Dietary supplements

The key to good health usually lies in a balanced diet, enough exercise and enough sleep. However, leading a healthy lifestyle is no easy feat. For many people, time is a luxury they don’t have to prepare well-balanced meals, exercise and get enough sleep while working a demanding job (or two) every day.

To filling perceived nutritional gaps in their diet and maintain overall health and wellness, people often take health supplements, says Jeffrey Linder, chief of general internal medicine in the department of medicine at Northwestern University Feinberg School of Medicine. Last year alone, Americans spent nearly $50 billion of nutritional supplements. However, research shows that they may not be as helpful as advertised.

Limited benefits for a healthy adult

The US Preventive Services Task Force (USPSTF)—an independent panel of national experts on disease prevention—recently released recommendation that says there is insufficient evidence to suggest that multivitamins and nutritional supplements help prevent cardiovascular disease or cancer in otherwise healthy, nonpregnant adults. In particular, they recommend against using vitamin E supplements, which have no benefit in reducing mortality or preventing the aforementioned conditions, and beta carotene supplements, which are associated with an increased risk of lung cancer in people who smoke or have been exposed to asbestos.

“The average person has no tangible benefits from nutritional supplements,” says JoAnn E. Manson, chief of preventive medicine at Brigham and Women’s Hospital. It’s important that taking supplements doesn’t lead to complacency about following healthy lifestyle practices, she adds.

In an editing published in JAMA, scientists at Northwestern Medicine supported the USPSTF’s updated recommendation, saying that chronic disease prevention should focus on evidence-based approaches. For example, public policies should ensure that all US residents have access to healthy foods and physical activity environments that are proven beneficial.

“We note in our editorial that if we are missing a benefit, it is likely to be very small,” says Linder, one of the authors of JAMA editing. “Since the recommendation was last published in 2014, the task force has included 52 new studies. Despite these new publications, there is still not enough evidence to recommend for or against multivitamins and supplements.

It is important to emphasize that the USPSTF recommendation only applies to healthy, non-pregnant adults, meaning that pregnant people and those who have certain health problems or deficiencies do benefit from supplements.

Older people, people with bone health problems, and those with diseases that interfere with nutrient absorption or metabolism—such as pernicious anemia, fat malabsorption conditions, inflammatory bowel disease, and celiac disease—may advantage from taking certain vitamins, says Manson. “The key group to benefit are pregnant women who need to take prenatal vitamins and ensure they are getting enough folic acid to prevent spina bifida and other neural tube defects in the baby,” she adds.

A healthy lifestyle is key

Many individuals view supplements as benign, preventative products at worst. However, more isn’t necessarily better when it comes to dietary supplements, because they can cause toxicity, liver and kidney damage, and other risks, Manson says. For example, excess vitamin A is associated with decreased bone density, hip fractures, and liver problems, while too much vitamin D can cause elevated calcium levels and kidney stones, Linder says.

Instead of relying on vitamins and supplements, experts recommend having healthy lifestyle practices, such as getting enough sleep and exercise, drinking in moderation, avoiding smoking, and controlling blood pressure and cholesterol levels. “Although the evidence is insufficient for taking multivitamins or supplements, there is excellent evidence that eating a well-balanced diet with lots of fruits and vegetables is associated with multiple health benefits,” says Linder.

Vitamins and minerals are usually better absorbed from food than from supplements, and they simply can’t be packed into a pill, Manson says. The emphasis should be on meeting nutritional needs from a healthy diet high in plant foods and whole foods that aren’t stripped of vitamins and minerals by over-processing, she adds. After all, healthy lifestyle practices may be more challenging than simply taking a pill every day, but they are more beneficial in the long run.

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