Court of Public Opinion
Surprisingly strong feelings can override facts in the court of public opinion of whether diet alone can provide all the nutrients needed for optimal health or if nutritional supplements are also needed.
In support of the pro-diet side, there isn't a nutritional supplement made that can surpass nature's complex synergistic designs for whole, living foods. Furthermore, early childhood experiences link food to nurturing, forming associations that can persist throughout life. Later in life, sharing a meal, or "breaking bread," still has a unique ability to foster emotional bonds among those who partake.
In support of the pro-supplement side, there is no faster, more convenient, or more effective way to address a nutritional deficit than by taking the lacking nutrient as a dietary supplement. There isn't a food that can even come close to supplying the high doses of nutrients possible through nutritional supplementation. For example, it takes about 14 oranges to equal the vitamin C in a single 1000 mg capsule.
A Changing Debate
The diet vs. nutritional supplements debate is markedly different today from the same debate that might have taken place just 80 years ago. This is in no small part due to the impact of technological advances in industry and agriculture that have proved to be a double-edged sword in regard to environmental and human ecology. Factors that have taken a toll on environmental and human ecology include:
- Nearly exclusive use of nonorganic agricultural practices that require the application of synthetic fertilizers, pesticides, and herbicides has depleted the nutrients in soil and has contributed to a body burden of synthetic chemicals not previously seen in human history.
- The levels of nutrients in several conventionally grown vegetables tested in 2000 showed a 30% to 70% loss of nutrient content when compared with levels established in 1963. The nutritional tables currently in use no longer represent the nutritional content provided by conventionally grown vegetables.
- Increased sugar consumption undermines health by depleting B vitamins and supporting the overpopulation of harmful bacteria in the gastrointestinal tract. The dominance of harmful gut flora can lead to an increase in digestive symptoms, the development of food allergy or intolerance, compromised immune function, and diminished absorption of nutrients.
- Overly liberal use of antibiotics has resulted in the ineffectiveness of antibiotics and the development of antibiotic-resistant bacteria called "superbugs." Successive generations of increasingly harsh antibiotics with more deleterious side effects continue to alter the ecology of the bowel, impairing digestive function and absorption of nutrients, which in turn undermine natural immune responses.
- A side effect of many pharmaceuticals includes depletion of nutrients, which can further result in symptoms of nutrient deficiencies and even contribute to the development of diseases. For example, long-term use of metformin can impair absorption of vitamin B12, and use of cholesterol-lowering statin drugs lowers levels of ubiquinone (CoQ10), an antioxidant compound essential for cellular energy production.
- Genetically modified (GM) foods (the most prevalent being soy, canola, cottonseed, corn, and sugar beets) have been introduced into the American food supply, many say without adequate scientific scrutiny. To date, labeling of GM foods in the US is not mandated. Given their known potential for adverse health effects, GM foods are a concern to a growing number of scientists and physicians.
- The human health effects from exposure to most environmental chemicals have not been adequately researched. The health problems from the synergistic effects of exposures to mixtures of chemicals that are more representative of real life exposures are even less likely to have been scientifically studied. Substances that mimic the actions of hormones (plasticizers such as phthalates or bisphenol A, pesticides, synthetic hormones), petrochemicals, heavy metals (e.g., lead and mercury), and industrial effluents and emissions all challenge living organisms' ability to adapt and detoxify. Individuals with impaired ability to detoxify are especially susceptible to adverse effects from toxic exposures.
Americans' default diet, the standard American diet (SAD), is lacking in fresh fruits and vegetables, healthy fats, and nutrients and is excessive in calories, sugar, and unhealthy fats. Currently an ongoing, massive dietary experiment is under way in America, and it is apparent that what we eat is directly linked to the development of our most prevalent chronic diseases: obesity, heart disease, stroke, cancer, diabetes, and arthritis.
