Still taking a hand full of vitamins everyday? Here’s the truth about dietary supplements.
Whether they are spilling out of your medicine cabinet or occupying your bedside table top, you are not alone if you’re one of the millions of people who take a vitamin or supplement every day.
What is the truth about dietary supplementation, vitamins and minerals?
What is a dietary supplement?
A dietary supplement is a product intended to supplement or add to a person’s diet by providing nutrients essential to a healthy body.
Dietary supplements are used to combat a vitamin deficiency or supposedly decrease the risk for developing disease.
Thus, vitamin supplements are primarily intended to add vitamins and minerals essential for a healthy body in the case where there is a deficiency of that vitamin/mineral.
While these supplements can be beneficial to your health, they also involve health risks and despite various research that has been done, scientific evidence about the effectiveness and benefits of supplements isn’t completely clear.
Most studies suggest that multivitamins won’t make you live longer, slow cognitive decline or lower your chances of disease such as heart disease, cancer or diabetes.
All the essential vitamins:
Vitamin | Effect/benefits & side effects | How much is needed? | Sources |
Vitamin A (retinol) | - proper immune function - skin health Too much vitamin A can affect bone health and increase likelihood of fractures in older people especially women. | 0.7mg for men 0.6mg for women | Cheese, eggs, fish, milk, yogurt, liver products, yellow, red and green leafy vegetables, yellow fruit. |
Vitamin B1 (Thiamine) | - helps release energy from food sources. - Nervous system health | 1mg for men 0.8mg for women | Peas, fresh fruit, nuts, whole grain breads, liver products. |
Vitamin B2 (Riboflavin) | - keeps skin, eyes and nervous system healthy. - Helps the body release energy from food sources. | 1.3mg for men 1.1mg for women | Milk, eggs, mushrooms, plain yogurt |
Vitamin B3 (Niacin) | - keeps skin, eyes and nervous system healthy. - Helps the body release energy from food sources. Taking too high doses can lead to skin flushes and liver damage, but evidence is limited. | 16.5mg for men 13.2mg for women | Meat, fish, Wheat flour, eggs. |
Vitamin B6 (Pyridoxine) | - helps the body to use stored energy from protein and carbohydrates in food. - Helps the body form hemoglobin, the substance in red blood cells that carries oxygen. Too high doses can lead to loss of feeling in arms and legs (peripheral neuropathy). | 1.4mg for men 1.2mg for women | Pork, poultry, fish, peanuts, soy beans, oats, bananas, milk. |
Vitamin B7 (Biotin) | - helps the body make fatty acids. The bacteria in your body makes biotin and thus it is unclear according to evidence if you need supplementation of biotin additional to your diet. | Needed in very small amounts. | |
Folic acid/folate | - helps the body form healthy red blood cells. - Reduces the risk of birth defects in unborn babies such as spina bifida. Too high doses of folic acid can mask the symptoms of vitamin B12 deficiency and can lead to nervous system damage. | 0.2mg a day for adults 0.4mg a day for pregnant women | Broccoli, leafy green vegetables, peas, chickpeas, kidney beans, brussel sprouts. |
Vitamin B12 | - helps the body make red blood cells and keeps the nervous system healthy. - Helps the body release energy from food. | 0.0015mg for adults | Meat, fish, milk, eggs, cheese. |
Vitamin C | - helps to protect and keep cells healthy. - Maintain healthy skin, blood vessels, cartilage and bones. - Helps with wound healing. Too high doses will lead to stomach pain, diarrhea and flatulence. | 40mg for adults | Citrus fruit, peppers, strawberries, broccoli, potatoes, blackcurrant, brussel sprouts. |
Vitamin D | - helps keep bones, teeth and muscles healthy. Too high doses over time can lead to calcium buildup in the body which can damage and weaken bones, kidneys and the heart. | 0.0085-0.01mg for children younger than 1 year 0.01mg for children over 1 year and adults | The body creates vitamin D from direct sunlight on the skin. Can also be found in a small number of foods such as fish, red meat, liver, egg yolks. |
Vitamin E | - helps maintain healthy skin and eyes and strengthen the body’s natural defense system. | 4mg for men 3mg for women | Plant oils (sunflower, soya, corn and olive oil), nuts, seeds, wheatgerm. |
Vitamin K | - essential for blood clotting in the body. - Helps with wound healing. | 0.001mg for every kg of body weight. | Green leafy vegetables, vegetable oils, cereal grains. |
Calcium | - helps to build bones and keep teeth and bones healthy. - Regulates muscle contractions. - Make sure blood clots naturally. Too high doses will lead to stomach ache and diarrhea. | 700mg for adults (aged 19-64) | Milk, cheese, green leafy vegetables, soya drinks, bread, fish. |
Iodine | - makes thyroid hormones which keeps cells and the metabolic rate healthy. Too high doses for long periods can change how the thyroid glands work which can lead to a range of symptoms such as weight gain. | 0.14mg for adults | Cows milk, eggs, sea fish, shellfish. |
Iron | - important in making red blood cells which carry oxygen in the body. Too high doses will lead to constipation, feeling sick, stomach pain. Too high doses can be fatal in children. | 8.7mg for men (aged 19+) 14.8mg for women (aged 19-49) 8.7mg for women (aged 50+) | Liver, red meat, beans, nuts, drier fruit, soybean flour. |
Other: Magnesium | - helps the body turn food into energy. - Helps the parathyroid glands function properly to produce hormones important for bone health. | 300mg for men (aged 19-64) 270mg for women (aged 19-64) | Spinach, nuts, wholemeal bread. |
Facts about supplements:
Supplements are regulated under different rules than pharmaceutical medicine.
