AHS13 Todd Becker -The Case Against Nutritional Supplements (AHS13)
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The document argues that for most people, routine supplementation with vitamins and minerals is unnecessary and can be counterproductive, advocating instead for a diet rooted in ancestral health principles. It discusses the ineffectiveness and potential harms of popular supplements, such as antioxidants, vitamin D, calcium, and omega-3 fatty acids, emphasizing that a whole-food diet and natural substances can better support health through endogenous processes. The author suggests that hormesis, the beneficial effects of low doses of stressors, plays a significant role in promoting health without the need for supplements.
AHS13 Todd Becker -The Case Against Nutritional Supplements (AHS13)
- 1. The case against nutritional supplements Todd Becker gettingstronger.org Ancestral Health Symposium August 17, 2013
- 2. How did our ancestors thrive without supplements? Do we really need them?
- 3. Main Thesis • For most* people, routine supplementation with vitamins, minerals and essential fatty acids is unnecessary and may be counterproductive • A paleo diet and lifestyle – enhanced by hormesis – reduces or eliminates the need for supplementation * Caveat: Short term supplementation may be advisable in cases of malnutrition, infection, illness, pregnancy or special athletic goals.
- 4. Outline • The case for nutritional supplements • General doubts and objections • Four examples – Antioxidants – Vitamin D – Calcium – Omega-3 fatty acids • The role of hormesis
- 5. The “paleo” case for nutritional supplements • Inability to synthesize (vitamin C) • Inefficient synthesis (vitamin D, omega-3) • Deficient soils and oceans (minerals, omega-3)
- 6. General doubts and objections 1. You are not what you eat You are what your body does with what you eat This applies to macronutrients • Excess glucose triglycerides • Excess protein glucose • Soluble fiber short chain fatty acids
- 7. General doubts and objections 1. You are not what you eat You are what your body does with what you eat But it also applies to micronutrients • Malabsorption / excretion (calcium) • Oxidation (antioxidants, fatty acids) • Hormone signaling (vitamin D) • Gene expression (antioxidants, vitamin D)
- 8. General doubts and objections 2. Nutrients are regulated homeostatically Exogenous nutrients can downregulate endogenous defenses Examples – Antioxidants – Vitamin D
- 9. The case for antioxidants • Reactive oxygen species (ROS) • Can’t synthesize our own vitamin C • Mega doses suggested for: – Common cold – Infections – Cancer • Other antioxidants • Vitamin A • Vitamin E • Beta carotene • Co-Q10 • Alpha lipoic acid
- 10. Fruits & vegetables • Health benefits of fruits and vegetables “ associated” with antioxidant content ?
- 11. Interventional studies show no benefit …or even positive harm AMA (2004): Meta-analysis 20 studies: C, E beta carotene > No reduction in CVD, stroke or mortality Cochrane (2008): Meta-analysis 67 studies: A, C, E, selenium > No reduction in mortality Antioxidants adversely impact exercise! Ristow (2009): Vitamins C and E + exercise for 4 weeks > decreased insulin sensitivity improvement > reduced antioxidant enzyme levels Before exercise After exercise
- 12. What could be going wrong? • Oxidative “stress” by ROS is not always bad! • ROS are essential for cell signaling, exercise regulation, and fighting infection • Moderate ROS plays a hormetic role in improving mitochondrial function and upregulating endogenous antioxidant enzymes • Antioxidant supplements indiscriminately suppress cell signaling and downregulate endogenous antioxidant enzymes
- 13. Endogenous Antioxidants • The xenobiotic metabolism produces Phase II antioxidant enzymes to catalytically neutralize chemical toxins: – Superoxide dismutase (SOD), glutathione reductase (GSH), etc. • We have co-evolved with certain edible plants to tolerate modest amounts their polyphenolic “toxins” • Exposure to these polyphenolic “hormetins” activate the Nrf2 pathway, which produces the endogenous antioxidants • Hormetins are abundant in pigmented, bitter plants and herbs • Resveratrol • Sulforaphane • Curcumin • Green tea
- 14. Supplements vs. Hormetins Supplements: Antioxidants, minerals, vitamins and essential fatty acids taken to correct apparent deficiencies Hormetins: Spices, herbs, phytonutrients that activate and strengthen the body’s endogenous processes of defense, repair, and tolerance and performance. Typically hormetins work synergistically and at low dose
- 15. Hormetins are agents of hormesis • Dose-response effect • Stressors we’ve evolved with • Activate Defense & repair mechanisms Edward Calabrese Suresh Rattan
- 16. Many examples of hormesis • Chemicals • Sunlight (UV) • Ionizing radiation • Exercise • Barefoot running • Fasting / Ketosis • Cold exposure • Immunotherapy • Vision Improvement
- 17. Vitamin C recycling • Vitamin C (ascorbate) neutralizes oxidants 1-for 1 • Dehydroascorbate (oxidized vitamin C) is readily recycled thousands of times by endogenous glutathione reductase • Elevated blood glucose inhibits reuptake and recycling of dehydroascorbate ROS
- 18. Vitamin C storage • Advocates of mega dose vitamin C note that most primates (simians) consume 10-20X the RDA of vitamin C • But humans can efficiently store 10-100X the blood levels of vitamin C in adrenal, thymus, pituitary and other glands – enough to ward of scurvy for 3-8 months Antioxidants: Take home message • Based upon adequate storage and catalytic recycling, a low glycemic diet rich in hormetic polyphenols greatly decreases the daily need for dietary and supplemental vitamin C
- 19. The case for vitamin D • From diet or action of UV on skin • D3 itself is not biologically active – Requires liver & kidney conversions – Active form (1,25-D) binds VDR receptor • Vitamin D has a dual function – Low dose: calcium absorption – Higher dose: immune function (VDR)
- 20. Correlation and causation • Low vitamin D3 levels correlate with higher heart disease, stroke, immune problems, infection & overall mortality • But is low vitamin D3 a cause – or a consequence – of ill health? – Healthy people may get more sun and exercise, elevating D3 – People with low D3 often have elevated 1,25-D • Could 25-D be a mere “biomarker” for health status?
