Your Health

Sizing up your supplements

Last year, an estimated 45 per cent of Canadians put vitamin and mineral tablets on their menu. But can these pills ever make up for a poor diet?

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Wave, March / April 2011

It's all part of her morning routine, one that Val Giesbrecht says she has been following for nearly 25 years.

It starts with a healthy breakfast - usually a bowl of granola, yogurt, and a slice of multigrain toast with peanut butter.

Next on the menu for the 57-year-old Winnipeg woman is a selection of vitamin supplements that include:

  • Vitamin C (1,000 mg) - to avoid getting sick with a cold or flu;
  • Vitamin D (2,000 IU) - to promote overall health;
  • Vitamin B50 complex - to reduce stress and enhance energy.

For good measure she also takes a multi-vitamin and mineral tablet that includes vitamins A and E, as well as folic acid and minerals such as calcium, magnesium and iron.

While Giesbrecht says she knows a balanced diet is critical to her overall health, she also believes supplements can help. "The vitamins give me what I might be missing in the food I'm eating. It helps strengthen my immune system, and gives me extra energy. I believe it prevents health issues that could be happening to me."

Giesbrecht is not the only one who believes vitamin and mineral supplements can play a role in boosting one's health. One industry official said last year that about 45 per cent of adult Canadians are taking some kind of vitamin supplement. It is estimated that Canadians spend hundreds of millions of dollars annually on these products to make sure they are getting their nutritional requirements.

The preoccupation with vitamin and mineral supplements is understandable. After all, vitamins and minerals are critical to our health and well-being. These tiny chemical substances allow the body to carry out many important functions, such as building strong bones, strengthening the immune system, facilitating the operation of nerve endings and allowing the brain to communicate with the rest of the body. Simply put, we can't function without adequate levels of vitamins and minerals.

Moreover, researchers continue to generate new studies suggesting that consuming larger amounts of one vitamin or another may play an important role in reducing the risk of developing an assortment of chronic conditions, from cancer to cardiovascular disease. Given their basic importance and the possibility that they might be able to ward off disease, it's no wonder sales of dietary supplements are on the rise.

But while the pills are popular, questions remain: Does the average Canadian need a supplement if he or she is eating a balanced diet? Is there any real proof that supplements can help ward off chronic conditions such as cancer, diabetes or heart disease? Can consuming too many supplements pose a health risk?

Not surprisingly, there are no simple answers to these and other questions. But there are some things consumers need to keep in mind as they make decisions about whether to add these supplements to their daily regimen.

Peter Jones is the Director of the Richardson Centre for Functional Foods and Nutraceuticals at the University of Manitoba, which conducts research into the nutrition of foods grown on the Canadian prairies. He says it is important for consumers to understand that while we do know quite a bit about vitamins and minerals and the effects they have on our bodies, we don't know everything.

For example, we know that our bodies require certain amounts of vitamins and minerals to maintain good health, which is why Health Canada has created recommended daily allowances (RDA) for all nutrients. We also know that consuming too much of a particular vitamin or mineral can actually cause serious damage to our health, which is why Health Canada has also established tolerable upper limits (UL).

But what we don't know with precision is whether consuming certain vitamins above the RDA but below the UL might actually enhance our health or even guard against certain diseases.

"Ten milligrams a day (of vitamin C) may be enough to prevent scurvy," says Jones, who is also a professor in the U of M's Faculty of Agricultural and Food Science, and holds the Canada Research Chair in Functional Foods and Nutrition. "But (Nobel Prize researcher) Linus Pauling will tell you that five or 10 milligrams a day is nowhere near optimal, and if you want to avoid cancer or the common cold, you need to be chugging back up to 10 grams a day - that's a thousand times more," he says.

And that, says Jones, is the heart of the issue: "Is it true that more is better? Will more do nothing for you? Or can more actually be dangerous?"

Further complicating matters for consumers is the fact that not all vitamins are equal. Exceeding the recommended levels of vitamin C, for example, may have no side effects. But taking more than the recommended doses of vitamin A and vitamin D can pose serious health risks.

"You don't want people running out and saying, 'Hey, if so many units of vitamin D is good for me, then 10 or 20 times that is better for me. Particularly, with vitamins A and D, it's really bad news."

So what is the average consumer looking to stay healthy supposed to do?

Like most nutrition experts, Jones says the vast majority of Canadians can and should get their nutritional requirements from eating a balanced diet.

"That's where I like to come down," says Jones. "I would assert that there is no instance where you can't meet your (daily) requirement" of vitamins and minerals by following Eating Well with Canada's Food Guide. And you are also getting a lot of other things in your diet that are considered healthy."

That's not to suggest that vitamin supplements can't be beneficial for some. It's just that consumers must be careful not to see supplements as a kind of shortcut to better health or a guarantee against chronic disease.

Lana Kusmack, a registered dietitian with the Winnipeg Health Region, agrees. She says the recommended portions and servings in the Food Guide are all calculated to provide the recommended daily allowance (RDA) of vitamins and minerals. "The Food Guide has done all of the research and calculated all of the RDAs so that we as members of the general public don't have to count micrograms or international units."