Dietary supplements fall under the Medicines and Related Substances Act, and are classified as a subcategory of Complementary Medicine. Thus, dietary supplements are intended to supplement your regular diet with necessary nutrients rather than serve as a replacement for your diet.
Supplements are thus registered with SAHPRA (South African Health Products Regulatory Authority) but not regulated as medicines are. However they must meet the same labeling and advertising requirements.
Requirements for supplements are often limited to the ingredient name, the dosage, the daily intake limit, the purity of the ingredients etc. but oftentimes the manufacturing company does not have to provide evidence of the facts.
The form of the ingredient, the dosage and the formulation of the entire product influences the effectiveness of the supplement.
Active ingredients can be sourced from various different places and in various different forms. Different forms of the same ingredient can have different properties such as one will be cheaper but the other will be biologically more active, some forms of iron (iron sulfate) can cause constipation whereas other forms (iron citrate formulated with vitamin c) is most readily digested and absorbed etc.
Because there are no regulations on these aspects of supplements, companies can use any form, dosage and formulation that they prefer which will then be advertised under a collective name such as Magnesium supplements. (Magnesium has various forms and each form provides different benefits but will be advertised in general as magnesium).
Thus, make sure to understand and have extensive knowledge on the ingredients in the supplements you are taking.
Efficacy and safety testing is regulated differently than other medicines.
For prescription medicine and over the counter drugs, extensive research and clinical trials have to be performed by SAHPRA before a drug can be approved, proving its safety and efficacy and determining its side effects etc.
Supplements however are not regulated and tested strictly for safety and efficacy as pharmaceuticals are. The regulations are very limited when referring to supplements.
However, many reputable companies do provide extensive evidence of safety and efficacy for their users, it is not a requirement for all and many times these safety and efficacy tests are limited to certain groups of people (often excluding children or people with chronic illnesses.)
There is a surge of new ingredients on the market.
Over the past few years there has been an explosion of new ingredients being introduced in supplements and with the less strict regulation on safety and efficacy of these ingredients, it does pose a new threat of uncertainty about issues such as health risks, side effects and contraindications.
Oftentimes the label will include all the ingredients and the strengths which will then submit to the legal requirements of labeling, advertising and daily intake limits but often the combination of ingredients and the formulation pose different threats.
For example in energy drinks the caffeine dose will always be within the allowed limits for daily intake, but with addition of a common ingredient Guarana (1 gram is equivalent to 40-80mg of caffeine with a more potent effect than caffeine) the effect of caffeine will be much higher than what calls for as safe.
Be aware of ingredients in multivitamins and supplements, do research on these ingredients as well as the companies manufacturing these products.
“Natural” doesn’t always mean good for you.
Looking at the supplements industry, it is a multimillion dollar industry where a ton of money is made from a lot of things with limited data and research. Even though many supplements are very effective and work well, data is very scarce for most supplements and natural products.
Just because something comes from earth, does not mean it is safe, cocaine and heroin also comes from earth but is not necessarily classified as the safest ingredients. Just because something is natural does not equal good and safe.
Supplements can benefit you but also hurt you.
Some dietary supplements can help you get enough amounts of essential nutrients if you don’t eat a nutritious enough diet. However, it can not replace a healthy diet.
Certain medical conditions and situations require supplementation, for example pregnancy. Folic acid in pregnancy lowers the risk for birth defects.
Some supplements can improve overall health and help manage some health conditions, but research oftentimes suggests contradictory beliefs.
Supplements also contain active ingredients that can have a strong effect on the body and can also interact with some medications to cause complications. For example, vitamin K can reduce the ability of a blood thinner to prevent blood clots and can pose a threat to someone prone to blood clots.
Yet again, many studies show that there are little benefits from supplementation for healthy individuals, thus thorough research on the benefits should be done.
Supplements are not a cure for disease. If it was, no one with osteoporosis would still be taking calcium supplements.
So what’s the truth?
Supplements have very little proven benefit for healthy people who have even a remotely balanced diet. As long as a person's diet falls within a wide range of what medical professionals consider balanced, it's unlikely they would benefit from any dietary supplement.
Some people have nutritional deficiencies and people with certain diseases are at higher risk for developing nutritional deficiencies. These people work with their doctors to determine what they should take to bolster their health, the rest of us (the majority) do not need supplements.
Supplementation should be modified specifically to your needs, lifestyle and your body. Speak with your healthcare providers on proper supplementation where it is needed and beneficial.
The best possible way for us to ensure our bodies get adequate amounts of nutrients is with a healthy, balanced diet.
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