Do You Need Supplements?

Written by Dr. Steve Chaney on . Posted in Supplements and Health

Supplements As Part of a Holistic Lifestyle

Author: Dr. Stephen Chaney

 

do you need supplementsDo you need supplements?

The headlines about supplementation are so confusing. Are they useful, or are they a waste of money? Will they cure you, or will they kill you? I feel your pain.

I will answer these questions in depth in my upcoming book, but let me give you a quick overview today. I call it: “Do You Need Supplements?” I created the graphic on the left to illustrate why I feel responsible supplementation is important for most Americans. Let me give you specific examples for each of these categories.

 

Examples of Poor Diet

do you need supplements dietDo you need supplements if you have a poor diet? You have heard the saying that supplementation fills in the nutritional gaps in our diets.  So what are the nutritional gaps? According to the USDA’s 2015-2020 Dietary Guidelines for Americans, many Americans are consuming too much fast and convenience foods. Consequently, we are getting inadequate amounts of calcium, magnesium, and vitamins A, D, E and C. Iron is also considered a nutrient of concern for young children and pregnant women. According to a recent study, regular use of a multivitamin is sufficient to eliminate all these deficiencies except for calcium, magnesium and vitamin D (J.B. Blumberg et al, Nutrients, 9(8): doi: 10.3390/nu9080849, 2017 ). A well-designed calcium, magnesium and vitamin D supplement may be needed to eliminate those deficiencies.

In addition, intake of omega-3 fatty acids from foods appears to be inadequate in this country. Recent studies have found that American’s blood levels of omega-3s are among the lowest in the world and only half of the recommended level for reducing the risk of heart disease (K.D. Stark et al, Progress In Lipid Research, 63: 132-152, 2016 ;S.V. Thuppal et al, Nutrients, 9, 930: doi: 10.3390/nu9090930, 2017 ). Therefore, omega-3 supplementation is often a good idea.

In previous editions of “Health Tips From the Professor” I have talked about our “mighty microbiome”, the bacteria and other microorganisms in our intestine. These intestinal bacteria can affect our tendency to gain weight, our immune system, inflammatory diseases, chronic diseases such as diabetes, cancer, and heart diseases, our mood—the list goes on and on. This is an emerging science. We are learning more every day, but for now it appears our best chances for creating a health-enhancing microbiome are to consume a primarily plant-based diet and take a probiotic supplement.

Finally, diets that eliminate whole food groups create nutritional deficiencies. For example, vegan diets increase the risk of deficiencies in vitamin B12, vitamin D, calcium, iron, zinc and long chain omega-3 fatty acids.  A recent study reported that the Paleo diet increased the risk of calcium, magnesium, iodine, thiamin, riboflavin, folate and vitamin D deficiency (A. Genomi et al, Nutrients, 8, 314; doi: 10.3390/nu8050314, 2016. The Keto diet is even more restrictive and is likely to create additional deficiencies.

 

Examples of Increased Need

do you need supplements increasedDo you need supplements if you have an increased need?  We have known for years that pregnancy and lactation increase nutritional requirements. In addition, seniors have increased needs for protein, calcium, vitamin D and vitamin B12. In previous issues of “Health Tips From the Professor” I have also shared recent studies showing that protein requirements are increased with exercise.

Common medications also increase our need for specific nutrients. For example, seizure medications can increase your need for vitamin D and calcium. Drugs to treat diabetes and acid reflux can increase your need for vitamin B12. Other drugs increase your need for vitamin B6, folic acid, and vitamin K. Excess alcohol consumption increases your need for thiamin, folic acid, and vitamin B6. These are just a few examples.

Vitamin D is a special case. Many people with apparently adequate intake of vitamin D have low blood levels of 25-hydroxy vitamin D. It is a good idea to have your blood 25-hydroxy vitamin D levels measured on an annual basis and supplement with vitamin D if they are low.

