If you are healthy, on no medications, eat really well, and live an optimal life with no stressors (including environmental stressors) you might achieve government RDI’s (recommended daily intakes) for nutrients.  However, RDI’s are only designed to prevent nutritional deficiencies, not to ensure optimal health.  What’s more, with many studies showing that many people don’t achieve even the basic RDI levels of nutrients and that certain nutrient deficiencies can cause DNA damage and lead to cancer, there is compelling evidence for educating healthcare practitioners regarding nutrient prescribing.

Whilst I am convinced about the need for supplements in many patients, I strongly believe they need to be prescribed by a practitioner trained in their use.  Medical school training does not cover this complex field in anywhere enough detail.  With studies showing certain supplements are harmful if using supratherapeutic doses of nutrients, in artificial forms, in patients with chronic disease, there is even more of an argument for educated prescribing.

The most common deficiencies I see in my Integrative Medicine practice, based on testing or clinical markers, are (in no particular order) zinc, iron, vitamin B12, folic acid, magnesium, essential fatty acids, probiotics, vitamin D and antioxidants in general.

I generally recommend a personalized supplement regime, because as in most things, one size does not fit all and we all have specific requirements.  However, there are a few supplements that would benefit most people, but again dose calculation and testing prior is ideal practice.  Whilst this is not the forum for an extensive discussion of the science of supplements and their risks and benefits, I have included one reference for each of the following.

  1. A multivitamin/mineral blend. This will provide most of the cofactors needed to optimise biochemical pathways. Whilst a multivitamin/mineral will provide some zinc, iron, vitamin B12, folic acid, magnesium, vitamin D and other antioxidants, extra is often needed.  One of the reasons I like supplement blends is that nutrients are team players and like all great teams work best together.  There is no (‘vitamin’ I in team)!
  2. Omega-3 oils. Westerners currently consume around 20:1 omega 6 (which are mostly inflammatory oils) to omega 3 (anti-inflammatory) oils.  A ratio of about 2:1 omega 6 to omega 3 confers more health benefits.
  3. These ‘good’ bacteria help optimise immune function; and also gut and overall health.
  4. Vitamin D. Although vitamin D can be made by exposure to UV, we obviously want to minimise this in order to reduce New Zealand’s horrific skin cancer rates.  Vitamin D optimisation is a passion of mine due to its role in preventing cancer, optimising immune function and easing depression among many other benefits.  However, overdosage is possible and so needs monitoring.  Interestingly the same is true for nutrients from food.  For example, seaweed is a great food with many health benefits, but if we eat too much seaweed as one of my patients was doing, it can adversely affect the thyroid as was the case in this patient.

Nutrient testing is ideal for reasons other than just avoiding over- or under-dosing and is important enough that it requires a whole opinion piece to itself, a topic for next week.  In the meantime, The Australasian College of Nutritional and Environmental Medicine is an excellent training body for the detection and management of nutritional deficiencies.

Dr Tracy Chandler BSc (Hons) MBChB FRNZCGP FNZSCM, PGDipSEM, Cert Dermoscopy, Cert Homeopathy, MACNEM member, gained her degree in England and worked as a GP in Timaru before doing postgraduate training in sports, skin and integrative medicine.

She specialised in integrative (wellness) medicine in line with her increasing interest in the impact of nutrition and environment on health and wellbeing.

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