If 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.
(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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Tags: antioxidants, food, supplements, synergy, trash, vitamins, whole
Thanks for the analysis. I’ve wondered about the supposed benefits of supplements for a long time. Certain supplements such as Vit B6,B12, E, and A make me feel horrible even in low doses if I take them for more than 3 days. I can only conclude that they’re not doing anything good for me and me even be doing damage, hence I avoid them. I do however take Vit D and cod liver oil without any ill effects.
I do have a question about minerals. I hear a lot of stories about how our depleted soil will lead to mineral deficiencies. I currently take a multi-mineral as “insurance”. Is there any evidence that supplementing with minerals can have negative effects?
Good post. Most of what I hear from scientists and scientific-minded physicians is that vitamin supplements are generally useless, but it seems the media and many doctors are still catching up.
I’ve given up taking most supplements, though I’m taking some calcium/vitamin D combo at the moment because I heard of some benefit. Also, as a vegan, it seems wise to take a Vitamin B12 since there isn’t much of that in my diet. For omega 3s there is algal oil instead of fish oil, though I haven’t noticed that taking or not taking it affects me at all, but maybe it does invisibly.
Also, I thought bacteria in the gut made enough vitamin K for us?
Hm, interesting. From where have humans gotten their K2 historically, if it’s not in very many foods?
Awesome post, Chris!
It’s great to see your continuos fight against reductionism in medicine.
Some notes and comments:
Vitamin D: In line with your general line of thought, I now think that the suggested 80 ng/ml target for vitamin D blood levels for cancer protection as suggested by the Vitamin D Council seems dubious. As far as I know no study has ever checked levels in hunter gatherers, and absolutely no-one has controlled for numerous potential contextual factors. A post at Hyperlipid discussing how the amount of meat in the diet may modulate the need for vitamin D, e.g, rickets only occurring when meat intake is low, really got me thinking. (I’m now happy with my 50 ng/dl level, and will not try to ramp up to reach 80.)
Iodine: What do you think of iodine? American soils seem to be particularly deficient in iodine, and ironically when we start eating less salty processed foods we are also less exposed to the involuntary iodine supplementation that goes with that territory. (As far as anecdotes go, I think there is a thyroid epidemic going on.)
Cod liver oil: What’s your stance on the vitamin A content? There is a confusing argument going on in regard to if vitamin A is either synergistic or antagonistic to D. The ancestral template suggests that A in levels available in foods like liver is perfectly fine, but is cod liver oil, as a concentrated source, an ancestral food?
Liver: This seems to be nature’s own multi vitamin and mineral “supplement”. The problem I see with it is that unless it’s obtained from pristine sources, it may also contain a large amount of toxins. (Think CAFO beef liver vs. grass fed beef liver.)
Anti oxidants: I note that the more sensible supplement promoting organisation Life Extension Foundation has gradually replaced isolated compounds with various plant extracts in their vitamin products. I use their “Life Extension Mix” occasionally (and in combination with a fatty meal) as if it’s just another food in my fridge on the premise that my diet is probably a bit low in fresh vegetables and organ meats.
The need for micro nutrients vs. inadequate supply: I think that one could argue that with the assault of “novel” compounds that our bodies have to deal with today, the need for adequate nutrition, including getting enough of the various trace minerals that are used in detox-pathways, has never been higher. Unfortunately, our food supply has gradually become more and more inadequate in terms of meeting this need. The question then becomes how to bridge the gap in a practical, affordable way. The task seems daunting since we can’t even know if foods that traditionally have provided adequate levels of the nutrients we need are really doing so today. (Food for thought!)
The study on Vitamin E and Vitamin A that caused increased mortality was faulty as the researchers had a poor understanding of vitamins.
The Vitamin E they studied was the synthetic Vitamin E not the Gamma E which is the natural Vitamin E. Second the dosage on the Vitamin A was lower than the RDA for Vitamin A.
B Vitamins do reduce your homocysteine level. My level was cut in half once I started supplementing B Vitamins.
My research shows that generally Vitamin studies are poor conducted, poorly designed and the researchers have no idea what they are doing.
The best way to study the effects of Vitamins is conduct a n=1 study on yourself and see if it affects important blood markers.
Sounds like what Pollan was preaching in “In Defense of Food”. Glad to see the establishment catching on.
