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Throw away your multivitamins and antioxidants!

April 30, 2010 in Food & Nutrition, Medical Industrial Complex | 32 comments

trash canIf you’ve been reading this blog for a while, you’ll know I’m not a big fan of supplements. I’ve always believed that it’s preferable to get the nutrients we need from whole foods, as they’re found in nature, rather than from isolated, synthetic sources (i.e. supplements).

Unfortunately, modern medicine is obsessed with isolated, synthetic nutrients and has convinced itself that they have the same beneficial properties as nutrients found in whole foods.

A gigantic dietary supplement industry has arisen from this misguided belief. A 2006 National Institute of Health (NIH) conference (PDF) revealed that 20-30% of Americans use a multivitamin daily, forking over $23 billion a year to supplement manufacturers for the privilege. Many more Americans effectively take a multivitamin by eating fortified grain products, like Shredded Wheat cereal and Wonder Bread.

Most supplements don’t work

With these statistics in mind, you might be surprised (or even shocked) to learn that clinical trials have shown that most of these supplements not only don’t work as intended, they actually make things worse. The NIH conference examined the efficacy of 13 vitamins and 15 essential minerals as reported in long-term, randomized clinical trials.

First the positive results:

  • A combo of calcium and vitamin D was shown to increase bone mineral density and reduce fracture risk in postmenopausal women.
  • There was some evidence that selenium reduces risk of certain cancers.
  • Vitamin E may decrease cardiovascular deaths in women and prostate cancer deaths in male smokers.
  • Vitamin D showed some cardiovascular benefit.

Um, not too impressive considering the near universal faith considering how many people are popping these pills on a daily basis.

Now for the negative results:

  • Trials of niacin (B3), folate, riboflavin (B2), and vitamins B6 and B12 showed no positive effect on chronic disease occurrence in the general population
  • There was no evidence to recommend beta-carotene and some evidence that it may cause harm in smokers.
  • High-dose vitamin E supplementation increased the risk of death from all causes.

Then there’s the now infamous JAMA meta-analysis on antioxidants. They looked at 68 trials with over 230,000 participants. Here’s what they found:

Treatment with beta carotene, vitamin A, and vitamin E may increase mortality. The potential roles of vitamin C and selenium on mortality need further study.

Oops!

(Re)-introducing the concept of food synergy

It’s crazy to me that so many health care practitioners – both conventional and alternative – tell their patients to take multivitamins and antioxidants when their is little support for that position in the medical literature.

That’s why I was so happy to come across a study in the American Journal of Clinical Nutrition addressing this issue. It’s called “Food synergy: an operational concept for understanding nutrition” and it’s one of the most encouraging pieces of research I’ve seen in a while. I’m relieved to learn that their are researchers working in the nutrition field that don’t buy into the synthetic nutrient hype, and understand the importance of whole food.

Since it’s such a great article, I’m going to quote from it and riff off of a few passages.

A person or animal eating a diet consisting solely of purified nutrients in their Dietary Reference Intake amounts, without benefit of the coordination inherent in food, may not thrive and probably would not have optimal health. This review argues for the primacy of food over supplements in meeting nutritional requirements of the population.

This is the crux of the authors’ argument, which I’m 100% behind. They congratulate science on the discovery of fundamental nutrients such as vitamin C, and clarifying their role in health and disease. The realization that scurvy is caused by vitamin C deficiency has saved a lot of lives. But, the approach to nutrition that is fundamentally guided by nutrients has a dark side:

The aspect of science that reduces to fundamental principles, however, can lead to oversimplification and ultimately stifle understanding and progress.

Translation: reductionistic thinking can get us in trouble if we’re not careful.

The concept of food synergy is based on the proposition that the interrelations between constituents in foods are significant. This significance is dependent on the balance between constituents within the food, how well the constituents survive digestion, and the extent to which they appear biologically active at the cellular level.

Yes! It makes me so happy to see this in a major, peer-reviewed journal. The authors go on to define several aspects of food synergy:

  • A buffer effect, i.e. the effect of a large intake of a particular nutrient may vary depending on if it is taken in concentrated form or as part of a whole food.
  • Nutrients can affect each other’s absorption, such as copper-inc and magnanese-iron. These interdependent nutrients tend to appear together in foods, but not necessarily in isolated supplements.
  • It matters whether the nutrients have been produced by technologic or biological processes. Trans fat produced in ruminant animals (such as conjugated linoleic acids in dairy products) are beneficial to health, whereas trans fats produced in the processing of industrial seed oils are highly toxic.

