Dear readers, this week’s column features the second of the top 10 nutrition questions I get asked. Tune in over the following eight weeks for the remainder. If you missed it, last week I covered soy products and those that are most and least beneficial for your health. Next week we’re going to talk about whether organic food is actually healthier.
If you are confused by conflicting nutrition advice or have lingering questions, this may help clear some of them up. If you don’t see your question answered, send me an email with your query and if I can I’ll feature it in an upcoming article.
Typically people are surprised to learn that I highly recommend dietary supplements - for pretty much everyone. The caveat here is that I recommend professional grade (high quality) supplements to be taken within known dosing parameters and purchased through a licensed professional with training in the therapeutic use of nutritional supplements. This includes orthomolecular practitioners, functional medicine practitioners, and naturopathic doctors. These professionals are qualified to guide you regarding the correct products and dosing for your specific health conditions and your specific biochemistry. With supplements (and diet) there is no one size fits all. We’ll unpack this as we go.
It’s important to recognize that some products are inherently superior. Items that come from other countries or unprofessional sources may not have the same manufacturing standards or use the most wholesome ingredients in some cases. We’ll touch on that, too.
So why the controversy?
The concerns I’ve heard typically come from dieticians/nutritionist and medical professionals who aren’t trained in the use of nutritional supplements. Or worse, articles online that rely on popular medical opinion rather than a systemic analysis of the data. I’ll address each in turn.
Isn’t food sufficient?
The first concern is that we should get our nutrients from food alone, as that is how we are designed. I have no qualm with that statement; we are designed to get our nutrients from our food (and sunshine). However, let’s consider if that’s actually happening today in Canada, given the way food is currently grown and processed.
In 2005 Cordain and Eaten et al. published a paper in The American Journal of Clinical Nutrition concluding that 50% of the population of the West are suffering from nutrition-based diseases due to changes in food staples and food processing practices. They find that this has “fundamentally altered” seven nutritional characteristics of our diets:
- glycemic load (the amount of sugars/starches we are exposed to)
- fatty acid composition (the types of fats we are exposed to)
- macronutrient composition (our protein, carb, fat ratios are different)
- micronutrient density (the amount of nutrients in foods are less)
- acid-base balance (this changes the mineral content of foods)
- sodium-potassium ratio (this essential mineral ratio is changed)
- fiber content (it is much less)
They conclude that at minimum 50 per cent of the population are suffering from deficiency states that result in disease. So, while we may be programmed to get our nutrients from our food, it’s not happening. In creating nutritional recommendations, we need to base those on the world we live in, not the one we feel is ideal.
Are they safe?
The second concern I hear is that because nutritional supplements aren’t tested and regulated by drug regulating agencies as therapeutics they are less safe than pharmaceuticals. However this is a completely inaccurate statement. Here I will default to the father of orthomolecular medicine, the late Dr. Abram Hoffer, from his testimony to the 38th Parliament Standing Committee on Health in the House of Commons on May 12, 2005. Dr. Hoffer was both a psychiatrist and a biochemist. Aside from being a very likeable prairie boy, he was an incredible physician and researcher and is the reason we have nutritionally fortified flour and cereal products today. The committee were reviewing Bill C-420.
Dr. Hoffer shares: “I think I am an expert in the field of vitamin therapy. The evidence is based upon the following.
Vitamins are generally safe, and when you have a chance to review all the evidence, you certainly can't disagree with that statement. Compared to food and drugs, it is amazing. In the United States alone, in any one year 150,000 people die from the proper use of medication. So I think they are essential, but I don't want to belabour that point…
I have treated perhaps 10,000 patients since 1950, first in Saskatoon, and since then in Victoria. I cannot recall any patient of mine whose death could be attributed to vitamins. It simply hasn't occurred. There's literature consensus. If you read the literature, you'll see there's no doubt that vitamins are safe.
The government has recognized this. The Government of Canada allows the fortification of food, and so does the Government of the United States.”
But you may ask, are nutritional supplements as tightly regulated as drugs? No, but there are regulations for natural health products. However, they’re different than those regulations used for pharmaceuticals, given the difference in risks. Consider the following:
In 2014, the Harvard University Centre for Ethics published a paper by Donald W. Light, titled, New Prescription Drugs: A Major Health Risk With Few Offsetting Advantages. In it he states, “Few people know that new prescription drugs have a 1 in 5 chance of causing serious reactions after they have been approved. That is why expert physicians recommend not taking new drugs for at least five years unless patients have first tried better-established options, and have the need to do so.”
