Get vitamins from food, not supplements: nutritionist

colourful vitamins

Consumers should get their vitamins from food, rather than eating a low-quality diet and adding supplements, a New Zealand nutritionist writes

Writing in the New Zealand Medical Journal, Anne-Thea McGill argues against the need for vitamin supplements, saying consumers should be able to get what they need from food.

This would improve health in a way that supplementation will not, she says.

Ms McGill argues that we have evolved to thrive on a wide variety of foods, which means we cannot rapidly adapt to consuming vast amounts of low-nutrient packaged food, with some supplements thrown in on top.

“So what is wrong with just adding in vitamin supplements to prevent scurvy and all the other vitamin deficiencies?

“There have been thousands of vitamin, mineral and nutraceutical supplement epidemiological and intervention studies, and massive marketing hype keeps the supplement (and pharmaceutical) industries funded,” Ms McGill writes.

“However, overall human health will only improve with appropriate food. Only the few longitudinal and/or interventional studies of low input whole and heritage type food consistently show health improvement.”

She writes that “there are multiple reasons that supplemental vitamins, minerals and extracts seem to fail to improve markers and signs of developmental and degenerative disease.

There are also complex synergies within the food components: phytonutrients, enzymes, minerals, fibre, the microbes, and gut epithelium complex and payers patches, all of which play a part in what nutrients are absorbed and toxins excreted.”

“If humans specifically evolved to physically and mentally thrive on a wide variety of micronutrient dense/low additive food, then expecting us to adapt to degraded/foreign chemical (xenobiotic) laden foodstuffs is unrealistic.

“We can only expect more infant developmental disease, and earlier and more severe degenerative disease, no matter what money is spent on ‘high tech’ cancer prevention research or public health messaging to change our ‘life situation status’.”

Friends of Science in Medicine’s Ian Carr, a Taree pharmacist, told the AJP that he “absolutely agrees” with Ms McGill’s philosophy.

“When people request multivitamins or ask me whether a multivitamin is likely to help them, I usually start counselling them about what their diet is like,” he says.

“I think the people who are concerned about their vitamin intake are probably already well-educated enough not to be missing very much from their diet.

“I’ve no doubt that there are people out there with poor diets, but it’s really a case of educating them to feed themselves better – there is no evidence that patching things up with a multivitamin has any positive effect anyway.

“And we know that say, fish oil extract in a supplement is not as good as fish eaten three times a week.”

The Complementary Medicines Association’s recently welcomed CSIRO data that showed a need for improving Australians’ diet: the Fruit, Vegetables and Diet Score report showed only 51% eat the recommended fruit intake, and 66% don’t eat enough vegetables.

“Many people take a multivitamin because they know they don’t always eat as well as they should,” said CMA’s Carl Gibson at the time.

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  1. Ron Batagol

    Very relevant summary by the author, especially her observation that “There have been thousands of vitamin, mineral and nutraceutical supplement epidemiological and intervention studies, and massive marketing hype keeps the supplement (and pharmaceutical) industries funded. I also noted her reasoning that that “supplemental vitamins, minerals and extracts seem to fail to improve markers and signs of developmental and degenerative disease”. Let’s face it- healthy eating and lifestyle are the only real answer. If people have, or show signs of, degenerative or serious health issues, and/or have poor eating habits, they need to be medically-assessed, with appropriate haematological or other relevant tests to see what specific vital nutritional elements they are requiring, rather randomly popping vitamin/mineral pills in the hope that that will help them!

  2. Jarrod McMaugh

    Clearly obtaining all nutrients from a balanced diet is true gold standard.

    We also all know that if people could adhere to a balanced diet, then we would never see people with nutrient deficiencies.

    We are in a time when people are obese and malnourished at the same time. This isn’t something that can be corrected with vitamins…. Not advising a patient to “eat better”

    The first priority should be nutritionist intervention, with short-term supplementation to improve nutrition the short term.

