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The A, B, Cs of vitamins: Simplifying the world of dietary supplements

Walking the vitamin aisles at the grocery store, seeing ads for customized supplement packs and simply considering the way you feel day-to-day can make you wonder whether you should be taking dietary supplements, which ones and in what form. There are a myriad of vitamin brands on the market, choices to make between taking multiple vitamins or one multivitamin each day, and a variety of options for ingesting the pills–vitamins can be swallowed, chewed, dissolved and even eaten like a piece of gummy candy. The choices can be overwhelming, and the fact is, most people don’t need to take supplemental vitamins at all.

While Americans spend around $30 billion on dietary supplements each year, these products are not regulated by the Food & Drug Administration and could be excessive to people who eat a healthy diet of nutrient-packed foods. 

"Supplements are never a substitute for a balanced, healthful diet," said Dr. JoAnn Manson, a professor of medicine at Harvard Medical School and professor of epidemiology at Harvard's T.H. Chan School of Public Health. "And they can be a distraction from healthy lifestyle practices that confer much greater benefits."
 
Local expert Annegret Kessler is a registered dietitian nutritionist and certified diabetes care and education specialist at Colorado Mountain Medical. She started working at Vail Health (then Vail Valley Medical Center) in 1985 and has more than 35 years of experience in nutrition counseling. In her career, she often turns to the Harvard T.H. Chan School of Public Health for information, and highly supports their reviews on supplements. As a nutritionist, Kessler relies on evidence-based, substantiated research, and she said the data simply doesn’t support the use of supplements. 

“You can’t replace a healthy diet with vitamins,” she said. “Food has more redeeming and quality ingredients and components compared to individual vitamins and minerals for the healthy population.”

The “healthy population” is the key group she, and other experts, refer to in regards to nutritional intake. That includes your average 40-something-year-olds, kids and those who may be feeling sluggish–all groups that vitamins are heavily marketed to. In contrast, there are a few groups of people for which supplements are necessary. These are people who are at higher risk of not getting enough nutrition through their foods–elderly people who may not have someone to cook for them; people with allergies or food intolerances that prevent them from getting all the vitamins and minerals they need; people who smoke, drink alcohol in excess or use drugs because the body needs a greater deal of nutrients to metabolize those substances; and those with conditions like celiac disease, cystic fibrosis and a variety of gastrointestinal disorders, all of which can cause malabsorption of nutrients. 

Pregnant women are another special group that needs to make sure they’re eating a balanced diet, especially in the first trimester when morning sickness can curb a woman’s hunger. In addition, supplemental folic acid is necessary to help prevent birth defects. 

Finally, men and women looking to shed weight should consider supplements if they are eliminating or limiting specific foods that carry nutritional value. 

“If you don’t think you’re getting the nutrients you need from food, consider consulting with your primary care provider at your next wellness visit,” advised Kessler. “And if you’re going to purchase a supplement, make sure it has the USP symbol.” 

The U.S. Pharmacopeial Convention (USP) symbol on supplements verifies they contain the ingredients listed on the label, in the declared potency and amounts; do not contain harmful levels of specified contaminants; and will break down and release into the body within a specified amount of time.

It’s interesting to note, none of those higher risk groups include those at risk for heart disease, the leading cause of death in the U.S. There isn’t a vitamin that can cure heart disease or the risk factors associated with it, including obesity and diabetes. Instead, Kessler goes back to food as the cure. She recommends a plant-based diet, including whole grains, which has been proven to lower heart disease risk by 52 percent. The Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets have also received evidence-based support from the American Heart Association and American Diabetes Association. 

“When the data came out on these diets, it was exciting to see there was finally evidence that, like your mother told you, ‘always eat your vegetables,’” said Kessler. “Veggies aren’t just a side dish; they’re the main course.”

So, why all the hype and rows upon rows of supplements in the grocery store? 

“There may be a placebo effect from taking vitamins. In addition, many of the multivitamins or vitamin packs on the market include some measure of B vitamins, which can make you feel like you’ve got more energy,” Kessler said. 

B vitamins help the body make energy from the food we eat. These vitamins can be found in fish, poultry, meat, eggs, dairy products and leafy green vegetables. 

Kessler summarized, “Vitamins could be very costly with little benefit.”

So, instead of investing in a medicine cabinet full of supplements, try focusing on eating nutrient-rich foods to ensure you’re getting the recommended dose of vitamins and minerals your body needs.