I’m often asked about my attitude to nutrient supplementation. Do we ‘need’ to supplement, is how it’s often put to me. My answer is that it is probably entirely possible to get all what we need to prevent overt nutritional deficiency diseases such as scurvy and beri-beri. However, less obvious deficiency states may occur quite easily that might impact on an individual’s ability to be optimally nourished and therefore enjoy optimal health. Also, there is evidence that, in the UK at least, the nutritional content of the diet has declined considerably over the last few decades. So, bearing all this in mind, I am generally warm to the idea of using nutritional supplementation, especially as an adjunct to (rather than a replacement for) a healthy diet.
However, not everyone is as enthusiastic as I with regard to the practice of nutritional supplementation. I often hear people contend that there is no evidence for it, and that taking supplements only serves to make expensive urine.
This attitude may come, at last in part, from a lack of evidence in the form of randomised controlled trials ” considered the gold standard of scientific studies. But, the reality is that very few such trials seeking to elucidate the benefits (or otherwise) of multivitamins and minerals or single nutrients have been done. So, let us not ‘conclude’ that nutritional supplementation doesn’t work when it has not, it seems, been adequately studied.
And furthermore, even when such studies are done, they are not without limitation. One major issue here is that many health conditions have considerable ‘latency’ ” which basically means they develop gradually over many, may years. Because of this, any benefits of nutritional supplementation may not materialise for many, many years. So studies may not be conducted for long enough for any benefits to come to fruition.
Also, there are certain ‘methodological’ issues to consider, which include the dose of nutrients and the form they come in. Using too little of a nutrient, particularly in a form than is not particularly utilisable by the body, may produce results that don’t say much about what benefits may be had by having decent doses of more ‘bioavailable’ nutrients.
Despite these limitations, there is indeed some evidence that nutritional supplementation can have benefits for health. Just such a study was published this month in the American Journal of Clinical Nutrition [1]. In this study, the effect of nutrient supplementation was assessed on the brain function of about 800 Australian and Indonesian children. For a period of a year, each child was given a daily drink containing:
1. the nutrients iron, zinc, folate, and vitamins A, B6, B12, and C
2. the omega-3 fats DHA and EPA
3. both the nutrients and the omega-3 fats
4. no additional nutrients (placebo)
The cognitive function of the children was assessed at the outset of the study, as well as at 6 months and the conclusion of the study (1 year).
Omega-3 supplementation was found not to enhance brain function, though the nutrient (vitamin and mineral) supplementation was. Those supplemented in this way saw significant increases in scores on tests of verbal learning and memory.
It is perhaps worth noting that the dosage of omega-3 used in this study (actually 88 mg per day of DHA and 22 mg per day of EPA) are much lower than the dosages generally believed to have benefits for the brain. So, not only does this study support the concept of nutritional supplementation, it aptly demonstrates one of the potential limitations of trials of nutritional supplementation too.
References:
Osendarp SJM, et al. Effect of a 12-mo micronutrient intervention on learning and memory in well-nourished and marginally nourished school-aged children: 2 parallel, randomized, placebo-controlled studies in Australia and Indonesia. Am J Clin Nutr 2007; 86(4): 1082-93.
It think there is a place for supplementation especially if eating heaps of refined carbohydrates and sugar.
In Good Calories, Bad Calories – Gary Taubes says “animal products contain all the amino acids, minerals and vitamins essential for health, with the only point of controversy being vitamin C. And the evidence suggests that the vitamin C content of meat products is more than sufficient for health, as long as the diet is indeed carbohydrate-restricted, with none of the refined and easily digestible carbohydrates and sugars that would raise blood sugar and insulin levels and so increase our need to obtain vitamin C from the diet”.
And for weight loss:
“A calorie-restricted diet that cuts all calories by a third, as John Yudkin noted, will also cut essential nutrients by a third. A diet that prohibits sugar, flour, potatoes, and beer, but allows eating to satiety meat, cheese, eggs and green vegetables will still include the essential nutrients, whether or not it leads to a decrease in calories consumed”.
Sue, are you worried about the apparent cancer risk of eating so much meat ? Or does restricting carbohydrates avoid this risk do you think ?
Does “restricting carbohydrates” also include avoiding eating fruit ?
I am a lactovegetarian by tradition as are many million others in India.
Outstanding scientists, mathematicians and statisticians have been produced by these people over a period of time.A few may have become carnivorous later but not in their childhood, in which the food intake itself was often inadequate many decades ago. They were often short and certainly thin framed; in other words they were somewhat physically stunted yet this did not affect their mental capacity seriously because they were often toppers in their classes in school and college. But most, in their older age were prone to heart disease, diabetes and hypertension, partly because of a more refined diet and a more sedentary life.
I suspect from my observation that the nutrients in the foods we eat have also gone down. I do not agree with Taube’s articles which have appeared in the US press for he seems to be unfamiliar with societies with a long tradition of vegetarianism. A good complex carbohydrate diet (which includes whole grains such as unpolished rice, wheat, barley and millets, beans and a variety of pulses and plenty of vegetables and fruits(preferably organic) can be the basis of a good and somewhat cheap diet.The only possible problem could relate to B12 but that has not been evidenced in terms of a adverse impact in these people. As most Indians seem to be unaware of their dietary needs and the medical profession is largely uninterested in nutrition, we do have a serious problem of lack of awareness. Combined with the availability/convenience of refined processed foods(with excessive amounts of sugar salt, fat and reduced nutrients)in the market and Government subsidy for less complex grains, sugar and oil ; there is a need for supplementation, especially in a from which can be absorbed easily and made from natural sources to the extent possible.This is critical in developing countries.At least in the case of a folate which seems to meet critical needs of various age groups and which is cheap policy intervention is urgently needed.
varadachary
sue – what meat products are u referring to – there is NO vit c in plain meats like beef, chicken etc. Liver contains vit c so is that what you are suggesting?
James, I don’t think you get cancer from meat – processed meat – most probably. Cancers feed on sugar.
You can eat fruit on low-carb – just choose low-sugar types.
When you first low-carb you go down to a strict level to get ketosis started. You can be real strict (20g carbs) until you get to goal or you can go higher. Its a personal decision. When you reach maintenance you work out the level of carbs that suits your lifestyle.
In Good Calories, Bad Calories – Edgar Gordon and endocrinologist and clinician (around 1963) designed a diet based on the carb restriction science – patients were first put on a 48 hr fast – “not to produce a spectacular loss of weight, but rather to break a metabolic pattern of augmented lipogenesis (fat synthesis and accumulation) and then protein and fat as desired but limited carbs to mimimal fruits, green vegetables and half slice bread daily”.
Chary, I’m sure Taubes is familiar with those vegetarian societies. He recommends reading Dr Weston A Price’s book and a lot of the traditional people Price visited ate a lot of carbohydrates without ill-effect. They were of course un-refined and these people knew how to prepare them – soaking, fermenting etc.
The main point that Taubes is making is that we have falsely being told to eat low calorie, low fat and high carb for health when the science just isn’t there to back it up. There is a lot of science on low-carb but the public was not told. Diabetes and heart disease are out of control possibly because the advice to maintain/achieve good health is incorrect. Also, in regards to obesity – rather than blame the over-weight person on his/her weight gain as self-inflicted (sedentary, over-eating) it looks at why these people are sedentary and why they may over-eat. What is driving their bodies to keep storing energy and why is it hard for them to access that stored energy?