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Should you be Supplementing?
by Dr Rowena Nicholson MBBS MRCGP DRCOG DipPCouns DipNSpH DipTHY&R BSEM member
As someone who has had a lifelong interest in natural health, I would like to think that it is perfectly possible for us all to be able to obtain everything that we need from a well balanced healthy diet. However, there is overwhelming evidence to suggest that in this day and age, it is not so.
So how could this have come about? Surely we must have evolved to be able to obtain what we need from local, easily obtainable food sources? There are many and complex reasons why this is not so. To start with, we do not eat as much as our ancestors did, which means that along with fewer calories, we are taking in less nutrients. With the current obesity epidemic, it may surprise some to learn that we currently eat about 800 calories a day less than we did after the second world war, and possibly a couple of thousand less than in the Stone Age. The reduction in our activity level, and therefore our food intake, has come about too rapidly for our systems to adapt from an evolutionary point of view.
Secondly, the soil is now lacking in nutrients. This is in part due to intensive monoculture. Crops which grow rapidly due to artificial fertilisers can strip trace elements from the soil, and these trace elements may then be lacking in our food. Artificial fertilizers and pesticides can kill the mycorrhiza which help plants to absorb trace elements from the soil. However, the lack in the soil is also due to the fact that we no longer recycle all human waste back into the soil, so we are not replacing what we are taking out. Some of our food is even grown hydroponically, so it has never been in contact with soil.
Much of the food that we eat is imported, so it’s nutritional value may have declined during months of travel, and it may well have been picked in an under ripe state and ripened with artificial chemicals. Processing further reduces the nutrient value of our food. We also eat many foods that cost the body a lot to deal with or detoxify, and these foods often have a low nutritional value in themselves. For example, we have not evolved to be able to deal with large quantities of sugar, hence the ever rising levels of diabetes. (In fact, some now consider sugar intake to be on a par with smoking in its effect on health). Alcohol and coffee use important nutrients in the detoxification process, as do so many of the drugs and various chemicals we take on board, either in our diet, or through the airways and skin.
In general most people live stressful and unbalanced lives. Stress in itself leads to increased nutritional demands. We are also paradoxically living longer, and we become less efficient at utilising nutrients with age.
So what should we be doing? That is a more difficult question to answer, but clearly we need to be doing something. Many people look to the RDAs (recommended daily amounts) found on supplement packaging. However, these only suggest the minimum level of nutrient intake needed to prevent gross deficiency diseases. For example, a gross vitamin C deficiency leads to scurvy, but vitamin C is one of the most important anti-oxidants in the body, and for optimum health it is needed at a higher level than that needed to prevent scurvy. Knowledge about nutrition, as with medicine, is in its relative infancy. Scientists are discovering more important functions and inter-relations all the time, and as a doctor I find it staggering that we pay so little attention to the evidence that is out there. However, such research currently remains at the fringe of medicine because it is often drug company funding that drives and promotes medical knowledge and interventions.
The optimum amount we need will vary according to our age, gender, stress level, overall health, what medication and toxins we are subject to and of course our diet. Anyone who has a particular health problem would benefit from the advice of a nutritionist, as nutritional supplements can be used as a treatment, which is different from the lower levels used in general supplements. When used in this way, one is in effect using nutrients like drugs, albeit natural ones. I say this only to emphasize the fact that it is an intervention, and as with most treatments anything that has the potential to help also has the potential to harm; there is also the potential for side affects and interactions with medication. The right nutrition can have a great impact on many health problems, from ME/chronic fatigue syndrome, autism, hyperactivity, cancer, osteoporosis, arthritis, infertility, depression and anxiety, to more minor complaints. Whilst I do not believe that nutrition is the whole answer to every health problem, I nevertheless think that it is an important part of any health plan, and it is included in the ‘Balanced Medicine’ approach we offer at The Centre for Balanced Medicine. But even if you are young, fit and healthy, you ignore your nutrition at your ultimate peril. Many of the health problems that our culture accepts as the inevitable consequence of ageing are in fact due to poor nutrition, and prevention is better than cure.
There is increasing evidence that we age at the rate of our mitochondria. Mitochondria are where energy in the form of ATP is produced at a cellular level. This ATP powers most functions within the body. Mitochondrial DNA is loose, unlike nuclear DNA which has a protective package. This susceptibility to damage, along with the fact that we cannot repair mitochondrial DNA (again unlike our nuclear DNA) means that if our ability to produce ATP declines, so do our energy levels and our ability to power other cellular reactions. This is seen most dramatically in chronic fatigue syndromes, when ATP production is poor, but it is also seen with age. There are many important nutrients involved in ATP production, and by ensuring that these are present, as well as reducing damage to mitochondrial DNA through good antioxidant levels, we can preserve or improve our mitochondrial function and ATP production. One of these important nutrients is magnesium, and this is one of the commonest deficiencies in the UK in those presenting with health problems.
Magnesium is therefore number one in my ‘must have’ supplement list. As well as its role in ATP production, it is an important nutrient in bone health, along with calcium. It also helps with menstrual and pre-menstrual problems. It may be poorly absorbed orally, and some people with specific deficiency problems, such as in chronic fatigue may need injected magnesium for a while. It is surprisingly well absorbed through the skin, so there was some sense in the old fashioned Epsom salts in the bath. However, care needs to be taken if you have renal failure.