More worrisome is the fact that we live in an increasing polluted world and some of these pollutants may increase our needs for certain nutrients. For example, in a recent edition of “Health Tips From the Professor” I shared a study reporting that exposure to pesticides during pregnancy increases the risk of giving birth to children who will develop autism, and that supplementation with folic acid during pregnancy reduces the effect of pesticides on autism risk. I do wish to acknowledge that this is a developing area of research. This and similar studies require confirmation. It is, however, a reminder that there may be factors beyond our control that have the potential to increase our nutritional needs.

 

Examples of Genetics Influencing Nutritional Needs

do you need supplements geneticsDo you need supplements if your genetics call for specific nutritional needs?  The effect of genetic variation on nutritional needs is known as nutrigenomics. One of the best-known examples of nutrigenomics is genetic variation in the methylenetetrahydrofolate reductase (MTHFR) gene.  MTHFR gene mutations increase the risk of certain birth defects, such as neural tube defects. MTHFR mutations also slightly increase the requirement for folic acid. A combination of food fortification and supplementation with folic acid have substantially decreased the prevalence of neural tube defects in the US population. This is one of the great success stories of nutrigenomics. Parenthetically, there is no evidence that methylfolate decreases the risk of neural tube defects.

Let me give you a couple of additional examples:

One of them has to do with vitamin E and heart disease (A.P. Levy et al, Diabetes Care, 27: 2767, 2004 ). Like a lot of other studies, there was no significant effect of vitamin E on cardiovascular risk in the general population. But there is a genetic variation in the haptoglobin gene that influences cardiovascular risk. The haptoglobin 2-2 genotype increases oxidative damage to the arterial wall, which significantly increases the risk of cardiovascular disease. When the authors of this study looked at the effect of vitamin E in people with this genotype, they found that it significantly decreased heart attacks and cardiovascular deaths.

This has been confirmed by a second study specifically designed to look at vitamin E supplementation in that population group (F. Micheletta et al, Arteriosclerosis, Thrombosis and Vascular Biology, 24: 136, 2008 ). This is an example of a high-risk group benefiting from supplementation, but in this case the high risk is based on genetic variation.

Let’s look at soy and heart disease as a final example. There was a study called the ISOHEART study (W.L. Hall et al, American Journal of Clinical Nutrition, 82: 1260-1268, 2005 ; W.L. Hall et al, American Journal of Clinical Nutrition, 83: 592-600, 2006 ) that looked at a genetic variation in the estrogen receptor which increases inflammation and decreases levels of HDL. As you might expect, this genotype significantly increases cardiovascular risk.

Soy isoflavones significantly decrease inflammation and increase HDL levels in this population group. But they have no effect on inflammation or HDL levels in people with other genotypes affecting the estrogen reception. So, it turns out that soy has beneficial effects, but only in the population that’s at greatest risk of cardiovascular disease, and that increased risk is based on genetic variation.

These examples are just the “tip of the iceberg.” Nutrigenomics is an emerging science. New examples of genetic variations that affect the need for specific nutrients are being reported on a regular basis. We are not ready to start genotyping people yet. We don’t yet know enough to design a simple genetic test to predict our unique nutritional needs. That science is 10-20 years in the future, but this is something that’s coming down the road.

What the current studies tell us is that some people are high-risk because of their genetic makeup, and these are people for whom supplementation is going to make a significant difference. However, because genetic testing is not yet routine, most people are completely unaware that they might be at increased risk of disease or have increased nutritional requirements because of their genetic makeup.

 

Examples of Disease Influencing Nutritional Needs

do you need supplements diseaseFinally, let’s consider the effect of disease on our nutritional needs. Do you need supplements because of disease?  If you look at the popular literature, much has been written about the effect of stress on our nutritional needs. In most cases, the authors are referring to psychological stress. In fact, psychological stress has relatively minor effects on our nutritional needs.

Metabolic stress, on the other hand, has major effects on our nutritional needs. Metabolic stress occurs when our body is struggling to overcome disease, recover from surgery, or recover from trauma. When your body is under metabolic stress, it is important to make sure your nutritional status is optimal.

