supplements — this week at FFFL — Food Fit For Living

"We cannot read... a verse without making a face at it, as if every word were a pill to swallow: he gives us many times a hard nut to break our teeth, without a kernal <sic> for our pains."

The expression - 'a pill to swallow', to which the adjectives 'bitter' or 'hard' were added in the following centuries by others - was first published in 1668 by the English poet John Dryden, in the sentence above. He was aiming his critique at fellow poet John Cleveland, using the pill as a metaphor for lack of substance, backed up by two food enforcers, one good and one bad. His words could just as easily be aimed at the modern supplement business in its relationship to 'real foods' - an industry which, poetry aside, relies almost solely on words to part us with our hard-earned dollars, with little science to back it up, little oversight to ensure its safety and honesty, and much (little-known) science to reveal its ineffectiveness in ensuring good health among the general pill-taking populace.

In plain 20th Century english, the vast majority of supplements don't work. Worse still, some deliver concentrated amounts of single nutrients that can actually harm us. The trick, as with everything health related in post-industrial America, is parsing science from market-speak. This week's post will share what we know about supplements, and how best to think of them as partners in health.

But first: foods. Real food can, should and must be thought of as your de facto source of complete and balanced nutrition. Eat real foods, and process them minimally. You know the rules, and have doubtlessly heard them ad nauseum, from me and from others, but they are worth repeating here, with brief explanation as to why you should consume them, and how:

On a daily basis, eat a highly varied diet of vegetables, fruits, whole grains, beans, nuts, seeds and oils - in that order (meaning the most of the first and the least of the last) - to ensure you receive adequate levels of plant-based vitamins, minerals, proteins, fats and carbohydrates. Why daily? A majority of vitamins are water-soluble and thus must be consumed daily in order for your body to get what it needs to thrive, since what is not immediately absorbed is flushed out. Dark leafy greens are the world's densest and broadest sources of these. A complete list of the 81 foods we consider healthiest - with a complete list of every nutrient each contains, and in what amount - is the basis of Week 9's post, here. Further, both proteins (in the form of amino acids), and carbohydrates (in the form of glycogen) are two essential nutrients whose ability to be stored by the body is limited. Similarly, minerals are used by the body for countless processes. Think of them as workers keeping a machine's parts moving - feeding adequate amounts of themselves to blood cells, tissue and bones as necessary, given the body's specific demands at any given time. Because, like other nutrients, minerals are used up, often to depletion, they must be replenished daily. Why in that order? First, the body uses carbohydrates as its primary source of energy, such as those in vegetables, fruits and grains. Second, vegetables and fruits comprise the primary dietary source of vitamins and minerals. Third, we require lesser food quantities to ensure adequate muscle-building, tissue- and organ-regulating protein; and lastly, because we need the least volumetric quantities of heart-healthy fats to ensure nutrient absorption and adequate lubrication of the body's internal tissue.
Every 2-3 days, supplement the foods above with healthy fish such as wild Alaskan Salmon or Pacific Sardines, to name two of the healthiest (and least polluted) sources of vitamins B12, D, choline, protein and good fats, because these are difficult (protein/good fats) or impossible (B12/D/Choline) to find in plant-based foods. Why every other day? The body has shown it can store vitamin D for up to six months (in adipose tissue - aka fat) and store vitamin B12 for years (in the liver). Ditto good fats, which like any form of fat, the body has an unlimited ability to store. Therefore, these nutrients needn't be consumed daily, but since they, like any other fuel source, are depleted by the body as needed, they must be consumed regularly.
If for whatever reason you really don't like fish, or just find yourself in a place where it's unavailable, then supplement your plant-based diet with by-products and meats from pastured/pasture-raised land animals, like eggs (with the yolk, which contains most of its nutrients), pure yogurts (with minimal to no added sugars - yogurt naturally has fewer than 10g of sugar per serving), cheeses (raw and unpasteurized if available in your state) - and finally animals, if you must, on occasion, for adequate intake of vitamin B12, choline and protein, although the latter two can be found in equal or greater doses in beans, shrimp and scallops - all of which are healthier. Why pastured or pasture-raised? As we saw in depth in Week 4's post, this is the only term that guarantees the animal ate its natural diet in a natural setting, which has a very real impact on the animal's own health on a molecular level. Pastured animals - and their by-products - have far higher densities of the nutrients we rely on them to provide, over conventionally raised or even organic fare. Ironically, this is the only term that is not governed or defined by the US government. As such, grass-roots farmers who have bucked the trend toward (heavily subsidized and more heavily under-regulated) industrial farming have come up with this term as a fancy way of saying 'the way animals were before we domesticated them'.

