10 responses to supplement naysayers

By Dr. Ronald Hoffman

Despite widespread usage, the controversy over supplements continues to roil. A recent editorial in the Annals of Internal Medicine called for an end to the debate: Supplements are worthless, it declared, "case-closed," "enough is enough."

As a result, you might soon find yourself in a place-be it in a doctor's office, or at the table of a skeptical friend or relative--where you could be called upon to push back on some commonly-cited reasons for abandoning your supplements.

Here's some ammo to help you counter some of the most frequently-invoked arguments against taking supplements:

1) If you eat a healthy diet, you don't need to take vitamins. So not! What's a healthy diet anyway? Most Americans eat a diet that is calorically-dense, but bereft of critical nutrients. According to "a rebuttal to the anti-supplement screed published recently in the Annals, the majority of people in the US do not meet the dietary guidelines for vitamins and minerals.

In addition, there are innumerable persons with genetic predispositions to disease that may require targeted use of supra-normal doses of, say, Omega 3 fatty acids (e.g. bipolar disease) or specific nutraceuticals like EGCG, curcumin, or sulfurophane glucosinolate (cancer prevention). Similarly, persons with autism or mental disorders may need special forms of B12 or folic acid to overcome methylation defects. The modern science of nutritional medicine is predicated on using nutrients not just to prevent the traditional diseases of deficiency like scurvy, rickets or beri-beri, but on strategic deployment of higher-than-RDA nutrient dosages to prevent or reverse disease states.

It's disingenuous to claim that supplement-takers are lazy people looking for a short-cut to health while simultaneously encouraging statins for heart disease prevention; cholesterol drugs have been conclusively shown to mask the "moral hazard" of high lipids, allowing takers to continue to put the feed-bag on and lie on the couch with illusory protection.

3) Vitamins aren't "natural." True to a certain extent. Supplements provide concentrated forms of natural nutrients and herbs, sometimes in doses much higher than available via food sources. For instance, heart patients benefit from Coenzyme Q10 supplementation delivering amounts not easily obtained from natural sources like organ meats.

But, unlike drugs, which are patented man-made designer molecules that are not present in nature, supplements are by and large natural substances. While this does not guarantee that they cannot be toxic if used inappropriately, at least their potential to do harm is limited.

4) You're just making expensive urine! This one's easy to push back on. If true, this would be a good argument against drinking water-you're just going to pee it out anyway, so why bother? Just because your body may expell some unused portion of the supplement doesn't mean it does not receive the benefit from what it absorbs. Much like with water, we're better off taking in a therapeutic amount and passing the excess than depriving our body of what it needs to be healthy.

5) Side effects from supplements are a vast, under-reported problem. A frequent meme of supplement foes, statistics actually reflect the opposite: Given the widespread use of supplements, there are virtually NO substantiated deaths from supplements, and adverse effects from supplements are surprisingly infrequent. They are often eagerly OVER-reported by doctors who blame supplements for patients' problems when they were sick to begin with, and more likely are suffering the adverse effects of the medications they're concurrently taking. Supplements usually get the blame.

The adverse effects of prescription medications-even when properly used---are among the top causes of hospitalization and death in America. And this is not even taking into account the horrible toll from prescription medication abuse, which is rampant.

6) If supplements are so good for you, why aren't they prescribed routinely by doctors? Another way of saying this is "If alternative medicine is so great, how come it's not mainstream?"

There is a deep-seated ideological bias against supplements among conventional doctors. The roots of this prejudice are deep, and are inculcated during medical training which short-changes discussion of supplementation and emphasizes pharmaceutical and surgical "fixes." Or, as we sometimes say in complementary medicine, "If you're not UP on something, you're DOWN on it."

Orthodox MDs get little chance to experience the benefits of targeted nutrition, and their mainstream medical journals perpetuate their ignorance, often unfairly dismissing supplements on scant evidence.

7) Vitamins increase the risk of certain cancers, don't they? This notion is based on a couple of isolated studies looking at unusual populations consuming now-obsolete synthetic vitamins. One frequently cited research paper found that alcoholic Finnish smokers who took beta carotene (instead of mixed carotenoids) had a slightly higher risk of lung cancer. This result is hardly likely to be extrapolated to normal individuals.

In fact, a recent study of thousands of physicians who took a multivitamin over many years found an 8% REDUCED risk of cancer.

8) Supplements aren't regulated so you have no idea what you're getting. This is a canard that is frequently repeated by proponents of more stringent regulation of supplements. In fact, supplements are already subject to strict requirements, and the FDA has the power to inspect natural product manufacturing facilities that are required to adhere to Good Manufacturing Practices (GMPs). Responsible companies self-police and undertake voluntary certification and quality control. For a full discussion, "see this excellent response by American Botanical Council's Mark Blumenthal, PhD to an anti-supplement op-ed in USA Today.

9) Where's the research? There aren't enough studies on supplements. Au contraire. There are literally tens of thousands. It blows my mind that many doctors don't avail themselves of the simple research tools that list reams of studies on supplements and their applications to prevention and treatment of myriad diseases. Vitasearch.com is one of my favorite resources, and it's free. It's just plain lazy not to look this stuff up-don't doctors take the time to study up on medications? Why not supplements?

10) Supplements can interact with or impede the efficacy of certain medical treatments and medications. This is sometimes true, but as often as not, supplements actually offer a helpful synergy with medications, boosting their efficacy. Conventional medical doctors often accentuate the negative consequences, which can be avoided with judicious study of drug-nutrient interactions.

And it's not as if we lack the tools to predict these interactions. Health practitioners and pharmacists need to be better trained to identify them, rather than discouraging patients from taking supplements altogether.

One of my favorite drug-nutrient interaction websites is Dr. Leo Galland's PillAdvised.

A bigger problem by far is the tendency for medications to deplete critical vitamins and minerals, often not recognized by conventional doctors. A handy website for revealing these is Dr. Jeffrey Gladd's Mytavin.com.

I hope these tips have armed you with some good responses to the supplement naysayers in your life. Perhaps, you may even be able to use them to encourage those around you to embrace what you already know - the benefits that supplements provide can make all the difference between a life lived with the bare minimum of health and a life lived to the fullest.