And I can vouch for magnesium supplementation. I was having a lot of odd problems, heart palpitations being one of them. After much googling I came across a chat board where someone suggested magnesium deficiency for similar symptoms. Not long after starting to take it, the palpitations went away.
Well, I was looking for a study I remembered reading with the conclusion that in general those people taking any types of supplements were healthier…but instead I found this scary abstract that concludes: “Multivitamin use was associated with a statistically significant increased risk of breast cancer.”
In any case, thanks for the thought-provoking articles and healthy advice!
This is another good article, as per usual on your site. I’ve been formulating whole food supplements for years and am amazed at the fact that isolates and synthetics are called “nutrition.” Nutrition is what we get from food, not from isolated chemicals. Plus, few people know that most of the vitamins supplements today are manufactured by Big Pharma. And they are used in the same way as drugs — pharmacologically. In other words, these pills are used to quell, stimulate or suppress a symptom, but not to offer real nutrition.
I don’t know if you pay attention to individual vitamins, but when I do take them (not often) I take Garden of Life’s raw/food based vitamins. The only exception is a CoQ10 Vitamin I buy from another big “natural” company, though I have fogotten the brand off the top of my head. They are usually only found in WFs or health food stores and have an orange label on everything.
Anyways, I usually only take them when I start to feel stuffy. A while ago I caught something that I couldn’t kick. I took a slew of suppliments after being miserable for two weeks and felt better over night. Now when I start to feel stuffy I take at least D3 (raw) and the CoQ10 and I feel better over night, no matter at what time of my illness I take the vitamins. It does seem that they are helping.
I don’t take them on a regular basis though, with the exception of FLCO, but I have been slacking on that lately.
Wait a second. Shredded Wheat is just that, wheat. No added vitamins or other nutritive additions. That cereal and maybe Grape Nuts are probably the most natural and least modified items on the market. Yes, grains are a problem for many, but don’t go knocking Shredded Wheat. Knock Total, with its cheap vitamins, or other MUCH more heavily processed cold cereals! (I got a soft spot for SWheat – always liked those big woven biscuits as a kid).
Yeah, I know. Love that cold cereal in milk. All of it is not too good, I agree. My only point was that, given cereal consumption being what it is, Shredded Wheat is probably one of the best of the entire group. Just did not want anyone knocking my childhood favorite! <VBG>
I agree with all of the supplements in your list. But I might consider additional supplements:
Natural vitamin E or wheat germ oil – Vitamin E is hard to find in food.
Zinc, if you don’t eat enough red meat or oysters, but please balance it with copper.
Vitamin A, if you don’t consume liver or fish liver oil. Don’t take too much of synthetic vitamin A, because synthetic, water-emulsified forms of vitamin A is highly absorbed.
Coenzyme Q10 or ubiquinol, if you’re over forty years old while not consuming enough food containing this.
Coconut oil and unrefined salt should be supplemented, but that may be too far-fetched because they are not usually categorized as “supplements”.
The reason that I don’t include iodine is because it’s found in kelp, which is cheap to buy. And iodine without accompanying with selenium is toxic because selenium’s antioxidant activity protects iodine from damaging the thyroid. Selenium is rich in western American soils, but poor in the eastern parts.
i’m new to this blog (not to the topic), and i have to say, that’s probably one of the worst and most naive title and blog post about this topic i’ve ever read. it’s like saying, “hey, if you’re not dehydrated, you really don’t need to drink water! so throw away your evian bottle alrady! but you know, if you don’t have enough water, you really should drink some!”. or stated otherwise: “you really all should throw away your MV/MM supplements, because you know, i’m sure your diet is already perfect and all as you exclusively buy organic and grass fed you definitely do not lack any single nutrient, because i tell you so. also, all MVs are from the devil! HOWEVER, if you think you lack something, you really should rely on some serious supplements, you know.” whaaaat? seriously? too simplistic for my taste, thank you very much
ok, apparently i wasn’t clear enough. here is what i mean:
you: ” 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).”
me: a) show me a single person on this planet who doesn’t think it’s preferable to get all needed nutrients from their food. duh..
b) “from whole foods as they are found in nature” -> well guess what, that’s exactly why most people take MVs, because they actually became aware that they do NOT have access to unadulterated, nutritionally-dense food anymore. most soil is not what it was anymore, even for organically grown food.
