We know that having enough of all the essential micronutrients is very important for optimal health. And that’s why your clients come to you – for optimal health.
In terms of serious deficiency diseases though, they are not that common in the developed world.
Few people here suffer the mental and physical consequences of iron deficiency, or develop night blindness from vitamin A deficiency; both of which are unfortunately not that uncommon in the developing world(1). Of course, there are the odd cases of scurvy(2) or rickets(3) from time to time, in places like Canada, but these are rare.
Even so, this doesn’t mean that we get enough of all the required nutrients for optimal health.
I’ve heard too many people say that if you follow a “balanced diet”, you’ll get enough vitamins and minerals. I personally love the theory and philosophy of this, and I’d love to believe it … but it just doesn’t hold up in real life. Not even in countries where most people have access to a variety of foods all year round.
And here’s the proof.
Deficiency, Insufficiency, DRIs (oh my!)
Before we get started, let’s mention the grey area that spans from a serious and debilitating micronutrient “deficiency” on one hand, all the way to a slight “insufficiency”.
The “official” recommended amounts for each nutrient is listed in the Canadian Dietary Reference Intakes (EAR, RDA, AI & UL) (4), which, of course, are based on averages.
As wellness professionals, we know that even if a client eats a well-balanced nutrient-rich diet and theoretically consumes enough nutrients for an “average” person (which most people probably don’t do consistently anyway), your client is likely not to be perfectly “average”.
Perhaps they have a digestive issue that reduces absorption of nutrients (think low stomach acid or celiac disease). Or they have a health goal that increases their need for nutrients (think athletes or pregnant women). Not to mention the nuances of foods that when eaten together can either increase or decrease bioavailability of nutrients (like vitamin C with non-heme iron, or phytates in grains).
So we can probably agree that even people who are not “deficient” or even “insufficient”, may still need to increase their nutritional status.
But, let me start by giving you the evidence of our actual nutritional status.
There are lots of ways to study the nutritional status of a population. Commonly, we survey with a food intake questionnaire or conduct an observational study analyzing nutrient levels in blood samples.
Whichever method we use requires careful selection of enough participants that accurately represent the population so that we can extrapolate the results. And, as with all observational studies, they do not provide the strongest evidence. (5)
But we don’t have to look very far to find ample evidence of poor nutritional status.
Let me summarize just a few of the published studies that look at nutritional status from both the food intake and blood nutrient level perspectives:
Do Canadian Adults Meet Their Nutrient Requirements Through Food Intake Alone? (6), based on the Canadian Community Health Survey.(7)
- “Many adults have inadequate intakes of magnesium, calcium, vitamin A and vitamin D.”
- “…there is concern that Canadian adults may not be meeting their needs for potassium and fiber…”
Foods, Fortificants, and Supplements: Where Do Americans Get Their Nutrients?
- “Without enrichment and/or fortification and supplementation, many Americans did not achieve the recommended micronutrient intake levels set forth in the Dietary Reference Intake.” (8)
Fruit and Vegetable Consumption. (9)
- These charts show that less than half of Canadian households ate the minimum recommended number of fruits and vegetables per day.
Blood Nutrient Levels
Metabolic vitamin B12 deficiency: a missed opportunity to prevent dementia and stroke. (10)
- “Metabolic B12 deficiency is common, being present in 10%-40% of the population”.
Prevalence of vitamin D inadequacy in athletes: a systematic-review and meta-analysis.(11)
- “…the prevalence of vitamin D inadequacy in athletes is prominent. The risk significantly increases in higher latitudes, in winter and early spring seasons, and for indoor sport activities. Regular investigation of vitamin D status using reliable assays and supplementation is essential to ensure healthy athletes.”
Severe iron-deficiency anaemia and feeding practices in young children.(12)
- “Fe-deficiency anaemia (IDA) occurs in 1-2 % of infants in developed countries, peaks at 1-3 years of age and is associated with later cognitive deficits.”
High prevalence of suboptimal vitamin B12 status in young adult women of South Asian and European ethnicity.(13)
- “Suboptimal vitamin B12 (B12) status has been associated with an increased risk of congenital anomalies, preterm birth, and childhood insulin resistance. South Asians – Canada’s largest minority group – and women of reproductive age are vulnerable to B12 deficiency. “
- “The prevalence of B12 inadequacy in this sample of highly educated women is higher than in the general Canadian population.”
The persistence of maternal vitamin D deficiency and insufficiency during pregnancy and lactation irrespective of seasonal and supplementation.(14)
- “The prevalence rates of vitamin D deficiency and insufficiency were 31·5% and 35·1% in pregnancy, 33·4% and 35·3% at 3 months, and 35·6% and 33·8% at 12 months postpartum, respectively.”
So, clearly, there is ample evidence of poor nutritional status.
Are multivitamins the answer?
As you can guess, the most commonly used dietary supplement is the multivitamin. (15,16)
A review article published in 2015 says:
“National surveys show that micronutrient inadequacies are widespread in the US and that dietary supplements, of which MVMs are the most common type, help fulfill micronutrient requirements in adults and children.”(16)
I could end this section right here, but we can dig a bit further into the science of multivitamins for just a minute.