The effects of surgery and trauma on nutritional needs are well documented. In my upcoming book, I will discuss the effects of disease on nutritional needs in some detail. Let me give you a brief overview here. It is very difficult to show beneficial effects of supplementation in a healthy population (primary prevention). However, when you look at populations that already have a disease, or are at high risk for disease, (secondary prevention), the benefits of supplementation are often evident.

For example, studies suggest that vitamin E, B vitamins, and omega-3s each may reduce heart disease risk, but only in high-risk populations. Similarly, B vitamins (folic acid, B6 and B12) appear to reduce breast cancer risk in high risk populations.

 

Do You Need Supplements?

 

With this information in mind, let’s return to the question: Do you need supplements? Here is my perspective.

  • The need for supplementation is greatest when these circles overlap, as they do for most Americans.
  • The problem is that while most of us are aware that our diets are not what they should be, we are unaware of our increased needs and/or genetic predisposition. We are also often unaware that we are at high risk of disease. For too many Americans the first indication they have heart disease is sudden death, the first indication of high blood pressure is a stroke, or the first indication of cancer is a diagnosis of stage 3 or 4 cancer.

So, let’s step back and view the whole picture. The overlapping circles are drawn that way to make a point. A poor diet doesn’t necessarily mean you have to supplement. However, when a poor diet overlaps with increased need, genetic predisposition, disease, or metabolic stress, supplementation is likely to be beneficial. The more overlapping circles you have, the greater the likely benefit you will derive from supplementation.

That is why I feel supplementation should be included along with diet, exercise, and weight control as part of a holistic approach to better health.

So, do you need supplements?

 

The Bottom Line

 

In this article I provide a perspective on who needs supplementation and why. There are four reasons to supplement.

  • Fill nutritional gaps in our diet
  • Meet increased nutritional needs due to pregnancy, lactation, age, exercise, many common medications, and environmental pollutants.
  • Compensate for genetic variations that affect nutritional needs.
  • Overcome needs imposed by metabolic stress due to trauma, surgery, or disease.

With this information in mind, let’s return to the question: “Do you need supplements? Here is my perspective.

  • A poor diet alone doesn’t necessarily mean you have to supplement. However, when a poor diet overlaps with increased need, genetic predisposition, or metabolic stress, supplementation is likely to be beneficial. The more overlap you have, the greater the likely benefit you will derive from supplementation.
  • The problem is that while most of us are aware that our diets are not what they should be, we are unaware of our increased needs and/or genetic predisposition. We are also often unaware that we are at high risk of disease. For too many Americans the first indication they have heart disease is sudden death, the first indication of high blood pressure is a stroke, or the first indication of cancer is a diagnosis of stage 3 or 4 cancer.

For more details, read the article above.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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Comments (5)

  • Kathryn

    |

    Thank you Dr. Chaney for making sense of the latest scientific studies, evaluating the way they are run and helping us to apply them in our layman’s terms.

    Reply

  • Maria Goldstein

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    Great article. Information everyone needs to know!!

    Reply

  • Marianne Cavett

    |

    Thank you, Dr. Chaney, for explaining (in layman’s terms) what has been confusing to me as a patient myself, in addition to discussing the need of supplements for different diagnosis’ with my doctor… Plus helping others create a healthier life through my business knowledge.

    Reply

  • Chris

    |

    Can you comment on MTOR and Leucine? I have been told that Leucince can enhance the negative effects of MToR. Anxious to read your book. Can you do an article on MToR and exactly what it is and it’s relation to Leucine?

    Reply

    • Dr. Steve Chaney

      |

      Metabolic regulatory pathways are very complex. This would be a graduate level article. Simply put, the effects of leucine on MTOR are both negative and positive. Leucine also affects other regulatory pathways. Unfortunately, some people try to oversimplify. If you focus on one small portion of the regulatory network (the relationship between leucine and negative effects of MTOR), the overall effect looks bad. However, when you look at the entire regulatory network, the effects of leucine are very positive.

      Reply

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Latest Article

The Truth About Vitamin D

Posted December 11, 2018 by Dr. Steve Chaney

Does Vitamin D Reduce Risk Of Heart Disease & Cancer?