you: “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.”
me: pure, unproven propaganda. no one is “obsessed” with isolated, synthetic nutrients, and no one believes that “a single synthetic nutrient” has the same effect as “nutrients found in food”. this comparison doesn’t even go together logically (the former is singular, the latter a multitude of “nutrients”)
you: ” 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.”
me: a) 20-30%? yeah, that’s bad indeed. it should be 100%, considering how depleted and poisoned todays food is. no comparison to what our ancestors got from the same amount of food, as you know very well. and yeah, i guess we the should abandon iodine fortification as well.. because you know, it’s so synthetic and singular..
you: “Vitamin D showed some cardiovascular benefit.”
me: i guess diabetes, breast cancer and multiple sclerosis was not good enough for you to list as a (huge!) benefit of D supplementation.. http://is.gd/chWey
i could go on and on. as i said: your post is biased, populist, imprecise, and partially untrue. what i could agree with as recommendation would be “eat as healthy as possible (depending on the available resources you have), but as we all know, today’s food doesn’t come nowhere near the nutrient-density our bodies where designed for, so it’s certainly a good thing to take a potent, high-quality (!) MV/MM, including some fish oil, and at least 3’000IU of vitamin D (even better, do a D3 blood test), just to be sure. and yes, there ARE crappy and worthless supplements. but thats true for all mass produced goods. buy quality – whether it’s food, or your supplements.
or wait, scrap that. dr. hyman puts it even better than i ever could:
http://is.gd/chYur (watch from beginning, but especially take note from 5:00 on..)
Organism, in my opinion, if you don’t get enough Vitamin A from your diet, you’re eating way too few vegetables.
Chris is pretty much correct in this article, actually: studies show that getting most vitamins from supplements does not prevent disease and can actually cause problems. If someone is deficient, that’s not good, but if supplementation doesn’t help the problem but causes more problems, that can’t be called a solution.
Supplementation does cause problems, if they are taken in large, isolated doses. I don’t recommend taking one large dose at once. It should be spread out evenly throughout the day.
Setting magnesium aside, I don’t recommend the supplementation of trace minerals such as chromium. Chromium is found to antagonize molybdenum and vanadium. If you supplement with chromium, your molybdenum and vanadium reserves will be depleted.
And a lot of whole foods contain amounts of minerals comparable to supplements. For example, one oyster contains about 10 mg of zinc.
Have you read the Mineral Primer? The authors have an opinion that minerals chelated to amino acids will cause serious imbalances in the body. If that’s true, then magnesium glycinate would be harmful because it’s an amino acid chelate.
The Vitamin A Saga suggests that the conversion from beta-carotene to retinol is poor. So one has to eat a lot of high beta-carotene foods, such as sweet potatoes, along with plenty of fats to emulsify the beta-carotene.
you: ” Again, show me the research suggesting that we can’t meet nutrient needs by eating fresh, nutrient dense foods. And show me the research supporting the health benefits of supplementing with synthetic nutrients.”
me: watch the video from dr hyman – he’s the man out in the filed treating patients. do you? no studies needed for this, thank you very much.
you: “there is very little clinical evidence that proves that D supplementation reverses disease.”
me: i just recently cured (=symptoms free) my neurodermatitis which began 20 years ago by taking 5’000IU D3 alone. nothing else had any effect, despite seeing 4 different doctors and using any kind of weird sulfur shampoos etc. who do you think i believe – your “guesses” that vitamin D can’t really cure/reverse anything, or my body?
my tip: go to an online vitamin shop of your choice (like http://is.gd/cby5h ), go to the “reviews” section for the best selling vit D supplement, and read the user reviews. done? any more questions? good.
What is your opinion on the whole food multi-vitamins where all the vitamins come from fermenting bacteria?
I haven’t seen much research on them but I do know ones like Garden of Life’s Living multi and NOW’s Whole Foods multi both do the create all vitamins via yeast free bacterial fermentation.
Excellent read Chris. Thanks for putting that together. Very enlightening. ~RR
I’m not looking for a debate or argument or whatnot. I’m just defending users such as qualia. Here it goes:
<blockquote>Are you seriously suggesting we make decisions based on a single doctor’s opinion and consumer reviews on vitamin shop websites, and that this somehow negates the need for solid research? Good grief.</blockquote>
Weston A. Price has surveyed traditional societies and found that natives often supplement with foods to cure diseases. For example, he found that Indians can cure scurvy by supplementing with adrenal glands. He has also found that liver is a supplement to cure blindness. They are anecdotal reports.