You probably remember the controversy over multivitamins a few years ago. The coverage blew up from an article that re-analyzed data from 21 clinical studies, pooling information from 91,074 people. This study found that there was no reduction in the death rate from any cause, including heart disease or cancer in people who used multivitamins. (17)
Of course your clients are coming to you to help them optimize their health, not simply to prevent death. And you may very well be recommending higher quality supplements than were used in these studies (some only had 3 vitamins & no minerals). (18)
A lot of people feel that multivitamins are an “insurance policy” for their health, and it very well may be. Not to mention that they’re safe (heeding the label warnings, of course). (19,20)
Here are a few examples of high-quality experimental studies or review articles that show health benefits of multivitamins. These include:
- 8% cancer reduction in men (21);
- 27% cancer reduction in men with a history of cancer (21);
- Reduced risk of certain types of cataracts (but not all types) (22);
- Improving immediate free recall memory, but not delayed free recall memory or verbal fluency (23);
- A supplement containing folic acid, vitamin B12, vitamin E, S-adenosylmethionine, N-acetyl cysteine, and acetyl-L-carnitine improved cognitive performance while the participants were taking it (24)
Here’s a quote from a recent review article summarizing the current knowledge:
“A common reason people take multivitamin and mineral (MVM) supplements is to maintain or improve health, but research examining the effectiveness of MVMs in the prevention of certain chronic conditions is ongoing. In addition to the utility of MVMs for filling in relatively small but critical nutritional gaps, which may help prevent conditions such as anemia, neural tube defects, and osteoporosis, some evidence supports possible benefits of MVM supplementation with regard to cancer prevention (particularly in men) and prevention or delay of cataract, as well as some aspects of cognitive performance. Unlike some single-vitamin supplements, MVM supplements are generally well tolerated and do not appear to increase the risk of mortality, cerebrovascular disease, or heart failure. The potential benefits of MVM supplements likely outweigh any risk in the general population and may be particularly beneficial for older people. “ (19)
Whole Foods vs. Individual Nutrients
Wellness professionals often recommend eating more whole foods and fewer processed foods (good advice!).
Of course, some processed foods are “enriched” or “fortified”, but that’s a whole other topic. However, within whole foods, there are unknown numbers of compounds that seem to contribute to good health, over and above the vitamins and minerals that are commonly in multivitamin supplements. Even today we are discovering more health-promoting molecules in our food.
Here are a few highlights from some recent meta-analysis reviews (i.e. the strongest type of scientific evidence)(5), about foods:
- People who eat more nuts have a 15% lower risk of cancer than those who don’t (25);
- People who eat more vegetables have a 29% less risk of ulcerative colitis (but no difference in risk of Crohn’s). And people who eat fruit have a 31% lower risk of ulcerative colitis, and a 43% lower risk of Crohn’s disease (26);
- “… increased intake of vegetables, but not fruit, is associated with lower risk for HCC [hepatocellular carcinoma]. The risk of HCC decreases by 8% for every 100 g/d increase in vegetable intake.”(27)
And here are a few about diets:
- Mediterranean diet reduces the risk of diabetes by 19% (28);
- “Diets that score highly on the HEI [Healthy Eating Index], AHEI [Alternate Healthy Eating Index], and DASH [Dietary Approaches to Stop Hypertension] are associated with a significant reduction in the risk of all-cause mortality, cardiovascular disease, cancer, and type 2 diabetes mellitus by 22%, 22%, 15%, and 22%, respectively, and therefore is of high public health relevance.” (29);
- Vegetarian diets (Seventh Day Aventist) have a 32% lower risk of death, 40% lower risk of ischaemic heart disease and 29% lower risk of cerebrovascular disease (30);
- “High adherence to a MD [Mediterranean Diet] is associated with a significant reduction in the risk of overall cancer mortality (10%), colorectal cancer (14%), prostate cancer (4%) and aerodigestive cancer (56%).” (31);
- “… DPs [Dietary Patterns] are consistently associated with risk of type 2 diabetes even when other lifestyle factors are controlled for. Thus, greater adherence to a DP characterized by high intakes of fruit, vegetables, and complex carbohydrate and low intakes of refined carbohydrate, processed meat, and fried food may be one strategy that could have a positive influence on the global public health burden of type 2 diabetes.”(32)
So, we know that actual real, whole foods can have a huge effect in protecting us from many chronic diseases.
There definitely seems to be something about foods, way beyond the individual vitamins and minerals, that help keep us healthy!
Factors to consider for your clients
Do they eat a nutrient-dense diet most of the time?
Might they have overt micronutrient deficiencies that may need a targeted supplementation?
Are they looking for a simple “insurance policy” for their nutritional status?
How can you help them to increase their intake of nutrient-dense foods?
Did you like this article? We’d love to hear your feedback in the comments. What else would you like to learn about?
A big thank you to Leesa Klich. Leesa is a science-based holistic nutritionist who helps holistic health professionals find and understand science-based health information so they can feel confident in their recommendations.
For a list of free science-based health resources, click here.