Author: Dr. Stephen Chaney

 

the truth about vitamin dYou have every right to be confused. One day you are told that vitamin D reduces your risk of heart disease and cancer. The next day you are told vitamin D makes has no effect on those diseases. You are told vitamin D is a waste of money. What should you believe?  What is the truth about vitamin D?

In mid-November a major clinical study called VITAL was published. It examined the effect of vitamin D and omega-3s on heart disease and cancer risk. Last week I wrote about the omega-3 portion of the study. This week I will cover the vitamin D portion of the study.

Once again, if you rely on the media for your information on supplementation, you are probably confused. Headlines ranged from “Vitamin D Is Ineffective For Preventing Cancer And Heart Disease to “Vitamin D Lowers Odds Of Cancer Death.” What is the truth?

The problem is that reporters aren’t scientists. They don’t know how to interpret clinical studies. What they report is filtered through their personal biases. That is why I take the time to carefully evaluate the clinical studies, so I can provide you with accurate information. Let me sort through the dueling headlines and give you the truth about vitamin D, cancer, and heart disease.

How Was The Study Designed?

the truth about vitamin d studyThe VITAL study (JE Manson et al, New England Journal of Medicine, DOI: 10.1056/NEJMoa1811403) enrolled 25,871 healthy adults (average age = 67) in the United States. The study participants were 50% female, 50% male, and 20% African American. None of the participants had preexisting cancer or heart disease. The characteristics of the study group were typical of the American population at that age, namely:

  • The average BMI was 28, which means that most of the participants were significantly overweight.
  • 7% of them had diabetes.

Study participants were given questionnaires on enrollment to assess clinical and lifestyle factors including dietary intake. Blood samples were taken from about 65% of the participants to determine 25-hydroxyvitamin D levels (a measure of vitamin D status) at baseline and at the end of the first year. The participants were given either 2,000 IU of vitamin D/day or a placebo and followed for an average of 5.3 years.

There were two important characteristics of the participants in this study that may have influenced the outcome.

  • The average 25-hydroxyvitamin D level of participants at the beginning of the study was 31 ng/ml (78 nmol/L). The NIH considers 20-50 ng/ml (50-125 nmol/L) to be the optimal level of 25-hydroxyvitamin D for most physiological functions. This means that study participants started in the middle of the optimal range with respect to vitamin D status.

[Note: The NIH defines the 20-50 ng/ml range as “adequate.”  However, I know many of my readers like to aim beyond adequate to reach what they consider to be “optimal.”  In the case of vitamin D, that might not be a good idea. The NIH considers anything above 50 ng/ml as associated “with potentially adverse effects.”  For that reason, I will refer to the 20-50 ng/ml range as optimal for this article. I wouldn’t want to encourage my readers to be aiming for above 50 ng/ml.]

  • Only 12.7% of participants had 25-hydroxyvitamin D levels below 20 ng/ml, which the NIH considers to be inadequate. The results with this group were not statistically different from the study participants with optimal vitamin D status, but it is not clear that there were enough people in this subgroup for a statistically valid comparison with participants starting with an optimal vitamin D status.
  • At the end of the first year, 25-hydroxyvitamin D levels in the treatment group increased to 42 ng/ml (105 nmol/L), which is near the upper end of the optimal range. Thus, for most of the participants, the study was evaluating whether there was a benefit of increasing vitamin D status from the middle to the upper end of the optimal range.
  • The study allowed subjects to continue taking supplements that contained up to 800 IU of vitamin D. While the authors tried to correct for this statistically, it is a confounding variable.

Does Vitamin D Reduce The Risk Of Cancer?

 

the truth about vitamin d and cancerYou may remember from last week that omega-3s were more effective for reducing heart disease risk than for reducing cancer risk. What is the truth about vitamin D and cancer risk?   The results are reversed for vitamin D, so I will discuss cancer first.

The study reported that vitamin D supplementation did not reduce a diagnosis of invasive cancer of any type, breast cancer, prostate cancer, or colon cancer during the 5.3-year time-period of this study. This was the result that was reported in the abstract and was what lazy journalists, who never read past the abstract, reported.