Then they provide evidence that whole foods are more effective than supplements in meeting nutrient needs:

  • Tomato consumption has a greater effect on human prostrate tissue than an equivalent amount of lycopene.
  • Whole pomegranates and broccoli had greater antiproliferative and in vitro chemical effects than did some of their individual constituents.
  • Free radicals were reduced by consumption of brassica vegetables, independent of micronutrient mix.

Note: In the supplement world, the idea is that “a nutrient is a nutrient, a molecule is a molecule” regardless of what source it comes from. These folks claim that it doesn’t matter whether a nutrient comes from a whole food complex or a laboratory. Did you know that most vitamin B1 supplements are made from derivatives of coal tar? That ascorbic acid (vitamin C) is made by reacting high-fructose corn syrup with sulfuric acid? That many iron supplements are made from rusty nails? I don’t know about you, but I’d rather eat some meat and vegetables to get those nutrients.

Should we all take a daily multivitamin as “insurance” against a nutrient deficiency? Here’s how the authors respond to that question:

In our view, the better “insurance” would be to eat food with a broad coverage of nutrients and take no supplements at all, unless they are deemed necessary to fix a specific medical problem.

Hallelujah! I’d like to buy these researchers a beer.

Okay, not all supplements are bad

Now that I’ve made my point (or at least I hope I have), I need to add a qualifier or two.

There are a few supplements that I do recommend – in certain situations.

Vitamin D may be necessary for those who live in northern latitudes, especially during the winter months. Low vitamin D is associated with so many diseases that it’s probably a good idea to keep levels up. The first choice would be to do this by eating seafood, but that’s not always practical or desirable for a number of reasons. Cod liver oil is my second choice for maintaining D levels. But note that this is more of a whole food than it is a supplement. In some cases when people are very deficient, i.e. under 25 ng/ml, I may suggest adding a D3 supplement in addition to the cod liver oil.

Fish oil has been shown to provide great benefit for cardiovascular disease and other inflammatory conditions. My preference here is that people reduce their intake of omega-6 fats and simply eat cold-water, oily fish a couple times a week to meet their omega-3 needs. Unfortunately, people have been scared away (unnecessarily, which is a topic for a future post) from eating fish, or perhaps it’s difficult for them to find or afford wild fish on a regular basis. In this situation I may recommend a fish oil. My favorites are whole-food based oils such as Green Pasture’s Fermented Cod Liver Oil and Vital Choice Wild Salmon Oil.

Magnesium is one of the most crucial nutrients in our diet, and many people are deficient. It protects against nearly every modern disease, and can be therapeutic for difficult to treat inflammatory conditions such as fibromyalgia, irritable bowel syndrome, arthritis, etc. Seaweed and various nuts and seeds are high in magnesium, but occasionally supplementation may be useful. I suggest using a highly-absorbable form such as magnesium glycinate.

Vitamin K2 has recently been revealed as an important nutrient in protecting against heart disease. It does this by telling the body to put calcium in the bones and teeth where it belongs, and not in the arteries and soft tissue. K2 is found in the fat of grass-fed animals and certain fermented foods like natto and hard cheese. I recognize that not everyone eats these foods for various reasons, so if someone has heart disease or is at risk for it I may recommend either Fermented Cod Liver / Butter Oil from Green Pastures, and/or an MK-4 supplement. For more on vitamin K, see my post Vitamin K2: The Missing Nutrient.

But even in these cases, I only suggest that people take these if they need them, and if they can’t (or won’t) get the nutrients from foods.

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Have some butter with your veggies!

October 14, 2009 in Food & Nutrition, Heart Disease | 9 comments

butterYes, yes, I’m supposed to be on sabbatical but sometimes I just can’t resist. A Swedish study recently published in the International Journal of
Environmental Research and Public Health found that eating fruits and vegetables didn’t lower the risk of coronary heart disease… unless said fruits and vegetables were consumed with high-fat dairy products!

Why would this be? The answer is simple biochemistry. Many of the vitamins and micronutrients in food are fat-soluble, which means they cannot be absorbed without the presence of adequate fat. That means that if you eat fruits or vegetables without fat, you’ll absorb only a fraction of the nutrients you would absorb if you ate them with fat.