Now, for the supplements. An increasing and unequivocally consistent body of science is accumulating, and like John Dryden's critique of his nemesis, it does not favor the pill.

Why is 'real food' better than supplements? There are several reasons that we will explore here:

Supplements are not regulated. The FDA inspects just 1% of the 65,000 supplements on the market, according to Todd Runestad, editor of the trade publication Functional Ingredients and the Engredea Reports. Those of us in New York will remember the recent scandal exposed earlier this year, when the State Attorney General examined supplements sold at the country's largest retailers, like Walmart, Target, and GNC, and found that they contained little to none of the ingredient they peddled, and often contained products that provoked allergies or other health risks instead. A great New York Times article from February 2015 is linked here. In just one example, Walmart's ginkgo balboa contained no ginkgo balboa, and was instead comprised of powdered radish, houseplants and wheat - in spite of claiming it was gluten-free. Taking it thus poses a real health risk to people with Celiac disease; and offers zero benefit to anyone else. According to the article, it found many supplements in GNC that contained legumes - a class of plants that poses a hazard to allergy sufferers, like those who are allergic to peanuts. In fact, according to healthline.com, 5% of all US grocery expenditure is on supplements, from which grocers make 10x the profit as on real food. James Johnson of the Nutrition Business Journal says that supplements keep many small grocers in business. The food business trend both here and among food product makers is consistent: the more unnatural the product is, the greater its profit margins for not just shareholders but for the middleman and retailer, as well. In market-speak, this is called "value-added", and it applies broadly, whether to 5 cents-worth of high-fructose corn syrup being resold as a 99 cent soda, or to 3 cents-worth of mulched up houseplants being resold as a $9.99 container of ginkgo bilboa. Thus commerce is almost always stacked against nutrition when it comes to feeding you and your family. The fact is that whatever is mulched up or concocted in the laboratory and stuffed into a pill casing on the factory floor before being shipped to a retail shelf where it sits, at great length, until purchased, is about as close to natural as an aging hollywood star. Natural once, perhaps, but at this stage unrecognizable.
Natural nutrients, whether vitamins, minerals or herbs, are delivered in their natural plant form with a variety of co-dependent chemical ingredients that are typically isolated in supplement form, thereby reducing or eliminating its efficacy. In one example, feverfew is an herb used historically to treat migraines. The plant consists of dozens of chemical components, of which one - pathenolide, is assumed by pill-makers to be the relieving agent. Assumed. In fact, product makers and independent testers cannot demonstrate feverfew supplements' effectiveness - in spite of the fact that it is on sale on shelves and its makers make claims, relying on the common lore surrounding the root plant to part consumers with their dollars. The fact is that one could make a similar claim for the overwhelming majority of supplements on shelves. In general, they are ineffective, deceitful, or both.
Related to the point above, when we eat a food, we are receiving far more than the benefit of one ingredient/nutrient therein. Natural foods are complex systems that deliver a multiplicity of vitamins, minerals, proteins, carbohydrates and fats whose interaction is often critical to their food value to humans, including our bodies' success in absorbing them. Furthermore, real foods deliver thousands of micro-nutrients whose names that we as consumers may not know but whose presence supports the body's health, like phytonutrients, carotenoids, retinoids, phytoestrogens, and polyphenols, to name a few such categories. In addition, real plant-based foods are full of fiber, which is critical to the health of our digestive system and its breakdown, expulsion and delivery of nutrients to our body's systems. Thus single-sourcing or targeting a laboratory supplement as the source of nutrition is not only ineffective, it denies the body the foundational value of the complex foods from which they are distilled.

