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By Alan Safdi, M.D., FACG
Dr. Alan Safdi is past chairman of the Section of Gastroenterology at Deaconess Hospital and served as co-founder and president of the Ohio Gastroenterology and Liver Institute. Dr. Safdi is board certified in internal medicine and gastroenterology, and is a Fellow of the American College of Gastroenterology. He is the former chairman of the Crohn’s and Colitis Medical Advisory Board in Cincinnati and still serves as president of Consultants for Clinical Research. He was also co-founder of eMerge Health Solutions, Consultants for Clinical Research, and outpatient GI and anesthesia programs.
We humans are constantly in search of the magic answer for health and longevity — a silver bullet that solves all our health woes. And that quest often has us buying a host of vitamin supplements. But rather than starting in the pharmacy, we should begin at the farmers market.
Americans, and especially older individuals, are hooked on vitamin supplements. Dietary supplementation in the United States is an approximately $30 billion industry with more than 90,000 products on the market. In recent national surveys, 52% of U.S. adults reported use of at least one supplement product, and 10% reported use of at least four such products. Vitamins and minerals are among the most popular supplements, and are taken by 48% and 39% of adults, respectively, typically to maintain health and prevent disease. That is despite the fact that no matter how rigorous our studies are, they show little known benefit for some vitamins.
When we try to deliver the key ingredients of a healthy diet in a capsule, those efforts nearly always fail. But what is known to provide real benefits is eating foods rich in vitamins and minerals. That’s because whole foods are more complex in the way they deliver nutrition. For example, there are numerous active phytochemicals in an orange, and not just Vitamin C. We are naïve to think we know what the best phytochemicals are to take out of a fruit or vegetable. It is often the combination of these that is important. It’s possible that the chemicals in the fruits and vegetables on your plate work together in ways that we don’t fully understand — and which can’t be replicated in one of the supplements for sale.
Most Americans eat fewer than two servings of veggies a day and just a single serving of fruit. Rarely do we choose the more vitamin-rich legumes or whole grains over refined breads, white rice, and pasta. With a diet so nutrient-poor, it’s little wonder Americans flock to supplements.
Sure, supplementation can be important in specific circumstances. Pregnant women should take folic acid to prevent birth defects, vegans need to supplement with vitamin B-12 to maintain healthy nerves, and if you’re not out in the sun often, you should consider extra vitamin D (although almost all of us may need extra vitamin D). Supplements support important health needs that our diet can’t always meet. But, beware if you’re taking vitamins or mineral supplements to fend off chronic disease in place of a nutrient-rich diet. It just doesn’t work.
Because healthy foods contain a complexity that is lost in supplements, my solution is simple: eat nutrient-rich foods like veggies, fruits, legumes, whole grains, and seeds. These foods pack in the vitamins and minerals we need, plus a whole lot more. Take your ordinary grapefruit. It combines fiber, beta-carotene, Vitamin C and folic acid with hundreds of other phytonutrients like flavonoids and limonoids. The way these nutrients interact lead to health benefits that don’t occur when each is taken in isolation. It’s no wonder that study after study shows eating plenty of veggies and fruits can prevent chronic diseases we fear the most, such as diabetes, heart disease, dementia, and even cancer.
Micronutrients made of a single element, like potassium, are called minerals. Small compounds are termed vitamins. Unlike carbs, fat, and protein – all macronutrients – that are broken apart for energy, vitamins and minerals are kept intact for specific uses by our body. Despite their small size, they carry a big load. Take Vitamin C. It helps create collagen, activates immune cells, and detoxifies free radicals. Or, consider the mineral calcium. It supports our bone structure, the contraction of muscles and blood clotting after injury.
When any one of these important vitamins or minerals goes missing, our health can take a serious nosedive. Though you won’t likely see a person’s gums bleed from scurvy these days, micronutrient deficiencies aren’t a thing of the past. However, researchers evaluated the adequacy of dietary supplements in the primary prevention of cause-specific death, cardiovascular disease (CVD), and cancer by utilizing meta-analytical approaches. And they didn’t observe sufficient proof to bolster the utilization of dietary supplements in the primary prevention of any of the three. Again, this adds to the argument that the best way for the body to acquire vitamins and minerals is through whole foods.
Vitamins are not inert; they are biologically active agents. It’s best to think of them in the same way as drugs: if you take too high a dose of them, they cause side effects. Sometimes the supplements with lower doses of supplementation near the recommended daily allowance may be better than one of the megadose vitamins. Unfortunately, vitamin studies are difficult since it may take decades to show a difference, and vitamin users often start out healthier and avail themselves of preventative healthcare more than non-users.
