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In response to the recent Montreal gazette article "Vitamins: One a day or one too many?", the critical comments to testing and individualization always come down to three points.
1. Do we need testing?
2. Do we need supplements ?
3. How much does it cost?
Interestingly the answers to questions 1 and 2 are intimately tied together.
One thing all experts and the public agree is that we “wish” and “dream” of getting all of our nutrients from our diet.
However, the reality is that people do not consume 7-10 servings per day of fruits and vegetables as recommended by the Canada Food Guide. This does not include potatoes and ketchup.
I have heard often the phrase, “my doctor says I get everything I need from what I eat”.
I have then always asked “did he actually ask you what you eat?”
The answer is always ”no”. It is remarkable how illogical this is and it becomes apparent to people when I point it out to them. Then when we actually ask people what they ate the previous day, they are startled to find out how sorely lacking their diet is.
Nutritional requirements also change with a number of factors that are not in an individual’s control. The following is a list of the factors that effect nutritional requirements:
1. Climate (latitude). As you travel north most people do not get enough sun to get adequate vitamin D levels. Most Canadians are deficient in vitamin D.
2. Age. As we age we do not digest and absorb nutrients as well as we did when we were younger. Often diets are restricted. The elderly have been proven to be at higher risk for all nutrient deficiencies
3. Disease States. A number of disease states have been proven to alter nutritional status. This ranges from cancer, diabetes to depression and mental disease. This is from direct and indirect effects of the disease. For example if you are depressed you either don’t feel like eating or you overeat.
4. Bowel Health. Gas, bloating, constipation and diarrhea may be symptoms of malabsorption. Over 50% of our clients complain of gastro-intestinal symptoms
5. Foods sensitivities. Food intolerances to gluten affect a minimum of 1% of the population. Researchers have noted a recent dramatic increase in this number. Other sensitivities from lactose to milk have shown to affect absorption
6. Food preferences and restrictions. Some people do not like fish. Some people are vegetarians. Some people do not like vegetables.
7. Sex. Menstruating females and pregnant females have higher requirements for certain nutrients. All females who get pregnant have higher requirements for folic acid. There is a large percentage of menstruating females that are iron deficient.
8. Prescribed Medications. There are a large number of significant drug nutrient interactions. What this means is that certain drugs increase certain nutritional requirements. For example. Proton-pump inhibitors (losec, nexium, prilosec etc) decrease ability to digest and absorb minerals. The list is endless!
9. Recreational drugs , Smoking and Alcohol. Smoking decreases vitamin C levels in the body as well as other anti-oxidants. Alcohol has been proven to antagonize vitamin levels in the body.
10. Genetics. Genetics can effect absorption and metabolism of nutrients. Genetics can effect the individual requirements of a specific nutrient. For example some people need more folic acid because of different genetics affecting the enzyme tetrahydrofolate reductase.
11. Lifestyle Active individuals may have higher requirements for protein and iron. Those that lead stressful lives have different requirements for nutrients.
When you take into account all these factors it is very difficult to find a Canadian that is not deficient in one or more essential nutrients. The evidence supports this.
The evidence also supports the fact that it is important not to be deficient in one or more essential nutrients. The word “essential” is not a term that one can use lightly. You need these nutrients to live…to sustain life...they are not “optional” You ignore them at the risk of compromising your life. All experts would agree about this. Deficiency of these nutrients is linked to short term issues such as energy and anemia to long term issues such as brain function and cancer.
Therefore if we agree on the following 2 points:
1. It is crucial and important not to be deficient in essential nutrients.
2. Diet and many other factors (listed above) not in your control affect nutritional requirements.
What are our Options?
1. We can do the testing, see what is missing from our body or not working as it should in our body and then we take the optimal vitamins designed for our specific body chemistry
Or
2. we can take vitamins without testing.
There are advantages to testing and every single nutrient that is tested has limitations on its interpretation.
For example iron is tested in blood, however; certain conditions such as inflammation, cancer and alcohol intake affect the accuracy of the blood test. However, if your are iron deficient the test will show it.
Calcium oddly enough was mentioned in the Gazette article as a test which is not valid in blood for measuring calcium intake. Firstly, we do not do calcium testing to reflect calcium requirements. It is not a valid test. Calcium requirements are very dependant on Vitamin D levels. On the other hand medical doctors measure calcium for other reasons. One of the reasons is calcium can reflect disturbed hormonal balance. Bone density testing is a crucial test but is not a measure of calcium alone.
The point is that you can not generalize about any lab nutrient test being “good” or “bad” as each single nutrient test has its advantages and limitations. But remember this also holds true for every test that your medical doctor orders to be done on your body for disease diagnosis purposes.
The reality is that for most people the choice comes down to cost.
The cost of testing ranges from $100 to $1000.
The most common testing requested averages about $500 and it is quite comprehensive in that it includes hormones and adrenals.
Gazette article comment about the supposed high cost of supplements was somewhat misleading.
The reality is that people who come to our organization are often on prescription medications or simple don’t want to take prescription medications. Many of our clients do not want to give prescription drugs to their children. They are coming to us with specific reasons revolving around drug therapy. One of the most common reasons is that they are usually suffering from side effects of their prescription medication or they have been on their medication for years and it is not working.
Long before they come to us they have been incurring high direct monetary costs of these prescription drugs that they are using or that they give to their children.
There is also indirect costs in term of side effects that these people are suffering from and/or unknown long term effects on their bodies.
In the high cost examples given in the Gazette article these additional costs are to address specific health concerns for specific purposes and objectives—not costs incurred for general nutrition purposes.
Some examples of these specific health issues that we commonly address in our organization are mood issues. Once the testing is done and product is designed for the purposes of improving mood and mental issues that person usually sees an improvement within 3 to 4 months. They then can cut back to a lower cost maintenance dose. Products recommended have the benefit of having referenced controlled studies proving effectiveness that address those specific health issues.
Again, another reason to do the testing which we often see has as its objective to stabilize mental function and focus in a child without having to use drugs. If there are deficiencies of nutrients that have been proven to affect brain function then parents have the right to try this approach without again medicating their child. As it stands today we absolutely do not have any long term evidence of safety with these prescribed drugs in children specifically. Again, our objective is to get results and then reduce the formula to less costly and less intensive doses.
Costs to our clients are always of concern to us. We consistently offer and are always developing a number of lower cost alternatives so that everyone can benefit from the essential nutrients that our bodies need.
Some nutrients cost more than others. Again testing is somewhat indiscriminate in that it addresses what your specific body needs not what it costs.
Furthermore, in the context of the Gazette article it should be clarified that higher costs are often born in the beginning for 3-6 months for some people that have specific objectives. These objectives are intended to relieve suffering. Some people then use adequate amounts of nutrients to maintain benefits.
That being said however, this is not always the case. By choice, many of our clients feel so much better that they want to maintain the same dosage of the product.
In some specific health issues, the maintenance of the dose is also recommended.
As a pharmacist that has been practicing for more than 25 years, I see almost on a daily basis drug and other health care costs spiraling to unsustainable levels. If you look at the crucial information about a person’s unique body chemistry that testing conveys in the context of health, these costs are actually quite inexpensive. The problem is that the already overburdened private and public system is not looking at these approaches which can be very “cost” effective in all senses of the word…financial and less side effects. What we are faced with today is a hope that by developing newer (and more expensive) drugs we hope to deal with chronic disease in a superior fashion. It is a bit of a catch 22.
With regards,
Kent MacLeod B.Sc.Phm.
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