Jeffrey Bland pushes back on the idea that healthy people don't need supplements, pointing out that pregnant women, older adults, people on metformin, and those with malabsorption may make up more than half the population. He argues the real question isn't whether you avoid deficiency diseases, but whether supplements improve bone density, immune function, and cognition.
You know, vitamin and mineral supplements are always a topic for some controversy, aren't they, in discussion? And so it was once again in our March 6 issue of 2018 in the Journal of the American Medical association with a short little piece entitled Vitamin and Mineral what Clinicians need to Know. That sounds pretty definitive. And it's, you know, two pages, so it can't be too voluminous. So what should clinicians know based on this article? Well, first of all, I guess we would say that the takeaway might be that there's no necessity for people that are apparently healthy to take vitamin and mineral supplements. That's kind of one of the themes. But there are certain subgroups within the context of the human population that might be candidates for nutritional supplements. And who are those? Well, for individuals that are practically healthy, if you turn over to the other side, you say, well, that would include women who are pregnant, that would include potentially infants and children, and that would include midlife and older adults who may need some supplemental B12, vitamin D and or calcium. So those are the groups that would not fall within the context of practically healthy and not needing supplements. Then you go on and you say, well, what about people that are maybe not apparently healthy? What's their potential need for nutritional supplements? And so that's another category. And those are guidelines for supplementation in higher risk subgroups. And who are those individuals? People with medical conditions that interfere with nutrient absorption. So that would be things like bariatric surgery, for instance, or that might be things of individuals that have been taking various antacid medications that lower the absorption of nutrients such as vitamin B12 or iron, or may be individuals who have osteoporosis or other bone health issues that require higher levels of vitamin D, vitamin K, magnesium, calcium, or those who have age related macular degeneration that has specific formulations that need things like lutein and zinc and copper and other antioxidants. Or individuals that are on long term medication use that is known to block or interfere with other kinds of nutrients, including magnesium, even metformin, a common antidiabetic medication, generic medication is known to alter B12 absorption. And then how about individuals who are on restrictive diets or individuals that have suboptimal dietary intake, they may require a family of nutrients in order to meet.
Their general nutritional needs. Now, when I put all these together personally, of those that are apparently healthy, that still are candidates for nutritional supplementation, and those that are in special groups that are considered not necessarily particularly healthy and are candidates for nutritional supplementation, that.
Comes up with some score to me.
Of being greater than 50% of the population.
So I'm not sure exactly why we are making the assumption then that the.
Average person would not be of benefit from nutritional supplementation after going through this lengthy list of individuals that could be benefited from selective supplementation.
Anyway, the controversy continues on and the.
Real answer to this question is what are we measuring as outcome? What is the determinant and the indices that we are using to determine whether a person is nutritionally competent and meeting their needs? Is it the absence of nutritional deficiency such as scurvy, beriberi, pellagra, zolithalmia and rickets? Or is it some functional health determinants that really determine things like bone mineral density, that determine things like immune function, that determine mitochondrial bioenergetics, that determine cognitive function, that term?
And on and on and on.
This is where the rub of the debate really comes, because we're still high bound by the old Food Nutrition Board kind of recommendations or that are establishing intake and need based on dietary supplementation in the face of deficiency. But we're really talking about function. So here we will continue to have this debate probably as we learn more about the role that nutrients play in a polygenomic individuals that have different needs for different functions over the course of their lifetime in what we call the great N of one experiment, which each of us is is an experiment under ourselves with no placebo control. So there we are. The JAMA's position on what everybody needs to know about nutritional supplementation.
