Vitamins and Minerals – Do We Need to Supplement?

Pharmaceuticals are very big business. In 2022, the global pharmaceutical market was estimated to be worth $1.48 trillion (US).

There’s a heck of a lot of zeros in 1.48 trillion! Expressed numerically it looks like this – $1,480,000,000,000. One and a half thousand billion dollars…per annum…Wow!

‘Big Pharma’ is somewhat of an understatement.

The nutritional supplements industry is also big business. In 2021 the global market for nutritional supplements was estimated to be worth $358 billion (US).

Both ‘industries’ are projected to grow significantly over the coming years.

I’m intentionally conflating these industries for good reason. Over the past couple of years, I’ve noticed a significant change occurring in our pharmacy sector.

The days of getting your prescription filled at a small pharmacy beside your local doctors, appear to be over.

Independent neighbourhood pharmacies are getting swallowed up by large chains: Chemist Warehouse, Bargain Chemist, Unichem, and Life Pharmacy.

Talking to a few junior pharmacists, it’s clear that ‘up-selling’ is a core part of the job. ‘Based on your prescription sir, this multivitamin will help you with…’

Former sports stars have moved on from selling undies. Now they’re endorsing nutritional supplements ‘specifically formulated’ to suit men, women, and people at all different life stages.

It feels like we’re being conditioned to view ‘health’ in the form of a pill.

The question is – does health really come in pill form? Do we really need multivitamin-this and multimineral-that? A good place to start answering these questions is with a review of vitamins and minerals.

In this article we’ll examine:

• Macro- vs. micro-nutrients – what’s the difference?
• Vitamins – what do they do and where do we get them from?
• Minerals – what do they do and where do we get them from?
• Micronutrient supplementation – is it necessary for good health?

What are ‘micronutrients’?

A former Personal Training client of mine was convinced that vitamins and minerals weren’t found in foods per se. The client believed that vitamins and minerals were a separate category of ‘foods’ altogether.

Somewhat reluctantly, and after a little ‘independent’ research, the client accepted reality. Vitamins and minerals do indeed come from the foods we eat every day.

This was 20+ years ago. Thinking about it now makes me wonder what our general understanding of nutrition is today. Is it better or worse?

I doubt the nutritional supplements industry worries much about a low level of basic nutritional knowledge though. If the public views vitamins and minerals as distinct from food, it’ll probably be easier to sell these essential nutrients in pill form…

Now without doubt, nutrition is core to human health. Hence, we cover it in detail during our Personal Training and Weight Management Coaching programmes. This doesn’t mean that we overlook the basics though!

When we talk about vitamins and minerals, we’re talking about ‘micronutrients’. There’s an important clue in the name ‘micronutrient’…

Micronutrients are those nutrients we only need in tiny quantities.

In contrast, we need to consume the macronutrients (carbohydrate, fat and protein) in comparatively large amounts.

Recommended Daily Intakes (RDIs) for macronutrients are broadly expressed in grams per day (g/day). For example, regarding protein, the NZ Nutrition Foundation recommends that the ‘reference’ adult (aged 19-70) consumes:

• 46g/day (female)
• 64g/day (male).

In comparison, RDIs for micronutrients are expressed in either milligrams (mg) or micrograms (µg) per day. One milligram represents one thousandth of a gram while one microgram represents one millionth of a gram.

As examples, the Nutrition Foundation recommends that those ‘reference’ adults consume:

• 45mg/day of Vitamin C
• 700µg/day (female) or 900µg/day (male) of Vitamin A.

As you can see, for good health, we really don’t need to consume micronutrients in large quantities!

And the good news is, the small quantities we need are obtained reasonably easily from common foods. For example, regarding Vitamin C,  just one:

• Orange provides approximately 46mg
• Grapefruit provides approximately 94mg
• Kiwifruit provides approximately 85mg
• Boiled kūmara provides approximately 30mg.

Vitamins – What do they do and where do we get them from?

Vitamins are small ‘organic’ compounds which means that they contain carbon. Currently, there are 13 recognised ‘essential’ vitamins. Essential means that they must be obtained directly from the food we eat.

Depending on definition, vitamin D is sometimes considered ‘non-essential’ because it can be synthesised (made) by the body when we are exposed to direct sunlight. However, depending on a variety of factors, most New Zealanders also require vitamin D from food. Hence, it is an ‘essential’ vitamin for kiwis, especially those living in ‘sunshine deprived’ areas (i.e., everywhere except Nelson, Blenheim and Hawkes Bay)!

Vitamins are categorised as:

• Fat-soluble: Dietary fat helps the body to absorb and store vitamins A, D, E, and K.
• Water-soluble: Vitamin C and the B-vitamins are absorbed in water but are not stored in the body.

Because water-soluble vitamins aren’t stored by the body, people need a more regular supply of these vitamins.

The following table provides an overview of the functions and common food sources of vitamins A, C, D, E, and K:

The ‘B-vitamins’ (also known as the ‘B-Complex’) are a group of eight distinct vitamins. In general, these vitamins are crucial to our metabolism. They help convert carbs, fats and protein into energy.

Of individual note:

• Vitamin B6 helps to protect us against heart disease.
• Vitamin B12 is required for healthy red blood cell formation and the development and function of the nervous system.
• Collectively, vitamin B9 and B12 are required for the development and function of our genetic material (DNA). As such, they impact every cell in the body.

The following table provides names and common food sources of the eight B-vitamins:

*Note: ‘Fortified’ means that the food has had particular vitamins/minerals added to it during processing.

