TO SUPPLEMENT OR NOT TO SUPPLEMENT?

In This Article

  • Micronutrients to consider
  • Getting vitamins B12 and D
  • Current research on supplements
  • The brilliance of your body

The most commonly asked question in nutrition today is whether or not supplements are necessary. In this multibillion-dollar industry, supplement manufacturers have confused the public beyond comprehension. You probably worry about whether you’re getting enough nutrients from your diet alone—especially on a plant-based plan. How do you know if you’re getting enough of each nutrient? Who can you trust for unbiased information? If you need a supplement, which type do you choose? Is taking more better than not taking enough? Are they safe?

In this article, we examine these questions in detail.

Do You Need to Supplement?

Many factors determine whether your diet meets your nutrient needs. Technically, there is no such thing as a perfect diet. Furthermore, we don’t typically eat the same foods nor do we necessarily meet all of our nutrient needs every single day. The standard Western diet tends to fall short on fiber, potassium, magnesium, folate, iron, and vitamins A and C. As we’ve discussed, a plant-based diet easily provides these nutrients; however, there are some specific nutrients that likely need to be supplemented to fill in potential gaps.

Dietary supplements need to be considered and treated as medications. If you have a nutrient deficiency, you need to determine what the origin of that deficiency is. Most of the time, a nutrient deficiency signifies either a health issue or a poor diet overall. In either of these cases, popping a supplement won’t address the real problem.

Additionally, nothing comes without risk. Every drug has associated side effects, and most of the science available shows that supplements don’t make you healthier. That being said, a whole food, plant-based diet that contains a wide variety of different foods every day should provide everything you need, with the exception of vitamin B12 and possibly vitamins D and K2, EPA, and DHA.

Boosting Your B12

Vitamin B12 deficiency in plant-exclusive eaters is more common than it should be with a broad prevalence range of 0 to 86.5 percent of the population, depending on the subpopulation and fortified products consumed. It can be a serious issue. Essentially, if you are excluding animal products from your diet and you don’t replenish your supply of B12, you will eventually become deficient. No gold standard exists to test for blood cobalamin deficiency. Currently, the most commonly used tests are serum cobalamin, MMA (methylmalonic acid), and Schilling test. Ask your physician to test you during your regularly scheduled visits, but remember blood tests may not detect a deficiency until it’s too late and irreversible neurological issues can transpire during that time.

If you’re plant based, the safest, cheapest, and most reliably effective way to avoid deficiency is to supplement. Consuming fortified products such as nutritional yeast or plant milks may provide some B12 in the diet, but it is easier to control and to ensure adequate intake with a supplement. Although the RDA for B12 is only 2.4 micrograms for adult men and women, supplements are not completely absorbed; this is why the recommendation for intake is higher.

Several different types of B12 compounds are available as supplements, and the two most commonly found are cyanocobalamin and methylcobalamin. Cyanocobalamin converts in the body to the active forms of methylcobalamin and 5-deoxyadenosylcobalamin. Evidence suggests there is no difference in bioavailability or absorption between the different forms. You can also ask your doctor for an injectable B12 if you have any absorption issues. Supplement with B12 using one of these three dosing schedules: 50 micrograms twice daily, 150 micrograms daily, or 2,500 micrograms once weekly. No tolerable upper limit has been set by the Institute of Medicine since B12 is water soluble and high levels are considered safe.

MIXED GREENS

Cyanocobalamin is a precursor to the more active form of hydroxocobalamin in the body. Yet, some people are concerned about a small amount of cyanide that is released into the body from the cyanocobalamin molecule. The body has the ability to convert this into a thiocyanate, which can be easily excreted. Not only that, but hydroxocobalamin is actually used in some cases to treat cyanide poisoning.

Do’s and Don’ts of Vitamin D

Vitamin D is not as cut and dried as vitamin B12. A vast majority of the world’s population has either insufficient or deficient levels of vitamin D. But this doesn’t mean you should just pop a pill. Before you do anything, have your 25-hydroxyvitamin D blood-level tested. If you end up with a result lower than recommended, you need to determine how best to bring it up. Adequate serum 25-hydroxyvitamin D levels are 30 to 50 nmol/L (12 to 20 ng/mL).

Try using the sun as your first line of defense. Everyone responds differently to sun therapy, depending on factors such as weather, season, latitude where you live, and your skin color (the lighter your skin, the more easily you absorb vitamin D). If you live somewhere that gets a lot of sunshine throughout the year, you’re at an advantage and might not have to supplement.

To maximize sun exposure safely do the following:

  • Go out during the peak time of the day when the UVB rays are strongest, usually between 10 A.M. and 2 P.M.
  • Protect your eyes with sunglasses.
  • Apply sunscreen to your face to prevent wrinkling, but do not wear it on the other exposed parts of your body.
  • Expose as much of your skin as possible without offending your neighbors.
  • Never allow your skin to burn or even to turn pink. The darker your skin, the more sun exposure you require to make vitamin D, and the harder it is for you to burn.
  • Do this two or three times a week at minimum.

