Why do we need supplements?

Executive Summary

There are various reasons why we don’t get adequate nutrition from our foods.

Modern plants have reduced amounts of nutrients due to topsoil erosion. Crops are grown for higher yields, which increases their size but not nutrient levels. Foods lose their nutrients as they are transported over long distances or stored for long periods. Air pollution increases inflammation and antioxidant stress in the body needing more anti-inflammatory and antioxidant ingredients in the foods.

A balanced meal is not enough; we need a variety of foods. That is, we need a variety of nutrients in a single meal; but also a variety of sources of each nutrient across different meals.

Modern foods are highly processed with reduced fiber and increased salt, sugar, and fats for taste and texture enhancement. New health imperatives, such as reducing saturated fats and increasing seed oils, have led to an increased need for anti-inflammatory omega-3 oils.

All in all, our diet has become calorically dense but nutritionally sparse. Supplements are needed for bringing the balance back to our health. They offer targeted, condensed, and convenient sources of required nutrients.

While some supplements still don’t have conclusive medical evidence seen of their benefit, a simple question begs a common-sense answer: why would a carrot help your vision when eaten as a vegetable but not when its beta-carotenes are extracted into a supplement?

When I interact with people about food supplements, the first question I get is “why do I need supplements?”

Some tell me that they eat the same foods that their grandparents ate, implying that they should not have any nutrient shortfalls since their grandparents did not. A few people give me a textbook response that a ‘balanced diet’ can take care of their health. Some others want double-blind, placebo-controlled trials to ‘prove’ that supplements can help them.

In this article, I will give you some reasons and research links to show why we are not getting enough nutrients.

Environmental or External Factors

These are extrinsic causes over which you have no control. A lot of things have changed since the times of our ancestors. Some of those changes have happened in the last 50 years. So while our grandparents did not have to worry about them, we surely should.

Reduction in Nutrients in Foods

You may be eating exactly the same food that your grandparents used to eat. But the foods, especially fruits and vegetables, have much less ‘health’ left in them compared to that in your grandparents’ time. Don’t believe it? Here are some articles from renowned sources:

1. Scientific American: Dirt Poor: Have Fruits and Vegetables Become Less Nutritious?
2. BBC: How modern food can regain its nutrients
3. American Society for Horticultural Science: Declining Fruit and Vegetable Nutrient Composition: What Is the Evidence?

Consider these research findings:

1. As per a big study done at the University of Texas at Austin, from 1950 to 2004, in 43 vegetables that were studied, important nutrients dropped by 6% to 38%. Specifically, calcium declined by 16%, iron by 15%, phosphorus by 9%, and vitamin B₂ by 38%. Even vitamin C dropped significantly.
2. Wheat is a good source of minerals such as iron, magnesium, zinc, and copper. In a study in the UK, these nutrients in wheat were found to be at similar levels between 1845 and the mid-1960s, but have dropped significantly since then.
3. A Kushi Institute of Europe study showed that from 1975 to 1997, in 12 fresh vegetables, calcium levels dropped by 27%, iron levels by 37%, vitamin A levels by 21%, and vitamin C levels by 30%.
4. A study published in the British Food Journal showed that in 20 vegetables, from 1930 to 1980, the calcium content decreased by 19%, iron by 22%; and potassium by 14%.
5. Another study showed that you have to eat eight oranges today to get the same amount of vitamin A that your grandparents got by eating one.
6. Closer to my home in Mumbai, India, a study done in 2013 found that the vegetables that were sourced from the markets in Mumbai had very low levels of iron, potassium, vitamin C, vitamin B₁₂, and protein compared to their organically grown counterparts from a nearby market.

Thus, if you are eating exactly the same foods that your grandparents ate, nutritionally you will be short by 30 to 35% compared to your grandparents. This is if you matched your grandparents’ food daily. But I don’t think your grandparents ate pizzas and burgers as frequently as you do.

So what are the reasons for this fall in the nutrient content of our foods? Here are some of them:

Topsoil Erosion

We use modern farming techniques, which involve intensive cropping. That strips off significant amounts of nutrients from the soil in which our vegetables and other plants are grown. Without returning the nutrients back to the soil, the farms become overcropped.

