The market for vitamins and other food supplements is booming, but is this a good thing? In countries where food is plentiful, affordable and convenient, why are people increasingly looking to pills and capsules to meet their nutritional goals? And who’s really benefiting? Bernice Hurst investigates.

More than ever before, people living in developed countries are taking note of what we eat and wondering whether we’re having enough of what’s good for us or too much of what’s bad for us. But while increasing numbers of us are knocking back daily multivitamin pills as insurance, the UK Food Standards Agency (FSA), along with similar organisations worldwide, advises caution. On one issue they seem to be as close to unanimous as one can expect of such organisations – getting the vitamins and minerals we need to keep healthy from real food, rather than a dietary supplement, is far more likely to be beneficial.

There are several reasons cited for this by the American Mayo Clinic, for example. Whole foods, they say (specifying fruits, vegetables, grains, lean meats and dairy products), are complex and therefore provide not just a single nutrient but a combination, giving you “more bang for your nutrition buck”. Whole foods also provide dietary fibre and other naturally occurring substances believed to offer protection against illnesses such as cancer, heart disease, osteoporosis and diabetes.

Supplements unnecessary but harmless?
This is not to say that the FSA, Mayo Clinic or anyone else for that matter is advising against dietary supplements. They are simply taking a cautious line, advocating balanced diets and medical consultation. While vitamins and minerals are essential to our bodies, which cannot produce them naturally, the quantities and types we need are generally available through what we eat regularly. Only if we suffer particular deficiencies, do supplements become necessary.

While there is near total agreement that supplements are not generally harmful, the current line is that there comes a point when you can have too much of a good thing. Sir John Krebs, chairman of the FSA, put it succinctly in May 2003 when announcing recommendations from the Agency’s Expert Group on Vitamins and Minerals (EVM). “Taking some high dose supplements over a long period of time could be harmful,” he declared in a carefully worded warning couched in all sorts of implications, hints and provisos.

Like the Mayo Clinic, the FSA contends that “it’s a mixture of different components that seem to be the most effective…taking supplements won’t necessarily have the same benefits as eating the recommended five portions of fruit and vegetables a day.” There is a danger of people exceeding their daily requirements “quite substantially”, the Agency warns. For some vitamins and minerals this isn’t a problem as the body gets rid of the excess (making what dietician Joanne Larsen calls “expensive urine” on her web site but it can be dangerous with those that the body stores.

Women more likely to take supplements
According to research carried out prior to approval of The Food Supplements (England) Regulations (2003), a target group index (TGI) of 25,000 UK adults in 1998 showed that 40.9% of consumers used vitamins and mineral supplements. Women tended to be greater users than men according to the 2000 TGI survey, with those over 45 making up the largest proportion of all. A report in Food and Nutritional Supplements explained that “the reason generally given for higher usage among women is that, compared with men, they tend to be more health-conscious, more aware of diet and more interested in preventative health care.”

No surprises there, then. People take vitamin supplements in the belief that they ensure good health and prevent illness. The purpose of the Regulations, however, is to define and regulate food supplements, clarifying which vitamins and minerals may in fact be used in food supplements and specifying both the labelling requirements which must be followed and the penalties for not following them. This was believed necessary because both the UK and the EU recognised the potential for misinformation and what it termed “distortion” of benefits. Safe products must obviously be so while control was exerted over what the EVM described as enriched or fortified foods. One specific area of concern was nutritional or health claims such as “with added vitamins” appearing on products believed to undermine guidance on healthy eating.

Although the Regulations have avoided blacklisting particular foods, they have created a “positive list” of the vitamins and minerals “that may be used in food supplements together with a list of their permitted chemical forms (sources)”.

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Clarifying the climate for health claims
While trying to safeguard consumers, note has also been taken of objections from manufacturers and retailers. David Byrne, EU commissioner for health and consumer protection, emphasised the importance of protecting both industry and the public when announcing the Commission’s regulations in July 2003. By clarifying the rules and requiring simplification of labels, he explained, “consumers will receive accurate and meaningful information while food producers will be able to use serious and scientifically substantiated claims as a marketing tool without being drowned out by the many unsubstantiated and inaccurate claims that currently exist on the market.”

Prior to completion of the Regulations, in November 2002, the Local Government International Bureau reported that the proposals were receiving a poor reception from manufacturers and suppliers of dietary supplements (as differentiated now from alternative medicines), particularly in the UK, who believed themselves to be under attack from the European Commission. The rigorous testing procedures to be instituted were considered prohibitively expensive for all but the largest multinationals, endangering the future of small producers and retailers.

These concerns resulted in a risk assessment of the effect on industry and an evaluation of the costs and benefits in models employed in countries such as the US, Canada, Australia and Japan and recommendations for the best ways to resolve financial concerns while implementing the new procedures.

As consumers take more and more pills, mixing prescriptions with vitamin supplements and others which may be self-prescribed, available over the counter, it becomes harder to predict the effect they will have on one another in the short, medium or long term. Accurate labelling and caution to prevent conflicts and overdoses are intended to minimise risks in this as well as other areas of food safety.