Great truth about dietary “supplements”

One of my readers recently asked a good question. She wanted to know how much of a popular dietary supplement she should take on a daily basis.

Her question sounds simple enough.

But it’s not.

You see, everyone is different due to “nutritional individuality.” People absorb, metabolize and utilize nutrients differently. And so we each have different “requirements.”

Determining those requirements metabolically is a two-step process. One step is to measure an actual blood level and the next step is to measure nutrient levels in tissue. As I have written previously, the best science is done that way. Unfortunately only a small minority of nutritional studies measure actual nutrient levels. And in medical practice with all the blood tests that are done, the only “routine” nutrient measurement is done on iron.

This is the great, forgotten truth when it comes to nutritional supplements (not to mention the practice of medicine and the “standard dosage form” of prescription drugs). And it’s an “inconvenient truth” for mainstream medicine. And even “integrative” medicine.

In addition to metabolic and nutritional individuality, practitioners can only precisely recommend the “correct” dose of a nutritional supplement if they know the diet of the individual. That’s because nutritional supplements are meant literally to “supplement” your diet. They add back the nutrients missing from your diet. And they help you reach optimal nutritional levels.

So, practitioners must also know their patients’ diets to make a truly personalized recommendation. But, this too is problematic.

As I have said before, dietary assessments have limitations. The three main types of assessment are:

1. Diet diary

2. 24-hour diet recall

3. Food frequency questionnaire

But each of these relies on a patient’s account of what they ate. And studies show they are rarely accurate

So how do experts set supplemental guidelines, given these limitations?

I was part of team that tried to do just that for a group of schoolchildren.

In 2006, newly elected Maryland Governor, Martin O’Malley, asked us to help develop a school nutrition program. We planned to launch the program in Baltimore City schools as well as the innovative community of Fallston, MD.  We had obtained promise of funding from a prestigious foundation that supports local programs in Baltimore (established by the owners of the Baltimore Sun newspaper). We gave teachers a questionnaire designed to assess the nutritional intake of each child.

The questionnaire had been developed over many years working with scientists by an organization called Signature Supplements in Urbana, MD. It was a kind of “nutrimetric” profile (much like the concept of our “emotional type” profile for determining which CAM therapies will work). And it had already been used to help thousands of people. In this instance, it would be used to assess the specific diet and nutritional needs of each individual student, and to tailor an individualized supplement formulation to each child, based upon known characteristics.

Meanwhile, at many other schools around the country, a popular nonprofit school “nutrition” program was already in vogue, which involved dumping willy-nilly, unused and expired supplements, literally backing up the delivery trucks to the school loading docks to hand out to students.

Somehow, most of the supplement industry and the “nonprofit” world heralded that project as a great achievement.

But when word got out about our program, the then-Baltimore health commissioner (who is now appropriately enough working at FDA) voiced a personal opinion that our program was not “scientific” enough. And the program funding was stopped cold. The governor quietly turned his back on us, and the problem. But the dump trucks kept rolling up to schools around the country with their supplies of random supplements.

Today, that former health commissioner is appropriately ensconced in a job down the road at the FDA. I’ll tell you more about my experience with him in an upcoming article.

But what about when individual metabolic and/or dietary assessments simply can’t be done? In those instances, we must resort to “average” recommended doses.

We base these on what it takes to supplement the “average” diet. Here again, the goal is to bring daily intakes up to optimal levels based on research findings.

But what is the “average” diet? And how do we determine it?

First of all, we must consider all the available evidence. Not just a small subset that happens to support some sensational new “finding.”

Yet, some notorious medical research scientists do just that. They miss the forest for the trees.

Fish oil recently became a good example of this bad, incomplete approach.

Some scientists are only looking at the findings from one sensational study that linked fish oil to prostate cancer. And they ignore hundreds of other studies that underscore the benefits of fish oil. Then, they use this one sensational study to make supplement recommendations–and to try to make a name for themselves along the way.

But real nutritional experts know that making fish oil recommendations is a tricky business. Because fish consumption varies dramatically between one population and the next. And even among different individuals within the same population. That’s why you have to look at ALL the data when making a recommendation.

For now, you know to be very wary of any “one-size-fits-all” approach. Even when it comes to dietary supplements.

Of course, as a matter of practicality we do give some supplement dose recommendations–for vitamin D and for fish oil, for example. But, most often, I make dosage recommendation in ranges–because that’s what the science shows, so far.

So remember, when you hear someone rant that “everyone needs to take 2,000 mg of vitamin C a day,” that person doesn’t truly understand the concept of nutritional individuality.


CLOSE
CLOSE