Living with Nutrient Shortfalls is Acceptable?

by Andrew Shao, Ph.D.

The Dietary Guidelines for Americans are intended to help guide Americans to good dietary habits that promote health and reduce risk for major chronic diseasesa difficult feat considering ours is a country struggling with obesity, heart disease and other health concerns stemming from calorie-rich, nutrient-poor diets and sedentary lifestyles. The Guidelines, available online (CNPP.usda.gov/DietaryGuidelines.htm), must, among other things, provide dietary advice that is consistent with the Institute of Medicines (IOM) Dietary Reference Intakes (DRIs). Unfortunately, the 2010 Dietary Guidelines Advisory Committee (DGAC) in its 2010 Report (CNPP.usda.gov/DGAs2010-DGACReport.htm) all but ignored a simple step that could help ensure Americans avoid nutrient shortfallstaking a daily multivitamin, or other nutritional supplements, to fill nutrition gaps.

The DGAC notes a significant number of Americans are still coming up short for 10 essential nutrients, with the probability of adequacy tenuous. Yet, the report goes out of its way to avoid recommending dietary supplements to fill these gaps, even noting the impractical recommendation of guava as a good way to fill the void for vitamin C.

As surprisingly, the 2010 Report takes the position that low nutrient intakes are only of public health significance if they result in overt deficiency. In other words, unless you have scurvy, the DGAC does not seem to be bothered by the portion of the U.S. population that is not reaching the Recommended Dietary Allowance (RDA) for vitamin C. Yet, the government goes to a good deal of trouble and expends substantial resources to fund the IOMs development of the DRIs, which includes the RDA. These, in turn, serve as the basis of Daily Value labeling on nutrition products, including dietary supplements. So, one would think nutrient shortfallsmeaning not just deficiency but also inadequacywould be a concern the Dietary Guidelines would address, in any safe, reasonable way possible. Yet, the DGAC appears to take the position that it is better for consumers to live with a shortfall rather than taking the convenient, cost-effective and calorie-free step of adding a multivitamin or other nutritional supplement to a well-rounded nutrition program.

A concern of the DGAC appears to be the notion that, if sanctioned, Americans will rely on a pill to substitute for a healthy diet or make up for a poor diet. However, there is no evidence this assumption holds. In fact, survey research consistently demonstrates those who take dietary supplements are more likely than non-supplement users to engage in other healthy habits.

By recognizing multiple nutrient shortfalls, but discouraging multivitamin use, the DGAC is, in effect, saying living with shortfalls is preferable to reasonably filling nutrient gaps with dietary supplements. But, it seems unfair to ask the general public to wait until nutritional shortfalls reach the cataclysmic level of deficiency, like rickets or anemia, before recommending additional nutritional support. Survey after survey reports Americans, including children, pregnant women, developing teenagers and aging Americans, are not meeting the basic nutrient recommendations through diet alone. As a nation, cant we reasonably agree it is better to achieve RDAs established by the IOM than not? In other words, in the absence of clear deficiency or prevention of chronic disease, isnt achieving recommended intakes, by definition, beneficial?

Its time for the government to provide advice that is as practical as it is science-based. The use of a multivitamin by health-conscious consumers who are taking proactive steps to better health should be supported rather than discouraged, particularly if they are trying to stay within a reasonable calorie limit, which U.S. consumers are having a difficult time doing.

Here are just a few important places where the Report misses the mark when it comes to nutrient shortfalls:

Vitamin D: While the DGAC recognizes most people fall short of recommended intakes of vitamin D, it reluctantly grants that if necessary, individuals may consider vitamin D supplementation. This unenthusiastic language positions the use of vitamin D supplements as a last option, when we should be reminding people daily of the inherent health risks of getting too little vitamin D.

Dietary Fiber: The DGAC report recognizes less than 3 percent of adult men and approximately 6 percent of adult women consume dietary fiber at intake levels that reach the adequate intake (AI); yet, the report makes no mention of any potential role for fiber supplements.

Folic Acid: There is no question multivitamins with folic acid have played a valuable role in helping women of child-bearing age prevent neural tube birth defects, yet the DGAC fails to recognize the possibility that this is an area where supplementation could close the gap. The IOM, the Public Health Service, and the Centers for Disease Control and Prevention (CDC) all recommend women of childbearing age consume 400 mcg/d of synthetic folic acid,  in addition to folate in the diet. The specific omission of the multivitamin in this area is disturbing, and could potentially set back all the education that has been done over the last two decades to help ensure women even considering having a child are obtaining sufficient folic acid.

When it comes to improving the nutritional habits of Americans, the government has a lot on its plate, so to speak. And as a nation, one would hope wed be looking for practical, affordable and realistic options for reachingat a minimumnutritional adequacy in the hopes of achieving improved health. Its time to recognize while dietary supplements should not replace food, nutritional supplements are a convenient and affordable option to fill in the gaps and, as such, have an important role in federal nutrition policy and education.

Andrew Shao, Ph.D., is the senior vice president, scientific and regulatory affairs, at the Council for Responsible Nutrition (CRN).