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Supplements - Friend or Foe?


Rekha V Shah, MD, MD(H)

There is so much contradictory information in the media, it is easy to become confused about the value of vitamins, minerals and other supplements.

We hear multivitamins are good for us one day and the next week we learn from the newspapers or television that we should not take them as they can be harmful.

Nutritional Supplememt articleVitamin E Fails to Stop Progress of Alzheimer’s

"Patients were randomly assigned to groups receiving Aricept, vitamin E and placebo versions of those substances, and then observed over a three-year period ended in January 2004... While the findings for Aricept are less than definitive, she said, the study provides clear-cut evidence that vitamin E is ineffective in the prevention of Alzheimer’s."

Nutrition experts contend that all we need is what’s typically found in a routine diet. Industry representatives, backed by a fascinating history, argue that foods don’t contain enough, and we need supplements. Fortunately, many excellent studies have now resolved the issue... On October 10, 2011, researchers from the University of Minnesota found that women who took supplemental multivitamins died at rates higher than those who didn’t.


Two days later, researchers from the Cleveland Clinic found that men who took vitamin E had an increased risk of prostate cancer. “It’s been a tough week for vitamins,” said Carrie Gann of ABC News... These findings weren’t new. Seven previous studies had already shown that vitamins increased the risk of cancer and heart disease and shortened lives. Still, in 2012, more than half of all Americans took some form of vitamin supplements.

Why, then, is the whole idea of vitamin and nutrient supplementation so controversial?

Vitamins and minerals are the essential nutritional elements required by every chemical reaction in our body to function properly. Studies performed on the general population shows widespread deficiency of multiple nutrients.[1]

Nutrients like magnesium, zinc, folate, vitamin D, vitamin B, control and affect multiple chemical reactions in our bodies. They are required for us to make the enzymes which enable our bodies to manufacture essential proteins at body temperature (in the lab, much higher temperatures are usually required, temperatures not compatible with life). These nutrients are essential for the formation of neurotransmitters, regulation of DNA, the production of energy, for proper function and methylation (detoxification) of hormones, getting rid of toxins, for proper health of the blood vessels and their lining - the endothelium. The list goes on...

For example as much as 82% of population in 2006 was deficient in vitamin D – with deficiency levels defined as less than 20 mg%.[1] Fish oil deficiency is also highly significant, associated with multiple diseases ranging from metabolic syndrome and diabetes to heart disease, Crohn's disease and even memory impairment and Alzheimer's dementia.[2] These nutrients are critical for cellular function, brain function, proper regulation of blood sugar, reduction of inflammation and pain etc. Deficiencies are implicated in the development of metabolic syndrome and the ongoing epidemic of Type 2 diabetes.[3]

supplements-friend3Our Standard American Diet (SAD) is low in greens, beans (legumes, pulses), and high in chronic stress, together with our over-consumption of coffee and alcohol, makes us prone to deficiencies of vitamins like folate, cofactors, minerals like magnesium, manganese, molybdenum etc. These deficiencies can cause muscle cramps, headaches, constipation and bloating, anxiety, depression, disturbed sleep, dry skin hair and nails, frequent colds, allergies, and again list goes on and on.

From reports of beriberi in Asia in 2600 BC, to night blindness in 19 century soldiers, the effects of vitamin deficiency and toxicity have led physicians and scientists to search for these vital molecules and its function.

supplements-friend4While multiple deficiencies may be required to generate frank deficiency disease, and replacement of more than just one nutrient at a time may be required for health, it is quite clear that insufficiency of nutrients may lead to problems related to less obvious physical dysfunction. One cannot overlook nutrient deficiency as a possible cause of a patient’s signs and symptoms.[4] Individual need for vitamins is based not only on genetic code for physiologic activity, but also on conditional need for increased vitamin and minerals nutrients in body. Increased need may arise from toxic overload, with subsequent increased use of nutrients for detoxification. In the presence of intestinal bacterial imbalance (called, in the functional medicine community, dysbiosis) our intestinal bacteria may not be producing the nutrients we need, because their population has been altered by stress due to physical, mental or emotional trauma, and antibiotics given for infections etc.

