To Supplement or Not to Supplement?

With winter fast approaching here in Australia, I hear more people telling me that they’re reaching for the supplement bottles in a bid “keep their immunity up” and arm themselves against the onslaught of viruses and bacterial infections to come.

The nutritional supplement or nutriceutical industry is worth over $48 billion USD, clearly a lot of people are popping a capsule, shaking up some powders and ingesting all sorts of weird and whacky supplements in the name of #health. This industry is essentially making a whole lot of money off expensive pills and powders because they tell you that your diet isn’t good enough to keep up with everyday life, which means YOU NEED OUR MIRACULOUS CAPSULES! Instead of just improving your diet… *hello dietitians!*

I’m going to take you through both sides, when and why I would consider supplementing and when and why I do NOT. And guess what, I do not make anyyyyy money out of telling you the actual truth about supplements! #notsponsored

Pros

Supplements are really convenient

In some settings and circumstances, supplements can be absolutely CRUCIAL to restoring somebody’s nutritional status. I think of the older man in hospital who has lost too much weight because his wife recently passed away and he doesn’t know how to cook and shop for himself. He’s also lost his appetite and is having difficulty chewing because his dentures don’t fit anymore.

A loss in muscle mass in the elderly is not a good sign, it is associated with poorer balance and therefore a higher risk of fractures, reduced ability to fight infections and increased recovery time. If he was refusing all fortified foods (i.e. we pump up the energy and protein content of the food), I’d consider using a nutritionally complete medically-formulated nutritional supplement drink or powder to get his weight back up and hopefully wean him back onto normal food once we get the dentures sorted. I know that he’s getting a good range of nutrients, they’re shelf-stable so won’t go off if he leaves them out of the fridge, they’re easy to consume and I can get him out of hospital quicker so we can work on him self-managing at home.

An appropriate use of supplements, but I used food first, because I know that food is the more enjoyable and more effective way to improve nutritional status (more on this later).

Sometimes supplements are just necessary

In some cases, it is just impossible to get the nutrient/s into that person. For example:

  • Vitamin B12 in a vegan diet (unless consuming adequate quantities of B12 fortified foods).
  • Folate & Iodine during pre-conception or during pregnancy.
  • Iron for an iron deficiency anaemia patient with critical levels.
  • Vitamin D in countries where winters are dark and long or there is poor exposure or ability to synthesise vitamin D due to the melanin content of the skin or cultural or religious dress.
  • Fish oil in the post-heart attack patient that refused to eat fish!
  • Protein supplements (powders & bars) for an athlete looking to build muscle, however is also a vegetarian and is struggling to reach their protein intake goals because they feel too full.
  • BCAAs (Branch Chained Amino Acids) for a liver patient with hepatic encephalopathy.
  • Zinc lozengesin the early parts (first 24 hours) of the common cold can also reduce the duration and severity of the cold.
  • Or perhaps you’re taking a cranberry supplement to reduce the recurrence of urinary tract infections – yep, that can actually work!

There’s many more cases, however you should ALWAYS consult your doctor before you start a supplement. This is because supplements may have undesirable side effects or interact with a medication you’re already taking and reduce its effectiveness (such as birth control). You do NOT want to be messing around with that stuff.

The Placebo Effect

Okay, so even if we know the supplement has little actual therapeutic benefit. The placebo effect can be handy when it comes to feeling a benefit or enhancing performance. The placebo effect is when you experience a benefit even though you have not received the intervention or therapy, it’s essentially the “sugar pill” effect. But… that’s some expensive sugar pills.

Cons

They’re a waste of money

Okay, if you genuinely need a supplement for a medical reason, for example, it’s worth the dosh. But I’m talking about the “supplements” you see on Instagram and the pre-workouts and the protein shakes and the BCAAs and all that jazz promising you a better workout or beautiful hair, skin and nails. All this stuff is expensive for the average person just looking to do a 45 minute session at the gym.

They sell it to you, as “but it’s for your health”, but what I ask you to do, if you don’t actually need a supplement, that you take that money and go and buy some real deal food and focus on eating more fruits and vegetables. Only 4% of Aussies eat enough fruit and veg everyday. Yes, it isn’t MAGICAL and there’s no before and after pics or an Instagram fitspo model telling you to go eat an apple. But there are no magic bullets and good nutrition isn’t as sexy as a pink bottle of glittery capsules promising eternal youth. …there are no magic bullets and good nutrition isn’t as sexy as a pink bottle of glittery capsules promising eternal youth.

