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A Guide to Supplementation within Health and Complementary Medicine

by Dr DF Smallbone(more info)

listed in nutrition, originally published in issue 24 - January 1998

Is supplementation really necessary?

In the best of all possible worlds, supplementation is not necessary. Unfortunately, we do not live in the best of all possible worlds. We live in a far from natural world and the more “civilised” we become, the more unnaturally we live. We adapt and change our environment, often to our own detriment. As a result of this we find, increasingly, that we need to supplement for our nutritional needs. Alone, supplementation solves no problems. It has to be used in association with other actions. Normally, the optimum outcome that can be obtained from supplementation is in co-ordination with lifestyle changes and changes and improvements in dietary and nutritional habits. These are described in other parts of this supplement.

Why are supplements required?

Because of our need to provide sustenance that can cope with our busy demands, we are forced to accept the processes to which we subject our food. Many of these remove essential elements and so we need to replace these, often with inferior materials. A typical misconception is that of “fortified foods”. This usually means that in its processing, the food has been denuded of one or more of its nutrients. These need to be replaced but, of course, they are replaced by cheap chemical versions that do not act in the same way within the body. This leads us to a very important consideration. Are all similar supplements the same?

Variations between supplements

It is becoming more and more evident that vitamins and minerals in natural foods are not the same and do not act the same as their purely laboratory chemical counterparts. Neither vitamins nor minerals occur in isolation in nature. They are always conjugated with a complex base such as proteins, amino acids, peptides, lipids, lipoproteins, polysaccharides or other similar organic materials. During digestion they do not become separated from some part of this moiety and consequently become absorbed with these structures still attached. These form the base for the carrier molecule within the body. The simple chemical structures that are usually offered as vitamins and mineral compounds rarely, if ever, exist in life. The body has the task of converting these to complex molecules to transport and use within the body. This requires energy and the necessary ingredients being present.

Here we have our first potential difference between supplements. There are those in conjugation with their organic substrates (true chelates); those that are simply admixed with various organic compounds (false chelates); those that are attached to organic or pre-organic bases (such as citrates, proteinates, orotates, gluconates, etc.) and there are simple inorganic chemicals (such as carbonates, chlorides, oxides, sulphates, etc.). Each behaves differently from the others, being absorbed, transported, utilised and detoxified very differently. This combination accounts for bioavailability. Generally, the more bioavailable the material is, the more akin it is to how it is found in nature.

How should we select an appropriate supplement?

The higher up the table (see Table 1), the more useful and bioavailable it is to the living animal organisms. Even the plants rely on bacterial intervention to prepare the minerals from the rocks and inorganic salts into suitable, simple bioavailable minerals.

Table 1

Table of relative bioavailability of different presentation forms of vitamins and minerals as supplements


Type of Presentation Nomenclature Stage of value

Conjugated with organic substrate
True chelate 1st class

Attached to organic or pre-organic bases
Pre-organics 2nd class

Admixed with various organic or food compounds
False chelates 3rd class

Simple inorganic compounds
Inorganics 4th class

Whenever possible, supplements should be selected from the highest class available unless there is a specific reason to choose one of the lower classes. They are often not the most expensive.

The insurance policy

The simplest way of selecting an appropriate programme of treatment is to start at the beginning. Because nearly all of us suffer from some degree of minor deficiencies, at best, it is probably wise to select a good multivitamin and mineral, in the 1st Class group that gives a very broad spectrum of content and supplies a minimum of 1/3rd of the daily requirements of those materials. This is the “insurance policy” that is likely to cover the deficiencies of the trace elements and provide a minimum intake of the others. We can now build on this, depending on the clues we find as to our more serious deficiencies.

The Special Needs

The first supplement that springs to mind is Vitamin C. We are nearly all deficient in vitamin C. Most animals and all plants can produce Vitamin C from glucose. In animals it is produced in the liver, at will and on demand. The advantage to this is that Vitamin C is an extremely necessary vitamin in animals under stress – and what human being isn’t? ALL the other animals that cannot produce Vitamin C (the large primates, the guinea pig, a fruit-eating bat of Asia and several bird species) are all fruitarians; ONLY THE HUMAN is unable to provide its daily needs by one method or another. This basically means that we need to supplement Vitamin C to remain healthy. If we extrapolate the needs and production of other animals into our own weight/height ratio, at rest and under little or no stress, we would require 1–2g/day. Under stress, at times of activity and/or growth, we may need 10g/day. An impossible mission to obtain from our diet. So supplementation is required and a not unreasonable level is about 2–3g/day of the simple ascorbic acid or 750–1000mg of the 1st Class form.

Another element that very few in the civilised world have adequate dietary amounts of is Selenium. Soil erosion, industrialisation and over-use of chemical fertilisers have all contributed to the loss of Selenium from our soil. It is calculated that every person in the West needs a supplement of 100–200 mcg per day to adequately supply our needs, and Selenium is very active in cardio-protection and the immune system.

We must also remember that in the “civilised” world very few people live a “normal” life for which we have developed through countless generations. It is only in the last few decades, after thousands of years of slow progressive change, that we have suddenly expanded our expectations beyond the evolutionary process. This creates stress. Stress demands extra materials, such as the B vitamins and magnesium, especially, in order to cope. These often need to be supplemented. Our current civilisation also throws great demands upon our protective abilities and this demands increased supplementation with the antioxidants, such as Vitamin C and Selenium (already mentioned), Vitamin E, Betacarotene and Coenzyme Q10. And so, the list grows!

A complete range of supplements we haven’t mentioned are the essential oils. These are often absent or of poor quality in our diets. We need them, both the Omega 3s and Omega 6s, to maintain cell structure and function. They can be found in a mixture of Evening Primrose Oil plus fish oils or in Flax Oil. There are many qualities available and it is wise to seek expert advice for the best combination.

To Simplify

Most of us need to supplement – but what? (see Table 2).

Table 2

Supplementation that may be required throughout the stages of development as a result of poor food sources.

Supplement Reason Daily dose (adults)
Vitamin C Insufficient in modern foods for needs of a modern society 2-3g (min)
Vitamin B6 Not present to any extent in modern refined foods 20mg (min)
Chromium Not present in refined foods 50mcg (min)
Folic acid Often inadequate amounts in modern noon-fresh vegetables as prepared by modern standards. (Fresh plant source only) 400mcg (min)
Vitamin B12 Often absent from current vegetarian/vegan diets. (Animal source only) Up to 10mcg (min)
Magnesium Modern life-styles and stress place a much higher demand on our needs which often cannot be met 300mg (min) in addition to food supply
Omega-3 oils Modern fat-free diets ensure inadequate supple of essential fatty acids especially Omega-3s 1 tablespoon flaxseed oil (also provides Omega-6 oils)
Selenium Most soils of the Western industrialised world are selenium deficient and plants grown on them are deficient in selenium 200-400mcg
Boron Many soils in areas with heavy rainfall are boron deficient and plants grown here will be boron deficient Up to 3mg

These are the main nutrients that will almost definitely require supplementation in the Western diet to prevent ill-health

Add to these suggestions any special needs that may be necessary and we have our supplementary requirements.


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About Dr DF Smallbone

Dr David Smallbone M.B., CH.B., L.R.C.P., M.R.C.S., M.F.Hom., F.C.O.H. Senior Medical Advisor and Senior Lecturer in Medical Sciences to the College of Natural Nutrition.

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