Food vs Supplements

My office is near several other physicians. It is common for me to see one of their patients coming out with a little brown bag of nutritional goodies.

Whatever this says about their business model it raises a question I am often asked: Hey, Doc, which supplements should I be taking?

Another version of that is when someone sends me a ‘health letter’ that advises the reader to take one supplement or another and appended to that is a request for my advice about those supplements.

I have seen more than one look of disappointment when I tell them to focus on a nutrient rich diet rather than supplements. I’ve had more than a few ‘yeah, but…’ assertions that run like this: ‘doc, you don’t understand, I travel and can’t always get good nutrient rich foods so shouldn’t I be taking various vitamins and minerals?’ Again, I say no, get your nutrition from foods. Then they up the ante and rehearse a story about depleted soils, industrial scale use of antibiotics and growth hormone altered foods. All true and all bad, but not so bad as the degree of nutrient complexity we assault by taking isolated supplements; from minerals to B-complex arrays.

Are there cases when we should take supplements? Absolutely. In the aging gut many no longer produce the cofactor which enables B-12 uptake; then you take B-12. If your vitamin D level is low, take it until your levels are in mid-range normal. Why are these exceptions to the general rule? Well, first ‘D’ is not a true vitamin, the very definition of which says that the substance is something the body cannot produce which is not the case with ‘D,’ as the body can produce it; that is if we run around in a loin cloth all day in the sun. We don’t, at least I don’t, but we still have a need for the substrate which over the counter D3 provides. Even here ‘D’ has become so fashionable that it is abused.

We’ve known for a long time that calcium supplementation increases the risk of stroke and heart attack.

A recent article in the Annals of Internal Medicine compared health outcomes in food derived nutrients vs. supplement derived nutrients. Be clear there are some methodological limitations to the study. The primary being duration of supplement ingestion and self-reported dosing and frequency.

Still it is on point and of interest. I am going to cut and paste a summary. Please note this is stolen/borrowed from

“The study used a nationally representative sample comprised of data from more than 27,000 U.S. adults ages 20 and older to evaluate the association between dietary supplement use and death from all causes, cardiovascular disease (CVD), and cancer. The researchers assessed whether adequate or excess nutrient intake was associated with death and whether intake from food versus supplement sources had any effect on the associations.

For the association between nutrient intake and the risk of death, the researchers found: Adequate intakes of vitamin K and magnesium were associated with a lower risk of death; adequate intakes of vitamin A, vitamin K, and zinc were associated with a lower risk of death from CVD; and excess intake of calcium was associated with higher risk of death from cancer. When sources of nutrient intake (food vs. supplement) were evaluated, the researchers found: the lower risk of death associated with adequate nutrient intakes of vitamin K and magnesium was limited to nutrients from foods, not from supplements; the lower risk of death from CVD associated with adequate intakes of vitamin A, vitamin K, and zinc was limited to nutrients from foods, not from supplements; and calcium intake from supplement totals of at least 1,000 mg/day was associated with increased risk of death from cancer, but there was no association for calcium intake from foods.

In addition, the researchers found that dietary supplements had no effect on the risk of death in individuals with low nutrient intake. Instead, the team found indications that use of vitamin D supplements by individuals with no sign of vitamin D deficiency may be associated with an increased risk of death from all causes including cancer. Further research on this potential connection is needed.

“Our results support the idea that, while supplement use contributes to an increased level of total nutrient intake, there are beneficial associations with nutrients from foods that aren’t seen with supplements,” said Zhang. “This study also confirms the importance of identifying the nutrient source when evaluating mortality outcomes.”

Note the remark about vitamin D. Almost simultaneously with this paper a spate of articles have looked at vitamin D supplement intake in various cancers and found that over all there was little benefit but no risk and there were a few cancers that responded positively to vitamin D supplementation. Note too, the remark about those taking ‘D’ with ‘no sign of vitamin D deficiency’ showing an increased risk of death. Right. And right; which is why even this non- vitamin should not be taken without clear – blood tests! -indication of deficiency.

“Eat Real Food or Else…” Available at Amazon. OK, that was a cheap promo but the point stands.

Have Fun, Smile, God Speed,

Dr. Mike

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