Many people like to bolster their health with supplements, the comfort of having that safety margin provided by a vitamin and mineral pill. And they're not wrong. Supplements can provide health benefits. However, with contradictory advice, risks from over-supplementing and poor quality products, what are the best options for supporting health? We believe in combining supplements with a whole food approach can deliver maximum benefit.
The supplement industry is a mega-industry and, without almost no regulation, not an honest one. In the US alone sales of all dietary supplements totalled an estimated $55.7 billion in 2020. In a market of that scale there is room for everyone, from honest players to charlatans. Often the evidence of supplements' effectiveness is simply weak, although the marketing will state otherwise.
Before diving into supplements, does your lifestyle and diet provide a solid foundation to your health? Supplements can support some gaps in nutrition but they do not provide an alternative to proper diet and nutrition. Exercise and sleep are also vital to health, as is avoiding or limiting 'toxic' substances. Without these positive lifestyle related habits in place supplementing may not provide the health solutions that you are looking and paying for. They might even be a detriment to taking action over a poor diet.
We propose a back to basics approach with a focus on supplements that have been shown to provide value and as a complement to key, micronutrient rich, whole foods that support health and vitality.
As ever, please talk to your doctor or medical practitioner most familiar with your medical history before implementing any changes in diet, exercise or lifestyle, especially if you are under treatment. Links to any supporting studies or resources are at the end of page.
Popping a Pill, A Daily Habit
Taking a supplement is an ingrained habit for many. Just to be safe, right? Or, we may have been recommended a pill by a well intentioned friend or colleague. After all, it seemed to work for them, perhaps it will work for us? But before buying any supplement, a key question is do you know if you have a deficiency for that compound? There are some common deficiencies that population health surveys identify but these may not even apply to you.
Some populations, for example, the elderly, pregnant women might, those on restrictive diets, likely need to supplement. This is a conversation to be had with your primary care provider.
Over supplementing has its dangers too, too much of any one vitamin or mineral can block the actions of others. Or even have harmful, unintended consequences.
So, what should we do?
First and foremost, focus on enjoying a diet rich in whole or minimally processed foods, a diet that supports a healthy weight. Try to ‘eat the rainbow’ get as many colours on your plate as possible: green, yellow, red, orange, purple, even white. (yes white, for example, white cauliflower). Enjoy whole grains, legumes, nuts and seeds. A little dairy, yogurt and other fermented products. Fish, meat, poultry in moderation. Outside of eating practices, exercise and sleep also have a powerful effect on health.
OK, so we might not be doing all those good things for our health. What if we want to supplement? The simplest protocol will cover most of the bases:
A Multi-Vitamin and Mineral Pill The daily RDA is fine. Mega doses have been shown to be potentially harmful.
An Omega 3, EPA-DHA Pill Try to find a product tested for contaminants or choose a cleaner algal oil. Fish get their omegas from algae, they do not create them themselves.
If you are not getting sunlight, a Vitamin D pill, as this is a common deficiency for many. Your multi-vitamin pill may already have this covered.
Unless you have a known deficiency or your Doctor recommends that you might need extra something, say if you are pregnant or breastfeeding, that should suffice. Certain age groups might benefit from different balances of vitamins and minerals. As might those who follow strict diets or exclude certain food groups, for example, vegans or 100% plant based eaters.
But what about all the other supplements on offer, doesn’t “insert name of influencer” take “pill x" or "formula y” or "greens blend z". Yes and no. Everyone is different, lives differently, eats differently. What we do know is that:
If you do not have a balanced diet and lifestyle, a strong foundation of health, taking a pill that might improve health outcome x by 1% in the long-term will make little difference to actual health outcomes.
If you take a $100 supplement endorsed by Dr Y, you will likely feel that it is giving you value. But is it really? If you don’t have the basics in place, likely not.
We know that many supplement products are not backed by strong scientific evidence, despite the marketing hype. Small scale, short term trials, paid for by the manufacturer are often the norm. Many supplements might not even be correctly formulated.
High Intensity Health
Here are some suggestions for how to get the basics right, via nutrient dense whole foods. These foods not only provide vitamins, minerals and phytochemicals (antioxidants, polyphenols) but also come in a whole food package that will help with absorption. Plus they come with macronutrients and often essential fibre (lacking in most people’s diets) to support a healthy gut microbiome.
Below are some elements my daily, weekly, eating practice. This works for me, and may not work for you.
Ground turmeric and walnuts. A half teaspoon turmeric with a few grinds of black pepper to help absorb the nutrients. 2 whole walnuts.
