That is the question.

A report from 2006 by NIH (National Institute of Health) recently came to my attention. This report (Ref below) discusses the benefits (or lack thereof) of vitamins and supplements. Not surprisingly, they found little evidence (or rather, none) that they do us any good. The conclusions were (as I understand them):

• More than half of the population use multivitamin supplements
• The supplement users tend to be people that eat a healthy diet, making it difficult to distinguish between any benefits from the supplements as compared to nutrition derived from the diet itself
• Fortification of foods further confuses the matter as it makes it impossible to evaluate the actual amount of nutrients people consume
• They also found no studies that pointed towards a positive effect for treating chronic conditions, except for certain subgroups such as calcium and vitamin D for bone density

They conclude with

Finally, the present evidence is insufficient to recommend either for or against the use of MVMs (multivitamins) by the American public to prevent chronic disease

And, of course, the recommendation is that more studies are required. I have never seen a study that didn’t include this recommendation. More work for the researchers!

What the study did not address is whether the RDA (Recommended Daily Allowance) for vitamins and minerals are optimal numbers. Personally, I very much doubt they are. They all seem to be based on a study treating a deficiency and the number that was required to restore the levels might not necessarily be the what is required for a person that has another composition of her diet.

So what does all this tell me? First, I’m not too worried about my inconsistency in taking supplements any more. I tend to jump on a bandwagon for a certain supplement, and then drop others. There are just so many pills I can take in a day!

I’m not even consistent with calcium. But then I read a study that taking calcium religiously for 3 years resulted in 1% (ONE percent) less loss of bone density as compared to not taking it. The study also concluded that you were better off getting the calcium from food. I have no trouble remembering to eat cheese!

The one supplement I will not drop for now is Vitamin D. I think there is enough evidence that most people can benefit from it. But I will not worry if I miss a dose a day or two as the vitamin is stored in the body and I can hopefully compensate by a higher dose the next day. Fish oil for Omega 3 and cod liver oil for Vitamin A also makes it into my mouth now and then.

Note. I do not recommend anybody to stop taking any supplements. I just present my personal opinion and I realize that what I think is good for me will not be valid for all people. I am not an expert and I don’t pretend to be. There are certainly groups that require supplementation for various reasons such as illnesses or malabsorption issues.

[Ref: National Institutes of Health State-of-the-Science conference statement: multivitamin/mineral supplements and chronic disease prevention. Ann Intern Med. 2006;145:000-000. Full report in pdf: NIH]

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Is it enough? Kimmer recommends a multivitamin per day for her 500 calories starvation diet, Kimkins. Theoretically, this will provide the RDA (Recommended Daily Allowance) for all essential vitamins and minerals. Does that mean that my body gets everything it needs to function? As the energy will be taken from stored body fat and the rest will be delivered by the pill? I know for sure, that the fat soluble vitamins will not be absorbed as the Kimkins diet is practically void of fat. But what about the other vitamins and minerals in the pill?

For reasons that scientists have yet to figure out, the body processes vitamins differently when they arrive in food than in pill form – probably because foods interact with one another in a way that may help nutrient absorption. So far, nutrition specialists said, scientists working in labs can’t beat what nature does.

Even multivitamins, which typically contain the recommended daily intake of a host of nutrients, are not universally accepted by nutritionists.

Alice Lichtenstein, a professor at Tufts University’s Friedman School of Nutrition, said there is no evidence that multivitamins are hazardous – but she said there’s also no compelling proof that they do much.

The RDA, or RDI (Reference Daily Intake) as it is now called, was developed based on getting the nutrition from FOOD, not a PILL. Will my body absorb what it needs from a pill? And is the RDA enough?

The RDA was developed during World War II by Lydia J. Roberts, Hazel K. Stiebeling and Helen S. Mitchell, all part of a committee established by the U.S. National Academy of Sciences in order to investigate issues of nutrition that might “affect national defense” (Nestle, 35). The committee was renamed the Food and Nutrition Board in 1941, after which they began to deliberate on a set of recommendations of a standard daily allowance for each type of nutrient. The standards would be used for nutrition recommendations for the armed forces, for civilians, and for overseas population who might need food relief. Roberts, Stiebeling, and Mitchell surveyed all available data, created a tentative set of allowances for “energy and eight nutrients”, and submitted them to experts for review (Nestle, 35). The final set of guidelines, called RDAs for Recommended Dietary Allowances, were accepted in 1941. The allowances were meant to provide superior nutrition for civilians and military personnel, so they included a “margin of safety.” Because of food rationing during the war, the food guides created by government agencies to direct citizens’ nutritional intake also took food availability into account.

I have not been able to find anything about what method they used to develop the RDA.
Surely they did not have the time to perform actual studies to see how the body responds to different vitamin and mineral levels. My guess would be that they looked at a “typical” diet of perhaps some 2,500 calories and then calculated what nutrition it would provide to use as their bench mark.

Despite the fact that RDA has proved useful, most physicians, medical practitioners, dietitians, and laypeople tend to assign too much authority to the RDA standards. Instead of using RDA as the minimal amount needed to prevent deficiency diseases, the society tends to use RDA as the maximum amount of daily nutrient intake. Chronic diseases, for example cancer, heart diseases, osteoporosis, indicated the fact that the RDA standard is not sufficient to prevent or deal with the root of chronic diseases. Studies in nutritional sciences and the medical field further show that we need a greater amount of nutrients than those recommended by RDA to provide optimal level of protection.

The RDA is constantly undergoing adjustments as new research suggests increase/decrease of a certain vitamin or mineral, mostly based on new studies where a certain vitamin or mineral is showed to protect against some disease.

But to my knowledge, there has been no long term study to see if the RDA is in fact representative of the nutrition a body needs. Especially when this nutrition is not derived from food but supplements.