A justification for utilizing dietary supplements in most, if not all, patients to achieve optimal health and wellness
There’s no doubt that our patients are overfed but undernourished. A U.S. national survey of 16,444 people four years and older, NHANES 2007-2010, found that 94.3% of people in the U.S. do not receive the daily requirement for vitamin D, 88.5% don’t get enough vitamin E, 52.2% don’t consume enough magnesium, 44.1% calcium, 43% vitamin A, and 38.9% vitamin C.1 Potassium, choline and vitamin K intakes were also low in regard to optimal health and wellness .1
Can a healthy diet regain health?
Most people aren’t eating a healthy, nutrient-rich diet to begin with. However, I know that even in my patients who are devoted to avoiding sugar and processed foods, disease still develops. That’s why we need to ask the question: A good diet may sustain optimal health and wellness, but can it regain health?
If a person with an illness eats a good diet, will that magically help them feel better? Probably not. Plenty of people who eat a healthy diet still become sick. And if patients only start eating a healthy diet once their health has declined, the damage may have already been too great to repair with diet alone. Plus, many patients are exposed to factors such as medications, age, digestive issues, or genetic or metabolic defects that do not allow them to absorb the nutrients they are consuming in the diet. Consequently, dietary supplements can work together with a healthy diet to promote optimal health.
The following are some types of patients who will greatly benefit from a carefully crafted supplement regimen along with a healthy, nutrient-rich diet:
Elderly people
Many seniors aren’t getting enough nutrients to encourage healthy aging. Sometimes this is due to not eating enough food to supply nutrients. Other times, it’s because they’re not absorbing enough nutrients from their diet due to increased genetic or metabolic needs for a given nutrient.
The elderly are at risk of vitamin and mineral deficiencies that may cause fatigue, cardiovascular disease, osteoporosis and cognitive impairment, to name just a few.
Table 1. Signs and Symptoms of Nutrient Deficiencies Common in Older Adults2
| Nutrient | Signs and Symptoms of Deficiency in Seniors |
| Vitamin B12 | Age-related atrophic gastritis can lead to decline in absorption. Deficiency common in older people, but often is undiagnosed. Deficiency linked to high homocysteine levels, a risk factor for cardiovascular concerns. Low levels also associated with cognitive impairment as well as anemia, resulting in weakness and fatigue. |
| Folate | Deficiency linked to high homocysteine levels, dementia and depression. Low levels are a common cause of anemia in older adults, resulting in weakness and fatigue. Due to the MTHFR polymorphism, which is common in the population, many people do not absorb folate or folic acid from food (see more information later in this article). |
| Vitamin B6 | Deficiency linked to high homocysteine levels, a risk factor for cardiovascular concerns. |
| Vitamin B1 (Thiamine) | Common deficiency in the elderly that’s often undiagnosed. Deficiency linked to heart failure, encephalopathy and peripheral neuropathy. |
| Calcium | This is a common deficiency in older women due to decreased dietary intake with age. Low levels linked to rapid bone loss, low bone mass, increased fracture risk. Leg cramps can be a sign to increase calcium intake. |
| Vitamin D | Elderly people usually receive less sun exposure. In addition, with age, the skin does not synthesize this vitamin very well. Furthermore, in older people, the liver and kidney have a weakened ability to hydrolyze vitamin D. Deficiency is associated with rapid bone loss, low bone mass, increased fracture risk and muscle weakness. |
| Vitamin C | Insufficient intake is very common among older adults. Vitamin C is important for immune support and maintaining collagen of blood vessels, among many other beneficial effects. Smokers have an increased need for this vitamin. |
| Iron | Women don’t need as much iron after menopause since they are no longer losing blood during menstruation. However, women with gastrointestinal problems, vegetarians, or who often donate blood can have low iron levels. Elderly who are hospitalized, institutionalized or chronically ill can also be iron deficient. Iron deficiency leads to anemia, weakness and fatigue. Chest pain, rapid heartbeat, shortness of breath, cold feet and pale skin are all signs of iron deficiency. |
| Zinc | Deficiency in the elderly leads to immune impairment and susceptibility to infection. Low levels of this mineral are commonly seen in older adults. |
| Selenium | Deficiency may lead to cardiovascular disease, impaired immunity and cognitive problems. |
| Magnesium | Low levels commonly seen in the elderly. Supports muscle function, heart health, and mood and well-being, and maintains healthy blood sugar and insulin levels. |
Keto, paleo or vegan diets
Many patients are on specific types of diets that can lead, if they are not careful, to deficiency in some nutrients. People eating keto diets often almost completely eliminate fruit, which is fine if they are also eating a lot of vegetables rich in vitamin C and potassium. However, some patients are not eating enough vegetables to achieve optimal health and wellness.
