To Supplement or Not to Supplement: That Is the Question

TIME reported on a new study this week that ultimately concluded that taking nutritional supplements is not the same as eating a healthy diet. Researchers report that you cannot be truly healthy without getting your nutrients from the source – from fruits, vegetables, and other plant-based foods.

My first thought: We call them “supplements” for a reason, right? They are intended to be “supplemental” to a mostly healthy diet. They are “supplements” not “replacements.”

A second thought: Not all supplements are created equal. I’m certainly not an expert on what makes a nutritional supplement effective or not, and I’m not sure how the scientists from this study qualified a “supplement,” but I do feel compelled to mention briefly the philosophy behind the nutritional supplements produced at Standard Process, my current employer.

An SP Aside

Standard Process produces nutritional supplements using ingredients from their organic farm in Palmyra, Wisconsin. Unlike other supplement companies, they boast a whole-food philosophy. This is based on the science of a whole food matrix, the idea that macronutrients (fat, carbohydrate, protein), micronutrients (vitamins, minerals), and phytonutrients (carotenoids, resveratrol, etc.) are the most bioavailable/biologically active/effective when they are consumed in the natural “matrix” in which they are found in nature. This separates Standard Process and other companies with a similar whole food philosophy apart from supplement companies that simply extract vitamin D or beta-carotene and insert them into a capsule to sell as a supplement.

That being said, I should clarify that my personal philosophy is food first, supplements second (if at all). We may not know for sure what types of supplements are most effective or if any are effective at all at improving nutrition, but you certainly can’t go wrong with getting your nutrition straight from the source (plant foods).

Okay, let’s talk about this new research.

TIME reporter Jamie Ducharme begins the story with two important facts:

• 90% of American adults do not eat enough fruits and vegetables
• 75% of American adults take some sort of dietary supplement (Council for Responsible Nutrition)

I think it’s fair to extrapolate from those two statistics that many of those 90% of Americans that do not eat enough fruits and vegetables are among the 75% who are taking dietary supplements, likely because they know that they aren’t getting enough nutrients from their diet. Fair – it’s certainly easier to pop a pill than to get enough servings of leafy greens every day, but those 75% might be wasting their money on supplements that aren’t giving them the nutrition they really need.

The Study: Annals of Internal Medicine

The study’s main point is this: “nutrients consumed via supplements do not improve health and longevity as effectively as those consumed through foods.” Pretty simple. Supplements are not as good as food. Anyone surprised?

More specifically, researchers report that nutrients consumed through supplements are not as strongly associated with living a longer life as nutrients consumed through food. The data comes from the National Health and Nutrition Examination Survey (NHANES) 1999-2010, including 30,000 American adults as participants who were followed for about six years (at the end of this period, there were more than 3,600 deaths).

Researchers factored in monthly supplement use and dietary habits when establishing nutrient levels for each participant. This data initially led them to the result that dietary supplements are associated with a lower risk of early death, but that result did not hold true with researchers factored in certain other details about the participants: education levels, socioeconomic status, and demographics. After controlling for these variables, researchers found that it was mostly the higher-income and better educated people who were taking supplements, and this group is on average more likely to be healthy anyway. Put another way: for this group, it wasn’t supplement usage that was improving health, it was the impact of wealth and education on health (another story for another day).

The study showed that sufficient consumption of micronutrients like vitamin A, vitamin K, magnesium, zinc, and copper are associated with a lower risk of dying early, but only when obtained from food – not supplements.

Researchers even mentioned potential negative health associations with supplement usage. For example, high doses of calcium via supplement was associated with a 53% higher risk of dying from cancer compared to people who did not take supplements. Excess calcium from food did NOT have that association.

Regulatory Considerations

I think it’s important to note that the Food and Drug Administration (FDA) not does not regulate nutritional supplements as tightly or in the same way as “conventional” foods and drugs are regulated. Whether it’s safety or efficacy that one is worried about, the regulatory difference is a significant factor.

Supplements for Specific Populations

Lastly, I’ll highlight that the study scientists did mention that nutritional supplements may provide positive health benefits particularly for two groups:

• The elderly: because the ability to absorb nutrients from food can decrease with age
• People with dietary restrictions (allergies, vegan, vegetarian, etc.): because they are more likely to have nutrient deficiencies from lacking certain foods

Take-home Points

1. While I acknowledge that it’s certainly easier said than done (I struggle in my own life), I agree with study co-author Fang Fang Zhang (Tufts University Friedman School of Nutrition Science and Policy) when she recommends that instead of relying on nutritional supplements, people should just eat a healthy diet rich with fruits, vegetables, and whole grains.
2. There’s always more to the story. That’s why I included my SP aside earlier. The conclusion is never going to be “all supplements are bad” or “all supplements are good.” There are so many factors that affect what makes an effective nutritional supplement, and the only way to truly determine what’s effective and what’s not is to follow reputable research like this study from Zhang and others at Tufts University.