. Taking a daily vitamin D3 pill can solve this problem. Finally, calcium has been shown to help with blood pressure, hormones, bone strength, and hypertension. Both of the experts took calcium and recommended others do the same, ideally calcium carbonate as opposed to citrate. As for the other vitamins, among them A and E, and minerals (iron and magnesium), the studies were either inconclusive or the benefits were useful only to a specific age or health subset of the population.

It is extremely important to note that taking too high a dose of just about any of these substances is bad for your health. This is particularly true for the fat-soluble vitamins (A, D & E) which can be stored in body fat for some time, as opposed to the water soluble vitamins (like vitamin C) which you will likely dispose of naturally. It is surprisingly easy to overdose on VM&S; one way to prevent this is to visit the NIH's website, where you can find intake guidelines, data and FAQ on most VM&S.

Going forward I will be taking the same assortment of pills described above, but will be adding one crucial vitamin: D3. It has proven health benefits and no major risk-factors. I was on the fence about continuing to take the multi-vitamin until one of the experts recommended it as a vitamin "safety net", but not your primary source of daily vitamins. My conclusion is that taking a select few vitamins, minerals and supplements makes sense. But it is important to understand and respect the potential downsides - mixing these pills with prescription drugs can be harmful. As previously mentioned, taking more than the recommended allowance is a bad idea as well. And finally, I've learned that the science is not only inconclusive in many cases, but it's also changing rapidly. So if you can stick to it (and I can't), the safest bet is to follow the advice of Michael Pollan, the author of The Omnivore's Dilemma: "Eat real food, not too much, mostly plants."


  1. Michael Pollan, not Polland. He's a solid dude.

  2. A great infographic of VM&S & amount of research supporting their health benefits:

  3. Thanks for the correction - fixed.

  4. I would be interested to learn more about herbal vitamins, which I tend to take.

  5. That didn't really come up on the talks... do you have a link to what you take?

  6. Be careful for what you wish when you ask for FDA Regulation--it may be granted.

    Heinz Ketchup set extraordinary standards
    for quality and purity in the unregulated processed food market of the late 19th Century and thrived.

    H.J. Heinz was unhappy his costs were higher than his competitors as a result of these quality standards so he lobbied for a government regulatory scheme that would force all competitors to follow his example.

    The downside came as the regulatory
    process through the 20th Century came to accommodate complaints from these competitors so former adulterants were slowly reclassified as "additives".

    As a consequence, a simple loaf of bread has dozens of off label ingredients approved by the FDA as necessary 'Additives".

    To appreciate the difference in flavor and quality between foods baked or prepared
    as they were in the 18th and 19th Century and manufactured in the 20th and 21st Century it is necessary to travel no further than Colonial Williamsburg in Virginia to eat bread and foodstuffs grown from "legacy" seed and "heritage" farm animals raised and prepared in the "old fashioned" way.

    Meanwhile, following the model of the 19th Century Heinz Package, Alvita Brand Herbal Teas ship their tea packaged far in excess of any regulatory requirement born from a simple desire to produce the best possible product at the lowest possible cost for the maximum number of willing consumers while the darlings of the Tea Industry- Celestial Seasons and Lipton- for example, engage in all manner of chicanery.

    Links for those interested:


  7. Thanks for the links, TJK. Although I don't believe I was wishing for government regulation and as you'll notice even pointed readers to a private and independent verification service!

  8. Supplements and health benefits...Hmmm...For more than a decade, one that I found to be exceptionally beneficial is Metamucil. Unfortunately it's commonly perceived as being no more than "a bulk-producing laxative" primarily for the treatment of constipation. As first explained to me by a very knowledgeable and passionate medical doctor, Metamucil -- with psyllium seed husks as the active ingredient -- is far more than that. His strong recommendation (one tablespoon per day in a large glass of water) came in conjunction with a discussion of my frequent trips to remote areas of the globe.

    He emphasized three key points: daily intake provides benefits whether or not you have a gastrointestinal problem (regardless of where you happen to be or travel); if you have unfortunate consequences related to international travel (diarrhea OR constipation) it will also help you; and, finally, it has numerous side benefits (absorbs and lowers cholesterol, adds 100% natural fiber to your diet, etc. ). He was right. Since then I have lived in or travelled through more than 50 countries in Africa, South America, Europe and the Middle East -- and was usually the only person in my group never to suffer from any of the negative gastrointestinal consequences often experienced by international travelers.