Addicted to Dieting
Judging by the number of diet books sold each year and America's increasing obesity epidemic, one can assume that Americans love to read diet books … and that "dieting," as it is done in America, has proved to be ineffective in putting a dent in America's prevalence of obesity. Having taken numerous dietary histories, I see that eating grain-based vegan diets is far easier than taking the time, planning, and effort to prepare more nutrient-dense, non-starchy vegetables fresh daily. Long-term adherence to restrictive diets, including vegan (which when practiced without knowledge or awareness, puts people at risk for insufficient iron, vitamins D and B12, selenium, and zinc), excessive caloric restriction, and various faddish dietary weight loss plans can cause nutritional deficiencies and their sequelae.
The obstacles to eating a good diet in our land of plenty are not insignificant and can overpower an individual's resolve to "eat better," as that resolve gives way to fast food, busy lives, convenience, stress, and the frailties of human nature. Expecting nutritional supplements to atone for such dietary habits as having a glazed donut and a soft drink for breakfast and a malted milk and french fries for lunch and dinner is not a reasonable expectation.
Living "under the influence" of being on high alert from chronic stress takes a toll on health, in no small part from the associated lack of regular, quality sleep and relaxation that are required for the body to repair and maintain itself. Depletion of B vitamins (especially pantothenic acid of B5), depletion of magnesium and vitamin C, and low blood sugar are some of the nutritional impacts of chronic stress.
Individual foods have long been known for their unique contributions to health. These include citrus fruits used to prevent or treat scurvy (vitamin C deficiency) that threatened the lives of sailors on long voyages years ago, and cod liver oil used to treat rickets (weakened, bowed bones from vitamin D deficiency), a condition that became apparent following the relocation of people from rural settings to cities during the Industrial Revolution in late 18th-century and 19th-century England.
Fortification of Foods
Purists in the pro-diet camp may not be able to entirely avoid getting some supplemental nutrients in their diet. Experts in nutrition and public health determined that the general population was not likely to get nutrients through diet alone in amounts needed to prevent disease, and the concern resulted in fortification of foods with nutrients. These include:
- iodine (first added to salt in 1924 to prevent goiter)
- vitamin D (first added to milk in 1933 to prevent rickets)
- B vitamins and folic acid (first added to flour in 1941)
Nutrients Synthesized in Laboratory
In 1913, the door to targeted nutritional supplementation was opened when thiamin (vitamin B1) became the first vitamin to be isolated in the laboratory. In 2007, the National Institutes of Health (NIH) estimated that more than half of American adults spent a total of $23 million taking nutritional supplements, including multivitamin/mineral formulations. A high-quality multivitamin/mineral capable of addressing the health stressors of life in the modern world commonly requires taking 4 to 6 capsules a day.
Diseases Can Create Nutrient Needs
Nutritional supplements can be used to help meet increased nutrient needs imposed by diseases and health conditions when nutrients from diet alone fall short of supplying the body's needs. These include the decreased intestinal absorption in Crohn's and celiac diseases, impaired thyroid function from inadequate intake of iodine, anemia from vitamin B12 deficiency, and depletion of electrolytes and beneficial health-sustaining intestinal bacteria from acute viral gastroenteritis.
Genetic Causes of Deficiency
Vitamins C is an antioxidant and is required for the synthesis of collagen, a structural protein in the body's connective tissue, including the skin, tendons, ligaments, cartilage, blood vessels, discs, digestive system, and corneas. The need for vitamin C is greatly increased during stress, infection, and injury. Vitamin C is synthesized as needed daily by nearly all mammals. However, a defective gene for the enzyme L-gulonolactone oxidase, required in the last steps of vitamin C synthesis, is lacking in humans (and a few other mammals), resulting in inability of the entire human population to synthesize vitamin C. This fact makes supplementation of this important nutrient worthy of consideration to support human health and functioning.
Lifestyle Causes of Deficiency
Vitamin D is essential for normal cell function, growth, and development. Aside from its long-known role in bone health, most of vitamin D's many vital roles in health have only recently come to light. Vitamin D is a strong determinant of immunity, and the deficiency of vitamin D plays roles in the etiology of many diseases, including cancer, periodontal disease, heart disease, resistance to infection, infertility, mood disorders (in particular seasonal affective disorder, or "winter blues"), and obesity. Only a small amount of vitamin D is supplied by diet. Instead, most vitamin D is synthesized in the body when bare skin is exposed to sunlight. Many Americans are sun deprived from living and working indoors and are thus vitamin D deprived, a fact confirmed by testing vitamin D levels in the clinical practices of many providers who assess nutritional status.
