A survey by the Israeli Ministry of Health revealed a figure that may be surprising: About 71% of the population in Israel take dietary supplements. What are the reasons? Most stem from a need to complete nutritional deficiencies or from the perception of dietary supplements as improving health and as part of a healthy lifestyle. But is this actually what happens? A position paper recently published by the Israeli Medical Association presents important findings: Many consume supplements without proven nutritional or medical justification, and in doing so may actually put their health at risk. During wartime, when routine is disrupted, anxiety and stress increase and emotional eating becomes more common, the temptation to rely on a capsule or powder as a "quick solution" grows stronger. And דווקא now, it is more important than ever to return to basics – real food.
Why is a dietary pattern more important than pills?
The document was published in collaboration with eight leading medical organizations in the fields of family medicine, pediatrics, public health and clinical nutrition. It presents an approach called "Food First Approach", and the principle is that the supply of nutrients should come from food and not from dietary supplements. The approach is based on a varied, balanced diet in adequate quantities, with a preference for natural food over dietary supplements.
In recent years, there has been a substantial shift in global nutrition research. Nutritional recommendations have moved from focusing on individual nutrients to focusing on overall dietary patterns. The first reason is that in Western countries the common diseases are chronic diseases such as cardiovascular diseases, cancer and diabetes. Unlike specific nutritional deficiencies, these chronic diseases are more influenced by dietary patterns than by a single nutrient.
And there is another reason. Foods consist of a combination of a variety of nutrients, some of which are not yet sufficiently known, that act together and complement each other within the food itself and also in combination with other foods. Relating to the dietary pattern makes it possible to examine the interactions between foods and between nutrients, and their combined effect on health.
The third reason is related to the microbiome, the population of bacteria that lives mainly in the intestines. Studies show that gut bacteria use components that come from the food we eat to produce substances that affect central systems in the body, including the immune system, the hormonal system and the nervous system. Therefore, the food itself has a significant effect on microbiome activity and on health.
Even when dietary supplements are consumed in an appropriate dose, there is not always evidence of their effectiveness, and sometimes reliance on them may reduce the consumption of healthy and varied food. But that is not the only risk. Taking dietary supplements increases the risk of excessive intake of various nutrients above the recommended daily allowance and even above the safe upper limit. This is especially important for nutrients whose excess may endanger health, such as iron and fat-soluble vitamins – A, D, E, K.
There may also be an undesirable and even dangerous interaction between certain supplements and various medications. Due to low regulatory supervision, the use of dietary supplements increases the risk of the presence of contaminants and various heavy metals. For example, laboratory tests conducted on 66 supplements from 21 different companies in the Netherlands found that between 33% and 40% of supplements intended to improve athletes' performance contained substances prohibited for use – substances that were not declared on the label.
In the case of protein supplements, the findings are even more concerning. The Clean Label organization in the United States found high levels of heavy metals in 77% of plant-based protein supplements and in 28% of whey protein supplements, levels that are above the standards of the state of California. In addition, there may be a gap between the information presented on the label and the actual content of the supplement.
So when are dietary supplements needed?
The position paper details clearly: There are situations that require the use of a dietary supplement. When a dietitian or physician assess that the diet does not provide all the components, they may recommend supplements tailored personally. There are situations of nutritional deficiency, with or without clinical symptoms, diagnosed in a physiological test and that cannot be corrected through diet. For example, severe iron deficiency with or without anemia, vision impairment in vitamin A deficiency, neurological manifestation in vitamin B1 deficiency (thiamine), and a severe clinical syndrome due to zinc deficiency.
In cases of nutritional deficiency according to a professional nutritional assessment, that cannot be completed through diet, it is advisable to consider supplements. For example, a recommendation for a vitamin B12 supplement in populations that avoid consuming food from animal sources, or a recommendation for a calcium supplement in cases of low dietary intake of it. Also, medical conditions that require the use of supplements, such as conditions of malabsorption in the digestive system due to disease, require supplements. When possible, it is desirable that the intake of various nutrients come from whole foods and not from the consumption of isolated food components or dietary supplements. Even in cases where dietary supplements are combined, emphasis should be placed on a balanced and varied diet as much as possible and maintaining the combination of dietary supplements at the minimum required dose. Attention should be paid to different nutritional requirements in different populations – infancy, pregnancy, the elderly – and compliance with recommendations tailored to them.
Competitive athletes can use international quality certification (such as NSF or Informed Sport) indicating that they are free of substances prohibited in sports.
The importance of the "Food First" approach does not ignore cases in which supplements are necessary, but emphasizes that the foundation should be a varied and balanced diet. Nutritional guidelines based on food support the prevention of diseases characteristic of the Western world, and express the interactions between different nutrients in whole food, between different foods and between the microbiome.