Supplementing
If you're like most people then it can be very overwhelming to figure out exactly what you should take in regards to supplements. The aisles at your local health food store or pharmacy seem to go on forever with these items. I hope to provide some simple and basic information here to help you understand which supplements you need, and the pros and cons of taking certain supplements.
The first and most important thing you need to know is that even though swallowing a pill is easy and convenient, it is usually never a better alternative than obtaining the same ingredient(s) naturally through eating healthy, delicious, plant-based, whole foods. When you're eating fruits, vegetables, legumes, and whole grains you're getting tens of thousands of antioxidants and phytochemicals from these foods, along with their vitamins and minerals, some of which haven't even been discovered by human beings yet. And all this comes without any added expense to your monthly budget, or potential to cause harm, which some supplements can do.
As a rule of thumb, you should take the minimum amount of dietary supplements to meet your individual needs. This amounts to only vitamin B12 for most people eating a plant-based diet. There are very few exceptions to this rule of supplementing with only B12. These include specific diagnosed vitamin deficiencies like rickets (vitamin D deficiency), scurvy (vitamin C deficiency), beriberi (thiamine deficiency), or pellagra (niacin deficiency) among others.1 It's important to work with your doctor if you suspect a true vitamin deficiency to be properly diagnosed, but again these deficiencies are almost unheard of in the Western world.
Many supplements can also interact with medications (another reason to avoid them if at all possible) so check with your pharmacist if you have any questions regarding this. Now, let's take a look at some individual supplements.
Vitamin B12
Vitamin B12 is a must supplement on a whole foods, plant-based diet. It is the only vitamin (other than vitamin D) which is not naturally found in plant foods. Biologically active vitamin B12 is actually produced by bacteria. These bacteria harbor themselves inside of other animals and are passed along to humans when eating the tissue or flesh of these animals. As noted on my nutrition page, animal-based foods pose potential human health risks. Because of this, they are not the preferred way to obtain vitamin B12 when attempting to achieve optimal health. This leaves supplementing to meet your body's needs on a plant-based diet.
To learn more about what vitamin B12 does in the body, how much you need, and what form(s) to get it in please read my article below:
Vitamin B12 - Why You Should Never Go Plant-Based Without It
Vitamin B12 is a water-soluble vitamin, meaning that excess B12 is often excreted in the urine. As such, there are no known vitamin B12 toxicities to date from getting too much, so you can rest assured that this is a safe supplement to take.2
Vitamin D
Vitamin D is actually a prehormone that is vital to maintaining optimal health in everyone. The best way to get vitamin D is naturally, from direct sunlight. As little as 10-15 minutes per day of sunlight is usually sufficient for most people during the peak hours (10am to 3pm) of the day.
Previously, I had written about the benefits of supplementing with vitamin D in my article - How To Feel Vitamin "D"errific! I also discussed how getting too much vitamin D could lead to an increase risk in death in this article. Since writing this article, some very important large-scale reviews analyzing controlled, interventional studies were published giving us a better overall picture on supplementing with vitamin D. These review studies looked at several clinical trials analyzing the effectiveness of vitamin D supplementation on various chronic diseases. It turns out very few people actually benefit from supplementing with vitamin D even after being diagnosed with a vitamin D deficiency. The one exception proved to be elderly females who saw a slight decrease in overall mortality after supplementing with low doses of vitamin D.3,4 To learn more about this topic please read my updated article below:
Vitamin D - To Supplement or Not To Supplement
Omega-3 Fatty Acids (Fish Oil)
Another popular supplement, omega-3 fatty acids or fish oil, is widely used by many. While omega-3 fatty acids do have anti-inflammatory effects there is little evidence to support their widespread use in supplement form. I cover all the large-scale review studies on this in my article below which I encourage you to read:
Fish Oil Reviews - The Evidence Behind Omega-3 Fatty Acid Supplements
Omega-3 fatty acids, along with omega-6 fatty acids, are known as essential fatty acids. The human body cannot make these fatty acids on their own, and, therefore, they must be obtained from dietary sources.