    The second option would be ongoing supplementation while wrestling with poor diet/motivation/exercise and low health/nutrition literacy.

    While the trying to meet the first priority is always the aim, we have to be realistic with how human nature will affect “compliance” here. Often the best intervention is the one that will be taken up by the person in front of you

    • Ian Carr

      I’m not sure about your “second option”. What evidence is there for throwing supplements (and which sort?) at a poor diet? The obesity/malnourishment from today’s poor Western diets seem to be the result of excess “empty” calories, and yet are rarely resulting in actual deficiency diseases. Has any study shown that hamburgers + multivitamins has any advantage over hamburgers alone?

      • Jarrod McMaugh

        G’Day Ian

        The issue of malnutrition in obesity is well established.

        The evidence for supplementation to improve this is not (and is unlikely to be, due to the ever persistent issue of a lack of studies with regards to supplementation).

        As I said in my original reply, the clear path to take is to encourage improved nutrition – this should involve a referral to a nutritionist or dietitian… if a person was capable of eating a balanced diet in the first place, then it is unlikely they would be in this position.

        We also have to consider human nature. People resist change; they don’t value good health advice, and there is often a psychological component to poor eating habits that can be difficult to identify and overcome.

        In the instances where a person’s nutrition is poor, and there is clear resistance to changing dietary habits, then is it not appropriate to recommend a supplementation of the nutrients that their diet does not contain? Would you disagree that a supplement of a particular nutrient is better than a diet devoid of this nutrient if the person in question will not change? I’m of the belief that encouraging a person to improve their diet month in, month out without success is a worse outcome than achieving some benefit with a supplement in that time.

        I’m for evidence based practice, and where the evidence exists. The problem we have is that evidence for a lot of therapies and supplements are lacking, and if we strictly adhered to the idea of only using therapies that have A1 levels of evidence, many items would not be on the PBS, many treatments would not be on the MBS, and the advancement of medicine over the last 300 years would have been severely truncated.

        Add to this the disdain that is shown to research done by “complementary” researchers and you have to think that it’s damned if you do (“research will be biased”) and damned if you don’t (“there is no research”).

        So I guess my point is, with the information we have, and presented with a person who will not alter their eating habits, supplementation is the lesser of two evils.

        • Ian Carr

          I hear where you’re coming from, Jarrod. We pharmacists treat individuals, but the problem involves socio-economics, education, advertising and media. We can only do our bit, but that includes campaigning and helping to educate. The front page of today’s Sydney Morning Herald headlines: “rich get fitter as poor get fatter.” Time for the authorities to get serious!

          • Jarrod McMaugh

            Fair point.

            I think that the authorities will be getting things in order around 6 months after good well designed and independently funded studies on the benefits of supplements are published.

          • Ian Carr

            These things probably won’t be funded until well after a federal Department for Porcine Aviation is up and running. We must chat over a Happy Meal sometime!

  3. Ian Carr

    The identification of the various vitamins and micronutrients, largely through their connection with deficiency diseases, has left us with an unfortunate reductionist view of diet. This, together with the human instinct to assume that if some is good, more will be better has been grasped by the marketers who — adding fear to the mix — now have two thirds of the population spending money on supplements in plastic bottles instead of on better food.
    Study after study shows that nutrients in food are better than nutrients in bottles. Those taking statins have poorer diets than those who don’t. By pushing supplements, we are tacitly excusing poor choices in diet and reinforcing the common myth that there’s pill (or gummie) to fix everything.
    In my opinion, our Australian Dietary Guidelines are far too prescriptive for the general public, and allow the supplements industry to instil misplaced guilt: “… only 51% eat the recommended fruit intake, and 66% don’t eat enough vegetables.”

