You may be wondering if you need to take supplements when you eat a healthy, whole foods diet. 

Some people argue that as long as you eat a healthy, balanced diet, that supplementing is not necessary. Other people out there, many people who are in the medical field, taut the absolute need for supplementing with vitamins and minerals. 

The answer is not that simple.

I know we all like neat and easy explanations and simple rules to follow, but if you are in the health industry for even a minute, you will soon realize that very little about being healthy on an individual level is simple. 

I would love to say, yes, just eat a wide range of whole foods and you will be just fine. And, yes, we “should” get enough nutrients from the foods we eat. And yes, food is by far the BEST way to get vitamins and minerals into our bodys’ (aside from vitamin D) in a way that is most useful.

But, the fact of the matter is, most Americans often are NOT getting even the minimum daily requirements for many essential vitamins and minerals even if when eating fortified foods and taking vitamins.

According to a study done by The National Health and Nutrition Examination Survey (NHANES), the majority of Americans do not meet the recommended daily requirements for many vitamins and minerals. In fact, almost everyone falls short in the requirements for vitamin D and E and more than a third are deficient in calcium, magnesium and vitamin A. Also, Americans are not getting enough vitamin C with 50 percent below the daily recommended value. Adequate vitamin C can be easily achieved through sufficient fruits and vegetables. However, certain nutrients are still deficient among people eating fortified foods and taking supplements (CDC.gov). 

With an abundance of food and a huge vitamin and supplement industry one may wonder, how is it that we are still nutrient deficient? 

While there is no shortage of food here in the US, we are lacking in healthy, nutrient dense choices for many people. Look at almost any “Main street” in the US and you will find plenty of food options. For instance, say you grab a popular doughnut option for breakfast. It may have about 240 calories, 4 grams of protein, 1 gram of fiber, 13 grams of sugar, and 11 grams of fat and minimal vitamins. Now, an everything bagel at 350 calories has a little more nutrition with about 50% Iron and 2% calcium and 15 grams of protein and 8 grams of fiber. 

Let’s consider a homemade organic egg and spinach muffin. One serving of this recipe will give you approximately 89% of your daily vitamin A, 244% of your vitamin K, 13% folate, 8% magnesium, 8% vitamin E, plus omega three fatty acids and for only 45 calories.

Ultra processed foods found at most fast food restaurants are rarely the most nutritious. In fact, many are highly inflammatory, contributing to obesity and chronic health problems.

Ok, so it is way too easy to grab fast food that is basically devoid of solid nutrition. How about just going to the store and grabbing healthier choices?

For many Americans in rural and inner city regions, access and price is a barrier to healthy food choices. The price of healthier choices, fruits, vegetables and especially the organic options are much more expensive. Grass fed and pasture raised beef, poultry and dairy can cost much more than conventionally raised livestock. 

Is there a difference between organic and conventional foods? Let’s look at eggs, for instance. Organic eggs means the hens were not given antibiotics or hormones. Pasture raised hens were allowed to roam free and eat plants and insects along with commercial feed. Conventional fed hens were raised on grains often containing pesticides. 

You may be wondering what is the nutritional difference between these eggs.

So, hens that were allowed to roam free had more vitamin E, 3.73 mg versus .97 mg than conventional eggs. Pasture raised hens vs conventional raised hens provide eggs with 791 IU versus 487 of Vitamin A. They also provide more omega-3 fatty acids and less saturated fat. Pasture raised eggs will cost you, though. A dozen pasture raised eggs may cost $3.99 to $5.99. While at target a dozen grade A eggs, conventionally raised hens’ eggs may be about $1.39. This is a steep difference in price.  

How about milk? Do you wonder if paying more for organic is really worth it?  A gallon of regular milk today will cost approximately $2.89. Organic, half gallon around $4.79 and pasture raised, organic around $5 for a half gallon. For starters, conventionally raised dairy cows are fed growth hormones and antibiotics and GMO (pesticide laden) grain feed. All of which gets passed on to the consumer. If that is not reason enough to opt for the pricier version of milk, organic milk also has a higher omega-3 versus omega-6 fatty acid ratio. Why is this important? The typical American diet has a lopsided ratio of Omega-6 to Omega-3 fatty acids which contributes to the inflammatory conditions that plague our health.

