Supplementation Over Fortified Foods?

Why are Supplements Seen as Healthy While Fortified Foods are Demonized?

Producer Potts  0:14  

All right. Dr. Sarah, this is a big question. Um, to things being true at the same time is really tricky within the wellness community that can be very black or white. And I think this topic needs some Dr. Sarah insight to help us wrap our minds around these two things being true. Okay. So you have spoken about how multivitamins while being healthy and neutral don’t improve certain health markers as we would expect them to. However, on the flip side, we do see fortified foods as a positive step to help avoid nutrient density. So here’s where the question comes in. I’ve seen a lot of people recently on your social media, where this really seems to be a sticking point for them, primarily, those who see supplementing as a healthy addition to the diet and fortified foods is something to be avoided. Can you help us square that? Yeah.

Dr. Sarah  1:13  

This is a fantastic question. I have seen this exact same thing, right. So this embracement of supplements in the wellness community at large, despite the lack of scientific studies, supporting the benefits of, especially multivitamins, obviously, when we get into individual supplements, the quality of life, the scientific evidence varies dramatically from supplement to supplement. And we could probably launch an entire YouTube channel where we just talked about a different supplement every week. And I’m not interested in doing that just so that we’re clear. But, yeah, this demonization of fortified foods, I, so let’s big picture, let’s make a little commentary on the wellness community, and the demonization of accessible affordable foods. Like I think that’s a really important place to start. Because one of the things that I’ve observed over the last almost 13 years talking about nutrition online, is this continuous raising of the bar, right, so we’re gonna make, however, we define healthy diet, right, different diets define a healthy diet differently. We’re gonna set this bar here, oh, wait, you’ve got all that. Okay? Well, now you have to be afraid of these more things that you’re eating. And now you have to buy this more expensive thing, this more niche thing that’s harder to find. Now you need this, like a $300 a month supplement. And there’s this every time that something gets popular enough that it’s like attracting a lot of people. It feels like the bar is raised to make wellness, more privileged, more, like a harder, harder thing to achieve something that is less accessible. And that is not supported by scientific literature. The scientific literature shows that healthy diet and health promoting behaviors like obviously, they’re not the only things that influence health, we also have social determinants of health, we have genetics, right there’s there’s other things that are influencing health other than our day to day choices. And there are things that make certain day to day choices. not accessible for people like whether or not you live close to a grocery store is going to influence what types of foods you can eat, how many jobs you need to work to make ends meet is going to influence how much time you have for activity or sleep. Right? So the health equation is really complex. But one of the things that the wellness community does is kind of propel an elitism with health right? And, and a false one, right? One that by raising the bar by making the things that you’re expected to do to be healthy, make them this much more expensive or take this much more time in the kitchen. It is this like constant making, making the things that you’re being sold to do for your health. Making them just like putting it putting them putting them on the higher shelf and it’s this constant like oh wait, you could reach that shelf, okay, I’m gonna build another shelf and put put all these things that even higher shelf, so it’s something that we’re constantly chasing, and that is the economy of the wellness community. That is the economy of diet culture. that the economy is reliant on you continuing to chase that next thing to spend your money on that next thing in order for people to continue making money. So let’s that’s the broader commentary on where these types of myths are coming from. Right. Okay, coming from a place of demonizing accessible affordable foods, because the economy of wellness relies on you spending more money and and, you know, going to greater lengths to get whatever is the deemed substitute, right. The science shows that multivitamins don’t improve cardiovascular disease incidence or mortality, cancer incidence or mortality or all cause mortality, even though you would expect that increasing nutrient intake does. Science doesn’t have a really good answer for why and I think, picking it, you know, making sure that we’re really clear that doesn’t mean that taking a multivitamin is harmful, getting too much supplemental calcium doesn’t seem to be great. Other than that, there doesn’t seem to be any harm of taking a multivitamin. But if you’re choosing between those funds going towards a multivitamin, or going towards Whole Foods, your money is better spent buying whole foods, because we do see the expected benefits when you’re getting those nutrients from foods. Fortified foods do have a really good track record for three health outcomes. So they have greatly reduced the risk of goiter. So an enlargement of the thyroid gland due to iodine deficiency, has greatly reduced the risk of iron deficiency anemia. And they have greatly reduced the risk of neural tube defects. Those are like the big wins of fortified foods. There’s lots of fortification, other than iodine, iron, and folate. So those are more in that amorphous gray of like, we don’t, there’s no signal, same as the multivitamins. But there’s no harm either, right. And there are some really important wins for fortified foods in terms of measurable health improvements. So I think probably one of the differences is like why fortified foods are showing these benefits where supplements are not, is in the bioavailability of the forms. When you put even though it’s the same form that’s in, you know, sprinkled in, sprinkled, it’s not sprinkled and incorporated into breakfast cereal, versus a multivitamin tablet, eating it as part of breakfast cereal, you’re getting all of your digestive processes are going right, you’re you’re breaking down lots of different aspects of that breakfast cereal, the milk that you poured on it, maybe you added some fruit, right, so your digestion tends to be really efficient. Whereas when you pack it all into a tablet, you kind of have to break down that tablet. And studies show that tablets, capsules aren’t quite as bad. But tablets can take too long to break down on the digestive tract. So they’ve missed their opportunity to be absorbed, because different nutrients are absorbed in different parts of the digestive tract. So a lot of it is going straight through us. And that’s because you’re packing in all that same nutrient nutrition that you would have gotten in that whole bowl into a tiny little pill. So I think that is the most likely explanation for why there’s a difference between a multivitamin being beneficial and eating like fortified food. But the big picture. Look, studies show that higher diet quality improves the full range of health outcomes other than, like, genetic diseases, right. So like, just about everything that can go wrong with us health wise is improved by higher diet quality. Is diet a cure? Absolutely not. Again, there’s so many different things influencing our health beyond our day to day choices. We can’t say that same statement for a multivitamin. Can we say that same statement for whatever, you know, like other supplements, it depends, again, we could we could probably do a video for like every single supplement out there and we would still be doing this 10 years right? 

