NUTRITION MISCONCEPTIONS, Part I – Supplements and Perfect Foods

Will focusing on “perfect foods” assure you of good nutritional status?

The food industry has marketed certain foods: berries, fish, cruciferous vegetables, dark-green leafy vegetables, nuts, and seeds; as superfoods due to their exceptional nutrient density and health benefits. However, no single food can offer all the nutrition, health benefits, and energy required for good health. Instead, concentrating your diet on a variety of foods, rich in color, will help ensure nutrient quality. The 2020–2025 US Dietary Guidelines recommends “a healthy dietary pattern consists of nutrient-dense forms of foods and beverages across all food groups, in recommended amounts, and within calorie limits”.(1)

The food color wheel, below, identifies food groups containing phytochemicals and corresponding health benefits. For example, the red color group contains lycopene, ellagic acid, quercetin and hesperidin, all of which can contribute to the reduction of developing prostate cancer and may lower blood pressure. These foods include tomatoes, watermelon, and beetroot. However, no single food supplies all the phytochemicals associated with good health.

Hence, there is no perfect food, and people who continuously eat the same few foods, because they believe these foods are ‘healthy’, increase risk of developing nutrient deficiency and poor dietary adherence due to increased dietary restrictions.

Are supplements really an effective means of improving nutritional status?

Does more really mean better? Not always. Read on to see why.

Many assume taking supplements may improve health. Over 70% of Americans take some form of dietary supplement each day, supplying the supplement industry with a

gross profit of over $28 billion annually.(2) Some supplements, however, when taken in large amounts, may result in undesirable effects. For instance, vitamin E supplementation (800U for 1-2 months) was found to promote lipid peroxidation and inflammation,

resulting in the generation of free radicals, during exercise, compared with placebo (3); leucine supplementation (greater than 500 mg/kilogram of weight/day was found to increase the risk of adverse events; and folic acid may increased risk of colorectal and prostate cancers, (4) in certain individuals. (5,6) As for athletes, it is also a concern that many supplements have banned substances not listed on the label. (7,8)

Vitamin C is one of the most commonly consumed supplements due to its significant role in improved immune function and antioxidant activity. According to the National Institute of Health, the recommended amount of vitamin C is 90 mg for adult males and 75mg for

adult females (9). However, dosages found in vitamin C supplements can be as high as 1000mg. Excessive consumption of vitamin C supplements may lead to gastrointestinal upset, such as diarrhea and nausea. In some cases, the risk of developing oxalate forming kidney stones increases. In a randomized clinical controlled trial, forty-seven calcium-stone forming patients received either 1000 or 2000 mg vitamin C supplementation; while 20 healthy subjects received 1000 mg supplementation for a period of 3 days to determine if urinary oxalate and pH were affected; both, of which, play a role in the development of oxalate forming kidney stones.. The findings revealed a significant increase in mean urinary oxalate observed in patients with calcium stone-forming, suggesting vitamin C supplementation may increase urinary oxalate excretion resulting in the formation of calcium stones. (10)

A more comprehensive study, published in the Archives of Internal Medicine, investigated the relationship between dietary supplements and mortality rate in older women. Long-term use of several commonly used multivitamins containing vitamin B6, folic acid, iron, magnesium, zinc and copper were found to be associated with increased total mortality

risk. It is worth noting that copper supplement was associated with the greatest risk change of 18.0%. (11). Additionally, the study found excesses in iron supplementation can promote oxidative stress, which according to the National Institute of Health, can lead to development of chronic diseases, such as atherosclerosis, cancer, diabetes, or rheumatoid arthritis, through increased production of free radicals.

It is important to note, some medical conditions warrant use of supplements to meet recommended daily allowances for micronutrients. For instance, pregnant women and older adults usually require supplements. Additionally, clinical conditions that affect the body's ability to absorb nutrients may warrant including supplementation as part of a daily routine. It is always important to discuss with your doctor or a registered dietitian whether or not including vitamin and mineral supplements is necessary.

So, what’s the take away? A food-first approach should take priority. Whole foods are more diverse with greater nutritional content. They provide fiber and naturally occurring phytochemicals and antioxidants, typically missing in vitamin and mineral supplements. Vitamins and minerals naturally occurring in foods are better absorbed than those found in supplements, and designed to work in our bodies the way nature intended. To be certain you are meeting your micro-nutrient needs, focus your attention on a colorful plate.

