By Pam Stuppy
The supplement market has expanded in leaps and bounds over the past few decades as consumers search for magic bullets toward better health. Glimpses of possible health contributions from assorted substances have led to more and more supplemental products, each promoting their contribution towards a potentially better quality of life and/or greater longevity. This market expansion and the health messages provided by supplement manufacturers have resulted in greater consumer confusion about the need for supplemental products.
Some of the vitamins and minerals that appear in supplemental products have been studied over a number of years for their benefits to our bodies. What researchers are exploring currently, however, are numerous other substances found in plant-based foods that work alone or more often synergistically with each other and/or vitamins and minerals. Think of it as a team working for your health. You may see terms such as phytonutrients or phytochemicals to describe these substances.
Whereas supplements contain limited numbers of nutritional substances, less processed food sources contain thousands of these phytonutrients, and there are probably many more we have yet to discover. One of the largest categories of phytonutrients is flavonoids. More than 6,000 different flavonoids have been identified to date.
Phytonutrients are found in fruits, vegetables, whole grains beans, legumes, nuts, seeds, herbs, spices and some beverages. A few examples of their potential benefits would be protecting our bodies from tissue damage, reducing the risk of chronic diseases and promoting maximal body functioning.
Another point of confusion for consumers is the marketing of some food products. Because we are learning that phytonutrients are important for health, some foods are being promoted as superfoods. Measuring the antioxidant capacity of foods (as in the ORAC system) has been one way of establishing a hierarchy of foods. Such criteria are often the rationale behind the promotion of some known and also exotic foods.
These laboratory assays can give us a little information about a foods health benefits, but antioxidant capacity is only one of numerous possible functions of the broad range of phytonutrients. We need to also look at how these substances operate in a body rather than just in a test tube and research has a long way to go before we have these answers. Until then, consuming a wide variety of plant-based foods would be a good goal.
Does this mean that supplements should not play a role in our health? Yes and no. We know that supplements are not a replacement for a healthy diet. A poor diet with added supplements can still result in poor health. That being said, individual vitamins and minerals may be warranted for people with certain medical issues, those who have had surgeries related to the intestinal tract, those taking medications that interfere with nutrient uptake, or people who are otherwise unable to consume adequate food intake.
When it comes to most nutrients, there is a window of benefit between consuming too little and too much. We know that deficiencies can cause problems but in some instances so can overconsumption. A UL (upper tolerable limit) has been established for most of the vitamins and minerals. Above this amount, there is concern for some negative side effect. Between supplements, fortified foods and beverages and other sources, consumers may be exceeding the UL.
Be aware that the supplement market is not tightly regulated. Some products may contain contaminants, may not contain what they say they contain on the label, may not dissolve appropriately, may contain excessive amounts, may promote unproven benefits and are often costly.
Some vitamins and minerals when consumed at the higher supplemental doses also compete with each other for uptake into the body. They may also interact with or interfere with certain medications. The level of nutrients available in foods is rarely a concern, however.
Some supplements that may be helpful to certain individuals might be vitamin B12, iron, vitamin D, magnesium and calcium. Dietary B12 requires acid in the stomach for availability but the supplemental form does not. Older adults who may have lower stomach acidity or people taking medications that lower stomach acid may want to take B12.
People with iron deficiency anemia could benefit from an iron supplement but this should be monitored because excessive iron is detrimental. Intake of supplemental iron and calcium should be separated by at least four hours.
A supplement of vitamin D may benefit those who get limited sun exposure (such as people living in northern latitudes, those with limited time outdoors or who use sunscreen, people who are overweight, and those with darker pigmented skin). A blood test can determine vitamin D status.
Most people should be able to consume adequate calcium and magnesium for bone health from a healthy diet. If not, the dose of the magnesium supplement should be kept to less than the UL of 350mg/day.
Note that the body cannot take in more than 500mg of calcium at a time, so doses higher than this amount should be split over the day. Calcium carbonate should be taken with meals due to the higher stomach acid needed for absorption. Calcium citrate does not require acidity so is the recommended form for older individuals with lower stomach acidity and for people taking medications that reduce stomach acid. Be aware that some studies of postmenopausal women showed an increased risk of kidney stones with calcium supplement doses over 500mg/day.
So, in answering the question as to whether foods or supplements are better for health, in some cases it may be a balance between the two. Ideally, a healthy diet made up of a variety of less processed foods, with special emphasis on those that are plant-based, should be the foundation for securing the wide range of nutrients needed for health.
Pam Stuppy, MS, RD, CSSD, LD, is a registered, licensed dietitian with nutrition counseling offices in York, Maine, and Portsmouth. She is also the nutritionist for Phillips Exeter Academy, presents workshops nationally, and is board certified as a specialist in sports dietetics. Visit http://www.pamstuppynutrition.com for nutrition information, healthy cooking tips and recipe ideas.
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