Easy access to unhealthy, fast and ultra-processed foods, for a convenience based lifestyle, coupled with decreased access to healthier, more nutritionally dense forms of food are contributing not only to an unhealthy lifestyle, but also food that are lacking nutrients. Unless we are making a conscious effort to maximize all our nutrition from foods, and have the budget for the more nutritionally dense versions, it is not easy to even get our basic nutritional needs met.

Now, another issue that we face in the US is the way foods are farmed. I mentioned earlier that GMO foods are laden with pesticides. So, if you are eating corn or soy in the US (which is in almost everything) then you are being exposed to large amounts of glyphosate, a pesticide. While glyphosate has been deemed ”safe” it negatively affects our microbiome. Micro-biome problems have become a major problem and may be linked to issues with being able to absorb nutrients among affecting almost every body function. So, the combination of a deficient nutritional profile in most foods and malabsorption issues or microbiome problems, create the perfect storm of nutritionally deficient diets among Americans.

The other issue that has come to light in recent years is the farming methods. Dr. Mark Hyman has an entire book highlighting the food industry problem: https://foodfixbook.com/ 

One such problem is that many farming soils lack the minerals and nutrients we need to provide the foods being grown. If you compare produce today with those grown twenty years ago, you will see a reduction in essential nutrient density. For example, a tomato today is less nutritious than the one your grandmother ate. 

In 2004, Donald Davis and his team published a landmark study of different fruits and vegetables between 1950 and 1999 in the Journal of the American College of Nutrition finding “reliable declines” in the amount of protein, calcium, phosphorus, iron, riboflavin (vitamin B2) and vitamin C. Similar studies have found reductions in calcium by 19 percent, iron 22 percent and potassium by 14 percent.  A similar study of British nutrient data from 1930 to 1980, published in the British Food Journal, found that in 20 vegetables the average calcium content had declined 19 percent; iron 22 percent; and potassium 14 percent. Until farming practices change, we are left to figure out how we can get as much nutrition per calorie as possible (scientificamerican.com, 2011). When we add the fact that most produce is shipped far and wide, the nutritional value diminished further.

Even if you manage to eat whole foods and are diligent about nutrition, there are other factors that deplete nutrients.  If you are an active adult with moderate amounts of stress, your nutritional needs and detox pathways may require even more vitamins and minerals to run your body at an optimal level. According to Ben Greenfield of Ben Greenfield fitness in “Do You Really Need To Take Supplements If You Eat A Clean Diet?”, many exercise enthusiasts and individuals with hard-pressed deadlines and hectic life need more nutrients than what is standardly recommended (Greenfield, 2020).

Breaking down your vitamin needs.

The following overview of five nutrients is an overview of 5 essential nutrients that we tend to be deficient. Anyone looking to add supplements should always consult with a qualified medical professional, as there are risks not fully covered below with certain medicines and conditions. Taking too much of a vitamin can be detrimental to your health, as much as being deficient in certain circumstances.

For a complete age-based and up to date list of recommended daily values for vitamins and minerals, check out this site: https://ods.od.nih.gov/Health_Information/Dietary_Reference_Intakes.aspx

The major vitamins and minerals that have been found to be most deficient among almost every american were  D, A, E, C, calcium and magnesium. Some experts also argue that we lack the optimal amount of fiber, Omega-3 fatty acids and vitamins K and B12.

The Top 5 Vitamin Deficiencies

Vitamin A

• The possible problems associated with vitamin A deficiency include eye problems, and infections critical for vision. 
• Vitamin A is necessary for vital organ formation and maintenance. 
• The RDA of vitamin A for adults between 19-50 years old is 900 mcg for men and 700 mcg for women.
• The top food sources of vitamin A in the U.S. diet include dairy products and beef liver (6582 mcg). Other good sources:
  • sweet potato (one whole) 1403 mcg
  • spinach (½ c cooked) 573 mcg
  •  raw carrots (½ cup) 459 mcg
  • cantaloupe per (½ cup) 135
  • skim milk (1 cup) 149 mcg
  • hard boiled egg 75 mcg
  • salmon sockeye(3 oz) 59 mcg 

