Fitness
To supplement or not to supplement
There is no substitute for a well-balanced diet. Individuals who are on medication, have stressful lifestyles or eat poorly are at an increased risk of oxidative stress and may need to take supplements

Supplements have always been a grey area of nutrition both among health professionals and public. That there is no substitute to a well balanced diet remains undisputed, many believe that some supplements are a must while others believe that they just make expensive urine or else support a multibillion dollar industry. With better understanding of the role of vitamins, minerals and antioxidants with respect to health and well being, it sure is an exciting area to explore.

Supplements must be taken only under careful supervision of a qualified medical practitioner

Vitamins and minerals are needed essentially to perform certain vital biochemical processes in the body. Their roles, deficiencies, and the amounts needed on a daily basis to prevent these deficiencies are well documented. Most individuals 'at risk' for deficiencies can be diagnosed. Special recommendations can then be laid out to overcome such conditions. For example: we know that daily requirement for iron, an important mineral needed by the body to make hemoglobin, is 30 mg. to meet our body needs. However, women may need more of this mineral to compensate for menstrual losses or during pregnancy and extra amounts must be provided by supplements to meet these extra needs.

The same may be true of calcium, another essential mineral needed to build bones and prevent osteoporosis. With advancing age in both men and women, requirements may increase and diet may not be enough to meet these requirements.

Governments around the world have provided guidelines called RDA's (recommended daily allowances) or RDI's (Recommended daily intake) that apply to healthy individuals with well-balanced diets. These levels are 'adequate' intake to prevent deficiencies and may not reflect new thinking on nutrition for optimal health and longevity.

With switch to increasingly refined and packed foods, refined oils, flours and sugars, and foods exposed to chemicals and pesticides, depleted soils, do our diets really meet requirements, let alone reach optimal levels?

The daily requirement for Vitamin E is only about 15 mg /33 IU for adults

The last decade unfolded many new exciting roles of various vitamins and minerals as antioxidants with disease-fighting properties. Much of the cell damage that occurs is caused by highly destructive chemicals known as free radicals formed during unusual biochemical reactions in the body. Free radical formation increases due to exposure to chemicals, toxins, illness and stress. These need to be neutralised by antioxidants as they encourage damage to cells causing diseases and accelerate ageing.

The most important antioxidants include Vitamin A, beta-carotene (plant precursor of Vitamin A), Vitamin C, Vitamin E, selenium, zinc, copper and to some extent manganese.

This led researchers to find out the extent of their benefits and amounts needed to protect against diseases and perhaps till date answers not clear. A classic example is the case of Vitamin E. The daily requirement for this vitamin is only about 15 mg /33 IU for adults. Researchers found that high doses of Vitamin E supplementation had a protective effect on heart disease, stroke, and death in both men and women. Several prescriptions recommended mega doses and it seemed almost like a wonder vitamin. However, the Heart Outcomes Prevention Evaluation Trials (HOPE), revealed no effect of Vitamin E supplementation on myocardial infarction, stroke or death from cardiovascular causes in men and women; instead, several trials of high-dosage Vitamin E supplementation (> or =400 IU/d) showed significant increases in deaths.

Also the results of the Heart Protection Study indicated no benefits of Vitamin E, C and beta-carotene, however natural sources of vitamin C reduced coronary heart disease.

Supplements are not substitutes for a balanced and healthy diet

The current recommended dietary allowance (RDA) for vitamin C for adults is 40 mg/d. However, recent scientific evidence indicates that an increased intake of vitamin C upto 200 mg. is associated with a reduced risk of chronic diseases such as cancer, cardiovascular disease, and cataract.

Further, individuals who are either on medication or have stressful lifestyles or eat poorly are at an increased risk of oxidative stress. These also include immuno-compromised individuals like elderly, diabetics, smokers, and those living in highly polluted areas. In fact the daily requirements for Vitamin C have been changed to almost double (80 mg) for smokers as against 40 mg for non smokers. Something which must be pointed out is at the end of the day we are all passive smokers exposed to the unacceptably high levels of pollution and smoke in cities and would very well carry the same burden even without lighting up. Thus, it increases the requirement for Vitamin C for all of us and perhaps other antioxidants as well.

The questions that are raised hence are — what levels are protective? Is an average person's diet able to meet these levels? Who should take supplements? Are mega doses (high doses) really beneficial? Should the daily recommendations change? What are the right combinations? While the answers to these questions are not very clear, one thing is certain that antioxidants function both ways. A certain level will be protective while an extra may be harmful i.e. they become redox agents which simply mean that extra amounts can cause harmful oxidation and disease.

I for one believe in judicious use of supplements. Those like folic acid, Vitamin B complex, vitamin C, are particularly useful for prevention of heart disease. Vitamin D, calcium, iron, zinc are generally safe provided taken under supervision.

Finally, supplements must be taken only under careful supervision of a qualified medical practitioner. They are not substitutes or shortcuts to eating well and following healthy lifestyles.

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