So while we cannot think of pills as replacements for food, we can think of them in two ways that are truly helpful in terms of human diet:

To fill in the nutrition gaps left by an inadequate or incomplete dietary intake of real foods. In this sense, supplements in some forms may provide us with a stopgap, such as that of those of animal-only nutrients B12 and choline for those with a vegan diet; vitamin D3 for people in northern climates who don't get enough exposure to D3-synthesizing sunlight; or Folic Acid in women who are pregnant and want to guard against neural tube defects, to name just three examples. Again, it's important to re-state here that the naturally-occurring form of any ingredient/nutrient is the best form, and supplements should be thought of as such - supplementing your diet in the case that a gap exists. Even there, some are effective - and backed by science - while others aren't. A phenomenal and beautiful interactive graphic that demonstrates which supplements science supports can be found here. In it, just four of the myriad available supplements are strongly supported by science: garlic, niacin (B3), probiotics and zinc. Yet here again, all four are widely available in 'real' form: garlic as such, niacin in turkey, chicken, beef, salmon, sardines and lamb - and in lesser concentration in plant-based foods like sweet potatoes, peanuts and brown rice; probiotic bacteria in fermented foods like yogurt, kefir, kimchi, kombucha, pickles and sauerkraut; and zinc in beef, lamb, beans of all kind, scallops, shrimp and turkey. So it's frankly easy, in a normal healthy diet, to glean all four of them in forms that provide great culinary enjoyment, to boot.
To provide additional support for people with specific medical or health conditions for which targeted dietary supplements can act as palliatives or prophylactics. Let's look again at niacin (vitamin B3). A 2010 review by the NCBI at the National Institutes of Health found that niacin supplements resulted in significant reductions in the rate of strokes or heart attacks for those who suffered from heart disease - yet in spite of this, only a minor drop in rates of mortality from same. Does that make it worth taking a niacin supplement? Absolutely. Here again, however, niacin is widely available in 'real foods', as we've seen, and so an informed sufferer of heart disease has many ways to ensure adequate niacin intake, if he/she were to know how to source it, as in our Week 9 food list. A second - perhaps better - example can be made of the joint pain medications glucosamine and chondroitin. Aimed at sufferers of joint pain - especially those caused by osteoarthritis (OA) - the NCBI at NIH reports 'statistically significant improvements in joint space loss, pain and and function here. As a 46-year old adult in excellent physical shape and with a diet better than that of most Americans, I have OA of the hips, and have been taking the supplement daily for nearly 10 years, following a diagnosis (a 'freak accident of DNA', in my doctor's own words) and a recommendation of urgent and immediate hip replacement, due to the fact that I had (and could see in my own x-rays) zero cartilage between my hip bones, lots of grinding, and I had been suffering increasingly until I finally went to the doctor to see what was causing it. 10 years later, I maintain a pain-free life, as long as I take the supplements, without having had the surgery. On rare occasions when I forget to (or cannot) take the pill for more than 3 days, I begin to feel dull but consistent pain, which goes away within a day of resuming my regimen. So in my personal experience, it both tangibly 'works' and is supported by science. Moreover, there are no food sources of glucosamine, which occurs naturally in the body, and in the shells of marine creatures, which make up the bulk of supplements. So here, a supplement is effective and necessary, unless you suffer from shellfish allergies.