    Dietary fiber helps the gastrointestinal tract absorb excess water and remove food wastes. A high intake of dietary fiber can negatively affect the absorption process in the intestinal tract, but this is clearly not the case with one or two table-spoons a day.

    (I'm amazed that Procter & Gamble does not do a more visible, better job of advertising the general health and travel benefits of Metamucil).

  9. Horse Chestnut -

    Question - Are you going to stop taking omega 3 fish oil?

  10. Steve said...

    Thanks for the links, TJK. Although I don't believe I was wishing for government regulation and as you'll notice even pointed readers to a private and independent verification service!
    April 28, 2010 4:44 PM

    You are correct!

    Sadly, the link escaped me as these newfangled highlight mechanisms do not always attract my attention as they possibly should.

    I will attempt to be more diligent!


  11. Thanks for the update on metamucil, anonymous. Wasn't discussed by those who I listened to, though.

    Tiffanie, yes I will certainly continue to take Omega 3 fish oil.

    TJK, it happens to the best of us!

  12. Carioca adds:

    According to a very knowledgeable medical doctor whose opinions I respect, there are two essential vitamins that are often missed by his American patients: Vitamins D3 and B12.

    He emphasizes that everyone who lives north of Latitude 33 North should take D3 supplements: “You cannot get enough sun to achieve adequate amounts of Vitamin D (…) which lowers the risk of colon cancer, breast cancer, diabetes, heart disease, prostate cancer, multiple sclerosis and possibly lymphoma. Vitamin D also helps the immune system and slows aging.” As to Vitamin B12, he states that “as we age we do not absorb Vitamin B12 as well – low levels of Vitamin B12 can cause neurologic damage and brain shrinkage.”

    Even more important, he adds, since B12 is not produced by either plants or animals, for proper nutrition ALL vegetarians must take it in the form of supplements. Furthermore, EVERYONE OVER THE AGE OF 60 should also take B12 supplements. (And yes, many of your most interested readers and fans fall into this category…;).

    How much? 2,000 international units (IU) of D3 once a day or, ideally, one 1,000 IU tablet in the morning, one in the evening. He recommends 1,000 micrograms per day of Vitamin B12 – a water soluble vitamin with extremely low toxicity…even enormous doses appear not to be harmful to healthy individuals. In the case of vitamin D3, according to one paper “one of the challenges is the outdated acceptable upper limit for Vitamin D3 consumption, which was set at 2,000 IU. However, researchers point out that more recent studies have shown that 10,000 IU is the safe upper limit.”

    One last point: if not from plants or animals, whence cometh B12? Well…a fascinating answer from one of my sources (

    “The only reliable unfortified sources of vitamin B12 are meat, dairy products and eggs. There has been considerable research into possible plant food sources of B12. Fermented soya products, seaweeds and algae have all been proposed as possible sources of B12. However, analysis of fermented soya products, including tempeh, miso, shoyu and tamari, found no significant B12.” And: “The current nutritional consensus is that no plant foods can be relied on as a safe source of vitamin B12. Bacteria present in the large intestine are able to synthesise B12. In the past, it has been thought that the B12 produced by these colonic bacteria could be absorbed and utilised by humans. However, the bacteria produce B12 too far down the intestine for absorption to occur, B12 not being absorbed through the colon lining. Human faeces can contain significant B12. A study has shown that a group of Iranian vegans obtained adequate B12 from unwashed vegetables which had been fertilised with human manure. Faecal contamination of vegetables and other plant foods can make a significant contribution to dietary needs, particularly in areas where hygiene standards may be low. This may be responsible for the lack of aneamia due to B12 deficiency in vegan communities in developing countries.”

  13. To the question "I'm a vegetarian -- not a vegan -- and drink milk and eat eggs. intake of B12 is OK, right?"

    Carioca's reply:

    I should have clarified that. The advice I got from the medical doctor who researches nutrition and whose opinion I trust said unequivocally: all vegetarians and all persons older than 60 should take B12 in supplement form. The other, internet sources I consulted -- albeit very quickly and superficially -- are unknown and possibly unreliable. This is an evolving field; opinions, conclusions, etc., change all the time (witness the evolving theories on Vitamin C, or how much aspirin one should take on a "regular" basis, and what are their side effects, the trade-offs...). So...yes...the article I quoted said vegan. The doctor I consulted said vegetarian. Both were specific. I believe vegetarians should go with the addition of a supplement ... ESPECIALLY since there do not appear to be toxic or other, major side effects.

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