Minerals – What do they do and where do we get them from?

In a nutritional context, minerals are chemical elements required to perform the functions necessary for life.

Being elements, minerals cannot be synthesised (made) by the human body itself. Minerals must be consumed by eating plants (which get minerals from the soil), animals, or by drinking water.

The following table provides an overview of eight key mineral nutrients:

Looking through these tables it’s clear that ‘common foods’ are rich sources of all the essential vitamins and minerals.

Hence, we don’t need access to goji berries from the Himalayas to satisfy our micronutrient needs!

Do we need micronutrient supplements?

Reviewing two decades of large-scale randomised trials investigating multivitamin/mineral (MVM) supplementation, Kamangar & Emadi [ref 1] concluded that:

• There is no overall benefit from taking MVM supplements for the majority of the population.
• There may be an increased risk of cancers associated with the supplemental intake of certain vitamins.

For many years, our own Ministry of Health (MoH) has held a position consistent with Kamangar & Emadi.

We published this article on micronutrients approximately 15 years ago. Then, the MoH’s food and activity guidelines made clear that:

• Micronutrient deficiency is rare in NZ.
• Consuming the recommended daily intake of the major food groups ensures that micronutrient requirements are easily met.
• Micronutrient supplementation should only occur under a doctor’s supervision.

Fast-forward to the MoH’s 2020 Eating and Activity Guidelines for adults, and these general messages remain. The only change concerns guidance for pregnant or breastfeeding women.

Because it is hard to get enough folate (Vitamin B9) from natural sources, and to reduce the risk of neural tube deficits such as spina bifida occurring, the MoH advises women to take:

• One 800µg folic acid only tablet daily throughout pregnancy and until the end of the first trimester.
• One 150µg iodine-only tablet daily throughout pregnancy and until breastfeeding finishes.

Additionally, the MoH:

• Doesn’t recommend supplements for pregnant women other than folic acid or iodine, unless under the direction of a doctor, dietitian, or midwife. This includes iron supplements and multivitamin supplements marketed specifically for pregnancy.
• Recommends that pregnant women on a strict vegan diet receive vitamin B12 supplements under the guidance of a doctor, dietitian, or midwife.

The MoH also make a point of stating that:

• ‘Women following a healthy eating pattern do not need multivitamins which can be very expensive’.

Why do we take so many micronutrient supplements?

Kamangar & Emadi [ref 1] note that in the US, 40-50% of adults over 50 regularly use MVMs. The 2008/09 NZ Nutrition Survey found that:

• 47.6% of NZ adults (15yrs+) had used dietary supplements in the last year. The majority of which were vitamin and/or mineral supplements.

It’s likely that this percentage has increased over the past 10-15 years. The question is – why do so many people use these supplements when they offer no overall benefit?

Kamangar & Emadi offer a number of explanations:

1. We’ve developed a deeply held belief in the benefits of vitamins and minerals due to their legacy of preventing diseases such as scurvy and rickets. Hence, we tend to view vitamins and minerals through a ‘magical lens’.
2. Unlike most pharmaceutical drugs, there is no regulatory requirement to prove the safety and effectiveness of nutritional supplements. Hence, our beliefs aren’t shaped by objective, independent clinical research.
3. There is a major issue regarding inaccurate and misleading advertising of nutritional supplements in the media. Our ex-sports stars wouldn’t be endorsing something we don’t need now would they…Surely not!
4. In relation to point 2, many people believe that even if these supplements aren’t useful, they won’t be harmful. “OK, so maybe they won’t work, but what’s the worst that can happen?”
5. Many people want to take an active role in improving their health and increasing longevity. For some, taking supplements is perceived to be easier than avoiding unhealthy foods, and increasing the intake of healthy foods.

A final word…

Dr JoAnn Manson a Professor of Medicine at Harvard Medical School states:

• “Supplements are never a substitute for a balanced, healthful diet…they can be a distraction from healthy lifestyle practices that confer much greater benefits.”

When large pharmaceutical and nutritional supplement companies talk about ‘health’, I think they’re talking a different language. For them, health may have more to do with the bottom line of their companies than human well-being.

For the vast majority of the population, health doesn’t come in the form of a pill.

At a fundamental level, good physical and mental health comes from:

• Regular physical activity that is enjoyable and rewarding to take part in.
• A healthy diet rich in real, unprocessed foods; fruit, vegetables, wholegrains, lean meat, fish and low-fat dairy.
• Regular, meaningful interaction with friends, family, peers, and significant others.

Unfortunately, the modern environment presents numerous obstacles to good health. It’s hard to:

• Find time to exercise or engage in outdoor pursuits.
• Eat healthily when surrounded by cheap junk and fast foods.
• Find time to relax and enjoy interacting with others.

This doesn’t validate the use of false purveyors of health in the form of nutritional supplements though.

Rather, it highlights the value of Personal Training and Weight Management Coaching as ‘hubs’ for changing key behaviours that enhance personal health and well-being.

At their core, being a PT or Weight Management Coach involves regular, meaningful, interaction with customers and clients that focuses on helping people to:

• Build and sustain a habit of regular physical activity.
• Build and sustain healthy eating behaviours, despite the modern food environment.

Ultimately, Personal Trainers and Weight Management Coaches provide a much safer, more effective, meaningful and sustainable pathway to health than any type of pills.

References

Kamangar & Emadi. (2012). Vitamin and mineral supplements: Do we really need them? International Journal of Preventative Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3309636/