This is what you need to know about supplements

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There’s a lot of confusion when it comes to the vitamins and minerals our bodies need. Some experts tell us we can get the necessary vitamins from a balanced diet, while others tell us a regular diet doesn’t contain enough vitamins. Who do we believe?

It’s time to set the record straight, so we asked Dr. Yoni Freedhoff to tell us everything we need to know about supplements. 

NOT EATING A BALANCED DIET
Unfortunately there isn’t great evidence to suggest that taking a multi-vitamin every day will be beneficial. Of course if there’s evidence of actual deficiencies (blood work), a different story. There is weak evidence both for and against the use of a daily multivitamin (excepting in special populations like women who are pregnant or trying to conceive). If you’re going to take vitamins, buying an age and sex appropriate multivitamin is all that you need to do. I wouldn’t recommend getting suckered into anything fancy - department/big box store brands are fine.

CHILDREN AND VITAMINS
If your child has a highly selective diet, or a very poor appetite their pediatrician might suggest a multivitamin. The concern here is simply which one. Many vitamins and supplements nowadays provide mega doses which aren’t wise, and many kids’ vitamin and supplement formulations are basically vitamin fortified candies - and there have been cases of vitamin toxicities in kids who overdose on same. Before starting your child on supplements, I’d recommend a discussion with their pediatrician or family MD.

REGULATIONS
A few years ago, a New York Times article revealed that, basically, scientists hae known for years that taking too much of a vitamin in supplement form can be really dangerous, but because the industry isn't regulated by the FDA, we can all go to a natural health store and buy a pill that has more Vitamin C in it than 8 cantaloupes.

The regulations in Canada are lax, to say the least. Mega-doses are easily obtainable in health food stores, and there are far too many on the market to expect Health Canada to feasibly police content. Biggest issue is that we really don’t have long term safety data on these mega doses, and there have been many cases where large doses of supplements have been shown to be associated with risks, including recently with B6 and B12 supplements associating with triple and quadruple the rates of lung cancer in men.

The bottom line is that taking supplements is in effect participating in a science experiment. And while certainly the possibility exists that there will be benefits, there’s no reason to presume that safety is assured. 

Health Canada has proposed tightening the regulations around so called natural health products so as to require them to provide proof of both safety and of efficacy. That’s a great thing for consumers, but not a great thing for manufacturers or resellers, which is why the Canadian Health Food Association has mounted a campaign fighting against Health Canada's science based plan. 

COMBINING MEDS AND SUPPLEMENTS
The wisest course of action is to speak with your pharmacist and ensure that there aren’t any medications you’re taking that might interact poorly with the supplements you’re considering.

BREAKING DOWN SOME SUPPLEMENTS
Here’s a look at some specific supplements and whether they actually work:

St. John’s Wort
There are studies that suggest that St. John’s Wort may be beneficial in mild to moderate depression. Unfortunately long term safety and efficacy data we don’t have, nor is there good data with severe depression. Biggest issue with St. John’s wort is the fact that it interacts with many prescription medications. General recommendation is don’t take if you’re taking any prescription medications without speaking first with your pharmacist.

Probiotics
Mainly that the promise and the hype has greatly exceeded the evidence. For some conditions there are limited studies that suggest benefit - especially in antibiotic induced diarrhea, but for the rest, we’re pretty much talking about hypotheses. All stems from notion that microbiome plays important role in human health. And it may well, which as far as I’m concerned is all the more reason you might not want to mess with yours. The introduction of foreign bacteria to your own microbiome may have unintended consequences - and once again I’m back to eat a varied healthful diet, exercise, sleep, cultivate relationships, don’t drink too much alcohol, don’t smoke as the far wiser things to focus on.

Melatonin
There have been a few studies showing slight benefit to melatonin, and when I say slight, I mean it, with the difference between taking and not taking being a matter of minutes, falling asleep 7 minutes faster and staying asleep for 8 minutes longer, not hours of sleep. I’m also unaware of any long term studies exploring risk - which is surprising given that it is the only human hormone that I’m aware of that you can legally buy in a store - and in doses many times greater than what our bodies produce.

Vitamin D
Vitamin D has enjoyed a great deal of hype, but unfortunately it hasn’t enjoyed as much evidence. There is some evidence to support the use of vitamin D, when combined with calcium, to prevent osteoporotic fractures, but it hasn’t been shown to do many of the other things it’s purported to do including improve mood, reduce the risk of colds, improve arthritis, lower risk of cancer, and more. Ultimately the role of supplementation remains inconclusive. 

The Canadian Paediatric Society recommends that Infants and young children who are breastfed receive 400IU of supplemental vitamin D daily. But again here, the issue is the lack of evidence. Though there’s certainly evidence that vitamin D supplementation will increase vitamin D levels, there aren’t studies that demonstrate supplementation improves patient outcomes, nor is there evidence proving long term safety. With my family I err on the side of caution and ensure my kids receive balanced diets, and play outside - both of which will help them in obtaining vitamin D.

Vitamin E and Prostate Cancer
At one point it was thought that Vitamin E might help to prevent prostate cancer. Then in 2008, the SELECT trial which was designed to specifically examine Vitamin E’s impact on prostate cancer, was cut short because neither of the study’s treatment arms (the others were selenium or both vitamin e and selenium) demonstrated benefit, and in fact found that the vitamin E group might have had a higher risk. Over time the trend seen then has continued and a recent analysis revealed Compared with the placebo group, men who took only vitamin E during the trial were 17% more likely to get prostate cancer over the seven-year period.

INGREDIENTS
Buying vitamins from trusted name brands probably helps with safety some, and as far as adulteration goes, it seems that the vast majority of those cases involve supplements purported to help with weight loss (none appreciably do), muscle growth, or erections. There are many causes of iron deficiency and it’s important to ensure that if you’ve been found to be iron deficient, that your doctor has considered those causes. Supplementation comes in a bunch of different options, some are better tolerated than others. 

IS THERE ANYTHING WORTH PICKING UP AT THE PHARMACY?
Unfortunately there are no proven bottled shortcuts to health. I wouldn’t recommend picking up any supplements unless you have a known condition that you’re treating, with evidence that the treatment will actually have benefit. Otherwise all you’re doing is buying into the natural fallacy which suggests that natural is synonymous with good. Tobacco is natural. So are the mushrooms that grow in my front yard, but I’m sure as heck not going to eat them. It’s an incredibly arrogant view to think that the natural world exists to service us.
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