Dr Aidin Rawshani

The fish oil is dead: do I need supplements with vitamins and minerals?

Contents

Vitamins and minerals supplements: a billion industry where companies fail to comply with the rules of the game

Food supplements are a billion-dollar industry. In the US alone, the industry has a turnover of 300 billion SEK and around the world, hundreds of thousands of products are on the market. Swedes can buy food supplements at the grocery store, health store, pharmacy or among thousands of online stores. Nowadays, you can buy dietary supplements to relieve or cure almost all diseases and symptoms. There are huge differences between the companies producing food supplements, ranging from small companies in far Asia to large international pharmaceutical manufacturers.

In recent years, clinics have noted that more and more patients have questions about dietary supplements in the form of vitamins and minerals. Some studies show that more than half of all individuals eat at least 1 food supplement and about 10% eat at least 4 different food supplements. 11 The purpose of eating extra vitamins and minerals is to prevent disease and/or improve the condition of those who are ill.

In Swedish trade, dietary supplements are marketed aggressively and not infrequently the manufacturer claims that the supplements are effective against a wide range of diseases and symptoms. The question is: is there any evidence that dietary supplements work or is it an industry that feeds on people’s anxieties and ignorance?

What is dietary supplements?

Vitamins and minerals in concentrated form are called dietary supplements. These can be sold in the form of capsules, tablets, powders, ampoules or liquids. Essential amino acids (building blocks in proteins), essential fatty acids (building blocks in fat), fibre, herbs and plant extracts can also be sold as food supplements.

The following picture shows what you find in a Swedish pharmacy when searching for food supplements. Nowadays, you can also buy stomach bacteria as a supplement. Manufacturers claim that the gastric bacteria in the supplement should improve the intestinal microflora (the set of bacteria that we normally have in the stomach and intestines) and thus improve our health.

Is there any evidence that dietary supplements (vitamins, minerals) are effective?

The best way to find out whether vitamins and minerals can actually prevent disease or alleviate disease is by doing randomized clinical trials. It simply means doing a study where participants in the study are allowed to eat either dietary supplements or idle sugar pills.

All medical research evaluating the efficacy of drugs and the like is done through such clinical trials. In short, most clinical trials with dietary supplements have shown that they have no significant effect unless the people in the study do not have a shortage of vitamins/minerals. This means that the majority of science speaks in favor of not benefiting from eating food supplements unless you have a shortage of vitamins or minerals.

In fact, several studies show that unnecessary dietary supplements can be harmful. Food supplements such as folate (folic acid), vitamin E, selenium and beta-carotene can, therefore, be harmful if you eat too much of these substances. The consequences can be very serious. 12

Who should eat dietary supplements with vitamins and/or minerals?

If you are healthy and eat a balanced diet, you will most likely not need supplements. If you do not eat a healthy and balanced diet (which offers all the vitamins and minerals you need), you may need to eat supplements. However, it is important to note that you have a shortage before you start investing in expensive supplements. In principle, it is always better to satisfy their need for vitamins and minerals by correcting the diet rather than buying industrially made dietary supplements.

Vitamins and minerals found in food are usually easier to take up and side effects are fewer. 13 There is strong scientific support that a healthy and balanced diet has a great effect on health, while support for food supplements is very weak if not non-existent.

Ordinary healthy people have no benefit from dietary supplements. However, there are special groups in society who should eat dietary supplements. These groups benefit from eating dietary supplements because regular food cannot satisfy their need for vitamins and minerals.

People with diabetes

If you have undergone gastric bypass, you usually need supplements with fat-soluble vitamins (vitamin A, vitamin D, vitamin K, vitamin E), B vitamins, iron, calcium, zinc, copper. It allows people who underwent gastric bypass should eat multivitamin and multimineral supplements. People who eat metformin may need vitamin B12 supplements.

Adults in omnipotence

Vitamin B12 (cobalamin)

A lack of vitamin B12 (cobalamin) is common among people older than 50 years. This is usually due to the fact that you cannot take up vitamin B12 as well as getting older. In these cases, one should eat supplements with vitamin B12.

