Vitamin Supplements: Should You or Shouldn't You? Part 3: Real food is the best source of nutrients

After looking at the disappointing studies showing no consistent association between antioxidant vitamin supplements and reduced coronary heart disease or cancer, folic acid supplements and colon cancer prevention, or vitamin C and common cold prevention, I’m happy to tell you that I do have some good news.

Following years of research, we can go back to the observation that started this journey: Eating plenty of fruits and vegetables is beneficial to health.

Dozens of studies looking at people eating plant foods-- whole grains, fruits and vegetables--showed the same correlation: lower risk of heart disease, cancer, diabetes stroke and many other chronic diseases.

The scientific pursuit to understand exactly what’s in these foods that does the trick is thrilling, if of no practical use as of yet. Natural foods contain thousands of different chemicals. Some of these, like the thirteen vitamins, have been well studied. Many others -- while known -- aren’t yet sufficiently examined, and I’m certain that better analytical techniques will identify many other compounds. On top of that, human metabolism is so incredibly complex, that understanding our interaction with food compounds seems an almost daunting task. Yet, it’s now clear that fiber, vitamins, minerals and specific fats in isolation don’t seem to give us the same benefits as when they’re present in our fruits and vegetables.

There are many possible explanations: The studies may be flawed (nutrition studies are especially hard to conduct); we have not yet identified the beneficial molecule in these foods; or it’s the combination of vitamins and the synergy between them in the food that’s beneficial, while each in isolation is ineffective.

If you’re lucky enough to have access to plenty of food to choose from, isn’t it obvious that you should stick to what works, and just eat plenty of fruits and vegetables?

Let’s compare white bread, made with enriched flour, to whole grain bread. Whole wheat flour contains nutrients from the three layers of the grain: Bran, germ and endosperm. The outermost bran layer contains fiber, B vitamins and antioxidants. The germ is the embryo of the grain, and contains B vitamins, minerals (magnesium, calcium, zinc, chromium, manganese, selenium, vanadium, and copper), protein, and unsaturated fats. The endosperm is the largest part of the grain and consists primarily of carbohydrate, some protein, and small amounts of vitamins and minerals.

A refined grain has had the germ and bran layers removed, taking with it 25% of the protein, almost all of the dietary fiber, and a number of vitamins and minerals. Manufacturers of refined grains “fortify” the flour by adding back the vitamins and minerals they’ve stripped from the grain, and they even add a little extra. (The FDA requires refined flour fortification with thiamin, niacin, riboflavin, folic acid and iron at a higher level than the original grain.) Many breakfast cereals are fortified with more than a dozen nutrients and fiber.

So why do foods made with refined fortified flour still fall short when compared to those made with whole grain? Is it that we’re missing some key nutrients that we’ve removed, and didn’t identify? Is it that there was a synergistic effect in the way the whole wheat is absorbed? Is the process of refining the grain adding something to the flour that is harmful? We simply don’t know, but clearly whole grain is healthier than refined grain with added vitamins, and there are dozens of studies to show that.

By the same token, 100 grams of apple (with skin) has 85 grams of water, 0.26 grams protein, 0.17 grams fat, 10.4 grams sugar, 4.6 milligrams vitamin C, 3 micrograms folate, 54 International Units of vitamin A, 0.18 milligrams vitamin E, and just trace amounts of other vitamins and minerals. If you look at the apple just from the macro- and micro-nutrient point of view, an apple would be like water with 10% sugar, sprinkled with a few vitamins and minerals, all of them in tiny amounts, so that if you were to put a label on your apple the FDA would not allow to even say it’s a rich source of any of these vitamins, as it does not supply anything close to 20% of RDA.

What are we missing here?

The apple has dozens of phenolic and flavonoid compounds. It has antioxidant activity that is a result of molecules other than the meager 4.6 milligrams vitamin C in it, and it is an excellent food that promotes health, whereas the sugared water with vitamins (even if you put 100% RDA of them) is probably worthless, since what’s missing from the average American diet is not vitamins.

Plant foods contain a host of important compounds that may someday be labeled essential to health. There are literally thousands of these compounds in every plant food. A pill can never contain all that. We have evolved with these plants as our food for millions of years, and we’re therefore brilliantly adapted to metabolize them in the most optimal way.

To most of us, living in this environment of plenty, the pursuit of the “super molecule”, that is the holy grail of good health should be academic only. We already know what works; we have been hearing this advice for years. One of my fondest memories of my maternal grandfather was his daily salad ritual. After a day's work, he would finely chop a mountain of fresh vegetables from the market into a huge green bowl that could easily double as a bathing tub for a newborn baby. As you can imagine, this fine dicing would take a while, and it seemed to me like he was having a Zen moment while we were anxiously waiting for his famous salad, the gentle aroma of scallions, cucumbers and lemon filling the air. And then my grandmother would tell us what my mother already told us so many times: Eat more fruits and vegetables. That is exactly the same advice I give my kids today. By eating this way we’re most likely covered, even if we don’t yet completely understand why.

Would you dream of replacing a friend with a slick, expertly designed computer program that you can talk to anytime, and that gives you comfort, support and great advice? Unlikely. We have deep relationships with friends; we care for them and they give us so much more than a good conversation.

Our traditional foods are like a good friend: so much more than the sum of their known nutrients. They are seeped with customs, memories, emotions and great flavor. We're just scratching the surface of what’s in them. They are in many ways our connection to nature. But we so readily trade them for highly processed foods high in fat and sugar. And we think that a vitamin pill supplement will fix the damage a bad diet can cause.

Don’t be misled by all the vitamin bottles promising wonders, or so-called “enriched” or “fortified” foods. (They need fortification because they are lacking what we need on their own, or to justify a higher price point.) Don’t go for the pill or the fortified foods. They’ll just postpone your commitment to actually doing something for your health and wellbeing.

Instead, do what grandma said: Eat more fruits and vegetables. Improve your diet. You’ll get all of the healthy goodness you need.

Dr.Ayala