The functional medicine practitioner looks at every clinical situation from the patient-centered point of view. Who is patient who has this particular condition? What are the stressors in that patient's life? What is the patient's cellular health? How are the rest of the patient's organ systems functioning? And where is the root cause of the patient’s condition?

To give you an example, inflammation is a common thread in conditions like hypertension[5], heart disease[6], osteoarthritis,[7] rheumatoid arthritis[8], cancer[9], diabetes[10],[11], and much more. So in order to treat those conditions, we must investigate the cause of the inflammation.

As we saw inflammation is one of the reasons among many that can cause nutritional deficiency. It's a Catch-22 situation, since nutritional deficiency can also predispose to having inflammation. You can't treat one without treating the other as well.

supplements-friend5Functional medicine is more than a step-by-step approach. It is conceptual guide, a way of putting all the pieces together in a puzzle. Optimal gastrointestinal function is important in proper handling of nutrients, vitamins, minerals. The gut, after all, is the Center of our vitality and health.

Organic food, free of pesticides and non-GMO (genetically modified, bioengineered) is the ideal medicine we can offer our body.

Nevertheless, there are times when the deficiencies are so severe that the right type and amount of vitamins, minerals, and supplements are needed for improving conditions and symptoms.


Rekha Shaw - Arizona Center For Advanced MedicineRekha Shah, MD, MD(H) practices integrative medicine at the Arizona Center for Advanced Medicine with a focus on gastrointestinal conditions. Dr. Shah is board certified in Gastroenterology and Internal Medicine, as well as in Medical Acupuncture. She is licensed in the state of Arizona by both the allopathic Medical Board and by the Board of Homeopathic and Integrated Medicine Examiners.

[1] Forrest KY, Stuhldreher WL. Prevalence and correlates of vitamin D deficiency in US adults. Nutr Res. 2011 Jan;31(1):48-54. doi: 10.1016/j.nutres.2010.12.001.

[2] Agrawal R, Gomez-Pinilla F. ‘Metabolic syndrome’ in the brain: deficiency in omega-3 fatty acid exacerbates dysfunctions in insulin receptor signalling and cognition. J Physiol. 2012 May 1;590(Pt 10):2485-99. doi: 10.1113/jphysiol.2012.230078.

[3] Simopoulos, A.P. Dietary Omega-3 Fatty Acid Deficiency and High Fructose Intake in the Development of Metabolic Syndrome, Brain Metabolic Abnormalities, and Non-Alcoholic Fatty Liver Disease. Nutrients 2013, 5, 2901-2923.

[4] Neel BA, Sargis RM. The Paradox of Progress: Environmental Disruption of Metabolism and the Diabetes Epidemic. Diabetes. 2011 July; 60(7): 1838-1848.

[5] D Conen. Inflammation, blood pressure and cardiovascular disease: heading east. Journal of Human Hypertension (2013) 27, 71; doi:10.1038/jhh.2012.7

[6] Ibid

[7] Bonnet CS, Walsh DA. Osteoarthritis, angiogenesis and inflammation. Rheumatology (2005) 44 (1): 7-16. doi: 10.1093/rheumatology/keh344.

[8] Ruhmann, M., Piccinini, A. M., Kong, P. L. and Midwood, K. S. (2012), Endogenous activation of adaptive immunity: Tenascin-C drives interleukin-17 synthesis in murine arthritic joint disease. Arthritis & Rheumatism, 64: 2179-2190. doi: 10.1002/art.34401

[9] Coussens LM, Werb Z. Inflammation and cancer. Nature. 2002 Dec 19-26;420(6917):860-7.

[10] Donath MY, Shoelson SE. Type 2 diabetes as an inflammatory disease. Nat Rev Immunol. 2011 Feb;11(2):98-107. doi: 10.1038/nri2925.

[11] Luft VC, Duncan BB et al. Chronic inflammation role in the obesity-diabetes association: a case-cohort study. Diabetology & Metabolic Syndrome 2013, 5:31 doi:10.1186/1758-5996-5-31