There have been a rash of studies over the past weeks that cast doubt on whether nutritional supplements are safe and effective. The Wall Street Journal reported on two of these just this week: one about dietary supplements increasing the risk of death among older women who took supplements and one about vitamin E being linked to prostate cancer. Meanwhile, USA Today reported on a study that showed that saw-palmetto extract doesn’t help enlarged prostate. Of course every one of these studies is flawed in some ways, just as the studies showing benefit are also flawed. But it still makes me wonder whether supplements are worth the risk and cost, or if it’s worth the risk of not taking them, given that our foods don’t have nearly the nutrients that they used to have.
Who doesn’t like the idea of a “magic pill” that prevents or cures our ills, helps ensure a healthy baby, extends our lives or helps make up for a poor diet? Unfortunately, as much as I want to believe in nutritional supplements and vitamins in particular, I accept the fact that the laws of physics do not apply to biological organisms. In biology, the whole is not necessarily equal to the sum of its parts due to all of the complex interactions between biological building blocks, like cells, proteins, and amino acids. After all, if juicing, cooking and drying an apple all change how your body processes it, then how can the much more involved laboratory process of extracting its micronutrients not have an even bigger impact on how your body synthesizes it? In his book In Defense of Food, Michael Pollan quotes NYU nutritionist Marion Nestle as saying, “The problem with nutrient-by-nutrient nutrition science is that it takes the nutrient out of the context of food, the food out of the context of diet and the diet out of the context of lifestyle.” I think she has a point.
The other concern I have about nutritional supplements is that it’s hard to get feedback on if or how well they’re working. Those who prescribe them seem to expect us to just take them on blind faith, without any regular followup to measure the impact. Three years ago, after $500 worth of blood tests, I found out that I was vitamin D deficient. I’ve made some changes since then, but I have no idea if those changes are making a noticeable difference. I also suspect that season could have something to do with vitamin D levels, since I don’t get out as much in the winter and that’s when the test was taken. I’ve looked, but can’t find any home tests for vitamin D, except for expensive ones that you have to mail off to a lab each time. I’d also like to track bone density, which is another way to see if the vitamin D I am getting is making a difference, but this test requires different instruments altogether. Ideally, I would have a way to measure my vitamin D and bone density levels weekly or monthly so that I can start to understand how diet and lifestyle impact the levels in my body. Until those tests become available and affordable, I’m going to err on the side of caution and try to get my nutrients from natural sources.
My OB-GYN recently told me that I should start taking nutritional supplements because of the special nutritional needs of my unborn baby. I asked her to share the results of my blood tests so I could understand how deficient I was. Apparently she hadn’t tested for any of this, despite many vials of blood she took from me. Instead, she tested me for conditions that, conveniently, would allow her to prescribe expensive medications or medical procedures. Disappointed, I asked her to name the specific supplements she thought pregnant women needed to add. Her list included calcium, iron and folic acid. I decided to read up on these before doing anything. Here’s what I eventually decided to do about each recommendation:
Iron: Apparently organ meats are one of the best sources of the more absorbable form of iron (heme). Unfortunately I’m not so fond of organ meats – unless it’s foie gras, sweetbreads or monkfish liver, which are all hard to come by. Therefore, I’ve added fermented cod liver oil to my morning breakfast routine. Putting it into gel-caps makes it much easier to take. I’m also trying to eat more eggs, red meat, and shellfish.
Calcium: I’ve been leary of calcium supplements for a long time. I know that they’re generally touted as helping improve bone density, but I’ve also heard about studies that show that taking calcium supplements doesn’t actually improve bone density and can cause arthritis, arteriosclerosis and kidney stones. It’s also been shown to increases women’s risk of heart attack and stroke. The more I looked into the research on calcium and bone density, the more I realized that we don’t yet understand much about how the body absorbs and uses calcium. For instance, some recent studies are looking at the relationship between calcium absorption and things like presence of Vitamin K2, and a person’s hormone levels (with the familiar Vitamin D being just one of several hormones that has an impact). Much can go awry if all these are not working in harmony. My conclusion was that I don’t want to volunteer my body to participate in calcium supplement “experiments,” but instead, I’m willing to try the following diet and lifestyle changes, which people have done safely for centuries: drink more raw milk, eat more aged and raw milk cheeses (no worry about listeria, as I explain in this blog post), spend more time out in the sun (maybe try a sun lamp in the winter), continue with power yoga and eat cod liver oil every day, which I understand to be the best dietary source of Vitamin D.
Folic Acid: Folic acid has well-documented risks and benefits. It’s the only vitamin supplement I recently decided to take, but only for the first half of my pregnancy, since that’s when it’s shown to have a (dramatic) impact on reducing the chances of the baby developing neural tube defects. It’s most effective when taken just prior to conception and for the first few weeks or pregnancy, but by the time I learned about my pregnancy, it was almost too late. The documented risks and side effects are minimal compared to other supplements, which I realize doesn’t mean that they don’t exist, just that they may not have been identified yet. The other reason I decided to take folic acid is because the amount my doctor prescribed, 0.5mg, seems pretty hard to get through food.
As much as I may try to avoid nutritional supplements, it’s nearly impossible do given how many of our foods are falready ortified with nutritional supplements. All the more reason explore all possible options to address a nutritional deficiency before jumping to supplements.