Think of it: if your plant pulls out chromium from the soil, how will it come back in the soil next year when you start growing a new crop? There is no way to create chromium out of thin air.

Dilution Effect

These days, we don’t optimise crops for nutrition; we enhance them for better yields and palate. For example, today’s wheat kernels are three times larger in size compared to those fifty years ago. While that has helped reduce global hunger (the same area under cultivation feeds three times more people), it has diluted its nutrient contents.

Our wheat now has three times the amount of carbohydrates than before but the same amount of micronutrients. This is called the dilution effect.

By eating such foods, people are satiating their hunger but not their nutrition needs. This is called the hidden hunger effect. Their foods are calorically dense but nutritionally sparse.

Global Movement of Foods

In our grandparents’ times, most of the produce was locally produced. As the means of transport have improved, we currently get food items from all over the world.

When I was a kid growing up in India, I had never seen fruits such as kiwi fruit, dragonfruit, or avocado except in books. These days, it is fairly common to see them imported from far corners of the world.

This increases the time lag between cutting the fruits or vegetables and consuming them. Unfortunately, once fruits and vegetables are cut from their source, their nutrient content starts dropping due to multiple reasons.

Respiration

Fruits and vegetables continue to breathe even after cutting. This process is called respiration, due to which their nutrients start breaking down. The breakdown is in carbohydrates, proteins, and fats—mainly the organic matter, and not minerals (as they cannot ‘break down’). Warm or dry air speeds up this process.

That is why health experts talk about eating foods produced in nearby regions. But that was possible in the earlier agrarian and rural societies. In today’s urban world, that is not easy. In many cities, food has to be brought in from far distances.

Oxidation

Once the fruits and vegetables are cut from their sources, parts of them get exposed to oxygen. This leads to a process called oxidation and is instrumental in spoilage. With oxidation, the enzymes in the foods alter the chemical composition of the foods causing them to soften and turn brown. Luckily, this oxidation is a slow process.

This also happens in foods that are processed. After orange juice is extracted, its vitamin C content drops at a decomposition rate of 2% per day. A study showed that the vitamin C contents of orange juice dropped from 85 mg a cup at the time of extraction to 45 mg a cup four weeks later.

Ripeness

Most fruits and vegetables have their best nutrient contents when they are ripe. However, if it takes time to transport them over long distances, they are often cut before they are fully ripe.

Sometimes, in the quest for providing certain seasonal foods year-round, the vegetables are cut when fully raw and stored in silos. They are then artificially ripened before delivering to the end customers. For example, apples in India are plucked when raw and stored for many months. Ever wondered why the apple, which is a seasonal fruit is now available all year round? Such foods come to you with less amount of nutrients than if they were available during their harvest season.

Cold Supply Chains

High temperatures increase the rate of spoilage. So if foods are to be transported over long distances, they are quickly frozen and then transported. For that, the region should have good cold supply chains.

In many developing countries, such cold supply chains don’t exist causing a reduction in the nutrients by the time they reach the consumers.

Air Pollution

Air Pollution is a modern evil that causes heart disease, stroke, dementia, cancer, and many respiratory disorders. Pollution mainly affects our bodies through a combination of inflammation and oxidative stress. So nutrients that have antioxidant and anti-inflammatory properties are useful in reducing the harmful effects of air pollution. The main nutrients recommended for this purpose are B-vitamins, vitamins C, D, and E, and omega-3 fatty acids.

Individual or Internal Factors

These are factors caused by our modern lifestyles. We have far more control over them.

The Myth of a Balanced Diet

To be clear, a balanced diet will definitely help us become healthier. But what really is a balanced diet? How much in carbohydrates, proteins, and fats? How much fiber, vitamin C, or B-vitamins? I have rarely met anyone who is not a health professional and knows what a balanced diet should be.

In fact, our dietary needs are different at various life-stages: youth, middle-age and old-age bring their own requirements. An active sportsperson needs more nutrients. Women of child-bearing age have different food requirements than post-menopausal women. All in all, a balanced diet itself keeps changing from person to person. Read here: The definition of a ‘balanced diet’ is often murky.