However, the rest of the study was more positive. For example, occurrence of invasive cancer of any type was reduced by:

  • 23% in African-Americans.
  • 24% in patients with a healthy body weight.

Several previous studies have suggested that vitamin D may be more effective at preventing cancer in people with a healthy body weight, but the mechanism of this effect is currently unknown.

Most previous studies have not included enough African-Americans to determine whether they respond more favorably to vitamin D supplementation. However, African-Americans have a higher risk of cancer, so this finding deserves follow-up.

In addition, when the study looked at deaths from cancer, the results were very positive. For example:

  • Cancer deaths during the 5.3-year study period were reduced by 17%.
  • The longer vitamin D supplementation was continued the more effective it became at reducing cancer deaths. For example,
  • When the authors excluded cancer deaths occurring during the first year of supplementation, vitamin D reduced cancer deaths by 21%.
  • When the authors excluded cancer deaths occurring during the first two years of supplementation, vitamin D reduced cancer deaths by 25%.

Finally, no side effects were noted in the vitamin D group.

 

Does Vitamin D Reduce The Risk Of Heart Disease?

 

the truth about vitamin d and heart diseaseThe VITAL study also looked at the effect of vitamin D on heart disease risk. What is the truth about vitamin D and heart disease?  The results from this study were uniformly negative. There was no effect of vitamin D supplementation on all major cardiovascular events combined, heart attack, stroke, or death from heart disease. Does that mean vitamin D has no role in reducing heart disease risk? That’s not clear.

The authors had a thought-provoking explanation for why the results were negative for heart disease, but positive for cancer. Remember that the participants in this trial started with a 25-hydroxyvitamin D level of 31 ng/ml and increased it to at least 42 ng/ml with vitamin D supplementation.

The authors stated that previous studies have suggested the 25-hydroxyvitamin D level associated with the lowest risk for heart disease is between 20 and 25 ng/ml. If that is true, most of the participants in this trial were already in the lowest possible risk for heart disease with respect to vitamin D status before the study even started. There would be no reason to expect additional vitamin D to further reduce their risk of heart disease.

In contrast, the authors said that previous studies suggest the 25-hydroxyvitamin D level associated with the lowest risk of cancer deaths is above 30 ng/ml. If that is true, it would explain why vitamin D supplementation in this study was effective at reducing cancer deaths.

However, previous placebo-controlled clinical studies have also been inconclusive with respect to vitamin D and heart disease. My recommendation would be to think of adequate vitamin D status as part of a holistic approach to reducing heart disease – one that includes a heart-healthy diet and a heart-healthy lifestyle – rather than a “magic bullet” that decreases heart disease risk by itself.

As for heart-healthy diets, I discuss the pros and cons of various diets in my book, “Slaying The Food Myths.”  As I discuss in my book, the weight of scientific evidence supports primarily plant-based diets that include omega-3s as heart healthy. As an example, the Mediterranean diet is primarily plant-based and is rich in healthy oils like olive oil and omega-3s. It is associated with reduced risk of both heart disease and cancer.

 

What Is The Truth About Vitamin D?

 

the truth about vitamin d signThere is a lot of confusion around the question of whether vitamin D reduces the risk of cancer. This study strengthened previous observation suggesting that vitamin D supplementation decreases cancer deaths. However, it is also consistent with previous studies that have failed to find an effect of vitamin D on cancer development. How can we understand this apparent discrepancy? The authors provided a logical explanation. They pointed out that:

  • Cancer development takes 20-30 years while this clinical study lasted only 5.3 years. That means that vitamin D supplementation only occurred at the tail end of the cancer development process. In fact, the cancer was already there in most of the patients in the study who developed cancer. It just had not been diagnosed yet. In the words of the authors: “Given the long latency for cancer development, extended follow-up is necessary to fully ascertain potential effects [of vitamin D supplementation].”
  • In contrast, none of the patients had been diagnosed with cancer when they entered the trial. That means that the patients were diagnosed with cancer during the 5.3-year study period. They were receiving extra vitamin D during the entire period of cancer treatment. Thus, the effect of vitamin D on reducing cancer deaths was easier to detect.

