Tuesday, February 03, 2015

Take Food, Not Vitamins

That's the take home message from an opinion paper published this week in the journal Medicine entitled, "Micronutrient Deficiencies, Vitamin Pills, and Nutritional Supplements".

In it Emilie Combet and Christina Buckton sought to summarize whether or not there's evidence to suggest that there's benefit to taking multivitamins and other supplements.

They point out that our bodies are incredibly well adapted to handle different levels of nutrient intakes and that we have mechanisms that help us to deal with shortfalls and surpluses of most supplements and that as a consequence, for true deficiency states to occur, usually a great deal of time (and dietary deficiency) needs to pass. They also point out that more is not always a good thing and that high levels of vitamins and minerals consequent to supplementation can in fact confer risk.

They suggest there are only 2 situations where good evidence would suggest a person should consider supplements.
  1. To correct specific and demonstrated deficiencies due to inadequate dietary intake (eg. a documented case of iron deficiency)
  2. To supplement people with disease states where requirements are heightened (critically ill patients), or absorption is compromised (inflammatory bowel disease, post-bariatric surgery, etc.)
The third situation that they highlight is the one that's most contentious, "to promote health and performance and protect against future chronic diseases in healthy adults". They note that there are in fact a few very specific situations where this would be true - folic acid before and during pregnancy and vitamin D in elderly institutionalized women, but that for the most part, meta-analyses of available supplement trials not only haven't been found to show benefit, they've actually shown harm (including for B-carotene, vitamin E, vitamin A and multivitamins).

As you might have already gathered, their conclusion is to eat a nutritionally balanced diet and not bother with supplements unless there's a real and non-theoretical need. My addition to that conclusion would be to suggest that unless there's a real reason for you to spend it, the money you're currently spending on supplements would be far better spent on any or all of:
  • Fresh fruits and vegetables
  • Cooking classes
  • Great new lunch boxes in which to pack your home-made lunches
  • Exercise equipment or clothing that might help you to move more
  • Dance lessons
  • Good room darkening blinds to improve your sleep
  • Etc!
Being concerned enough about your health to buy vitamins and supplements, while no doubt full of hope, probably isn't the best place for you to be spending your energy and concern. Instead, pretty much anything you can do that would improve the basics building blocks of health that we know matter so much - food, physical activity, happiness, and sleep, would stand a far greater chance of actually making a difference to your quality, and potentially quantity, of life than buying bottles full of wishful thinking.

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