Tara Parker-Pope, the health columnist for the Wall Street Journal, wrote an article about this some time back. She actually gives the ratios of nutrient absorption with and without accompanying fat.

She reports on a study of the nutrient absorption from fat-free salsa with and without extra fat:

For the salsa study, 11 test subjects were first given a meal of fat-free salsa and some bread. Another day, the same meal was offered, but this time avocado was added to the salsa, boosting the fat content of the meal to about 37% of calories. In checking blood levels of the test subjects, researchers found that the men and women absorbed an average of 4.4 times as much lycopene and 2.6 times as much beta carotene when the avocado was added to the food.

And here’s a study with and without avocado:

The first salad included romaine lettuce, baby spinach, shredded carrots and a no-fat dressing, resulting in a fat content of about 2%. After avocado was added, the fat content jumped to 42%. When the salad was consumed with the avocado, the 11 test subjects absorbed seven times the lutein and nearly 18 times the beta carotene. Lutein is a carotenoid found in many green vegetables and is linked with improved eye and heart health.

Another study done a few years ago at Ohio State University showed that salad dressing with oil brings out the best in a salad when compared to no-fat, low-fat dressings.

When the seven test subjects consumed salads with no-fat dressing, the absorption of carotenoids was negligible. When a reduced-fat dressing was used, the added fat led to a higher absorption of alpha and beta carotene and lycopene. But there was substantially more absorption of the healthful compounds when full-fat dressing was used.

Consuming adequate amounts of fat with fruits and veggies is especially true in the case of children. Vitamins and micronutrients are crucial for proper physical and mental development. Without adequate fat in the diet, children are literally starved of these nutrients.

Parents will often be very worried if their toddler doesn’t like vegetables. But Dr. Tom Cowan, a practitioner of functional medicine in San Francisco, CA, counsels such parents not to be too concerned about vegetable intake in the first few years of a child’s life. It’s far more important to ensure that the child is getting adequate saturated fat. What’s more, most parents find that if they slather some butter on the veggies they’re serving, their kids actually like them!

So, next time you eat broccoli or feed it to your kids, remember to add a big pat of butter! And have some full-fat cream with those strawberries while you’re at it.

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Nourishing a growing baby

April 29, 2008 in Fertility & Pregnancy, Food & Nutrition | No comments

pregnant woman

THS reader Roselle sent in this question:

Is vitamin/mineral supplementation truly beneficial before & during pregnancy for women with a healthy diet?

The first thing I’d like to emphasize is the importance of this question. Adequate maternal nutrition prior to conception and during pregnancy can protect the baby from diabetes, stroke, heart disease, kidney disease and memory loss later in life.

Intuitively, most mothers know that what they eat will have a significant impact on the developing fetus. And traditional cultures have been aware of this for millennia. Special preconception and pregnancy diets have always emphasized foods that are particularly rich in certain nutrients known to promote healthy growth and development. In some cases, these groups provided special nutrients for fathers preparing to conceive as well.

Traditional cultures with access to the sea used fish eggs. Those that consumed dairy products used high-quality milk from the spring and fall when grass was green and rapidly growing. African groups whose water was low in iodine used the ashes of certain plant foods to supply this important element. These foods were always added to a foundational diet rich in liver and other organ meats, bones and skin, fats, seafood and whatever local plant foods were available.

In the Winter of 2007, Chris Masterjohn published a fantastic article called “Vitamins for Fetal Development: Conception to Birth” in the Wise Traditions in Food, Farming and the Healing Arts Journal. Masterjohn remarks:

“Although modern science still has much research to accomplish in order to fully elucidate the value of traditional wisdom, it has already confirmed the fact that many of the nutritional factors that we now recognize as the most important to embryonic and fetal development are the same ones emphasized in traditional pregnancy and preconception diets.” (p.26)

What are these nutrients that both modern science and traditional wisdom recognize as essential? Briefly, they include:

