The Truth About Supplements: Do They Actually Work?
Is supplementation effective, or is it a literal case of money down the drain?
A few years ago, three major studies published in the journal Annals of Internal Medicine found that multivitamin supplements were not any more effective than placebos in preventing heart disease, memory loss, or in promoting longevity.
This prompted physicians from prominent medical schools in the US and UK to write an editorial entitled "Enough is Enough: Stop Wasting your Money on Vitamin and Mineral Supplements."
So can we go ahead and say that, across the board, supplements are a waste of money?
Not. So. Fast. Although it’s clear that multivitamins are not an effective insurance policy to replace a balanced diet, this isn’t a reason to entirely dismiss the idea of supplementation.
There is no doubt that eating well is one of the most important things we can do to improve our health. Diet is related to almost all forms of chronic disease, including obesity, diabetes, heart disease, osteoporosis and many types of cancer.
In particular, a whole food, plant-based diet is an excellent method for disease prevention and health promotion. Whole food is the best source of nutrients, because nutrients don’t act in isolation, the way you find them in some vitamins: they often work together, and in combination with countless phytochemicals in whole food, to aid digestion and absorption.
But does that mean isolated nutrients don’t offer any benefit? And if that’s the case, what can we do to obtain the few nutrients that are difficult to source from whole plants, like B12, D3, and DHA/EPA?
"Let’s be clear: the need for some supplementation does not indicate a weakness in the plant-based diet. Indeed, any pattern of eating will have some strengths and some areas of which one needs to be mindful."
An Example of Effective Supplementation: Vitamin B12
To answer these questions, we need to put things into a more nuanced perspective: While it is true multivitamins have not been shown to prevent certain diseases, like dementia or heart disease, the evidence shows that supplementation and fortification can be effective strategies for correcting or preventing nutrient deficiencies.
Vitamin B12 is a great example. Most people eating plant-based diets recognize that this particular diet does not have any whole-food sources of B12, and on a whole-food, plant-based diet, we could become B12 deficient without supplements or fortification.
To combat this, the National Institute of Health recommends supplements or fortified foods -- often breakfast cereals, nutritional yeast, and plant-based milks -- for those who don’t get enough B12, or who have trouble absorbing B12.
Interestingly, B12 deficiency also occurs in people eating an omnivorous diet, particularly those over age 50. Thus, the Institute of Medicine encourages all people over 50 to take B12 supplements and to eat B12 fortified foods. It is a good idea to have your B12 checked at least annually to ensure that your levels are adequate.
And the good news is that B12 supplementation works! Both oral and intramuscular B12 effectively reverse deficiency, and B12 deficiency is rare among people who supplement and eat fortified foods.
So what can we surmise from all this data on B12? Answer: That sometimes supplements do work, when they’re properly taken and chosen for the right reasons.
Many of us who eat a whole-food, plant-based diet are already benefiting from fortification as part of our nutrition plan. Vitamin D, iodine, and B12 are all commonly added to our foods, even when most of us don’t realize it - and if you're keeping processed foods to a minimum, it's very easy to find high quality vegan supplements providing those nutrients.
Multivitamins are not an effective insurance policy to replace a balanced diet, but that's not a reason to entirely dismiss the idea of supplementation.
Evidence shows that supplementation and fortification can be effective strategies for correcting or preventing nutrient deficiencies.
Some nutrients for vegetarians and vegans to consider: Omega-3 fatty acids (like DHA and EPA), zinc, Vitamin D, and Vitamin B12.
How Iodized Salt Ended an Epidemic
To take another example of the positive impact of preventative supplementation, consider goiters. A goiter, which is swelling of the neck or larynx due to thyroid malfunction, is most often caused by iodine deficiency and used to be common in the Appalachian, Great Lakes, and northeastern areas of the United States -- so common that this area was known as the “goiter-belt.” As much as 26-70% of school children had suffered from it in the early part of the 1900s.
Today, however, table salt in the U.S. is fortified with iodine. And because iodine deficiency is highly responsive to supplementation and fortification, conditions like goiter are easily corrected and prevented through thoughtful consumption of this mineral. Now, thankfully, in the era of government-mandated fortification (in the form of iodized salt) goiters are very rare. Again, for those keeping salt intake to a minimum, finding a vegan supplement with iodine is easy and effective.
On a population level, as well as on an individual level, most of us benefit from supplementation and fortification. In their 2016 Vegetarian Diets position paper, the Academy of Nutrition and Dietetics identified some nutrients for vegetarians and vegans to consider: Omega-3 fatty acids (like DHA and EPA), zinc, Vitamin D, and Vitamin B12. These are nutrients to which vegans and vegetarians need to pay particular attention, and may want to consider including, in the form of fortified foods or supplements, to ensure adequate intake.
Let’s be clear, though: the need for some supplementation does not indicate a weakness in the plant-based diet. Indeed, any pattern of eating will have some strengths and some areas of which one needs to be mindful. Consumption of certain foods, like meat and dairy, while sources of B12 or calcium, also comes with drawbacks, like inflammatory agents and relatively high levels of dietary cholesterol. Avoiding those foods and looking to whole plant sources of these nutrients, along with some fortification and supplementation, is an evidence-based choice.
So what’s the answer?
Are supplements good or bad? Do isolated nutrients work or not?
Answering those simplistic questions would miss the point: The key is to not take a broad brush approach when it comes to supplements.
While it’s certainly not the case that more is better, it is also not the case that supplements “do not work,” or that we should never take them. Supplements can be an important part of a healthy, whole food, plant-based diet. Avid plant-based eaters don’t need to apologize for including them, or fall prey to the belief that the need for supplementation diminishes the value of a vegan or vegetarian diet, or points to issues in our practice of those lifestyles.
So don’t wait to become deficient before you consider including certain key, carefully chosen supplements into your diet. Staying healthy and energetic and avoiding deficiency is what we all want, and supplements can play a role in our attainment of those common goals.
Written by Dr. Pamela Fergusson, RD, PhD.
All that you need from a vegan supplement - and nothing you don't!
1. Annals of Internal Medicine, 17 December 2013 Vol: 159, Issue 12. http://annals.org/aim/issue/929454
2. Diet, nutrition and the prevention of chronic diseases. http://www.who.int/dietphysicalactivity/publications/trs916/summary/en/
3. Effective treatment of cobalamin deficiency with oral cobalamin. https://www.ncbi.nlm.nih.gov/pubmed/9694707
4. Plasma vitamin B-12 concentrations relate to intake source in the Framingham Offspring study. https://www.ncbi.nlm.nih.gov/pubmed/10648266
5. History of U.S. Iodine Fortification and Supplementation. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3509517/
6. Position of the Academy of Nutrition and Dietetics: Vegetarian Diets. http://www.eatrightpro.org/~/media/eatrightpro%20files/practice/position%20and%20practice%20papers/position%20papers/vegetarian-diet.ashx