- 21. Vitamin D risks & questions • Interventional studies show no benefit, possible harm: – AMA(2010): Supplements for 5 years in women over 70 produced 15% more falls and 26% more fractures – NCI (2012): Elevated 25-D linked to aggressive prostate cancer • Vitamin D is a secosteroid – binds the VDR receptor – VDR activation dampens the innate immune response – Provides short term control of infection and autoimmunity – Long term supplementation with the inactive 25-D might inhibit 1,25-D action and/or down-regulate VDR function
- 22. An alternative to vitamin D? • Can we get the benefits of Vitamin D without the risks of daily supplementation or sun exposure? • Hoyer-Hansen studied the pathways activated by the VDR receptor and noted that “Autophagy could be a general mediator of the health-promoting effects of 1,25-(OH)2 (D3). Accordingly, there is a striking overlap among the diseases promoted by VD deficiency and defective autophagy.”
- 23. Autophagy • A cellular housecleaning process – Recycles damaged cytoplasmic matter – Activated by calorie restriction and exercise • Regulates the same pathways as vitamin D receptor – Inhibits mTOR, bcl-1, bcl-2 – Inhibition of carcinogenesis and tuberculosis Take home message – Vitamin D • Be wary of supplementing , especially at high doses • Consider that intermittent fasting and exercise might activate the same metabolic benefits
- 24. The case for calcium supplements • Strong bone formation requires an adequate supply of calcium • Deficiencies of calcium (and vitamin D) lead to rickets and osteoporosis
- 25. What do interventional studies show? • Harvard study of 77,761 nurses for 12 years showed no protection from bone fractures at any dose of calcium (from dairy or supplements) • Confirmed by similar studies in Australia and the UK
- 26. Is calcium getting to where it is needed? • Blood levels of calcium are tightly regulated • High levels of vitamin D deplete vitamin K2 and promote calcification of vascular tissue • On a standard diet high in grains, phytates bind calcium, leading to poor absorption • High blood glucose and insulin levels “leach” calcium from bones • In short, taking calcium supplements doesn’t ensure it will get into bones
- 27. A better way to build bones • The solution is not supplementation, but a whole food diet of “available” calcium, with vits. D, A, K2 • Weight bearing exercise is the most practical way to stimulate uptake of calcium into bones
- 28. The case for omega-3 supplements • EPA and DHA are long chain essential N-3 fatty acids (EFAs), critical to brain, eye and heart function • A low n-3/n-6 ratio has been linked to CVD, Alzheimer’s, depression, autoimmune disorders • Most Westerner’s show poor enzymatic conversion of shorter chain n-3s to the EFAs • EFAs from consumption of fatty fish is inadequate Hence, dietary supplementation is recommended
- 29. Stillwell, William. “The role of polyunsaturated lipids in membrane raft function”, Scandinavian Journal of Food and Nutrition, 2006; 50 (S2): 107 -113.