After following these suggestions for a couple months, take a follow-up blood test. If your results go up, congratulations! Continue with the sun exposure regimen. However, if you’re unable to raise your 25-hydroxyvitamin D to at least 30 nmol/L (12 ng/mL), continue with the sun exposure, but add a vitamin D supplement.

Note, this trial works best during the warmer months and in warmer climates. If you’re performing the sun exposure trial during the heart of winter, you probably won’t increase your levels. Your result may be situational and not a reflection of your personal ability to make vitamin D. Test this during the spring or summer seasons for optimal results. You might need to supplement only in the colder months.

Supplemental vitamin D is derived from animal sources—usually from lanolin in sheep’s wool—in the form of cholecalciferol, or vitamin D3. Now there is also a plant-derived version of D3 commercially available sourced from lichen. An additional form called ergocalciferol, or vitamin D2, is found in plant sources, mostly in UVB-irradiated mushrooms. Dietary supplements may contain either D2 or D3, both of which can be effective at raising blood levels to optimal levels in smaller doses (4,000 IU and less). Cholecalciferol (D3) is superior when using larger doses. You can safely take 2,000 IU per day with 4,000 IU per day being the established tolerable upper limit. Physicians can prescribe high-dose supplementation in certain cases, but this needs to be monitored. Unlike vitamin B12, vitamin D is fat-soluble and toxicity is possible.

PLANT PITFALL

Never double up on a multivitamin to attain optimal levels of vitamins B12 or D. You’ll be doubling up on other compounds, too, which can be toxic.

Consider taking a moderate multivitamin that contains dietary reference intake (DRI) levels of nutrients including iodine, selenium, zinc, and K2. If the multivitamin is comprehensive, be sure folate is used instead of folic acid. There are formulas that include vitamins B12 and D, so you can simply take them altogether in one supplement and cover your bases. Beware of multivitamins that megadose nutrients to levels higher than DRI. Furthermore, taking a microalgal formula of EPA and DHA may be a good idea. It’s optimal to have your blood tested for potential deficiencies common in the general population, including DHA, iron, zinc, and iodine. But as a universal rule, don’t supplement “just in case.” Instead, get your nutrients from food and monitor your blood levels regularly to confirm your nutrient intake is sufficient.

The Dangers of Supplementation

In addition to cashing in on nutrient fears, supplement manufacturers imply their products can perform miracles for your health. Herbs, botanicals, blends, powders, bars, and potions promise to stop aging, prevent cancer, replace exercise, and make you popular. If it sounds too good to be true, it probably is.

The Dietary Supplement Health and Education Act

A major force influencing the supplement industry is a piece of legislation called the Dietary Supplement Health and Education Act (DSHEA). Passed in 1994, this act took away responsibility from the government to ensure the safety of a product before it’s put on the market. Instead of the FDA determining safety, as it does for foods and medications, the drug manufacturer is in charge of its own products.

If a problem comes up after a product makes it onto the shelves, only then does the FDA become responsible. But until then, buyer beware! Only the drug manufacturer that benefits from you buying and using a supplement decides whether it is safe. This possible conflict of interest has broad implications.

What’s Up in Supplements?

Unless you have a deficiency, supplements don’t make you healthier. In certain cases, the opposite is true. Beta-carotene, vitamin E, and folic acid have been found to be harmful in numerous trials.

After the discovery that people who ate more fruits and vegetables developed less cancer, researchers were on a mission to find out precisely what component in those foods caused the prevention. This made antioxidants all the rage in the nutrition world. In the mid-1990s, two well-designed studies compared a group at high risk for lung cancer (smokers and those exposed to asbestos) taking beta-carotene and vitamin A supplements with a control group taking no supplements. Much to the dismay of the researchers, the groups taking the supplements started developing lung cancer and dying more than the control group. They had to stop the study prematurely.

Several explanations are possible, but the results are still not completely understood. Perhaps it was due to the lack of synergistic compounds found in food sources of vitamin A. Or maybe it was because out of approximately 563 identified carotenoids, taking a large dose of only one of them (beta-carotene) prevented the others from working. The lesson to be emphasized is that isolating and concentrating a nutrient doesn’t have the same effect as eating it in its original packaging.

Taking large amounts of vitamin E to ward off Alzheimer’s disease and prevent oxidation is popular. But in a large meta-analysis of 19 studies performed in 2005, vitamin E was found to “increase all-cause mortality” at high doses “and should be avoided.” Not only do you risk dying by taking these supplements, but many studies have shown that they don’t even work to begin with.

Obstetricians advise their pregnant patients to take 600 micrograms of folic acid every day to help prevent neural-tube defects in their babies. Unfortunately, research shows that taking supplemental folic acid increases the risk of breast cancer. It may also lead to a higher risk of dying from breast cancer, as well as from all causes.

It’s not the nutrient itself causing these results. Instead, it’s the fact you’re taking it in an unnaturally isolated, concentrated form. When consumed in its original packaging—surrounded by fiber and other nutrients—the synergy among all the compounds working together creates magic in your body.

DEFINITION

Synergy is the effect of two or more units working together to produce a result not obtainable by each of the units independently.