These reports aren’t based on “solid research” that eating the adrenal glands will cure scurvy, or that eating liver will cure blindness. They are anecdotes from traditional societies, and you continue to respect them?
The consumer reviews on vitamin retail stores are also done by people. They have a large number of people showing that magnesium supplementation lowered their blood pressure, and that vitamin D cured their depression. They are also anecdotal reports.
What’s the difference between the anecdotal reports done by traditional societies and the anecdotal reports done by consumer reviews? They are both anecdotal, and they should be both condemned.
So you have a double standard against the reports by consumer reviews whilst respecting the anecdotal cures done by traditional societies.
<blockquote>I said in the original article and now twice in the comments that I recommend supplementing with D. Somehow you keep missing that.</blockquote>
I think his point was that supplementation is useful in many cases other than vitamin D, magnesium, or vitamin K2. You should have argued against the context of his words, rather than the words themselves.
You seemed to have selectively interpreted his argument in the literal form, so you can easily succeed in one-upmanship with him. You’re afraid to admit that you have no argument if you have interpreted his argument to context. So you unconciously decided to interpret his words is a biased manner, as an excuse to win over him when nothing should have won.
One of your arguments was that some nutrients interact, antagonize, and synergize with each other, but supplementation is isolated. But as you know, that doesn’t mean that supplementation itself is bad. People can just choose to supplement with a balanced ratio, and that will solve it. Yes, most people don’t do this, but my point is that it’s possible for people to supplement with a balanced ratio.
Whole foods doesn’t even necessitate a correct ratio. As you know, you can overdose on whole foods. You can also create an imbalanced ratio with whole foods. For example, if you eat too much calf liver, you can create an imbalance of copper and zinc. If you eat too much Brazil nuts, you can overdose on selenium.
Of course, whole foods are harder for people to overdose, but as you know, it’s still possible for people to overdose on whole foods.
Your concept of “food synergy” is based on a rationalization. All of your arguments against supplementation aren’t good.
Your argument on the “buffer effect” is flawed because people can just take supplements that are buffered on with lower dosages with food. Of course, most people don’t take buffered supplements or lower their those, but your argument doesn’t refute supplementation in itself.
Your argument that nutrients compete with each other is refuted by my words above.
Your argument against synthetic nutrients isn’t sound. You are like attacking a whole group of people who take the only natural forms of supplements. Even though you did not, that argument doesn’t apply to supplementation chemically identical to the natural forms. That doesn’t refute supplementation itself.
You cherry pick a series of studies that show that vitamin supplementation have harmful effects, and then make your case that all vitamin supplementation can have “potentially unknwon effects”, even if it’s proven to be natural and eaten in a correct ratio.
So I have shown that all your argumentations are mere rationalizations against supplementation. You seem to have a “whole food bias”. And you’re unaware of it, at least subconsciously. That isn’t objective, even though you claim otherwise.
You made these arguments, not only because of your bias against them, but because you value consistency. You value purity. You value the purity of eating a whole foods as “natural” so you condemn supplementation.
You randomly pick data in order to generate your arguments against supplementation, because you are against supplementation in the first place! That’s what I call rationalization. No, I’m not saying that all of your arguments are like that, but your article sounds like “propaganda” against supplementation.
I’m not attacking you. I’m not attacking your reputation. I will continue to read each one of your blog posts with scrutiny, being as careful as possible to prevent any biases on your posts. I will continue to value each of your posts as much as Stephan Guyenet or any other top paleo blogger.
What I’m really attacking is the paradigm of the entire paleo blogosphere. They rationalize. They have a “whole food bias”. They value the “purity” of eating whole foods rather than supplementation. I’m attacking the entire blogosphere, so I’m not treatening your reputation. I’m attacking the reputation of the entire paleo blogosphere.
I know that these arguments aren’t necessarily yours. Other people such as Stephan Guyenet, Richard Nikoley will make the same arguments against supplementation. Calm down Chris, I’m not attacking you. I’m attacking every other paleo blogger (except myself because I’m arrogant :-) ).
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