In the little bubble of hyper-relevant social media and consumerism, nutrition trends change more quickly than you can click "BUY NOW" on an amazon purchase. This blog post is partly prompted by my annoyance of food bloggers providing misinformed messages that certain supplements are necessary, and conveniently having a coupon code for which they can earn profits when it's sold. This is potentially harmful, and certainly a waste of your heard earned money. Secondly, I've been wanting to share my thoughts on this topic because apart from questions related to medical training, it's the most popular inquiry I receive. My message center is filled with questions like "How much collagen do you think I should be consuming a day?," and "Which probiotic should I be taking?"
The theme in the majority of these questions is that they all assume an absolute need for supplementation, rather than taking a step back and evaluating whether it's necessary in the first place. This, my friends, is the power of advertisement and industry.
If you're reading this, you're probably lucky enough to live a life with food abundance- both in quantity and variety. If you're concerned about what brand of supplement to buy, you probably also have the financial means to eat a well balanced diet filled with nourishing, high quality foods. We are the fortunate ones, this is for certain. And it also means that you probably don't NEED any form of supplementation.
In a wonderful editorial from JAMA (Journal of American Medical Association) last October entitled The Supplement Paradox, the authors highlight the use of several common supplements (calcium, multivitamin, etc) as having no benefit in mortality. Indeed, calcium supplementation in observational studies actually may have negative effects, correlating to a high coronary calcium score (thus predicting a higher risk for cardiovascular disease mortality.) Despite emerging evidence of potential harms, the utilization of supplements remains high among most Americans. Furthermore, it's important that we understand the history of dietary supplements and how they can be sold on the market. Under the law of Drug and Supplement Health and Education Act (DSHEA), all supplements are considered safe until the FDA finds evidence of harm. This is completely flipped compared to the approval of a prescription drug, which undergoes considerably lengthy clinical trials and subject to continued scrutiny for its duration before and after its availability on the market. You can imagine then, that the incidence of harm from supplements could occur repetitively until the FDA identifies this and takes it off the market.
Beyond the standard commercial supplements used over the past decades, there are emerging trends for supplements that quite literally have no scientific basis (neither negative or positive studies) but being advertised for their "health benefits." Examples just in the past year include cordyceps (an herb derived from mushroom) with well-known bloggers claiming it improves stamina, immunity, and liver detox (HUH?) And back to my original question I've been getting so frequently: collagen. Entire posts have been dedicated to why you should be taking collagen on a daily basis, with claims that it "improves gut health," "balances hormones" and with the added benefit of giving you "beautiful skin and nails." Show me the research, please. How about the potentially dangerous use of consuming exogenous ketones? For what benefit? A little more aerobic endurance? Also, you don't NEED protein powder. You don't NEED a pre-workout energy supplement. A myriad of other trendy products keep popping up in my newsfeed that make me want to pull my hair out sometimes. The truth is- maybe these things DO have a little benefit, but the cost and potential harm can't be outweighed. More than that it's my frustration that so many people have a (rightfully so) distrust with their physicians when it comes to nutrition due to our lack of training. But the answer is NOT turning to the recommendations of random internet bloggers for your health answers. I can only hope that this blog can give you some perspective on what you need (or don't need.)
Who needs to take supplements? (Absolute indications)
If you have a known and true vitamin deficiency determined by blood work and prescribed a supplement by your doctor/PA/NP, I feel comfortable in saying you need it.
If you are a woman of childbearing age and actively trying to get pregnant, you should be taking a prenatal or folic acid supplement to reduce the risk of potential birth defects.
If you are on certain medications that can reduce the bioavailability of certain vitamins (for example, methotrexate reducing vitamin B6,) you should be taking an appropriate supplement.
If you are an alcoholic with very poor nutritional intake, you will benefit from taking a daily thiamine and folate supplement (and also seeking the help you need in order to achieve abstinence from drinking.)
In what scenarios is there a potential supplement benefit? (Relative indications)
In certain scenarios where a supplement provides convenience, but recognizing that obtaining the micro/macronutrient from a natural food source is very likely the better option. (i.e., a probiotic, protein powder supplement, etc.) Obtaining it from the food itself provides the benefit while reducing the risk of over-consumption (which can be potentially harmful, such as in the scenario of calcium supplementation.)
Evidence based supported uses for reducing the risk of certain medical conditions; examples include taking vitamin E to reduce progression of age-relate macular degeneration, or the *potential* use of anti-oxidant vitamins for reducing the risk of certain cancers.
What CAN'T supplements do?
They can't replace whole, real food.
They can't cure the common cold. Nope, not even your Airborne or Emergen-C.
They can't cure a chronic disease.
They can't help your body "detox."
So what do you recommend?
Firstly, recognize that your health optimization is best served under the care of a doctor/PA/NP. If your healthcare professional is not well-versed in nutrition, and this is an important topic for you, seek a new provider or seek the assistance of a trained dietitian.
Secondly, never underestimate the power of a well-balanced diet that works for YOU. Food can truly be your greatest form of medicine and completely eliminate the need for added supplements. I certainly recognize the challenges in buying and preparing food rich in a wide variety of necessary vitamins, minerals, and macronutrients. However it is undoubtedly the greatest investment you can make in yourself and your health.
Finally, stop the comparison and the feeling of FOMO when you're scrolling through your social media feeds seeing people posts about the latest and greatest food products and supplements. It's a trend. It will pass. And seriously, you don't need it :-P