Keto and paleo diets also eliminate grains, which are a good source of B vitamins, iron, zinc, copper and magnesium. Additionally, many patients are undertaking intermittent fasting, where food is only eaten in a 6-8-hour window each day. Doing this may reduce the number of meals patients consume and therefore reduce the nutrient intake.
Furthermore, paleo and vegan diets eliminate dairy, which can lead to calcium deficiency. Vegan diets can also be deficient in vitamin B12, iron, creatine, carnosine and taurine.3-7
Individuals and sugar
Foods with added sugars, like table sugar and high-fructose corn syrup, take the place of foods that are nutritionally superior. Even worse, in the process of liberating their calories as energy, sucrose and high-fructose corn syrup can deplete nutrients from other healthier foods in the diet and from body stores.8
Riboflavin, niacin and other B vitamins are needed for the oxidation of dextrose. Yet, sugar doesn’t supply these nutrients. In fact, it actually boosts their requirements.8 Sugar actually uses vitamins from other foods or steals them from body tissues. As one group of researchers stated, “Sugar supplies nothing but calories and the vitamins provided by other foods are sapped by sugar to liberate these calories.”8
Furthermore, drinking soft drinks is linked to lower intakes of calcium due to decreased milk consumption as well as a lower intake of riboflavin.9 In addition to depleting nutrients, sugar can also ruin the appetite for nutrient-rich foods.10 Sadly, studies in a variety of animals found that adding sugar to otherwise adequate diets caused the animals to malnourish themselves to death.10
Although it would be nice if we could convince our patients to give up sugar and soft drinks, the reality is these substances are addictive and many patients are unwilling to abandon their less-than-ideal dietary habits. Even patients who limit their sugar intake like to indulge from time to time. Consequently, a good multivitamin that includes bioavailable forms of nutrients may make up for the nutrients that sugar depletes from the diet, and can move patients toward optimal health and wellness.
MTHFR polymorphism
A large number of people have a polymorphism in the MTHFR gene that prevents them from metabolizing folic acid from food or supplements or folate from food.
The body needs to convert both folic acid and folate to the metabolically active form, 5-methyltetrahydrofolate (5-MTHF). The enzyme methylenetetrahydrofolate reductase (MTHFR) plays an important role in this process. However, people with a polymorphism are genetically unable to make enough of this enzyme and therefore can’t convert folic acid or folate into the biologically active form.11
Supplementing with 5-MTHF allows the body to bypass the MTHFR enzyme, which is advantageous for anyone who can’t make enough of this enzyme on their own and is unable to make use of the folic acid or folate in food.
Active, coenzymatic forms of other B vitamins — Methyl B12 (cobamamide and methylcobalamin), riboflavin-5-phosphate and pyridoxal-5-phosphate — also tend to be better absorbed by the body. Patients taking a multivitamin that contains those forms bypass some of the difficulties that occur when trying to adequately absorb those nutrients from the diet alone. Therefore, a good multivitamin that offers superior absorption and bioavailability can provide advantages over deriving nutrients from the diet alone.
Patients infected with Helicobacter pylori
Helicobacter pylori, a common bacterium linked to peptic ulcers and other gastric concerns, is associated with certain nutrient deficiencies. Infection with H. pylori is common due to frequent exposure from various sources.
For example, H. pylori has been found in drinking water, vegetables, milk, ready-to-eat foods and animal foods.12 In epidemiological studies, H. pylori infection is associated with iron deficiency anemia as well as deficiency in vitamins B12, A, C, and E as well as folate.13
H. pylori is thought to cause nutrient deficiencies by reducing stomach acid, interfering with the ability to absorb crucial nutrients.13 Eradication of H. pylori leads to improvement in serum levels of iron and absorption of vitamins B12, A and E.13
People who don’t get enough sun
In today’s modern world, most people spend much of their daylight hours inside working or getting things done around the house. According to a report in the Journal of Exposure Science & Environmental Epidemiology, people spend 92% of their time indoors.14
This leaves many people deficient or insufficient in vitamin D. Obtaining sufficient quantities of vitamin D from the diet is usually not possible. To raise patients’ levels up to a healthful 50-80 ng/mL usually requires supplementation and testing to ensure levels are not rising too high.
Patients who don’t eat enough fish
Omega-3 fatty acids which are obtained from eating fish or plant sources like flaxseeds, hemp or algae are essential for cardiovascular and overall health. Yet many people don’t consume enough fish or plant sources to obtain nourishing amounts of these nutrients to move towards optimal health and wellness.
