By Caroline Cederquist, M.D.
Sales of vitamins, minerals and nutritional supplements were 31 billion dollars in The United States in 2018. According to The Council for Responsible Nutrition which is a trade organization representing supplement manufacturers, 75 percent of U.S. adults take dietary supplements. The highest reason given for taking supplements is “overall health and wellness”. The next most common reasons were filling nutrient gaps, bone health, heart health, healthy aging and joint health, energy, hair-skin- and nails, immune health, digestive health and weight management.
Supplement users compared to non- supplement users were found to exercise regularly (70% verses 57%), visit a doctor regularly (80% verses 68%), try to eat a balanced diet (87% verses 76%) get a good night’s sleep (74% verses 67%), maintain a healthy weight (69% verses 64%) and not smoke (75% verses 70%). It appears from this that supplement users have more healthy behaviors overall.
Certainly, Americans are on board with taking supplements but this is not necessarily positive news. A study published in the Annals of Internal Medicine in 2017, did a review of multiple studies on multivitamins and supplements and looked for the outcome of primary prevention of cardiovascular disease and cancer. They analyzed trials they considered fair and good quality looking for benefits and harms of supplements. They found one study that showed a lower cancer incidence in men taking a multivitamin for ten years. The study that looked at women did not show that effect. Several other studies showed no clear benefit or harms from supplements. One study showed increased risk of lung cancer in smokers who used beta-carotene supplements.
As a medical doctor who has worked with patients for almost thirty years, my opinion is that some people are clearly benefited by supplements, some do not need supplements, and some people can be harmed by supplements. How can this be figured out for the individual?
In my practice, we actively work with patients on healthy diet, increasing exercise, losing weight and maintaining a healthy weight and we address sleep deficiencies and life stress. As we create lifestyle adjustments and changes to promote these effects, we also order targeted vitamin and mineral levels in our patients based upon their symptoms and medical conditions.
A great example is evaluating for magnesium deficiency. Tomatoes, even organic tomatoes, contain less dietary magnesium now compared to fifty years ago. Changes in farming practices and other environmental concerns have affected the quality of our food so that just eating a healthy diet, is not adequate for some people. We also know that when people are under stress, the body consumes and excretes more magnesium creating conditions of insufficiency or deficiency. The symptoms of magnesium deficiency are many- constipation, anxiety, muscle cramps, muscle spasm, joint discomfort, insomnia, irregular heart beat or arrhythmia and others. Very often people with these symptoms seek medical care but intracellular magnesium is not tested. I have had patients who have had resolution of life-long issues with constipation, muscle spasm and anxiety once we diagnosed and determined the proper amount of magnesium need for replacement.
Zinc deficiency or insufficiency is another important example. Zinc completes with copper for absorption and we are experiencing increased exposure to copper. Zinc deficiency can lead to symptoms of depression, memory loss, and hormone abnormalities like low testosterone in men. We have also found that many of our young women who have a diagnosis of polycystic ovarian syndrome have relatively low levels of zinc and higher levels of copper. Replacement of zinc is important in these patients but it is equally important that levels be monitored and that people don’t take zinc for years on end without reassessing what is going on as they then can develop significant copper deficiency.
An evaluation of nutritional genomics, looking at our individual genetic differences and how it impacts the absorption of the transport of nutrients can be valuable. I have tested myself and my four children and found all of us had vitamin D deficiency and low serum B12 levels. When I first investigated this years ago, I was perplexed because we live in Florida with ample sunlight which stimulates vitamin D production and we consume a diet high in nutrients like B12. Our genetic evaluation showed we have a genetic SNP (a difference in a nucleic acid in our DNA) that affects the delivery of vitamin D to our cells. Our levels have easily normalized with vitamin D supplementation and this is important for bone health at all ages but especially for my teenagers as peak bone mass is determined by nutrients in childhood and adolescence. Nutritional genetic testing also explained why our vitamin B12 levels were low despite a healthy diet and we were able to correct this with supplementation.
I think there are several important components for safe and effective treatment with nutritional supplements. The first is having evidence that levels are low so people who invest in supplements actually need them. The second is that supplements should not be continued ongoing without any monitoring of safety or ongoing need. A great example is vitamin D. Vitamin D is often deficient and important to correct. It is a fat-soluble vitamin which means that you can take too much, it can build up and cause harm. Often people need to correct low levels with a higher dose supplement but can be transitioned to a lower dose for maintenance of a normal level.
A third, very important, concern is that dietary and herbal supplements can contain things that are harmful. Studies in the medical literature show that supplements fo\r weight loss are the most highly contaminated and may contain actual medications that are banned in this country. Buying supplements on line can be risky as products may be obtained from other countries with less regulation. Even in the U.S., supplements can be found that do not have the active ingredients listed on the label and instead contain something else or just inert ingredients. In my practice, we recommend pharmaceutical grade brands of supplements that have extensive third party testing done to verify the ingredients and to test for the presence of allergens or other contaminants.
The use of nutritional supplements can be an integral part of an overall health and wellness plan. Determining recommendations for each person needs to be individualized by having a complete medical evaluation and appropriate vitamin level testing. An evaluation of nutritional genomics is a new tool that can also be very helpful. Lastly, using quality nutritional supplements and having levels monitored is essential for safety and positive results.
Cederquist Medical Wellness Center
1575 Pine RIdge Road