Dr. Sarah  9:50  

So, you know depending on the supplement like you know Yes, I think vitamin D is great for people with low vitamin D levels like there’s there’s lots of there’s a time and a place For supplements, supplements, those should be something that you are not buying from a diet guru or a wellness influencer, you should be talking to your doctor and having a conversation about your health goals and concerns, your test results, your family history, your individual medical history, and deciding with your doctor whether or not a supplement is going to benefit you. There’s a lot of supplements that are marketed at us, along with fear, right, like the the predatory marketing strategy in the wellness community right now is like, cars that you know, show the problem, like and then sell the solution. Right. So right, right. The problem is usually, this fear created around foods, that the science doesn’t support that fear, right, it’s be afraid of right be afraid of fortification. But but take my multivitamin that has the exact same chemicals in it. That is the level of cognitive dissonance that’s happening in the wellness community right now. And again, I’m not saying that all supplements are bad multivitamins, in most cases are not harmful. And there are some like niche, like, more like niche health measures where a multivitamin may be beneficial for some people like not looking at the big cardiovascular disease, cancer all cause mortality. For example, older adults may benefit from supplements, in terms of their cognition, right. So there’s, there’s so many different things, like, there’s so much NASA, things to do with your doctor.

Producer Potts  11:35  

You shouldn’t just take a supplement because you think you should, because someone’s marketing it to you. However, you can definitely go enjoy your bowl of cocoa puffs and not have to worry about it.

Dr. Sarah  11:48  

Yes, yes. So I can’t have this conversation about what the benefits and limits are of fortified foods like I think, I think fortified foods are fascinating. Like, scientifically, we are only fortified with B vitamins, iron. Some foods are fortified with calcium, vitamin D and iodine, right? There’s so many nutrients we don’t fortify with. And I think there’s a really interesting question to ask of, in our current food supply, where many people are getting too much energy from the foods they’re eating and not enough essential nutrients, right? Not enough vitamins, minerals, protein fiber, certainly not enough. phytonutrients. 