- 30. However EFA supplements have a downside • A 2013 JAMA study of 2000 men found that men with the highest blood levels of EPA and DHA had – 71% higher risk of aggressive prostate cancer – 44% higher risk of low-grade prostate cancer • These results replicate earlier findings from a 2011 study • Under-reported: The increased risk appears associated only with the more easily oxidized DHA, not EPA (Nina Bailey)
- 31. Diet impact on DHA “survival” • Low carbohydrate diets dramatically increase “end product” DHA in muscle membranes – This improves insulin sensitivity and inhibits lipogenesis • This happens despite reduced enzymatic synthesis of DHA under carbohydrate restriction • Low carb diets appear to help “preserve” DHA by suppressing ROS-driven lipid peroxidation From Volek and Phinney, “The Art and Science of Low Carbohydrate Living” (2011)
- 32. Diet controls fate of EFAs • DHA is less stable than EPA to lipid peroxidation. The higher association of DHA with cancer may reflect this fact. • Low carb/paleo/non-inflammatory diets result in a reduced dietary requirement for EFAs because they are better “preserved” against oxidative damage and inter-conversion is optimized • Thus, a non-inflammatory diet may be critical to getting EFA benefits without the risks posed by unstable and “damaged” DHA
- 33. Parting thoughts • Recommended Daily Allowances for supplements came from studies of people eating Western diets • Those diets oxidize nutrients, impair absorption and recycling, and downregulate endogenous defenses • A low insulinogenic, non-inflammatory, whole food diet greatly improves micronutrient utilization • Phytonutrients and hormesis can boost endogenous antioxidants and other defenses
- 34. For further reading Related articles on my blog gettingstronger.org “The case against antioxidants” “Why I don’t take vitamin D supplements” “An alternative to vitamin D supplements”
- 35. References Antioxidants 1. Kris-Etherton, Penny M. et al, “Antioxidant vitamin supplements and cardiovascular disease” Circulation 2004, 110: 637-641. 2. Bjelakovic, Goran et al, “Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases”. Cochrane Database of Systematic Reviews 3: John Wiley & Sons, 2008 and updated 2012. 3. Cheung, M.C. et al, “Antioxidant supplements block the response of HDL to simvastatin-niacin therapy in patients with coronary artery disease and low HDL” Arterioscler Thromb Vasc Biol, 2001, Aug; 21 (8) 1320-6, 4. Ristow, Michael et al., “Antioxidants prevent health-promoting effects of physical exercise in humans” PNAS 2009 ; published ahead of print May 11, 2009, doi:10.1073/pnas.0903485106 5. Mendriatta, S. et al. “Erythrocyte ascorbate recycling: antioxidant effects in blood”, Free Radic Biol Med. 1998, 24 (5): 789-97. 6. Wang, Yaohui et al. “Ascorbate recycling in human neutrophils: Induction by bacteria” Proc. Nat Acad Sci of U.S.A., 1997, 94 (25) 13816-9. 7. Li, Guolin, “The Positive and Negative Aspects of Reactive Oxygen Species in Sports Performance”, Ch. 6 in Michael Hamlin et al., ed, Current Issues in Sports and Exercise Medicine, ISBN 978-953-51, 2013, -1031-6,, 2013
- 36. References 8. Rountree, Robert, “Beyond Antioxidants: Nutrigenomic Regulation of the Adaptive Stress Response.” Integrative Practitioner, 2010. http://www.integrativepractitioner.com/article.aspx?id=17183 Vitamin D 9. Sanders, K.M. et al., “Annual High-Dose Oral Vitamin D and Falls and Fractures in Older Women: A Randomized Controlled Trial. JAMA 2010, 303 (18) , 1815-1822. 10. Masterjohn, C. “Vitamin D toxicity redefined: vitamin K and the molecular mechanisms” Med Hypotheses 2007, 8 (5): 1026-34. 11. Agus, David B., The End of Illness. New York: Simon & Schuster, 2011. 12. Hoyer-Hansen, M.D. “Autophagy as a basis for the health-promoting effects of vitamin D”. Trends in Molecular Medicine (2010) 16:7, 295-302 Calcium 13. Feskanich, D. et al. “Milk, dietary calcium and bone fractures in women: a 12-year prospective study” Am J Public Health, 1997, 87 (6) 992-7.
- 37. References Omega-3 fatty acids 14. Stillwell, William. “The role of polyunsaturated lipids in membrane raft function”, Scandinavian Journal of Food and Nutrition, 2006; 50 (S2): 107 -113. 15. Brasky, T. M. et al. “Plasma Phospholipid Fatty Acids and Prostate Cancer Risk in the SELECT Trial” Journal of the National Cancer Institute, Aug 7; 105 (15) 1132-1141, 2013 16. Bailey, Nina. “DHA, not EPA, responsible for omega-3 prostate cancer risk. Igennus Healthcare Nutrition blog, http://www.igennus-hn.com/dha-not-epa-responsible-for-omega-3-prostate- cancer-risk-by-dr-nina-bailey/ 17. Volek, Jeff S. and Stephen D. Phinney. The Art and Science of Low Carbohydrate Performance: A Revolutionary Program to Extend your Physical and Mental Performance Envelope. Createspace.com, Chapter 9 and references, 2012 Hormesis 18. Calabrese, Edward J., and Linda A. Baldwin. "Hormesis: The Dose-Response Revolution." Annu. Rev. Pharmacol. Toxicol. 43: 175-97, 2003. 19. Rattan, Suresh I and Dino Demirovic. “Hormesis Can and Does Work in Humans.” Dose- Response. 8(1): 58-63, 2010.