Antioxidants for Athletes
Even highly trained, conditioned athletes (in particular extreme runners) have experienced sudden death during or just after stopping extreme exertion. The additional oxygen consumed during strenuous aerobic exercise is thought to increase the damage to body tissues (including the heart) through oxidation. The flood of oxidants from strenuous exercise can rapidly consume and deplete the body's stores of antioxidant nutrients. Ken Cooper, MD, author of Antioxidant Revolution, advises extreme athletes to not only eat antioxidant-rich vegetables, but also to take supplemental antioxidants. Laboratory testing of blood markers measuring oxidation before, during, and after exercise has shown that taking supplemental antioxidant nutrients can be life-saving for extreme athletes.
Thirteen nutritional and health experts convened under the auspices of the NIH to review randomized controlled trials of nutrients used for disease prevention. (http://consensus.nih.gov/2006/MVMFINAL080106.pdf) Their findings, considered to be a small drop in a large pond of the potential use of nutritional supplementation by those trained and experienced in nutritional medicine, were released in 2006. They include:
- Calcium and Vitamin D: benefit bone mineral density and prevent fracture risk in postmenopausal women
- Selenium: may cut risk of prostate, lung, and colorectal cancers
- Vitamin E: may decrease deaths from heart disease in women; it may also lower the risk for prostate cancer in male smokers
- Antioxidants and Zinc: an antioxidant combination of vitamin C, vitamin E, beta-carotene, and zinc may benefit intermediate age-related macular degeneration, a degenerative eye disease
Deficiency State/Optimal Nutrition
When reading supplement labels, remember that a nutrient's Recommended Dietary Allowance (RDA) is the minimum amount required to avoid a deficiency state. The amount of the same nutrient needed to support optimal health, on the other hand, is always higher, and often significantly so. Supplemental iron should be avoided unless a person has a medical reason to take it. While iron is essential to health, excess iron can harm health.
Central in this ongoing food fight is the fact that all people are not created equal when it comes to genetics and acquired health problems. Those who did a good job of choosing their parents are more likely able to maintain their health with less attention to what they eat. Less fortunate individuals have genetic glitches that don't allow them the same casual attitude toward their diet and lifestyle. The good news is that DNA is no longer thought to be destiny. Virtually all genetic glitches (called single nucleotide polymorphisms, or SNPs) express themselves through a dynamic interplay with lifestyle, diet, and environmental toxins.
In my experience, people who eat nutrient-dense, organic diets may or may not fare better on laboratory testing of nutrient levels than people who eat the SAD. This seeming injustice points to the silent undermining of health by decreased nutrient content of foods, malabsorption, genetics, and environmental stressors (toxins).
A Balancing Act
What is the best strategy to protect health? If your ancestors died after a long healthy life, if you haven't acquired chronic health problems along the way, if you eat organic food, eat 6 to 9 servings of fresh highly colored vegetables a day, eat additional servings of fresh fruits daily, don't live or work in a polluted environment, get regular moderate exercise, and avoid excessive junk food, you may be able to rely on your genes and lifestyle.
As for the rest of us, partnering informed dietary choices most of the time with the use of nutritional supplements to help cover the numerous influences of the 21st century that undermine health and nutrition may be the best tactic.
A condensed version of this article was previously published in Health Matters, a newsletter of Great Smokies Medical Center in Asheville, North Carolina, where Dr. Shuler practices with a focus on women's health care.
Dr. Shuler has published numerous theoretical and research articles, has coauthored the textbook Natural, Alternative and Complementary Health Care Practices, and holds an adjunct faculty position at Western Carolina University in North Carolina. Dr. Shuler's original holistic practice model, "The Shuler Nurse Practitioner Practice Model," is used worldwide.