Producer Potts  12:37  

And can I point out that they’re also missing out on the joy because most of us feel guilty when we eat too much of those foods. So then it’s like we’re we’re just it’s, it’s even worse, right? Versus like, if you come to a place where you don’t feel guilty about foods, and you just enjoy that food for what it is, then, you know, that has to have an impact on our health, I would imagine because there’s a stress component to that. Right. So absolutely, absolutely.

Dr. Sarah  13:05  

Now part of that stress response can be like if we’re talking about Ultra processed foods, there is some research that this is definitely contested in the science, but whether or not food addiction is a real thing. But there’s definitely some dopamine response things happening with Ultra processed foods. That is not the same type of response that you get when you’re eating an apple or a salad. Right. So they’re like how much of our food supply’s altered process right now is a challenge because a diet that is over abundant Ultra processed foods, which means more than 20% of our calories coming from ultra processed foods does increase risk of health problems. 20% and below does not increase risk of health problems. There’s absolutely room and a healthy diet for these foods. Diet is over abundant and ultra processed foods, we start to see the risk of these health problems crop up in it’s most likely because those foods are falling short of meeting our nutritional needs. So what if we fortified them? And what if we fortified them with more nutrients? So that when we were eating those types of foods, we actually were meeting our nutritional needs. We do not know what the population level effect on health of that type of fortification program would be because that experiment has never been done. But I think that is when we’re talking about making health accessible and affordable. And you know, something that you know, somebody who doesn’t live close to a grocery store is still able to eat a diet that meets the nutritional needs. Got some that’s a really interesting strategy.

Producer Potts  14:53  

They can’t afford the fancy supplements anyways, right? Right. Right

Dr. Sarah  14:57  

Even potentially the apple generic ain’t like a freight suit is much more expensive than Ultra processed foods. So I think, you know, there’s a really interesting big question to ask about, can fortification be done in a more strategic way to improve health in a really broad, like public health type way? That’s a really interesting question. We cannot even start exploring that. If we’re so stuck on elitism,  healthism. 

Producer Potts  15:33  

Yeah, but fortification is bad to add, but my supplements are good.

Dr. Sarah  15:39  

So I think, you know, I think as, like the place to wrap up this question is like, how do you? I don’t know if this was the follow up question. You were gonna ask producer Potts. But I think the question is, like, how do you identify when somebody is trying to make you afraid of food unnecessarily? To sell you? Their solution? Right, like, how do you make yourself more immune to that? You know, the person putting the, you know, health backup on the higher shelf? And they’ll say, actually, no, I don’t need to reach that. Because I happen to know, there’s more health over here in this cupboard that’s reachable? I don’t I’ve really taken this analogy far too far.

Producer Potts  16:33  

I think it’s like people that speak in absolutes. Right?

Dr. Sarah  16:40  

For sure. I would say, I mean, it’s not. Because I would recommend a product that I truly believe in, right and think the sciences there and take myself. So I think it’s that somebody’s recommending a product. I don’t think that is automatically a red flag. Right? Like, if, if that’s wrapped up in being afraid of something?

Producer Potts  17:01  

Yeah, if you’re using fear to sell something, that thing you’re selling probably isn’t that great if you need to make people afraid of something else to buy your product. So you need to dash your competitors’ product in order to sell your own product, like good.

Dr. Sarah  17:24  

And I think, you know, it’s one of the reasons why. You know, I have so many really detailed articles that have dozens, if not hundreds of citations on the website. It’s why there’s 42 pages, I think of references in my book, is because I want to give people the information that they need to be able to really understand what nutrients do in the body, what foods have, what nutrients, like where do our nutrients come from, and understand these types of nuances of like, it’s okay to eat fortified foods. But you can’t supplement your way out of a poor quality diet with a multivitamin like understanding those bits of pieces and being able to go read the studies that helped to support that important information. Like a number, like a really important goal of this book is to give people the knowledge base, they need to be able to hear that type of a sales pitch. That is selling the product conditioned on you believing the misinformation about an accessible affordable food. Right? Let’s see it for what it is, predatory marketing.