There are three main types of beneficial omega-3 fatty acids. They include EPA (eicosapentaenoic acid), DHA (docosahexaenoic acid), and ALA (alpha-linolenic acid). ALA is the "parent omega-3 fatty acid" and serves as the building block for DHA and EPA. ALA is converted to EPA and DHA but only in small amounts.5 For a more in depth look at fatty acids in the diet (and how much fat is actually needed in the human diet) please see my article below:
The Essentials of Fats in the Diet
The best way to get your omega-3's is via these plant-based foods:
- Flaxseeds or Chia Seeds
- Soybean
- Nuts (Walnuts, Brazil nuts, Soy nuts)
- Seeds (Pumpkin seeds, Hemp seeds)
You can also get EPA and DHA from eating cold water fish (Atlantic herring, salmon, albacore tuna, sardines, mackerel, swordfish, etc.). The downside of this is that fish usually contain heavy metals, such as mercury and other pollutants (PCB's and dioxins), that can increase one's risk of cancer, as well as cause other health consequences. Remember, fish get their omega-3's from eating plants, so you're better off getting these essential fatty acids from plants too, as close to their natural state as possible.
A sufficient daily dose of omega-3's is between 2,000-3,000 mg/day. One to two tablespoons of ground flaxseed or one to two oz of nuts/seeds provides this amount. In addition to the high omega-3 content of these plant foods, you also get a healthy dose of fiber and many other phytonutrients, such as lignans in flaxseed, to help ward of chronic diseases.
If you choose to supplement with omega-3's you should be aware that taking more than 3,000 mg/day can increase your risk of bleeding and of developing a hemorrhagic stroke.6,7 There is a specific group of people who should absolutely NOT take omega-3 fatty acid supplements. These people include those who have congestive heart failure OR chronic, recurrent angina (chest pain) due to insufficient blood flow to the heart. In these patients omega-3 supplementation actually makes their conditions worse.8
Avoid Multivitamins and Other All-In-One Supplements
Many people believe a multivitamin (MVI) acts as an "insurance policy" to ensure getting all the recommended daily amounts of vitamins and minerals the body needs. However, if you eat a diet plentyful in whole, unprocessed, plant-based foods you do not need to supplement with a multivitamin or any other all-in-one vitamin supplement. You only need to supplement with vitamin B12 as mentioned above. Unfortunately, the belief of taking a MVI or other all-in-one supplement to support optimal health may actually be causing more harm than good in people. Below are just a few studies showing documented risks to human health by doing so:
- Many MVI's contain vitamin A. Vitamin A is fat soluble and can be toxic to the liver.9 It has also been shown to counteract the positive effects of Vitamin D.10 Vitamin A comes from beta-carotene, which is found in plants. While beta-carotene consumption from fruits and vegetables has been shown to be beneficial for reducing cancer, vitamin A supplements have been shown to actually increase gastric and lung cancer risk.11,12 You're better off getting vitamin A directly from colorful fruits and vegetables.
- Folic acid is also another component of many MVI's. Its natural form is called folate. This is not the same as its man-made synthetic counterpart folic acid. Folic acid has been shown to promote free radical production, which increases the risk of cancer.13
- Vitamin E has long been touted for its cardiovascular effects and cancer reduction benefits. However, vitamin E supplementation has been shown to increase the risk of prostate cancer and the overall incidence of death (mortality rate) in individuals who take them.14,15 Consuming more vitamin E in the form of fruits and vegetables has not been shown to be detrimental. In fact, increasing dietary sources of vitamin E has been shown to decrease the risk of prostate cancer in men.16
As you can see, there are several individual components of multivitamin supplements which cause more harm than good. The further you get away from the natural source of a vitamin, mineral, or any other natural substance found in food, the less predictable its course of action is in the human body. Harmful effects due to this unpredictability can and do happen to people.
