Are Supplements a Waste of Money?

The media has been full of sensational headlines “Vitamins Are A Waste of Money” following a number of publications including those in the Annals of Internal Medicine , under the title, “Enough is enough: stop wasting money on vitamin and mineral supplements”.   In this article the authors stated that vitamin supplements has no clear benefit and might even be harmful.   While I am all for evidence based research there are some major flaws in their conclusions.  It is certainly based on selective reporting and analysis of complex research on the health effects of nutritional supplements and neglects to address more fundamental issues with current nutritional status and needs of many people.

It is also important to remember that commercially available multivitamins encompass thousands of products with varied ingredients that may differ in dosage and bioavailability. Simply stating all of these supplements must be a waste of money based on a few selective reviews is ridiculous.

Furthermore we know that nutritional status varies amongst individuals and you could also argue that multivitamin users are likely to follow healthier lifestyles anyway.  Collectively this makes research on multivitamins and multivitamin users difficult to interpret and generalisations about multivitamins potentially misleading.

Interestingly in one of the studies cited the use of supplements reduced the recurrence rate of cardiovascular events (such as heart attack, stroke, or heart surgery) by 11 percent, compared with a placebo but because this reduction was not statistically significant it was rejected. However just because something was not statistically significant does not mean the treatment was ineffective or dangerous.  The review also does not include numerous studies demonstrating clear positive effects. For example one study showed daily supplementation with 400 mcg of folic acid and 100 mcg of vitamin B12 significantly improved cognitive function in elderly men.  Another study showed that daily supplementation with 800 mcg of folic acid, 500 mcg of vitamin B12, and 20 mg of vitamin B6 slowed the rate of brain atrophy in elderly individuals suffering from mild cognitive impairment.

More generally there are many studies indicating benefits from supplements – For example in a study published in the June 2012 issue of the “European Journal of Nutrition,” German researchers reported that in a group of about 24,000 people, those participants taking vitamin/mineral supplements at the start of the study encountered a 42% reduced risk in all-cause mortality over the 11 years of the study, and a 48% reduced risk in cancer-related death.

It is also assumed that a good diet means you won’t benefit from a supplement. However a 2010 study from U.K. researchers found that young to middle-aged women taking a multivitamin/mineral supplement for nine weeks performed significantly better on cognitive tasks than women taking a placebo. The study mentioned that even healthy people may well benefit from supplements.

One of the reasons there may be differences between studies is the amount of vitamins and minerals used in some of the studies. In some of the studies showing more positive benefits the amounts of the vitamins used were in higher doses.  Just because a supplement contains the Recommended Daily Amount does not mean it is enough for your needs or to prevent certain health conditions – RDAs are simply amounts needed to prevent a deficiency not to provide optimum health.

Another clear factor not considered is the quality of the supplements used. You only have to look down the aisle of a health store to see the vast differences in supplements out there. Many of the cheaper products are made from non-organic minerals which are often poorly absorbed.  For example a calcium carbonate supplement is quite cheap but it is not absorbed by the body effectively.  Calcium citrate is approximately four times better absorbed than the carbonate form.

Remember we are all different. Our nutritional needs are different – they are influenced not just by your diet but your lifestyle, age and activity levels

Certain nutrients are known for their specific health benefits too – here’s just a few examples.

• Suboptimal intakes of folic acid are common worldwide and increasing folate though dietary supplements may reduce neural tube defects, correct megaloblastic anemia and improve blood levels of homocysteine, a risk factor for cardiovascular and other chronic diseases.
• Vitamin D deficiency is a pandemic health problem. Vitamin D deficiency causes rickets in children, exacerbates osteopenia, osteoporosis, and fractures in adults and has been associated with increased risk of common cancers, autoimmune diseases, hypertension, and infectious diseases.  To correct and prevent deficiency experts now recommend vitamin D supplements particularly over the Autumn and Winter months.
• Iron deficiency is the most common deficiency globally and resulting anaemia poses a health risk to reproductive age women.   Iron deficiency anaemia is related to several serious health complaints including fatigue, immune dysfunction, gastrointestinal disturbances, and cognitive impairment and can be prevented and treated with iron supplementation.
• Vitamin B12 deficiency is common in people over the age of 60 and may have serious consequences.  Deficiency and suboptimal intakes may have important implications for cognitive health in the elderly.  Supplementation is the preferred means of correcting and preventing B12 deficiency.  Vitamin B12 deficiency is common in vegans and supplementation is recommended daily as the main food sources are found in meat, fish, eggs, dairy rather than plant foods.

Many of the specific supplements I recommend in clinic have actually been used in scientific trials. For example NT lipid replacement has been shown to reduce fatigue in patients.  It has also been shown to reduce side effects during cancer treatment 

Likewise certain probiotic supplements I recommend have been widely studied for their benefits. Lactobacillus GG is the most prolifically researched probiotic in the world—over 400 studies have been published that document its remarkable immune-modulating properties.

Clearly you can’t supplement you way out of a bad diet – supplements have never been a substitute for a healthy diet and lifestyle but just because you are eating a good diet does not mean you won’t benefit from certain supplements – particularly vitamin D for example.

The National Health Surveys undertaken by the Government consistently reveal common nutritional deficiencies among many people including children and teenagers.  If you look for example at the Summary of 2008 to 2011/2012 UK National Diet & Nutrition Survey (NDNS) here are some of the Key findings regarding teenagers as an example. (you can access the survey results from this website)

• Teenagers eat 2.9 portions of fruit and vegetables – below recommend 5 a day.
• Teenagers eat 14 grams of oily fish compared to recommended 140 grams (1 average sized fillet of salmon is around 220 grams) – therefore omega 3 intakes much lower than recommended.
• Calcium recommended intake for boys and girls is 1,000mg and 800mg respectively. Research showed boys were achieving an average intake of 889mg and girls 670mg.
• Folate recommended intake for boys and girls is 233mcg and 186mcg respectively. Research showed boys ate a daily average of 200mcg and girls 186mcg.
• Riboflavin inadequate in comparison to ‘adequate’ for other B vitamins.
• Iron: 46 % of girls had intakes below the LRNI.
• Girls age 11-18 below LRNI for: vitamin A, riboflavin and folate.
• Deficiency risks in all age groups (including adolescences), for vitamin D.
• Evidence of intakes below the LRNI in a substantial proportion of older children – for some minerals, particularly magnesium, potassium and selenium.

If you do want to take a supplement make sure it is high quality and ideally supported by research.  Remember that if you are on medications check for any interactions before taking a supplement.