Supplements

In Australia, vitamins and minerals come under the term complementary medicines. Do we really need to be taking them? Supplements are only meant to be used if dietary intake is inadequate and they should not replace a balanced diet. Have we been marketed into thinking that we are deficient in all nutrients and need to buy supplements? It is understandable that people worry about this especially if there is no counter advice to supplement marketing. Unless you are working with a dietitian then you probably haven’t received evidence-based scientific information about vitamin and mineral supplements.

I wanted to provide you with some information regarding supplements so that you can make an informed decision as to whether you purchase them or not.

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Complementary Medicine Regulation

In Australia, the TGA (Therapeutic Goods Administration) regulates vaccines, medicines, complementary medicines, health products, sunscreen, over-the-counter medicines, etc.

Complementary medicines are non-prescription medicines that primarily contain complementary medicine ingredients that have an established identity and tradition of use. For example:

Vitamins
Minerals
Plant material (e.g. fibre)
Nutritional substances (e.g. protein)
Essential oils
Microorganisms (e.g. probiotics)
Animal material (e.g. fish oil)

Complementary medicines are regulated by a risk-based approach

Lower-risk medicines can be listed on the Australian Register of Therapeutic Goods (ARTG)
Higher-risk (prescription) medicines must be registered on the ARTG

Some complementary medicines are exempt including homeopathic preparations.

Products that must be registered include:

All prescription medicines (antibiotics, strong painkillers, blood pressure-lowering medication, etc.)
Most over-the-counter-medicines (panadol, cough syrup)
Some complementary medicines (vitamins, minerals, fibre products)

Registered complementary medicines can be registered under 5 levels - RCM 1 to RCM 5

RCM 1 is registering a complementary medicine that is the same as another complementary medicine, the only differences can be colour, flavour, or fragrance. For example, if Company 1 has a 1000IU Vitamin D supplement that is pink, and Company 2 wants to sell a 1000IU vitamin D supplement that is blue they would apply under this category.

RCM 5 is for products that have a new dosage, a new active ingredient, an increase in strength of the active ingredient, or the addition of a substance not used in complementary medicines.

Listed medicines (Complementary) are not individually evaluated by the TGA for quality, safety, and efficacy (the ability to produce a desired or intended result). They are listed based on certification by the product owner that their product meets requirements in relation to safety, quality, and efficacy. Listed medicines are assigned an AUST L identification number that must be displayed on the label. Listed medicines must meet certain low-risk criteria and can only contain ingredients found here TGA eBusiness Services

You can search products here Australian Register of Therapeutic Goods (ARTG) | Therapeutic Goods Administration (TGA) to see what wording is allowed to be listed on the bottle and what is not.

Vitamins and minerals are essential for human health, however, the jury is out as to whether supplementing them is beneficial for healthy people. In some cases it may even be harmful.

Vitamins written in white writing over a rainbow of images of different fruits and vegetables

What are vitamins, minerals, and trace elements?

They are non-energy-providing essential nutrients found in food that regulate many body processes and are involved in supporting growth and maintaining life.

Vitamins

Fat Soluble: vitamin A, vitamin D, vitamin E, vitamin K

Fat-soluble vitamins require bile to be absorbed, they then travel through the lymphatic system before entering the bloodstream. Once in the blood, fat-soluble vitamins require protein carriers to move around the body. Excess fat-soluble vitamins are stored in the liver and adipose (fat) tissue. You can consume under the requirements for fat-soluble vitamins for significant periods of time without any ill effects. The risk of toxicity from supplementing with fat-soluble vitamins is high because they are not easily excreted like water-soluble vitamins. This is exactly why you do not see these vitamins marketed as you do with water-soluble vitamins.

Water soluble: B vitamins - thiamin, riboflavin, niacin, vitamin B6, vitamin B12, folate, pantothenic acid, biotin, choline, and vitamin C

Water-soluble vitamins are absorbed directly into the blood and move around the body freely until they reach the cells where they are needed. Our kidneys monitor the levels of water-soluble vitamins in the blood and excrete any excess in the urine. This is why companies market water-soluble vitamins and minerals as there is less of a chance of toxicity. However, the chance is not zero, when people are taking multi supplements the chance of toxicity increases.

Toxicity

A prime example of this is vitamin B6, a water-soluble vitamin found in many supplements, energy drinks, effervescent drinks, and ‘meal replacement’ shakes. There have recently been over 30 reports to the TGA of peripheral neuropathy.

Peripheral means away from the centre of something i.e. hands and feet
Neuro means nerve
-pathy means a disorder or condition involving a particular organ or tissue
Peripheral neuropathy translates to a disorder or condition of the nerves in the hands or feet. The symptoms are tingling, burning, or numbness.