Vitamin D

• Almost every American is deficient in Vitamin D, which is crucial for the absorption of calcium, another nutrient that most of us lack. 
• Vitamin D deficiency has some pretty significant possible consequences, such as: – Depression, osteoporosis, depression, cancer, multiple sclerosis, glucose intolerance, and high blood pressure.
• Drinking less milk, use of sunscreen and rising weight are three factors that contribute to vitamin D deficiency. 
• The RDA of Vitamin D for those 1-70 year old, both female and male is 600 IU or 15 mcg. WHile difficult to quantify, direct sunlight is the most effective way for your body to get vitamin D. Some people, whether due to genetics, religious reasons, or because of their geographic location do not get sufficient sunlight for the body to make sufficient vitamin D. 
• Food sources can include:
  • 3 oz salmon – 566 IU
  • 3 Oz canned tuna 154 IU
  • *Fortified OJ  oz 137 IU
  • *Nonfat milk fortified  oz 115-124 IU
  •  Egg 41 IU
  • Beef liver 3.5 oz 60 IU

*amounts can vary

• Sun exposure is the most abundant and effective way to get vitamin D in most cases, however, sunrays must be direct, not through glass, and the amount needed is difficult to predict. In general about 5-30 minutes of direct exposure to face, arms, legs or back between 10 am to 3 3pm is sufficient.

Magnesium

• Magnesium is a powerhouse mineral that most of us are lacking in sufficient amounts. A lack of Magnesium has been linked to type 2 diabetes, high blood pressure, and cardiovascular disease. Magnesium helps to control muscles and nerves; keeps bones strong and the heart healthy; helps with blood sugar normalization, decreases inflammation, and aids in relaxation. Magnesium is also known for preventing migraines, and decreasing arrhythmias. 
• Females over 30 years old need 320 mg, while males over 31 years old need 420.  (Mister, 2007) (WebMD.com, 2019).
• Top foods rich in magnesium
  • Spinach (1 cup cooked) 157 mg
  • Swiss chard (1 cup cooked)  150 mg
  • Black beans (1 cup cooked) 120 mg
  • Almonds (¼ cup) 97 mg
  • Potatoes (1 large) 85 mg
  • Pumpkin seeds (¼ cup) 42 mg
  • Avocado (1 raw) 39 mg
  • Banana 37 mg

Vitamin E

• Vitamin E is important for vision, reproduction, health of your blood, brain and skin. It’s an antioxidant, and protects against free radicals. Found in canola and olive oil, dairy, meats, leafy greens and fortified cereals, vitamin E deficiency can cause nerve pain, retinal myopathy, impaired immune response, and myopathy. 
• The RDA for adults is 15 mg ( NIH 2020). 
• Sources of vitamin E include: 
  • Sunflower seeds (1 oz)  7.4 mg
  • Almonds (1 oz) 6.8 mg
  • Peanut butter (2 Tbsp) 2.9 mg
  • Spinach (½ cup cooked) 1.9 mg
  • Broccoli (½ c cooked ) 1.2 mg

Calcium

• Calcium, which is important for bone health, is also essential for the transmission of nerve impulses, blood clotting, cell metabolism and muscle contraction. Calcium  absorption requires vitamin D. Therefore, inadequate vit D production means inadequate calcium. 
• Deficiency in Calcium can lead to brittle bones,tingling around the mouth, difficulty breathing, tetany, muscle spasm and an increased risk of heart attack. People aged 19-50 years old are recommended to get 1000 mg of calcium daily.
• Common foods with calcium:

• • Yogurt plain (8 oz) 415 mg
  • OJ fortified (1 cup) 349 mg
  • Cheddar cheese (1 oz) 116 mg
  • Milk nonfat (1 cup)  299 mg
  • Kale (1 cup cooked) 94 mg
  • Whole wheat bread (1 slice) 30 mg

Supplementing Your Diet

Studies have shown that even eating a diet fortified with vitamins and minerals and taking supplements does not necessarily provide us with the daily recommended values. 

Vitamin A, which is commonly deficient among Americans, benefits people who have a poor or limited diet and a medical issue demanding an increased need. Vitamin A taken for antioxidant benefits may not be as effective as food sources. According to the Mayoclinic.org, vitamin A is best when gotten through a healthy diet. Overdose of vitamin A can cause nausea, vomiting, vertigo and blurry vision – even with one large dose (Mayoclinic.org, 2017). Vitamin A can be abundantly found in dairy, liver, spinach, leafy greens, carrots and cantaloupe.

Getting enough vitamin D from food sources can be difficult. The body can produce vitamin D with sufficient levels of direct sunlight on the skin, however, this does not always occur and can be difficult to quantify. Taking vitamin D supplements can help people get closer to the 600 IU goal. Vitamin D3 is the suggested form (cholecalciferol) 400-800 IU. Taking vitamin D3 is also better when taken with a healthy fat, such as avocado as it is fat soluble (Everydayhealth.com, 2019).