  • Vitamin E: originally named “Fertility Factor X” in 1922 because rats could not reproduce without it. Recent research indicates it is almost certainly required for human reproduction.
  • Vitamin A: vitamin A is necessary for the differentiation and patterning of all the cells, tissues, and organs within the developing body. It is especially important for the development of the communication systems between the sense organs and the brain. Vitamin A deficiency during pregnancy has been shown to produce spontaneous abortion in several different species of animals.
  • Vitamin D: Vitamin D plays a role in lung development, and protects the newborn from tetany, convulsions and heart failure. Vitamin D probably plays a much larger role in fetal development than currently understood due to its interaction with vitamin A.
  • Vitamin K: relatively little is known about vitamin K’s role in embryonic and fetal development compared to vitamins A & D. However, cases of birth defects that occurred with mothers taking Wafarin (which depletes the body of vitamin K) suggest that vitamin K plays an essential role in the development of proper facial proportions and the fundamental development of the nervous system.
  • DHA: DHA may be necessary for the formation of neurons and for the synthesis of the important brain lipid phosphatidylserine. It is also the precursor to an important compound that protects the neurons from oxidative stress. The fetus hoards DHA from the mother and incorporates it into its brain at ten times the rate at which it can synthesize it.
  • Biotin: biotin is a B vitamin that has also been called “vitamin H”. Researchers have recently discovered that marginal biotin deficiency during pregnancy is extremely common. Biotin deficiency has been shown to cause birth defects in rats. Whether this extends to humans is currently unknown, but there is little reason not to increase biotin intake during pregnancy as a precaution.
  • Folate: the importance of folate during pregnancy is widely known. It is necessary for the production of new DNA, and new DNA is needed for new cells. Adequate folate intake prevents spinal cord and brain defects and increases birth weight. It may also prevent spontaneous abortion, mental retardation and deformities of the mouth, face and heart.
  • Choline: a low intake of choline during pregnancy is associated with a four-fold increased risk of spinal cord and brain defects. Choline plays a direct role in the development of the brain; in particular, for the formation of neurons and synapses.
  • Glycine: the amino acid glycine is “conditionally essential” during pregnancy. This means that while we can normally make enough of it ourselves to meet our needs, during pregnancy women must obtain it from the diet. It is required for protein synthesis in the fetus, and is almost certainly a limiting factor for fetal growth.

Based on the established role of the nutrients listed above, Masterjohn makes the following recommendations:

Nutritional recommendations for preconception and pregnancy

  • Take a daily dose of high-vitamin cod liver oil (available online from Radiant Life and Green Pasture) to obtain 20,000 IU of vitamin A and 2,000 IU of vitamin D, and 2 grams of omega-3 fatty acids (roughly 1 3/4 teaspoons per day).
  • Grass-fed animal fats supply vitamins E and K2; palm oil, fresh fruits and vegetables, nuts and freshly ground grains are also sources of vitamin E; fermented foods (cheese, yogurt, kefir, sauerkraut, etc.) are also good sources of vitamin K.
  • Biotin can be obtained from liver and egg yolks. Cooked egg whites can be obtained in moderation, and raw egg yolks (from organic, pastured chickens of course) can be added to smoothies and cream to boost biotin status.
  • Folate can be obtained from liver, legumes, beets and greens. Choline can be obtained from grass-fed dairy, egg yolks, liver, meat, cruciferous vegetables, nuts and legumes.
  • Muscle meats and eggs should be used along with skin, bones and gelatin-rich broths to obtain glycine.

The answer to Roselle’s original question largely depends upon what is meant by “a healthy diet”. The low-fat, nutrient-depleted diet that is currently considered to be “healthy” by the medical establishment is likely to be deficient in several key nutrients, particularly the fat-soluble vitamins A, D & K and the omega-3 fatty acid DHA. However, even a nutrient-dense, whole foods diet may need to be supplemented with additional foods or additional servings of foods already in the diet.

Most of these can and should be obtained from local and organic foods. The exception is cod liver oil, which one of nature’s highest sources of vitamins A & D and a rich source of DHA as well. Not all cod liver oil is created alike, however. Most commercial brands contain synthetic vitamin A & D, which are known to be toxic at high doses. Unfortunately, this means you will have to order high-vitamin cod liver oil from a reputable company online. The brands I recommend are Green Pasture High-Vitamin Fermented Cod Liver Oil or High-Vitamin Cod Liver Oil, and Radiant Life Cod Liver Oil.

Finally, I highly recommend obtaining the Winter 2007 “Wise Traditions” journal and reading the full article by Chris Masterjohn. It will eventually be available on the Weston A. Price Foundation website, but it can take up to one year from the original publication time for an article to be posted to the website.

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