He continues: “Few know that systematic reviews of hospital charts found that even properly prescribed drugs (aside from misprescribing, overdosing, or self-prescribing) cause about 1.9 million hospitalizations a year. Another 840,000 hospitalized patients are given drugs that cause serious adverse reactions for a total of 2.74 million serious adverse drug reactions. About 128,000 people die from drugs prescribed to them. This makes prescription drugs a major health risk, ranking fourth with stroke as a leading cause of death. The European Commission estimates that adverse reactions from prescription drugs cause 200,000 deaths; so together, about 328,000 patients in the U.S. and Europe die from prescription drugs each year. The FDA does not acknowledge these facts and instead gathers a small fraction of the cases.”
So back to the idea that vitamins are unsafe because they are not regulated as carefully as pharmaceuticals are, without the addition of hallucogens to my coffee, I can’t get to that conclusion.
So we can see they are needed because of the quality of our foods today, and they have a demonstrated history of being safe - so safe that they are added to our flours, our cereals, our dairy products, our baby formulas. So what’s behind the controversy?
Again, I’m going to default to Dr. Hoffer’s testimony.
“My estimate is that over 50 per cent of our population in Canada is suffering from one or more deficiency diseases.
You may wonder why that is the case, but I think one of the factors is that our medical students are not taught nutrition. In the past six years I have had 40 fourth-year medical students come to visit me and spend two days at my office in Victoria. They have come from all the universities - England, Scotland, Ireland, Australia, eastern Canada - and every time I asked them during those two days how many hours of nutrition they got, they all said, “one hour”. That's one hour in four years… That indicates that the medical schools are not teaching nutrition, which I think is one of the most important aspects of any modern practice.”
If our medical doctors do not understand nutrition and the importance of nutrients, how can we expect them to give an unbiased and informed perspective on the safety of nutritional supplements?
Both Dr. Hoffer and the researchers above believed that at least 50 per cent of our population is deficient in particular nutrients. But wouldn’t we see this on a grand scale then?
Again, from Dr. Hoffer’s testimony: “I want to give you just one recent example. You might have heard about a disease called rickets. It disappeared. It never appeared in Canada. Every mother used to know you had to give your children cod-liver oil; that just took away rickets. But since the dermatologists began to frighten us all that we would get skin cancer because we were getting too much sunlight, what has happened is that we're not getting enough vitamin D, and in the past three years 80 cases of rickets have been reported in Canada.”
A study on vitamin D deficiency in children in 2017 found there were 104 confirmed cases of rickets in Canada at that point. This is a completely preventable disease, which is easily avoided with adequate sunlight exposure in season and cod liver oil supplements in cold weather.
Pellagra is another such deficiency disease (vitamin B3) of the last century. You can read more about that here. Dr. Hoffer hypothesized that schizophrenia is a low grade form of pellagra. I would concur.
Beriberi is yet another.
Today we rarely see these recognized deficiency diseases in Canada, but we are seeing an extreme escalation in the rates of cancers, of inflammatory conditions, and of mental health conditions and diabetes. We don’t know the degree to which these conditions are actually attributable to deficiency states. Chromium and magnesium are just two nutrients that are very important in managing diabetes, for example.
Which supplements are necessary?
This comes down to individual lifestyle and dietary habits and biochemistry. Two people can have the exact same diet and lifestyle and still have different dietary needs. Again, quoting Dr. Hoffer:
“We have something called individuality; not every human is the same. We don't look alike, we don't think alike, we don't have the same genes, and there's no evidence whatever that we all have the same nutritional needs. They are different.
You might have a general, average population, perhaps 50 per cent or 60 per cent of the population, that would require a certain range of nutrients, and we have people with special needs, the elderly, women who are pregnant, women who are nursing, people who are sick, and children. We have a large part of our population, which I think runs around 50 per cent, who have special needs, and even with the best possible diet they cannot meet these needs. These are the people who have to have access to vitamin supplements.”
We know that Vitamin D3 is a very common deficiency in Canada, especially in the winter, in those who do not get regular, unfiltered sun exposure, and those with darker skin tones. Additionally, the recommended doses are currently inadequate, according to many experts. I recommend clients with deficiencies to take 5,000IU per day. I also recommend testing from a physician to know and monitor levels.
I also believe the B vitamins are a common deficiency. Anyone who suffers anxiety, low energy, and mood swings or who is a vegetarian or vegan can try a B complex to see if they notice improvement.
Magnesium, chromium, iodine, and zinc are also very common deficiencies I see in clinical practice. I believe many people suffer from mineral imbalances, as well, as seen by poor dentition and heart issues, and many also suffer from a lack of probiotic foods in their diet. These are essential for immunity, hormone balance, and healthy digestion and elimination.
I hope this is helpful. Tune in next week for a discussion on organic food. Is it actually better? As always, if you have a question for the column, you can write to me by email. If you want clinical care or to know more about what I do, you can find me online here.