Tuesday, June 8, 2010

Nutritional supplements?

The more we study food and its components, the more evidence we see for the benefit of the whole food rather than supplements or extracts. We simply don’t know enough about what it is in any given food that makes it work. It may be that there is something in the combination of foods that creates some of the benefit.

Then, when we examine the evidence connecting nutrition and good health in real people in the real world, we see that good food improves health, while controlled prospective studies using nutritional supplements generally show no benefit. Even the most ‘natural’ supplements don’t resemble what is found in real food, and some (vitamin E and carotene, for instance) have been associated with increased health risks. [1], [2]

Choose whole food as your source of nutrients and fiber, as close to the original formula as possible. Don’t trust your health to man’s ingenuity or extraction processes. Too much may be lost in the translation. Supplements cannot replace good food, adequate sleep, and daily exercise.

Be cautious of using nutritional supplements based on results of obscure blood tests or other controversial testing methods. Always be ready to ask for the evidence behind the recommendation, and examine that evidence to see if taking the supplement can be expected to lead to a clear-cut benefit.

In my medical practice I use supplements only when there is a good reason. I treat nutritional deficiencies with supplements when I can’t achieve adequate levels with food. I use supplements in the absence of documented deficiency when there is reasonable evidence for benefit, and only on a case-by-case basis.

We like to remind patients that most nutritional supplements are not natural and should be considered as mild drugs with potential for both benefit and harm, and not as food substitutes. When thought of in that way, nutritional supplements are used with much more discretion.

[1] American.J.Resp.Crit.Care.Med.2008;177:524-30

[2] JAMA 2005;294:56-65. Circulation 2004;110:637-41

Folic acid versus folate

Recent data concerning folic acid is a sobering reminder that relatively little is known about isolated vitamins.

Folic acid and folate are forms of a water-soluble B-complex vitamin. Folic acid does not usually occur naturally in foods, but is the form most often used in vitamin supplements and fortified foods.  In contrast, folate is the umbrella term for the folates that are naturally found in foods and the human body. (Examples of some folate-rich foods are green leafy vegetables, asparagus, lentils, chick peas, and liver.)

For many years it has been observed that a higher intake of folate from foods was associated with a broad range of health benefits such as less heart disease, certain types of cancer, and neural tube defects in pregnancy. Because so many people do not get enough folate through their diets, synthetic folic acid is used to fortify foods like cereals and breads, and folic acid supplements (such as in multivitamins) are often prescribed.

However, it’s apparently not that simple. An increasing number of studies are showing that folic acid supplements may actually increase the overall risk of cancer and heart disease. For example, in two recent Norwegian studies with 6,837 patients using 800mcg of folic acid per day or placebo, those using folic acid had their cancer risk increased by 21%, their risk of dying from cancer raised by 38%, and death from any cause went up by 18%; all were statistically significant. Those are sobering numbers. [3]

So although we know folate is an enormously important micronutrient for many reasons, including preventing birth defects and the other benefits mentioned at the top of the page, folic acid supplements aren’t looking like the smartest option. A simple solution? Eat foods naturally high in folate frequently, and minimize foods fortified with folic acid.

If you have any doubts as to whether you are getting enough folate, which is a particular concern for women who could potentially become pregnant, simply have your folate blood level measured. If you do take a folic acid supplement, we recommend you keep the dose to no more than 400mcg daily.

Our favorite folate supplements? Warm Lentil Salad, Roasted Asparagus, Green Eggs and Rice, and Hasty, Tasty Hummus which can be found in Good Food, Great Medicine.

[3] Ebbing, M. et al. JAMA 2009;302:2119-26; Mason, J. Nutrition Reviews 2009;67:206-212

Warm Lentil Salad

People who recoil at bean salads can relax. Lentils have a peppery nuttiness and a disarming daintiness that allow them to slip under the radar. Furthermore, this is possibly impossible to dislike. As well as being simple and relatively last minute (lentils cook in about 30 minutes), this recipe is very forgiving. You can substitute your own choice of vegetables, like green onions and sweet red bell peppers, or just minced onion. It’s an especially good dish to have ready when you’re expecting to feed a group that may include vegetarians. Personally, I like to make enough for me to snack on for a week.

(Serves 6)

1½ cups brown lentils
6 cups water
1 tablespoon salt
¼ cup apple cider vinegar (or lemon juice)
¼ cup extra-virgin olive oil
1 teaspoon freshly crushed garlic
1 teaspoon salt
½ teaspoon freshly ground pepper
½ teaspoon ground cumin
1 cup minced sweet onion
1 cup ¼ -inch diced cucumber
1 cup ½ -inch diced tomato
(½ cup chopped fresh cilantro, if you have it)

1. Rinse lentils, and then combine with the water and the tablespoon of salt. Bring to a simmer and simmer until lentils are tender, 30 – 40 minutes. (Check after 30 minutes.) You should have about 4 cups of cooked lentils.

2. While lentils are cooking, combine vinegar, olive oil, garlic, seasoning, and onion in a mixing bowl. Set aside until lentils have finished cooking. Drain lentils in a colander. Add hot, drained lentils to dressing and onion mixture and toss thoroughly but gently. Set salad aside for about 15 minutes to marry flavors, tossing once or twice.

3. Add cucumber, tomato, and fresh cilantro, if you have it. Toss again. Serve hot, warm, or room temperature.

Like any type of bean salad, this begs to be part of a buffet. It pairs nicely with something like Marinated Carrot Matchsticks, also found in Good Food, Great Medicine.

(Copyright 2010 Miles Hassell, MD and Mea Hassell)