According to the Mayoclinic.org, people who eat a vegan diet, have lactose intolerance or who limit dairy consumption, have osteoporosis or certain digestive diseases and/or people on long-term corticosteroids may need calcium supplementation. There are medical conditions in which calcium supplementation is not indicated and medicines that interact with calcium, so always discuss with your doctor before adding more to your diet. When looking for a calcium supplement, however, there are some key things to keep in mind. Calcium carbonate and citrate are the two main forms with carbonate being the cheapest and best choice (Mayoclinic.org, 2018). Calcium carbonate is better absorbed when taken with food.

Vitamin E is another antioxidant which has numerous health benefits by protecting our cells from free radicals that create damage and improve immunity to fend off disease and illness. Like other nutrients, supplementing with Vitamin E has its possible benefits, but also can have negative side effects. So, people taking medications, people who have certain medical conditions should discuss with their healthcare provider prior to supplementing with vitamin E. Getting adequate vitamin E through diet is suggested by including sunflower seeds, almonds, hazelnuts, spinach and nut butters in a well-balanced diet. A single tablespoon of wheat germ oil has enough vitamin E to meet the daily requirement (health.usnews.com, 2019). People who cannot or do not eat wheat or who have digestive issues may be more at risk for vitamin E deficiency.

Magnesium supplements are found in a dizzying array of forms. Magnesium chelate is highly absorbable and the form found in foods -and means it is bound to amino acids. Magnesium citrate another absorbable form is combined with citric acid and can have a laxative effect taken in higher doses, but is otherwise safe. Magnesium chloride oil is applied to the skin and helps when people have trouble absorbing through the Gi tract, but is also used by athletes for sore muscles. Magnesium glycinate is highly absorbable and less likely to cause GI issues. Magnesium Threonate is also highly absorbable and can penetrate the mitochondrial membrane, but is not as readily available at this time. Magnesium orotate has benefits to the heart. 

Magnesium is mostly stored inside cells and bones, making it more difficult to detect deficiencies. Magnesium seems to work in conjunction with other vitamins and minerals, such as calcium, vitamin K and vitamin D. Taking high levels of vitamin D and K can contribute to deficiencies in magnesium (Levy, 2019).

So, eating whole foods with balanced nutrition is the most important and effective way to get the nutrition you need. You must be careful when supplementing because of interaction with medicines and contraindication for certain medicines. Furthermore, knowing how vitamins and minerals interact and how they absorb is important. 

References:

CDC.gov retrieved from:  https://www.cdc.gov/nutritionreport/pdf/4page_%202nd%20nutrition%20report_508_032912.pdf

CRNUSA retrieved from: https://www.crnusa.org/resources/americans-do-not-get-all-nutrients-they-need-food CDC’s Second Nutrition Report:A comprehensive biochemical assessment of thenutrition status of the US population

Everydayhealth.com, 2019. Retrieved from: https://www.everydayhealth.com/vitamin-d/you-need-vitamin-d-supplement-everything-know/#pickingasupplement

Greenfield, Ben. 2020. Retrieved from: https://bengreenfieldfitness.com/article/supplements-articles/supplements-necessary/

Health.usnews.com 2019. Retrieved from: https://health.usnews.com/wellness/articles/vitamin-e-benefits-and-risks

Levy, Jillian. Magnesium Benefits, Dosage Recommendations and Best Types. Retrieved from: https://draxe.com/nutrition/magnesium-supplements/

Mayoclinic.org, 2018. Retrieved from: https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/calcium-supplements/art-20047097

Mayoclinic.org, 2017. Retrieved from: https://www.mayoclinic.org/drugs-supplements-vitamin-a/art-20365945

Mister, Steve. 2007. Retrieved from: https://www.thetimesherald.com/story/opinion/columnists/2017/09/25/many-americans-get-enough-nutrients-food/105977872/

NIH, 2020. Retrieved from :https://ods.od.nih.gov/factsheets/VitaminA-HealthProfessional/

NIH 2020. Retrieved from:  https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/

(NIH 2020) retrieved from: https://ods.od.nih.gov/factsheets/VitaminE-HealthProfessional/

WebMD.com, 2019. Retrieved from:  https://www.webmd.com/diet/ss/slideshow-diet-magnesium

Scientificamerican.com, 2011. Retrieved from: https://www.scientificamerican.com/article/soil-depletion-aND-NUTRITION-LOSS/