Essentially, the guide reminds everyone to eat lots of colourful vegetables and fruits, choose whole grains, eat fish, choose low-fat dairy, eat meat and meat alternatives, and not to overdo it with the salt, sugar and fat. It also explains ideal portion sizes and servings.

"Really, it (good health) boils down to eating more fruits and veggies and whole grains - which most of us don't," says Jones. "We eat processed fast food, and it is highly devoid of the kinds of things that provide vitamins and minerals."

Jones's argument is underscored by studies that show many Canadians do not eat the kind of diet outlined in Eating Well with Canada's Food Guide. Most recently, the Community Health Assessment, produced for the Winnipeg Health Region, suggested that Winnipeggers are not eating as much fruit and vegetables as they should.

There are a lot of reasons for this, says Kusmack. Busy lifestyles often lead to fast-food dinnertime solutions. More people eat out at restaurants, which can often mean meals with higher salt and fat content. The availability and affordability of fresh fruits and vegetables can also be a problem for many. Media reports of studies that focus on the benefits of a single vitamin can also lead people into thinking that a supplement of that particular nutrient could be beneficial. And then there is the question of taste - some people just don't like vegetables.

But those who think supplements can compensate for a lack of healthy food for any of these reasons should think again, says Jones. "I don't think you can really make it up by swallowing a bunch of different pills that you think are adding back the (nutrients) you are missing," says Jones. "There are so many other things that we haven't even discovered yet in fruits and vegetables that keep us healthy that by far you are better off to eat a healthy diet first."

Jones notes that other cultures figured this out a long time ago. "In Asia, there are so many more fruits and vegetables served," he says. "They have fruits and vegetables for breakfast. Their breakfast is like their supper - it's full of hot vegetables and fruits."

Of course, there will be times when a person cannot get their recommended daily allowance of vitamins and minerals from his or her diet. In these cases, dietary supplements are an option.

"A supplement, like a single vitamin or mineral or a combination in one, can help people to enhance their nutritional status," says Kusmack.

Giesbrecht is a case in point. While she eats a balanced diet, she is also over 50, which means she needs to be paying attention to her vitamin D and calcium levels. There are other examples of cases where a person may need a supplement. Vegetarians, for example, may not be able to get all the vitamin B they need from their diet because they don't eat meat or animal products. Jones recommends vegetarians talk to their doctor to determine whether they require a vitamin B shot once or twice a year to ensure they are getting they are getting their vitamin requirements.

Women who are pregnant or planning to have a baby also benefit from a daily multivitamin containing folic acid and iron. Folic acid (the chemical name for folate) promotes the healthy development of a baby's brain and spine, and helps prevent related birth defects.

Folate is found in foods like lentils, white, black and kidney beans, spinach, kale, broccoli, asparagus and romaine lettuce. Many breads, pastas and orange juices are now fortified with folic acid. But a lot of women do not get enough of this nutrient in their diet. Moms-to-be with a family history of neural tube defects and higher-risk pregnancies, as well as other health conditions like diabetes, obesity, and epilepsy, should consult their doctors about how much folic acid is right for them, says Kusmack.

A daily multivitamin containing 16-20 mg of iron is recommended for pregnant women. A separate iron pill may be prescribed by a doctor if the woman has diagnosed iron deficiency anemia. Low iron levels can lead to fatigue and can cause anemia - a condition that can contribute to premature delivery, low birth weight and increased risk of perinatal infant death, she says.

One of the more interesting discussions about dietary supplements concerns vitamin D levels.

Vitamin D helps the body to build and maintain strong bones and teeth, but consuming too much can affect the kidney and other soft tissues including the heart, lungs and blood vessels. While vitamin D is not found in a lot of foods, it is readily available from the sun, which is where most people get their required amounts. The problem is that during winter, people are not exposed to the sun as much, and, as a result, vitamin D levels may drop.

Previously, it was thought that most people could get the recommended amount of 400 IUs per day of vitamin D through their diet, with older adults topping up their needs with a supplement. But last fall, Health Canada moved to increase the recommended daily allowance to 400 IUs for infants up to 12 months of age, 600 IUs a day for teens and adults, and 800 IUs a day for those over the age of 70. The changes raise questions about whether most people can meet the higher recommended daily allowances without taking a supplement.

But Kusmack says the changes do not automatically mean everyone has to increase their vitamin D intake. "Based on Health Canada's preliminary analysis of Canadians' vitamin D blood levels, most are currently meeting their needs for vitamin D," she says.

But what about people of any age who eat fairly well but still want to take a supplement in the hope that it might enhance their health. Is there a danger they could overdo it?

Jones says the best advice is to try and stay between the recommended daily allowance (RDA) and the tolerable upper limit (UL). In most cases, people who eat a balanced diet will meet the recommended daily allowance. Those who take a supplement according to the instructions on the bottle should not exceed the acceptable upper intake level.

And, of course, if you are wondering about whether you are getting the vitamins and minerals you need, talk to your doctor.

Liz Katynski is a Winnipeg writer.

About Wave

Wave is published six times a year by the Winnipeg Health Region in cooperation with the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books.

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