A study comparing omega-3 fatty acid blood levels in regions around the world found that in many areas, including North America, most people are deficient in these critical nutrients.15 Furthermore, a systematic review found that none of the alpha-linolenic acid (ALA) from nut and seed oils was converted to the omega-3 fatty acid DHA.16
However, the review found that supplementing with micro-algae oil resulted in significant rises in blood erythrocyte and plasma DHA. This indicates that fish oil supplements or algae oil in vegetarian patients play a major role in providing meaningful amounts of DHA.
Individuals with gastrointestinal issues
Digestive issues can lead to poor nutrient absorption. For example, poor intestinal permeability (leaky gut) can impair nutrient absorption.
Leaky gut can block the absorption of zinc from enterocytes,17 intestinal cells that play a key role in digestion and transport of nutrients. Patients with Crohn’s disease may also be malnourished due to reduced dietary intake, poor absorption of nutrients, and intestinal losses.18
Consequently, patients with digestive concerns will find it helpful to supplement with a high-quality multivitamin.
Patients taking certain medications
Some pharmaceutical drugs can deplete certain nutrients.
Statin drugs can lower levels of coenzyme Q10 (CoQ10) and vitamin E. Proton pump inhibitors are known to interfere with calcium and magnesium absorption. The diabetes drug metformin reduces levels of vitamin B12.19 See Table 2 for common nutrient depletions caused by medications.
Table 2. Select Nutrient Depletions Caused By Pharmaceutical Drugs20
| Medication | Nutrient(s) Depleted |
| Anticonvulsants | Calcium, vitamin D, folic acid. Patients on phenytoin should be aware that folic acid in high doses can lower levels of this drug and increase the risk of seizures. |
| Corticosteroids | Calcium. Supplementing with calcium and vitamin D to improve calcium absorption is recommended. |
| Bile Acid Sequestrants | Vitamin D, K and A |
| Biguanides
(Metformin) |
Vitamin B12 |
| Oral Contraceptives | Folate, magnesium |
| Loop Diuretics | Calcium |
| Loop Diuretics and Thiazide Diuretics | Potassium, magnesium, thiamine, zinc |
| Proton Pump Inhibitors | Magnesium, calcium, vitamin B12 |
| H2-Blockers | Vitamin B12 |
| Statins | CoQ10, vitamin E |
Optimal health and wellness and overweight and obese patients
Increased body fat is associated with a number of nutrient deficiencies.
The risk of iron deficiency is 2-4 times greater in obese women and children compared with people of normal weight.21 Vitamin D deficiency is also common in overweight and obese people in part due to this fat-soluble vitamin becoming sequestered in adipose tissue.22
Other deficiencies in obese people include vitamin B12, folate and zinc.23 In addition, weight-loss diets are also associated with some nutrient deficiencies.24 In a study analyzing the Atkins for Life diet, the South Beach diet, the DASH diet and the Best Life Diet, none of these eating plans provided the recommended dietary intakes for most of the 27 micronutrients measured.24 The diets provided RDI of only 11 out of 27 micronutrients.24
Optimal health and wellness and dietary supplementation
There is strong justification for utilizing dietary supplements in most, if not all patients, for optimal health and wellness.
Various factors such as gastrointestinal issues, polymorphisms such as MTHFR, medication-induced nutrient depletion, age, being overweight or obese, excess sugar consumption, low dietary intake of omega-3 fatty acids, being on a keto, paleo, or vegan diet, not spending enough time outdoors, and H. pylori infection can all lead to nutrient depletion.
It is important, when choosing a multivitamin for patients, to ensure it contains the active form of folate, 5-MTHF, as well as active, coenzymatic forms of other B vitamins. I also find it helpful to test vitamin D levels before implementing a supplement program. When combined with a healthy diet, dietary supplements can lead patients over the threshold to optimal health and wellness.
CHRIS D. MELETIS, ND, is an educator, international author and lecturer. His mission is “Changing World’s Health, One Person at a Time.” He believes that when people become educated about their bodies is the moment positive change begins. He is widely recognized as a world-renowned expert on the science of CBD and has authored 16 books and over 200 national scientific articles in such journals and magazines as Natural Health, Alternative and Complementary Therapies, Townsend Letter for Doctors and Patients, Life Extension and The Journal of Restorative Medicine. He served as dean of naturopathic medicine and chief medical officer for seven years at NUNM, the oldest naturopathic medical school in North America. He has received numerous awards, including the prestigious Physician of the Year Award by the American Association of Naturopathic Physicians; Excellence Award for his work in treating and advocating for the medically underserved; and most recently, the NUNM Hall of Fame Award. He represents TruGen3 and can be contacted at DrMeletis.com.