Convenience-Based Lifestyle

It is very difficult to eat healthy these days for people with busy lifestyles. Just consider:

1. What does your child get at a birthday party of a friend? Stirred-fried vegetables and pomegranate juice? Or is it more like cake, wafers, and ice creams?
2. What do you get at your office parties? Kale and spinach salads? Or is it more like pizza, chips, and sweetened orange juice?
3. What does an elderly person with dentures and a very weak appetite eat? Can she eat copious amounts of crunchy vegetables or manage with a small, soggy bowl of rice and lentil soup?

So how are such individuals going to cover their nutritional needs? It is very easy to talk about eating a balanced diet; it is hard to implement it in real life.

Limited Variety

Most families have a preference for certain food items, even within the food groups such as the lentils. Repeatedly consuming the same foods is not going to give you adequate coverage of nutrients, even if you eat a ‘balanced diet’.

For example, if you eat a lot of proteins from beans and pulses and do not eat grain proteins, you will be deficient in methionine—an essential amino acid whose deficiency is linked to premature greying of hair and is a critical part of your metabolism.

In other words, a balanced meal gives you a good variety of nutrients. But it is not enough to eat the same ‘balanced’ meal every day. You need to add a variety of food items within each category of a ‘balanced’ meal. Over multiple days, rotate amongst your choices of lentils, cereals, green leafy vegetables, and fish or meats. Easier said than done!

Processed Foods

Our modern lifestyle has made convenience the driving force. In our busy schedules, we have less time to choose, cook, and even eat food. Various food companies market their wares by making their offerings more attractive and even addictive. I won’t go into all those factors as I have provided links to many good articles at the end of this blog. But I will summarise some key issues.

Removal of Fiber

Foods high in fiber are difficult to chew. Think of eating a carrot. That is just ‘too much effort’. These days, we get many foods with roughage—the fiber component—removed. The idea is to make it easy on the palate.

This can happen even when you don’t choose processed foods. For example, the bananas eaten by our ancestors were full of seeds making them harder to eat. Nowadays, we have varieties that have no hard seeds. As a kid, I remember eating grapes full of bitter seeds. But over the last few decades, we get seedless varieties of grapes that make wolfing them down so much easier.

Appetising and Addictive Foods

Processed foods need more salt or sugar for better shelf life as that prevents rapid growth of microbes. Salt and spices also enhance the flavours of the foods. Adding sugar or high-fructose corn syrup gives you a dopamine surge, which is addictive. Some organisations even do ‘research’ on how artificial flavours, thickeners, and other additives enhance the texture and mouth-feel. Read the articles at the end.

Combine all of these factors and you get processed foods that are calorically dense and nutritionally sparse.

Reduced Activity Levels

In agrarian societies of yesterday, people had to toil hard through the day. Their calorie needs were high. So they ate thousands of calories more than us daily, giving them ample amounts of nutrients in the process.

These days, such food intake would lead to obesity as our lifestyles are sedentary. And if we reduce our food intake to stay healthy, we end up getting lesser amounts of nutrients than our ancestors did.

Health Scares and Diet Changes

Over the last 50 years, our society has developed a fear of heart disorders. One is told to have more omega-6 oils, compared to saturated fats. Unfortunately, this alters the healthy omega-6 to omega-3 ratio in our foods. It used to be 1:1 in the earlier days. Currently, it hovers around 20:1 in the Western diets when anything in excess of 4:1 is said to cause chronic inflammation in the body. And as we know, such inflammation can lead to many modern disorders.

This kind of dietary change necessitates a far higher intake of omega-3 oils in the form of supplements. Read on this website: Why must we consume more omega-3 oils?

Similar thing happens with other nutrient pairs, too. Harvard Medical School says:

So we have gone from a ratio of 1 to 16 to 1 to 0.74. One should at least have a ratio of 1 to 2. So if your munchies are giving you 2 g of extra salt, which is roughly 1 g of extra sodium—the typical amount we consume in excess, you will need to take 2 g of extra potassium.

In other words, our body’s daily requirement for potassium has gone up by 40% from our grandparents’ time simply because we consume more salt through processed foods.

Triage Theory

Some ‘experts’ use reverse evidence to defend that we get adequate nutrition. For example, they say that if our food is deficient in calcium, a mineral needed for heart function and muscle contractions, why don’t we get into an emergency situation?