If you are taking multiple supplements, especially multivitamins, magnesium, zinc, energy drinks, and effervescent drinks. Check all of the labels for vitamin B6 also labeled as pyridoxine hydrochloride, pyridoxal 5-phosphate, and pyridoxal 5-phosphate monohydrate. The recommended daily intake for

For men & Women aged 19-50 years is 1.3mg/day
The upper level of intake is 50mg/day
Many supplements contain 50mg per tablet!!!

Vitamin B6 deficiency is rare and if you are eating food then you should very easily be meeting your vitamin B6 requirements. Toxicity does not occur from eating food!

Minerals

Major minerals: Calcium, phosphorus, potassium, sulphur, sodium, chloride, magnesium

Trace minerals: Iron, zinc, copper, manganese, iodine, selenium, chromium, copper, fluoride, molybdenum, nickel, silicon, vanadium, cobalt, boron

Minerals are referred to as major and trace, not due to their importance but to the amounts our body requires. Most of the trace minerals are toxic at doses only 2.5 to 11 times above the upper level. As with vitamins, minerals travel and are stored in the body differently. For example, 99% of calcium is stored in the bones, iron is stored in red blood cells and muscle cells, sodium travels in the blood, and potassium lives inside the cells.

The absorption of vitamins and minerals can increase or decrease depending on our body's requirements.

Large doses of iron from supplements can cause constipation, nausea, vomiting, and diarrhoea. The upper level is 45mg/day and iron toxicity is a leading cause of accidental poisoning in children and can result in death. Please keep them locked well away from inquisitive children.

The upper level of zinc is 40mg/day because it interferes with copper metabolism.

Magnesium toxicity while rare can be toxic, the upper level is 420mg for men and 320mg for women per day from non-food sources.

Foods high in iron — Foods ‘that are high in iron. Fun fact dark chocolate has 15mg/100g of iron that’s 83% of a woman’s recommended daily intake!

Drug Nutrient Interactions

It is also important to mention that nutrients and herbs from foods, fortified foods or drinks, or supplements can have potentially adverse or beneficial interactions with medications. Certain nutrients and herbs can affect the absorption of a drug, and its action within the body and may increase the risk of side effects from the medication. Some medications also decrease the absorption of certain vitamins and minerals. Please make sure that you check with your pharmacist or doctor before taking any supplements or herbal preparations if you are taking prescription medications.

For example, herbs such as Gingko, Milk thistle, St John’s Wort, Valerian, Echinacea, Ginseng, Don Quai, and Guarana have been shown to adversely interact with quite a few medications.

Caffeine, alcohol, and grapefruit are also common culprits.

Protein Powders

Protein requirements per day for healthy adults are 0.84g/kg for men and 0.75g/kg for women. Protein intake above 2g/kg in healthy adults may lead to digestive, kidney, and blood vessel problems. As well as a reduction in gut microbiome diversity. Do you really need to be taking a protein supplement or is it all just hype?

Protein powder: $2.72/serve for 25g protein per serving plus artificial sweeteners, emulsifiers, and gums.

Protein from one meal: $1.80/serve for 32.4g protein 2 eggs, a glass of milk, 2 slices wholegrain bread plus 6.4g fibre, calcium (32% RDI*), vitamin d (82%), vitamin B12 (15%), choline (59%), iron (26%), lutein, zeaxanthin (antioxidants that protect cells from damage), carotenoids, riboflavin (24%), pantothenic acid (22%), vitamin A (14%), vitamin E (20%), phosphorus (42.5%), folate (49%), iodine (68%), selenium (45.5%), potassium (9%), magnesium (30%), zinc (18%), carbohydrates, fats, minus any artificial sweeteners, emulsifiers, and gums.

*Recommended Dietary Intake/day

fruits and vegetables lined up in a rainbow colour pattern

What are you missing out on

Vitamins and minerals are not the only nutrients that we get from food. There are also macronutrients (fat, protein, and carbohydrates), water, and fibre. Then there are phytochemicals, the compounds found in plants that are beneficial to human health. Phytochemicals are also often referred to as phytonutrients. They are the compounds in plants that are responsible for their colours, tastes, and aromas. You may have heard of beta-carotene (oranges), lycopene (tomatoes), flavonols (onions), or tannins (tea). Phytochemicals have anti-inflammatory, antifungal, antibacterial, antiallergic, cholesterol, and blood pressure-lowering properties. They are protective against developing type 2 diabetes, cardiovascular disease, high cholesterol, inflammation, high blood pressure, and many cancers among other things.