So, let's recap the reasons supplements don't work, by and large, as a viable strategy for nutrient intake in 'normal' people - those without specific health conditions. 1. Supplements are big business: $17 billion annually, according to Dr. Joseph Mercola. He goes on to say that in spite of this, the rates of some chronic diseases have not diminished, while the rates of others continues to increase. The reason for the existence of supplements, by and large, is that supplements make their makers money. 2. Supplements ignore the fact that in naturally occurring sources, their 'key' ingredients are one among many that require interaction in order to be effective. 3. Supplements are 'single nutrient' palliatives. Real foods contain many nutrients that benefit the body broadly - not in a limited way. 4. Science does not support the vast majority of claims of efficacy. Again, take a look at the interactive graphic here to see which supplements are supported by current science, or lack thereof. The graphic is fantastic. 5. Supplements are not regulated. They often fail to include the ingredients they peddle; and often include other harmful substances as either fillers or substitutes - making them not only deceitful, but potentially (and often) harmful, as exposed by the New York State Attorney General at the outset of 2015.

We support your health, as we do our own. Supplements have a place in human health, but it's one that's far smaller and for far fewer people than the 1 in 5 Americans who currently rely on them to guarantee their dietary health and well-being. I take them for my hips, much as others take them for medical reasons that real food cannot help, or as a 'belt and suspenders' strategy, as in women's intake of folate while pregnant. In either case, do the research, or refer to our Week 9 post, in which we list every essential nutrient in the 81 foods we consider healthiest. These are readily available real foods that provide countless ways to eat your way to a delicious state of (largely) supplement-free health.

What are vitamins, anyway? We all know we need them. We know that malnourishment stems from a deficiency in them, among other nutrients. Many of us even have a vague sense that we’re probably not getting our full dosage on a regular basis, but rationalize, “Well, I’m still alive and kicking, so does it really matter?” Maybe the word conjures up memories of choking down massive, oddly metallic-tasting pills or dinosaur-shaped Flintstones tablets. Maybe you’re one of those folks who swears by loading up on massive doses of Vitamin C at the first sign of an oncoming cold. But really, if you had to explain to someone who had no concept of what a vitamin is, could you tell them where they’re found, what they do and why they are so crucial to the processes and functions that keep our bodies running? Could you explain to that person why you’re downing all that Vitamin C, in the hopes that you can fight off that cold before it fully sets in?

Merriam-Webster defines a vitamin as ‘a natural substance that is usually found in foods and that helps your body to be healthy.’ Seems straightforward enough. But what about all those letters: A, B, C, D, E and K? And what happened to F, G, H and I? To muddy things further, some vitamins have alternate names, like Retinol – one form of Vitamin A. In addition to aliases, some vitamins are broken down and assigned numbers, like B-Complex vitamins, which include a range of distinct but co-dependent nutrients – 1, 2, 3, 5, 6, 7, 9 and 12 – aka Thiamin, Riboflavin, Niacin, Pantothenic Acid, Pyridoxine, Biotin, Folate and Cobalamin, respectively.

Vitamins—like our bodies themselves—are complicated, but the good news is you don’t need to be a medical professional to understand what you need and be confident you’re doing right by your health. As long as you can familiarize yourself with a few basic concepts and terms, and ensure adequate intake of a broad variety of real, whole foods in your diet on a regular basis, you can be reasonably confident about your vitamin levels.

One critical thing to remember about vitamins, as with any other nutrient: intake is not the same thing as absorption. For example: if you swallow a pill whose label tells you it contains 4,000% of your Dietary Reference Intake (DRI) of vitamin ‘X’, by no means can you take it for granted that you’ve actually supplied your body with 4,000% of that vitamin. For starters, your system has a limit to what it can absorb for immediate use on its way through your digestive tract before being excreted. On average, foods take anywhere from 30-48 hours to pass through our system before being eliminated; and specific nutrients have particular locations within the digestive tract where they are absorbed. Since water-soluble vitamins in particular cannot be stored by the body and pass relatively quickly through your system, and since the body can only absorb so much at once, then often, the overabundance of a nutrient is excreted before it has a chance to ‘do the body good’.