In addition, supplements often give you nutrients in such a high doses that they are in excess to the body’s needs. Essentially resulting in excretion or accumulation (more on that in a moment).

Before you run for your vitamin C capsules at your next sniffly nose. Let’s look at some facts. You need 45 mg per day of vitamin C for the average adult and vitamin C is a water-soluble vitamin. Meaning, when you get a mega dose of like 1000mg in a vitamin C capsule, all of that 950+ mg extra that your body does not need, ends up in your toilet bowl (via your wee). Excessive amounts of some vitamins and minerals can actually cause toxicity, for example excessive vitamin A which can cause liver damage and hair loss (alopecia) and is particularly dangerous in pregnant women.

That’s some expensive wee! $2 at the fruit shop could buy you a couple of pieces of fruit to reach that 45 mg requirement daily and bonus you get fibre, potassium, antioxidants and all sorts of other nutrients that your body will love you for.

They’re usually unnecessary

What we know, is that good nutrition from wholefoods is adequate for a healthy person to get all their vitamin and mineral needs. What we also know, is that without this foundation, supplements that are added don’t do as well anyway! So if you’re band-aiding a diet that needs work with supplements, it’s probably not having it’s desired effect anyway. And one of the 10 recommendations released by the World Cancer Research Fund to reduce the risk of developing cancer, is to get nutrition from food not supplements.Food is more than the sum of its nutrients

And this is why I use the food first principle. Food is more than the sum of its nutrients and I often use this little phrase when I’m talking about the relationship with food or culture and food but there is more this saying. It’s called the Food Matrix Effect, this describes that for reasons we are yet to study, the way in which nutrients are consumed in wholefoods and interact with our bodies is preferred, it’s more bioavailable (i.e. readily available for absorption).

Almost, no food is just a single nutrient (like a vitamin or mineral capsule is), therefore the range of nutrients available in foods and eating a mix of foods is the way our body prefers it and they are not in mega doses.

Nutriceutical companies are now researching this area so that (you guessed it), they can add more nutrients into their vitamins to enhance absorption and THEN CHARGE YOU MORE FOR IT! When you could simply spend that money on, you guessed it, just plain boring (but delicious) wholefoods.

Their effectiveness is widely not well-studied

Because the supplement market is growing faster than research can keep up, new products are always cropping up that may not be all that well-studied or rigorously tested. Not just for efficacy (which in my opinion, is already a big problem) but even for safety! Weight loss or fat burner type of supplements are perhaps the most dangerous types of “supplements”, showing some potential ability to cause liver damage and other questions regarding safety. 15% of people in the US say they have tried a weight loss “supplement”!

And for a society which is moving towards more “pure” and “unprocessed” foods and wanting to be empowered by knowing what’s in our food, we are still willing to pop a capsule or drink some weird coloured powder without questioning ingredients or the methods used to create that product. Yet, people are shunning wholefoods for supplements! Madness, I say.

There are risks!

With all the nice marketing, the risks of taking supplements is minimised and being well-informed when it comes to health is absolutely critical! Not all supplements have risks, but most have some potential side effects so ask your doctor and read the fine print to ensure you know what’s going on. A key example is herbal supplements, some herbal formulations are associated with liver damage. As stated in that article there is simply “a regulatory oversight in non-prescription products”, so please be wary.

They all hinge on ONE word – “may”

Almost all supplement claims have the word “may” in there somewhere, may improve the appearance of hair skin and nails, may help “boost your metabolism”, may help with inflammation. What will benefit you is just eating a balanced diet and a variety of foods with an active lifestyle.

You could get banned from your sport

If you’re an athlete that plays and competes in sports that are regulated by “The Code” by WADA (World Anti-Doping Agency) and you use supplements to enhance performance or for any other reason, even if they are considered “allowed”, it’s always a risk.

As supplements can be contaminated by banned substances on “The List”. To reduce your risk, it’s usually best to avoid supplementation, visit the Australian Institute of Sport website for more about supplements. However, it is possible to inadvertently return a positive test with supplements and be banned from your sport. Check out the ASADA website for more information and consult a sports dietitian to work out whether supplements (and which types) are right for you.

The Verdict: Choose whole, real food and be very judicious and cautious if you venture down the supplement path. There is a time and place for supplements, however ALWAYS seek expert advice before commencing any kind of supplement (even over the counter stuff).

See an Accredited Practising Dietitian, if you need more help about supplements and whether they are right for you.