Recently, there was a study pointing out the potential risks of taking excessive amounts of certain vitamins. Many years ago, we thought that since carrots have a lot of beta-carotene, we can take this vitamin A precursor and put it in a pill to prevent lung cancer. (Beta-carotene is the precursor form of vitamin A, which is found in fruits and vegetables.) The study results were surprising. Eating plenty of fruit and vegetables containing beta-carotene can help to prevent cancers but taking high dose supplements of it is linked with an increase in incidence of lung cancer in smokers. We were increasing incidence, or growth rates, of lung cancer in some smokers in this study.
New research suggests long-term, high-dose supplementation with Vitamins B6 and B12 – long touted by the vitamin industry for increasing energy and improving metabolism – is associated with a two to fourfold increase in lung cancer risk in men relative to non-users. Risk was further elevated in male smokers taking more than 20 milligrams of B6 or 55 micrograms of B12 a day for 10 years. Male smokers taking B6 at this dose were three times more likely to develop lung cancer. Male smokers taking B12 at such doses were approximately four times more likely to develop the disease compared to non-users. The Health Office of Dietary Supplements suggests that men who are age 51 years and older need B6 at a dose of 1.7 mg daily (women, 1.5 mg daily), while for B12 the recommended dose for adults is 2.4 mg daily.
Men and women have different susceptibility to tobacco-induced lung cancer and supplementation with high-dose Vitamins B6 and B12. Longer duration of use may support more rapid cell growth and promote carcinogenesis in already mutated cells in smoking men.
I have to point out that this was an observational study, and, as such, it cannot provide proof of causation.
To sum it up: We are not yet smart enough to know what the best part of a blueberry or carrot is to put in a pill, so stick with whole foods and take supplements under physician guidance. There are a lot of beneficial phytochemicals that are not vitamins, and just taking a vitamin will not give you those very important compounds.
There are a lot of good reasons to make sure you have enough Vitamin B6 and B12 in your diet or by supplements, but we have a lot of work to do evaluating very high doses of these vitamins. Too little of some vitamins may be deleterious, such as Vitamin D. But, too much also has serious adverse effects. The same can be said for a lot of minerals, vitamins, and electrolytes so please take these agents with guidance and always ask your health care provider if anything new was recently published.
Data from the 2012 National Health Interview Survey (NHIS) Alternative Medicine Supplement showed that 17.7% of adults in the United States had used natural products in the previous year, including herbs and other naturally occurring non-botanical supplements such fish oils. There are a variety of reasons to consider these natural products.
Natural products such as turmeric, fish oil, prebiotics and probiotics, melatonin, and glucosamine are often considered healthy in today’s nutritional trends. Again, it’s important to review the literature evaluating the risks and benefits of these products to ascertain their true benefits.
The makers of dietary supplements are not required to prove efficacy, safety, or quality of a product prior to marketing it. Supplement manufacturers are also not obligated to report post-marketing adverse events to the FDA. In general, regulation of the quality of herbal products is significantly greater in the European Union than in the United States. Multiple reports of inaccurate herb labeling have been documented. For example, a study of commercially available Asian ginseng products showed that among products with a labeled concentration of ginsenosides, the actual measured ginsenoside varied from zero to over 300 percent of labeled concentrations. Increasing data shows the potential for herbal medicines to interact with prescription and nonprescription pharmaceuticals, so always discuss their use with your healthcare provider. That said, I have found some of these products to be very beneficial when used in the correct circumstances.
What it boils down to is this: nutrient-rich foods offer us something beyond abundance. They give us the health that supplements can’t provide. There’s no substitute for good eating if you want a long and active life.
Are you interested in learning more about living a healthy life? Alan Safdi, M.D., FACG is running 6-day wellness retreats in our hometown of Telluride this summer. For more details on the retreats and the Telluride Longevity Institute, visit https://telluridelongevityinstitute.org/. One week won’t just change your life, it will prolong it!
This article was written by Alan Safdi, M.D., FACG:
The information included in my posts are for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult his or her healthcare provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a medical condition or treatment plan. Reading the information in my posts does not create a physician-patient relationship.
Alan V. Safdi MD, FACG
Co-founder Emerge Healthcare Solutions and Consultants for Clinical Research
Past President Ohio Gastroenterology and Liver Institute
President Nominations Committee Ohio GI Society
Served as Chairman Section of Gastroenterology at.Deaconess Hospital
President Consultants for Clinical Research
Past Chairman Cincinnati Crohn’s & Colitis Medical Advisory Committee
Former Medical Director Tri-State Endoscopy Center
Served as President of the Ohio Gastroenterology Society
Lectures Nationally and Internationally on Health and Wellness