Next in my supplement wish list is a good quality multivitamin and mineral daily, as an insurance policy to cover most things. (For example in the UK: Biocare multivitamin/mineral, Quest super multinutrient, or a product with a similar range/dose of nutrients).
Zinc is another mineral which is commonly deficient. Indeed, amongst patients suffering from allergies, deficiency is almost universal. It has important roles in the immune system, reproduction, growth and development, and is also an antioxidant.
Vitamin C is an important and cheap antioxidant. Anti-oxidants mop up free radicals, which cause a lot of damage to our cells. I would suggest 1g daily of a slow release form, or 500mg twice daily of the ordinary sort for adults.
Fatty acids are the fats which we cannot synthesize ourselves; they are essential components in the cell membrane. Overlooked in the past, they have recently become quite trendy, with many food products now promoting their ‘omega’ status. These are vital nutrients to include, but it is easy to do so in your food rather than as a supplement. We need a combination of omega 3 and 6 oils. Vegetarians naturally have a high omega 6 intake, but usually low omega 3, so I would suggest including flax oil in your diet. Personally, I add a desert spoon full to my morning smoothie, or it can be used as a salad dressing; however, don’t heat the oil, as the fatty acids are destroyed by cooking. You can just have flax seeds, but you need to have the time to grind these freshly in a coffee grinder daily. If you eat meat and fish, you should have a blended omega 3 and 6 oil or supplement, as having too much omega 3 in relation to your omega 6 intake can also be harmful. You can also absorb your omegas through your skin if you use the oil on your body.
B vitamins are also very important. They mostly act as coenzymes, so are important in a wide range of metabolic and other chemical reactions in the body; we utilise more B vitamins when under stress. Reasonable amounts of most of the B’s are included in good multivitamins. However, zinc interferes with B12 absorption, so needs to be taken separately. There are no reliable vegan B12 sources, so vegans and often vegetarians should consider taking B12 regularly. Oral B12 absorption is also often poor. My solution to this is to take sublingual (under the tongue) B12 once a week in a higher dose, and not to take a multivitamin/mineral or zinc on that day.
Vitamin D is also worth considering in the winter if you live at northern latitudes. Once thought to be mainly about bone health and preventing rickets, it is now believed to act like a hormone, and to have many important actions in the body. Interestingly, most cancers (except the rare melanoma) increase in incidence with reducing sun exposure (and therefore vitamin D intake). It has been proposed that the sun avoidance that has been encouraged to reduce melanoma may have in fact have played a part in increasing the incidence of other cancers. Time will tell. Burning the skin is still a no no. However, to be able to produce adequate vitamin D yourself, it has been suggested that we need to expose our face and arms (or an equivalent area) to ¼ of the amount of sun needed to make our skin first start to turn pink daily. With many of us working indoors, it is not surprising that we may lack vitamin D at certain times of the year, and darker skins will need more sun exposure than those of us who are pale and interesting.
An important nutrient for women is iodine, as it is required by breast tissue as well as the thyroid. You can get iodine from eating seaweed, fish, or iodised salt. If you can’t bring yourself to include seaweed in your diet (try arame or nori rolls), you may want to take kelp in tablet form. This is a food rather than a supplement.
Once you get to your 50’s, you might also want to consider coenzyme Q10 60mgs daily (the most important mitochondrial antioxidant). Post menopausal women also need to play attention to their calcium intake. Calcium, along with magnesium and vitamin D is vital in reducing the risk of osteoporosis.
It is worth pointing out that some companies now offer ‘food state’ supplements. These are nutrients in the form that our body most easily recognises and uses, and they are increasingly being encouraged by nutritionists. They are more expensive, but doses of these should be only ¼ of the amount you would take of a standard supplement.
We must not forget water when we consider nutrition. Most functions in the body require water in some form, and many of us don’t drink enough. We should be aiming for 2-3L of water a day (unless you have been advised to restrict your fluid intake by your doctor for a specific reason), and it is best if you drink your water filtered. Try not to drink with meals however, as this dilutes the enzymes involved in digestion.
If you are well, you may wish to utilise an intuitive approach to what you need, looking to RDAs to make sure your intake is not overly excessive. However, do not ignore your diet. Some people think that by taking a lot of supplements they don’t have to worry about what they eat. No supplements will ever replace your dietary intake. Include whole grains and pulses, a range of raw and cooked vegetables (going for a wide range of colours for good antioxidant intake), healthy oils and a good protein intake. We were designed to have a wide range of foods, and this is better nutritionally; limited diets always cause problems. Local, organic, home grown or unprocessed foods are preferable, but only do what you reasonably can within your budget and time constraints. Then forget it. Good nutrition is only one part of a healthy balanced lifestyle. Do not let your diet take over your life, and do not let yourself become an obsessive supplement junkie. Remember the old saying: Eat to live, don’t live to eat.
Professional advice is recommended for children, in pregnancy, and for those with health problems. This article cannot take the place of individual medical/nutritional advice, and cannot be considered as such.