Vitamin D

Regarding vitamin D, it is currently recommended that 600 IU per day for adults up to 70 years of age and 800 IU per day if you are older than 70 years. 14 Some organizations still recommend the right intake (between 1000 and 2000 IU per day) but it is unclear whether this has any benefits. Studies are underway to clarify this.

Calcium

It is recommended that 1 g of calcium per day for adults aged 51 to 70 years and 1.2 g for women aged 51 to 70 years and for others over 70 years. There are data indicating that unnecessarily high calcium intake may increase the risk of kidney stones and possibly cardiovascular disease, which is why one should not eat more than recommended.

Studies also suggest that moderate supplements with calcium (1 g/day) plus vitamin D (800 IU/d) may reduce the risk of bone fractures (fractures) and osteoporosis in women 65 years of age or older. 15

Thus, multivitamin and multimineral products are not generally recommended for adults. 16

However, it should be mentioned that a clinical trial showed that the risk of cancer was lower among men who ate multivitamin supplements. 17 More studies are simply needed before we can give an opinion on this.

Note that elderly people with osteoporosis should eat supplements with vitamin D and calcium (the effect of magnesium is not ensured).

Omega 3 fatty acids and cardiovascular disease: the constant question

In Sweden, you can find Omega 3 supplements (a special type of fatty acid) in almost every grocery store, as well as in pharmacies. The enthusiasm took off because some studies showed that people who ate a lot of omega 3 also had a lower risk of heart attack and death from cardiovascular disease. Omega 3 has been studied extremely carefully over the last few decades and just recently a large analysis was published which summarized the best studies done on omega 3.

That study showed that omega 3 does not reduce the risk of heart attack or death from cardiovascular disease. There is, therefore, no credible support for eating Omega 3, as thousands of Swedes are likely to do to prevent cardiovascular disease. 18

Pregnant (dietary supplements during pregnancy)

Women who may become pregnant or who are in the first trimester of pregnancy should eat sufficient folic acid (folate) (0.4 to 0.8 mg per day). This is explained by the fact that a lack of folic acid (folate) can lead to the fact that the fetus has congenital malformations of the nervous system. These malformations can become serious and therefore it is justified to ensure their intake of folic acid (folate) during the first trimester of pregnancy. Folate (folic acid) contained in canned (artificial folic acid) works at least as well as folic acid in natural food. This means that one can satisfy one’s need for folate (folic acid) through products in trade.

In Sweden, pregnant women usually eat supplements that contain several minerals and vitamins that are important during pregnancy. This is recommended throughout the country and there is credible scientific support for eating such dietary supplements. Pregnant women with low blood counts (anemia, anemia) should eat an iron-rich diet (a diet that contains a lot of iron) to correct their low blood count. You can also receive iron supplements if you have anemia due to iron deficiency during pregnancy. 19

Eating extra calcium (calcium supplements) during pregnancy is said to reduce the risk of getting high blood pressure and preeclampsia during pregnancy. However, this is not clear and more studies are needed. Likewise, it is unclear whether high doses of vitamin D have any effect during pregnancy. 20

Children

Children who are partially breastfed or breastfed should receive vitamin D supplements shortly after birth and this should continue until the baby’s diet covers the need for vitamin D. Often baby food has added vitamin D to cover their nutritional needs. It should also be ensured that children receive sufficient amounts of iron by 4 months of age. The recommendations of the Swedish Food Agency have resulted in the fact that baby food is often iron-enriched. Otherwise, healthy children should not eat food supplements unless it is established that the child does not consume enough vitamins and minerals.

Final advice

If you eat a balanced and healthy diet and have not found a shortage of vitamins/minerals and also do not belong to any risk group (pregnant, gastric bypass, etc) you are unlikely to have to eat supplements. If you are in need of dietary supplements, you should always give preference to products prescribed by your doctor. Products requiring a doctor’s prescription undergo a more thorough inspection process than products not subject to the supervision of the Agency.

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