Think of a rainbow.

Everytime you prepare your meal, ask yourself how many colors are on your plate? Could you construct a rainbow from the food choices made?

Can you add more colors? Food is an amazing and enjoyable medicine designed to nourish our bodies and keep us healthy. No food is bad and no food should be eliminated.

For more information on how to improve the quality of your diet, and Eat a Rainbow, consider working with a registered dietitian.

Eat the Rainbow!!

Content contributed by Yuyi (Amber) Chen currently a bio-major student at Emory University. Originally from Hangzhou, China, Yuyi has been studying in the US for 8 years. Yuyi is interested in nutrition and hopes to use her knowledge to help people maintain a healthy lifestyle.

References

1. U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2020-2025. 9th Edition. December 2020. Available at DietaryGuidelines.gov.

2. Ronis, M. J. J., Pedersen, K. B., & Watt, J. (2018). ADVERSE EFFECTS OF NUTRACEUTICALS AND DIETARY SUPPLEMENTS. Annual Review of Pharmacology and Toxicology, 58, 583–601. https://doi.org/10.1146/annurev-pharmtox-010617-052844

3. Nieman, D. C., Henson, D. A., McAnulty, S. R., McAnulty, L. S., Morrow, J. D., Ahmed, A., & Heward, C. B. (2004). Vitamin E and immunity after the Kona Triathlon World Championship. Medicine and Science in Sports and Exercise, 36(8), 1328–1335. https://doi.org/10.1249/01.mss.0000135778.57355.ca

4. Nagao, K., Jinzu, H., Noguchi, Y., & Bannai, M. (2015). Impact of Dietary Essential Amino Acids in Man. In R. Rajendram, V. R. Preedy, & V. B. Patel (Eds.), Branched Chain Amino Acids in Clinical Nutrition: Volume 1 (pp. 3–12). Springer. https://doi.org/10.1007/978-1-4939-1923-9_1

5. Figueiredo, J. C., Grau, M. V., Haile, R. W., Sandler, R. S., Summers, R. W., Bresalier, R. S., Burke, C. A., McKeown-Eyssen, G. E., & Baron, J. A. (2009). Folic acid and risk of prostate cancer: Results from a randomized clinical trial. Journal of the National Cancer Institute, 101(6), 432–435. https://doi.org/10.1093/jnci/djp019

6. Lee, J. E., Willett, W. C., Fuchs, C. S., Smith-Warner, S. A., Wu, K., Ma, J., & Giovannucci, E. (2011). Folate intake and risk of colorectal cancer and adenoma: Modification by time. The American Journal of Clinical Nutrition, 93(4), 817–825. https://doi.org/10.3945/ajcn.110.007781

7. Kwiatkowska, D., Wójtowicz, M., Jarek, A., Goebel, C., Chajewska, K., Turek-Lepa, E., Pokrywka, A., & Kazlauskas, R. (2015). N,N-dimethyl-2-phenylpropan-1-amine—New designer agent found in athlete urine and nutritional supplement. Drug Testing and Analysis, 7(4), 331–335. https://doi.org/10.1002/dta.1741

8. Maughan, R. J. (2013). Quality assurance issues in the use of dietary supplements, with special reference to protein supplements. The Journal of Nutrition, 143(11), 1843S-1847S. https://doi.org/10.3945/jn.113.176651

9. Office of Dietary Supplements—Vitamin C. (2021, March 22). National Institute of Health. https://ods.od.nih.gov/factsheets/VitaminC-Consumer/

10. Baxmann, A. C., De O G Mendonça, C., & Heilberg, I. P. (2003). Effect of vitamin C supplements on urinary oxalate and pH in calcium stone-forming patients. Kidney International, 63(3), 1066–1071. https://doi.org/10.1046/j.1523-1755.2003.00815.x

11. Mursu, J., Robien, K., Harnack, L. J., Park, K., & Jacobs, D. R. (2011). Dietary supplements and mortality in older women: The Iowa Women’s Health Study. Archives of Internal Medicine, 171(18), 1625–1633. https://doi.org/10.1001/archinternmed.2011.445