    Here are the Brazilian government’s dietary recommendations, a far better place to start for an improvement in our national diet:

    Ten Steps to Healthy Diets:

    1. Make natural or minimally processed foods the basis of your diet

    Natural or minimally processed foods, in great variety, and mainly of plant origin, are the basis for diets that are nutritionally balanced, delicious, culturally appropriate, and supportive of socially and environmentally sustainable food systems. Variety means foods of all types – cereals, legumes, roots, tubers, vegetables, fruits, nuts, milk, eggs, meat – and diversity within each type – such as beans and lentils, rice and corn, potato and cassava, tomatoes and squash, orange and banana, chicken and fish.

    2. Use oils, fats, salt, and sugar in small amounts when seasoning and cooking natural or minimally processed foods and to create culinary preparations

    As long as they are used in moderation in dishes and meals based on natural or minimally processed foods, oils, fats, salt, and sugar contribute to diverse and delicious diets without making them nutritionally unbalanced.

    3. Limit consumption of processed foods

    The ingredients and methods used in the manufacture of processed foods – such as vegetables in brine, fruits in syrup, cheeses and breads – unfavourably alter the nutritional composition of the foods from which they are derived. In small amounts, processed foods can be used as ingredients in dishes and meals based on natural or minimally processed foods.

    4. Avoid consumption of ultra-processed foods

    Because of their ingredients, ultra-processed foods such as salty fatty packaged snacks, soft drinks, sweetened breakfast cereals, and instant noodles, are nutritionally unbalanced. As a result of their formulation and presentation, they tend to be consumed in excess, and displace natural or minimally processed foods. Their means of production, distribution, marketing, and consumption damage culture, social life, and the environment.

    5. Eat regularly and carefully in appropriate environments and, whenever possible, in company

    Make your daily meals at regular times. Avoid snacking between meals. Eat slowly and enjoy what you are eating, without engaging in another activity. Eat in clean, comfortable and quiet places, where there is no pressure to consume unlimited amounts of food. Whenever possible, eat in company, with family, friends, or colleagues: this increases the enjoyment of food and encourages eating regularly, attentively, and in appropriate environments. Share household activities that precede or succeed the consumption of meals.

    6. Shop in places that offer a variety of natural or minimally processed foods

    Shop in supermarkets and municipal and farmers markets, or buy directly from producers or other places, that sell varieties of natural or minimally processed foods. Prefer vegetables and fruits that are locally grown in season. Whenever possible, buy organic and agro-ecological based foods, preferably directly from the producers.

    7. Develop, exercise and share cooking skills

    If you have cooking skills, develop them and share them, especially with boys and girls. If you do not have these skills – men as well as women – acquire them. Learn from and talk with people who know how to cook. Ask family, friends, and colleagues for recipes, read books, check the internet, and eventually take courses. Start cooking!

    8. Plan your time to make food and eating important in your life

    Plan the food shopping, organise your domestic stores, and decide on meals in advance. Share with family members the responsibility for all activities related to meals. Make the preparation and eating of meals privileged times of conviviality and pleasure. Assess how you live so as to give proper time for food and eating

    9.Out of home, prefer places that serve freshly made meals

    Eat in places that serve fresh meals at good prices. Self-service restaurants and canteens that serve food buffet-style charged by weight are good choices. Avoid fast food chains.

    10. Be wary of food advertising and marketing

    The purpose of advertising is to increase product sales, and not to inform or educate people. Be critical and teach children to be critical of all forms of food advertising and marketing.

  4. JimT

    depending on where fruit and vegetables are grown the “goodness” in them is often compromised by poor or “old” soils let alone genetic modifying and fertilizers and getting “stuff” we don’t want from pesticides etc…so some “quality” multivits and minerals may not be such a bad idea….but then again what is a quality supplement???

    • Ian Carr

      From my survey of the recent literature, it would appear that some organic farming techniques marginally increase some desirable components — but hardly enough to make a measurable health result. The nutrient composition of plants is largely determined by its DNA. Fearmongering about our food sources is a common technique of quacks. We have the most bountiful, varied, safe and secure food supply we have ever had — just check out the average supermarket or greengrocer!

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