What Does This Study Mean For You?

the truth about vitamin d questionsVitamin D Is Likely To Decrease Your Risk Of Dying From Cancer: When you combine the results of this study with what we already know about vitamin D and cancer, the results are clear. Vitamin D appears to reduce your risk of dying from cancer. More importantly, the longer you have been supplementing with vitamin D, the greater your risk reduction is likely to be.

Vitamin D May Decrease Your Risk Of Developing Cancer: Association studies suggest that optimal vitamin D status is associated with decreased cancer risk, especially colon cancer risk. However, the long time for cancer development means that we may never be able to prove this effect through double-blind, placebo-controlled clinical trials.

Holistic Is Best: When you combine the VITAL study results with what we already know about vitamin D and heart disease, it appears that supplementing with vitamin D is unlikely to reduce your risk of developing heart disease unless you are vitamin D deficient. However, a holistic approach that starts with a healthy, primarily plant-based diet and makes sure your vitamin D status is adequate is likely to be effective.

The same is likely true for cancer. While the latest study suggests that vitamin D supplementation reduces your risk of dying from cancer, those vitamin D supplements are likely to be even more effective if you also adopt a healthy diet and lifestyle.

How Much Vitamin D Do You Need? The optimal dose of vitamin D is likely to be different for each of us. One of the things we have learned in recent years is that there are significant differences in the efficiency with which we convert vitamin D from diet and/or sun exposure into the active form of vitamin D in our cells. Fortunately, the blood test for 25-hydroxyvitamin D is readily available and is widely considered to be an excellent measure of our vitamin D status.

I recommend that you have your blood level of 25-hydroxyvitamin D tested on an annual basis. Based on the best currently available data, I recommend you aim for >20 ng/ml (50 nmol/L) if you wish to minimize your risk of heart disease and >30 ng/ml (75 nmol/L) if you wish to minimize your risk of cancer. If you can achieve those levels through diet and a multivitamin supplement, that is great. If not, I would recommend adding a vitamin D supplement until those levels are achieved.

Finally, you shouldn’t think of vitamin D as a magic bullet. If you are a couch potato and eat sodas and junk food, don’t expect vitamin D to protect you from cancer and heart disease. You should think of maintaining adequate 25-hydroxyvitamin D levels as just one component of a holistic approach to healthy, disease-free living.

 

The Bottom Line

 

There is a lot of confusion around the question of whether vitamin D reduces the risk of cancer and heart disease. A major clinical study has just been published that sheds light on these important questions. It reported:

  • Vitamin D did not decrease the risk of developing cancer during the 5.3-year study duration. The authors pointed out that cancer takes 20-30 years to develop, which means their study was probably too short to detect an effect of vitamin D on the risk of developing cancer.
  • Vitamin D did decrease the risk of dying from cancer, and the longer people were supplementing with vitamin D the bigger the protective effect of vitamin D was.
  • Vitamin D did not decrease the risk of heart disease. However, most study participants had a level of 25-hydroxyvitamin D that was optimal for reducing the risk of heart disease at the beginning of the study. There was no reason to expect that extra vitamin D would provide additional benefit.
  • With respect to both cancer and heart disease the best advice is to:
    • Get your 25-hydroxyvitamin D levels tested on an annual basis and supplement, if necessary, to keep your 25-hydroxyvitamin D levels in what the NIH considers to be an adequate range (20-50 ng/ml).
    • We do not have good dose response data for the beneficial effects of vitamin D on heart disease and cancer. However, according to this article, previous studies suggest you may want to am for 25-hydroxyvitamin D levels above 20 ng/ml to reduce the risk of heart disease and above 30 ng/ml to reduce your risk of cancer.
    • Consider vitamin D as just one component of a holistic approach to healthy, disease-free living.

For more details about the interpretation of these studies and what they mean for you, read the article above.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

 

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