Supplements 101 — Part 2

The Good & The Bad

In Part 1 of this series, I reviewed what supplements are and that the supplement industry is disturbingly underregulated.

Today, we are going to review the good & the bad of turning to supplements.

Photo by Daniel Dan on Unsplash

The Good:

• Nutrient deficiencies: The most common scenario in which I recommend supplementation is to address an identified nutrient deficiency. In fact, when it comes to vitamin & mineral supplementation, specifically, there doesn’t seem to be much benefit when there is no deficiency or insufficiency¹.

• Increased needs: Some people have increased needs for certain nutrients, which can be difficult to get through diet alone. During pregnancy, for example, research supports specific vitamin and mineral supplementation to protect the health of the mother and the growing baby.

• Digestive challenges: We get nutrients into the parts of our body that need them through eating food. That food is then digested into small enough pieces to be absorbed into the bloodstream and distributed throughout our body. Several digestion and absorption challenges may make this process ineffective, and supplementation can sometimes be part of the intervention.

• Inadequate intake: Whether because of necessary or chosen food restrictions (allergies, vegan, etc.), decreased appetite due to medication or illness, or even eating disorders, supplements can sometimes help fill nutrient intake gaps when food alone is not sufficient.

The Bad:

• Risk of toxicity: More is not better, especially for supplements whose excesses are stored in our tissues instead of being excreted. I see this most commonly for Vitamins A, D, E, and K, which are fat-soluble, meaning that they require fat to be absorbed as well as stored, which gives two important pieces of information:

  • First, if you are taking a Vitamin D supplement, for example, you will absorb it more readily if you take it with a meal containing at least a little bit of healthy fat.

  • Second, if you overdo that Vitamin D supplement, excess will be stored in body fat, increasing the risk of Vitamin D toxicity. More is not better.

• Supplement interactions: Supplements are not benign. Even if you take a supplement because you need it and you choose a product that has been third-party tested, interactions between individual supplements and between supplements and medications are common, ex:

  • Supplement<>Supplement: Calcium blocks iron absorption, so taking both in supplement form at the same time reduces the amount of iron that gets into your body.

  • Supplement<>Medication: St. John’s Wort famously interferes with some birth control pills, making them less effective, and interacts with common antidepressant (SSRI) medications.

• Mask other deficiencies: Blindly taking supplements because you’ve heard they are healthy may mask a true deficiency, which can be incredibly dangerous. Taking folate or folic acid without monitoring, for example, may disguise a Vitamin B12 deficiency, which is associated with cognitive decline.

• Contamination risk: As shared in Part 1, there is no pre-market regulation for supplement safety. This means that supplements may or may not have the ingredient(s) listed on the label, may have more or less than the amount on the label, and/or may have contaminants such as lead. Third-party testing is the best way to evaluate each of these risks.

• False sense of security: You can’t out-supplement a low-quality diet. Too often I see people who are spending loads of money on supplements only to be eating fast food, highly processed snacks, and other low nutrient quality foods. In this case, it is often best to save the money you spent on supplements to buy higher-quality food.

• Cost: The supplement industry is valued at $70 billion in the US alone, with the average US adult spending more than $500 a year on various supplements, with some spending way more. I’m not saying some supplements aren’t worth it, but being well-informed about supplements can protect your health and your bank account.

Are there any good or bad aspects of supplements I’ve missed? Leave a comment:

Next week I will present the framework I use to determine whether a patient needs a supplement, and if they do, how much they need and how long they need it for.

Thanks for being here,

~Allison

1. More on what these mean next week.