Now, an absence of evidence (of deficiency) is not an evidence of absence (of deficiency). But even if that were to be true, there is a major reason why you may fail to notice a deficiency: when faced with any nutrient shortfall, your body triages its use.

To triage is to divide the resources by priority level with the highest priority getting the most allocation. It is common in the clinical world where in emergency situations, such as a natural calamity or a war, limited medical resources are not used equally for all needs. The highest priority needs get the most allocation.

In 2007, Dr Bruce Ames of University of California propounded Triage Theory, which claims that our body does the same. When faced with a micronutrient shortfall, the body apportions it to the most urgent and life-saving uses. The long-term and less critical needs get shortchanged. In other words, you don’t notice any deficiency for survival needs but long-term health requirements are postponed.

So if your food is deficient in calcium, your body steers its limited amount for heart functioning and muscle contractions. Your bones get much smaller part of it, leading to fragile bones or osteoporosis sooner.

The triage theory was proven recently in case of vitamin K. When faced with vitamin K shortfall, the body uses it for critical functions such as blood clotting but not for its tasks that protect against the diseases of ageing.

I hope I have shown you that our environment and modern lifestyles are leading to a serious shortfall of nutrients in our bodies.

My Views

1. Sometimes, the deficiencies cause a simple, temporary problem. Once corrected, the condition is rectified and disappears for good. For example, iron-deficiency anemia.
   
   On other occasions, the deficiencies are causative factors that trigger a medical problem. Once activated, such a disorder gathers its own pace and worsens with time. What once was just a nutrient imbalance, becomes a serious medical disease that needs proper medical or surgical management. For example, atherosclerosis (blocked arteries) or dementia (memory loss).
   
   
2. Anything short of changing our lifestyle and spending hours cooking and eating healthy food, we need a short-cut solution. Let’s face it: most of us are busy and eating healthy is not our number one priority (though it should be).
   
   Enter the supplements. Ideally, supplements are quick, condensed nutrients that one can take in a short period of time. So as I like to say, they are the second-best option for all of us.
   
   Ideally, you should eat healthy foods. But if you cannot do that, staying nutritionally deficient is not an option, especially given the rising medical costs of healthcare.
   
   
3. Some people, rightly, have the attitude that they need proof that taking supplements will benefit them. The thinking is: The deficiency of some nutrients may be causing me a problem but what is the guarantee that taking those nutrients in a supplement form will remove the deficiency and control the problem? Fair point.
   
   The evidence about the use of supplements for certain medical conditions is often conflicting and therefore, confusing. Some trials show benefits, while some others don’t show that much improvement. Some nutrients don’t have any large studies about them that can give conclusive evidence. Here is my detailed article on this website: How to understand the evidence from clinical trials of nutrients.
   
   Finally, many studies that show benefits are done in animal models (an animal with a disease either the same as or like a disease in humans) or in vitro (in a Petri dish). No one knows whether they will work equally well with human beings.
   
   In such situations, you have to take a nuanced view: Are you going to wait for another two or three decades before scientific research conclusively proves if a nutrient supplement helps in your medical condition, or are you willing to try based on ‘what is the harm?’ thinking?
   
   
4. In my experience, most supplements help multiple body systems. For example, a supplement of coenzyme Q10 helps many organs such as the heart, lungs, liver, kidneys, brain, and the skeletal system. So if you take the supplement for your brain ageing and dementia, it will still help your heart, liver, and kidneys. That means, even if future research proves that coenzyme Q10 does not help your brain, your other organs would still have benefitted from it.
   
   
5. “There is no supplement for common sense”.

To Read More

• National Health Services (NHS), UK: Eating Processed Foods
• Academy of Nutrition and Dietetics: Processed Foods: What’s OK and What to Avoid
• MedicalNewsToday: How do processed foods affect your health?
• WebMD: The Truth about Processed Foods
• Healthline: Healthy Food vs. Highly Processed Food: What to Know
• The New York Times: Unhealthy Foods Aren’t Just Bad For You, They May Also Be Addictive
• The Conversation: Your brain on sugar: What the science actually says
• Cleveland Clinic: Why Are Certain Foods so Addictive?
• KCRW: Many foods are more addictive than smoking. How to break unhealthy eating habits?

First published on: 14th May 2022
Image credit: Cottonbro on Pexels
Last updated on: 29th August 2022