Currently, taking fish oil supplements to attain high levels of the essential fatty acid DHA is the trend. Fish may be the most polluted organisms. Their muscles and livers are filled with PCBs, dioxin, mercury, organochlorines, pesticides, and DDT. All these compounds pose serious health risks to humans. If you think about it, eating one fish for dinner provides you with a dose of these toxins. In the food chain, bigger fish eat smaller fish, and those bigger fish absorb the toxins from the smaller fish. Now if you concentrate the oil from hundreds or thousands of big fish and put it into a capsule, consuming that capsule concentrates your exposure exponentially!

Lawsuits have been filed over fish oil–supplement manufacturers providing these toxins in their products. Even with the highly regarded molecular distillation process, products have still been found to contain these detrimental compounds. So far, not enough research has been done to confirm the potential health risks from taking these supplements.

Why chance it, especially when you don’t need to take fish oil supplements in the first place? Be diligent about consuming ALA-rich foods (i.e. flaxseeds, hempseeds, chia seeds, walnuts, and soybeans), and also consider taking a microalgae DHA/EPA formula as a safer option than fish oil.

Knowing When to Supplement and When to Eat

The human body is the most unmistakable example of synergy. It contains 10 trillion of your cells and 100 trillion foreign cells in the microbiota, communicating with one another in a giant life symphony. The complexity of our bodies leaves even the most knowledgeable experts in awe. So many mysteries lie unsolved that we’re only just beginning to scratch the surface of how exactly the body functions.

When consumed, the thousands of phytonutrients a plant contains become a part of trillions—both friendly and foreign—cells through complex, interrelated mechanisms. How, then, can you expect one isolated, concentrated compound—a vitamin, for instance—to cure disease? Yet that’s precisely what the supplement industry often implies. This ignores the intricate, complicated, and synergistic workings of the human body and it’s biological hitchhikers.

We are sick and overweight because of the way we eat, not because of micronutrient deficiency. Mostly we wrestle with malnourishment diseases of overnutrition, not undernutrition. You’re more likely to see someone with heart disease (excess saturated fat, refined sugar, and cholesterol) than scurvy (vitamin C deficiency), with cancer (excess IGF-1, methionine, and environmental toxins) than beriberi (thiamin deficiency), and with diabetes (excess refined sugar and saturated fat) than pellagra (niacin deficiency). Popping supplements will never replace the effectiveness of correcting chronic overnutrition by eating whole-plant foods and exercising regularly for achieving and maintaining optimum health. While we can overcome certain nutritional deficiencies with supplementation, you can’t expect to counteract a poor diet of excess merely by taking pills. Unfortunately, it’s far more complicated.

Supplementation, when part of a proper diet, does afford us the ability to cut out certain foods that may have had some nutritional benefit packaged with nutrition of excess. Remember, just because humans ate various foods along the way to fuel our adaptive evolutionary journey, doesn’t necessitate we eat those same foods now in our quest to diminish risks of certain chronic diseases. What we can eat for 45-50 years of life to reach reproductive age, reproduce, and raise our youngest offspring in a world of natural food scarcity isn’t necessarily the best choice for health later in life once our genes are past. We are struggling with the chronic diseases that strike typically after our 40s.

Evolution doesn’t act to perfect organisms; evolution is simply change over time. Natural selection leads to adaptation, but other somewhat random genetic forces lead only to change. We must live with those changed genes today in our world of abundance. This clash between natural scarcity and agricultural excess might be a large part of the problem. While we clearly have adapted to cope with times of scarcity, it’s hard to believe that any of our genetic ancestors lived or adapted to a world of excessive food with the exception the more recent kings, queens, emperors, and pharaohs. Of course, history teaches many of these privileged few died early from disease of affluence. Today, even many poor are living the royal life when it comes to food and obesity is often a symptom of poverty.

We are fortunate to have plentiful food and the luxury of knowing those nutrients that need to be supplemented in the diet. We can supplement when desired to compliment a healthy whole food, plant-based diet and eliminate any potential shortfalls such as vitamin B12. There are a limited number of known nutrients that may be deficient and these can be tested. It is likely a detriment to take large quantities of biologically active compounds at concentrations never seen in nature. At the very least, it is wasteful and excreted in the urine, but it might also accumulate in organs (e.g. kidneys, liver, and fat), where it may ultimately reach toxic levels. Perhaps instead of spending so much time and money trying to outsmart nature’s harmony, the best advice is to eat whole plant foods as close as they are found in nature and avoid highly processed or refined foods even if they began as plant food.

The Least You Need to Know

  • Your individual nutrient needs are based on genetics, age, makeup of your diet, and other factors.
  • Vitamin B12 must be supplemented in a whole food, plant-based diet to avoid deficiency.
  • Get your 25-hydroxyvitamin D blood level checked regularly, and treat deficiency with sun first and perhaps supplements additionally.
  • The DSHEA Act of 1994 gave dietary supplement manufacturers, not the FDA, the power to determine their own products’ safety.
  • Ample research shows dangerous effects of taking supplemental beta-carotene, vitamin E, and folic acid.

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