Muesli (oats, barley, rye) with a half teaspoon Ceylon (not cassia) cinnamon. Add goji berries and raisins, cut fruit, berries, some natural yogurt.
Kopi (coffee), less sweet or black, 1 or 2 cups per day.
Enjoy herbal tea, organic green tea or matcha.
Fruit and vegetables, 5 to 6 servings per day. Dark, leafy greens (brassicas) if possible and remember to get as many colours as you can.
Mixed sunflower and pumpkin seeds, 1 or 2 small palmfuls per day.
Ground flaxseeds and black sesame seeds, stored in the fridge. Approx. 2 tablespoons, once per day, mixed with water and drunk as a shot.
Mixed herbs, fresh or dried, whenever possible. For example, in salads, soups, pastas.
Crushed or chopped garlic, whenever possible. Leave for 10 minutes after chopping to maximise the health benefits. For example, in salads, soups, pastas; or (if you are from SE Asia) mixed with chopped chile and soy sauce.
Sun-dried tomatoes, preserved in olive oil.
Chocolate ‘Milk’. Soy milk mixed with cacao powder and spice mix (cloves, nutmeg) or use a 'pumpkin spice' blend. Every time as a treat after my run or workout.
Mushrooms. Usually two or three times per week, more if possible.
Tinned sardines or grilled mackerel, oily fish for Omega 3s, two or three times per week.
Frozen mixed berries, rich in antioxidant anthocyanins, two or three times per week. Frozen berries, rather than fresh (always expensive in Singapore) last longer in the freezer.
When it comes to health and especially supplements, keep it simple and back to basics. at well, exercise well, sleep well, love well and add a pill if you need it. If you have the foundations of health in place, and can afford additional supplements, by all means look into it. If you have a deficiency or special dietary needs, identify the issue and seek unbiased and qualified advice.
Stay Healthy,
Alastair
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Related Resources
Vyas CM, Manson JE, Sesso HD, Cook NR, Rist PM, Weinberg A, Moorthy MV, Baker LD, Espeland MA, Yeung LK, Brickman AM, Okereke OI. Effect of multivitamin-mineral supplementation versus placebo on cognitive function: results from the clinic subcohort of the COcoa Supplement and Multivitamin Outcomes Study (COSMOS) randomized clinical trial and meta-analysis of 3 cognitive studies within COSMOS. Am J Clin Nutr. 2024 Mar;119(3):692-701. doi: 10.1016/j.ajcnut.2023.12.011. Epub 2024 Jan 18. PMID: 38244989.
US Preventive Services Task Force; Mangione CM, Barry MJ, Nicholson WK, Cabana M, Chelmow D, Coker TR, Davis EM, Donahue KE, Doubeni CA, Jaén CR, Kubik M, Li L, Ogedegbe G, Pbert L, Ruiz JM, Stevermer J, Wong JB. Vitamin, Mineral, and Multivitamin Supplementation to Prevent Cardiovascular Disease and Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2022 Jun 21;327(23):2326-2333. doi: 10.1001/jama.2022.8970. PMID: 35727271.
Wierzejska RE. Dietary Supplements-For Whom? The Current State of Knowledge about the Health Effects of Selected Supplement Use. Int J Environ Res Public Health. 2021 Aug 24;18(17):8897. doi: 10.3390/ijerph18178897. PMID: 34501487; PMCID: PMC8431076.
Ronis MJJ, Pedersen KB, Watt J. Adverse Effects of Nutraceuticals and Dietary Supplements. Annu Rev Pharmacol Toxicol. 2018 Jan 6;58:583-601. doi: 10.1146/annurev-pharmtox-010617-052844. Epub 2017 Oct 6. PMID: 28992429; PMCID: PMC6380172.
Liu X, Machado GC, Eyles JP, Ravi V, Hunter DJ. Dietary supplements for treating osteoarthritis: a systematic review and meta-analysis. Br J Sports Med. 2018 Feb;52(3):167-175. doi: 10.1136/bjsports-2016-097333. Epub 2017 Oct 10. PMID: 29018060.
Bailey RL, Gahche JJ, Miller PE, Thomas PR, Dwyer JT. Why US adults use dietary supplements. JAMA Intern Med. 2013 Mar 11;173(5):355-61. doi: 10.1001/jamainternmed.2013.2299. PMID: 23381623.
Bolland MJ, Leung W, Tai V, Bastin S, Gamble GD, Grey A, Reid IR. Calcium intake and risk of fracture: systematic review. BMJ. 2015 Sep 29;351:h4580. doi: 10.1136/bmj.h4580. PMID: 26420387; PMCID: PMC4784799.