I want to stress an important point here—No human being has ever supplemented their way out of heart disease, cancer, or any other chronic disease by taking multivitamin and multi-mineral supplements. Preventing and reversing disease should always start (and end) by adopting of a whole foods, plant-based lifestyle. When it comes to pills (natural or otherwise) save your money and spend it on nutritious food and other healthy lifestyle interventions, such as gym memberships or a bicycle.
References:
1 Piro A, Tagarelli G, Lagonia P, et al. Casimir Funk: his discovery of the vitamins and their deficiency disorders. Ann Nutr Metab. 2010;57(2):85-8.
2 Carmel R. Efficacy and safety of fortification and supplementation with vitamin B12: biochemical and physiological effects. Food Nutr Bull. 2008 Jun;29(2 Suppl):S177-87. Review.
3 Autier P, Boniol M, et al. Vitamin D status and ill health: a systematic review. The Lancet Diabetes & Endocrinology, Early Online Publication, 6 December 2013 doi:10.1016/S2213-8587(13)70165-7.
4 Zheng Y, Zhu J, Zhou M, Cui L, Yao W, et al. (2013) Meta-Analysis of Long-Term Vitamin D Supplementation on Overall Mortality. PLoS ONE 8(12): e82109. doi:10.1371/journal.pone.0082109.
5 Wang C, Harris WS, Chung M, Lichtenstein AH, Balk EM, Kupelnick B, Jordan HS, Lau J. n-3 Fatty acids from fish or fish-oil supplements, but not alpha-linolenic acid, benefit cardiovascular disease outcomes in primary- and secondary-prevention studies: a systematic review. Am J Clin Nutr. 2006 Jul;84(1):5-17.
6 Weksler BB. Omega 3 fatty acids have multiple antithrombotic effects. World Rev Nutr Diet 1994;76:47-50.
7 Kromann N, Green A. Epidemiological studies in the Upernavik district, Greenland. Incidence of some chronic diseases 1950-1974. Acta Med Scand 1980;208(5):401-406.
8 Dean Ornish M.D. The Dark Side of Good Fats. Newsweek Web Exclusive. May 2, 2006 | Updated: 3:28 p.m. ET May 15, 2008.
9 Geubel AP, De Galocsy C, Alves N, Rahier J, Dive C. Liver damage caused by therapeutic vitamin A administration: estimate of dose-related toxicity in 41 cases. Gastroenterology. 1991 Jun;100(6):1701-9.
10 Rohde CM, DeLuca HF. All-trans retinoic acid antagonizes the action of calciferol and its active metabolite, 1,25-dihydroxycholecalciferol, in rats. J Nutr. 2005 Jul;135(7):1647-52.
11 Lin J, Cook NR, Albert C, et al. Vitamins C and E and beta carotene supplementation and cancer risk: a randomized controlled trial. J Natl Cancer Inst. 2009 Jan 7;101(1):14-23. doi: 10.1093/jnci/djn438. Epub 2008 Dec 30.
12 Druesne-Pecollo N, Latino-Martel P, et al. Beta-carotene supplementation and cancer risk: a systematic review and metaanalysis of randomized controlled trials. Int J Cancer. 2010 Jul 1;127(1):172-84. doi: 10.1002/ijc.25008. Review.
13 Baggott JE, Oster RA, Tamura T. Meta-analysis of cancer risk in folic acid supplementation trials. Cancer Epidemiol. 2012 Feb;36(1):78-81.
14 Klein EA, Thompson IM Jr, et al. Vitamin E and the risk of prostate cancer: the Selenium and Vitamin E Cancer Prevention Trial (SELECT). JAMA. 2011 Oct 12;306(14):1549-56. doi: 10.1001/jama.2011.1437.
15 Bjelakovic G, Nikolova D, et al. Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases. Cochrane Database Syst Rev. 2012 Mar 14;3:CD007176. doi: 10.1002/14651858.CD007176.pub2. Review.
16 Bidoli E, Talamini R, et al. Dietary vitamins E and C and prostate cancer risk. Acta Oncol. 2009;48(6):890-4. doi: 10.1080/02841860902946546.