Another important thing to note: if you’re relying on artificial supplements, you need to know whether it is in a form that can be absorbed and used by your body – aka bio-available. At the health food store or pharmacy you’ll find aisles full of lab-developed – i.e. synthetic – versions of every vitamin, but in many cases our bodies don’t even know what to do with them. An excellent example: we’ve been taught that Ascorbic Acid and Vitamin C are the same thing, ascorbic acid being what you’d find in those little brown bottles on the shelves. Unfortunately they are not in fact the same substance and studies show ascorbic acid doesn’t provide any of the same health benefits as actual Vitamin C as found in natural sources. In fact, these pills pass through your system without benefiting it in any way. Some call this ‘snake oil’. Thus Vitamin C tablets – whatever the dose – unfortunately won’t save you from that cold. This is why we stress the importance of obtaining vitamins from actual food sources – sources our bodies recognize and which allow us to effectively process, absorb and synthesize what they need.

Most doctors and nutritionists agree that synthetic supplements are inferior to a healthy balanced diet for gleaning your nutrients, and many even argue that some if not all of those benefits pass through you unabsorbed. Conversely, there are vitamins (the fat-soluble variety to be specific) that don’t get flushed when they should — instead they’re stored for later use, contributing to hyper-dosages that can actually become toxic in excess, or that can throw your body’s natural balance. We will discuss this in a minute. Another important thing to remember about vitamins is that more is definitely NOT always better. Even when consumed from healthy sources, vitamin excess can cause damage as readily as can a deficiency.

We’ve created a comprehensive chart as an at-a-glance reference to explain the specific roles each vitamin plays in keeping us healthy, including the body systems and functions with which each one is most closely associated; daily recommended doses for average healthy adults; and the healthiest sources for obtaining each. One caveat: there are plenty many situations in which your ideal consumption levels will vary from the generic, including, health conditions. The levels we have included in our chart are for the ‘average’ man or woman.

Water-soluble vs. Fat-soluble

Water- and fat-soluble vitamins are exactly how they sound: vitamins that dissolve in either water or fat, respectively. If you’re wondering why this is important, picture a bottle of olive oil and vinegar salad dressing. The oil sits atop the water-based vinegar in a distinct layer, because the oil is less dense than the vinegar. As we all know, oil and water (or vinegar) don’t mix. You can shake that bottle all you want to form an emulsion (i.e.: combine them), but if you let the bottle settle, it’ll invariably separate once again. However, if you were to combine two oils – say olive and walnut – they would have no trouble bonding. Ditto vinegar and lemon juice – both water-based foods. For the record, this is not about salad dressing – it’s just there to illustrate a point.

What we are saying is that fat-soluble vitamins need to be consumed with fats in order for the body to absorb them; otherwise they pass through unused. By contrast, water-soluble vitamins are readily absorbed without additional need, because water is readily on hand for use with digestion.

To wit: all B Complex Vitamins and Vitamin C are water-soluble, so they dissolve in the water in your body as soon as they’ve been ingested. Unfortunately, this readily available format also means that they’re easily flushed out of our systems, which means it’s important to make sure we get adequate amounts of each on a consistent, even daily basis. Fortunately, because of their transient nature in our body, it’s extremely difficult to consume too much of these vitamins from food sources, as any excess is excreted as waste, obviating the need to worry about toxicity.

Fat-soluble vitamins A, D, E and K, on the other hand, are dissolved and absorbed by fat globules that are present in our digestive tracts while passing through, if present. This is why it’s important to consume these vitamins with a healthy fat source like avocado, healthy oils, fatty fish or full-fat dairy. After being broken down in the small intestine and assimilated into the globules – called Triglycerides – the vitamin stores then make their way into the blood stream to be carried away to other parts of the body and stored in various tissues. Unfortunately the body doesn’t do a great job of regulating these stores once they’ve been deposited, so the caches grow unchecked and can reach toxic levels if our intake is too high (aka hypervitaminosis.) Thus it is extremely important to be informed about optimal intake levels to ensure we don’t exceed these amounts. Excess intake is relatively easy to avoid when relying on natural food sources for our vitamins rather than on supplements, both because real foods typically don’t contain concentration levels of vitamins as extreme as in supplements; and because our stomachs become full long before we can consume enough food to do vitamin-based damage. On the reverse end of the spectrum, vitamin levels can easily become deficient if our fat intake is too low or fat absorption is compromised, such as in the case of digestive conditions (i.e.: Crohn’s Disease, IBS or Ulcerative Colitis), or by our selective exclusion of food groups, such as when we follow diets or make other dogmatic food-based lifestyle decisions.

As far as cooking and storing goes, water-soluble vitamins tend to be highly sensitive to light, heat, and of course time, so it is important to try to consume foods in their freshest state with minimal cooking, and to store them in cool, dark places when you won’t be eating them immediately, which slows the decomposition of these nutrients. Fat-soluble vitamins tend to be more stable and can withstand more abuse with regard to cooking, though they too are sensitive to light and should be stored accordingly. Keep in mind, however, that when working with real, whole foods, they tend to boast a whole swath of different vitamins, as well as minerals and other nutrients, so it’s generally a good rule of thumb to try and keep these foods relatively intact – i.e.: minimally processed or altered – to minimize damage. Interestingly, some foods benefit from cooking, as doing so can raise nutrient levels and/or bio-availability (the ability to be absorbed) more so than it their raw state. You may have heard that the tomato, for instance, is very high in the phytochemical lycopene, but may not know that the amount of lycopene (and its bio-availability) differs greatly whether consumed raw or cooked. One study conducted by Cornell University showed that while Vitamin C levels unfortunately drop by up to 30% during cooking, lycopene levels increase by 164% after a half-hour. This provides us with an excellent example of why we should vary our methods of food preparation, since in many cases the levels of nutrients are affected by how we consume them – often in opposite directions.

Vitamins in Pill Form

We at FFFL are not doctors. We are people who have a passion for healthy eating and a penchant for doing research to feed our knowledge. Naturally we understand that our readers come from all walks of life: male, female, a wide age range, various body types, health conditions and concerns. It is important that you use your best judgment when making decisions for yourself and your family. That being said: from what we – like others – have researched, pills and supplements don’t seem to be the answer. They are synthetic, and their bio-availability, as we’ve seen, doesn’t match that in real foods. Thus, supplements should be relied upon only if your health needs or lifestyle choices really do pose the risk of undermining your ability to otherwise obtain the nutrients you need, from whole foods. This is certainly the case with veganism and vegetarianism, in which the lack of good sources of critical fats, as well as choline, B3, B6 and B12, in particular – all overwhelmingly or exclusively found in animals – can pose a real challenge to ensuring your body gets what it needs to be healthy. This is why we emphatically advocate nutritional completeness over blanket lifestyle choices.

Vitamin-Enriched Foods

As with pill form, vitamin-enriched foods are synthetically added post-processing, most often because industrial processes strip source foods of most health benefits. For example: wheat. Its grain, composed of the germ, bran and endosperm – which sit at the base of the soft ‘crown’ atop each stalk – contain the bulk of its nutrients. The vast majority of wheat-based products in the United States – the breads, pasta, baked goods and snack foods – are milled to 60% extraction. This means that 40% of the original grain has been removed. Sadly, milling also correlates to a 50% loss of its store of vitamins B1, B2, B3, B9 (folate), and E – not to mention an equal loss of other minerals and nutrients, like calcium, phosphorus, zinc, copper, iron, and fiber. By contrast, whole grain foods – not to be confused with whole wheat flour products, as flour of whatever type is milled as described above – maintain 100% of its nutrient integrity. This is why since 1941, the US government has instated laws that require flour-based products be enriched to replace what has been lost. Enrichment means the addition of synthetic forms of vitamins and minerals, as with pills. We’ve seen already that these are poor substitutes to real food sources, with their lack of bio-availability. The same strategy has been widely applied to dairy, due to the destructive nature of pasteurization, as we saw in Week 4’s post; and to eggs, also covered in that post.

The answer, predictably, is to eat real foods that provide ample vitamins in their full complement and in combinations that ensure their absorption and utility.

Week 10: Real food or Supplements - Fact vs. Fiction

Week 6: Vitamins - A Comprehensive Guide