I was recently asked by a Natuopathic Doctor (ND) whether supplements should be prescribed to help patients achieve certain therapeutic effects that may not be achieved through diet alone. In regards to vitamin, mineral and nutritional supplements I believe that most people following a traditional western junk food diet or a vegetarian/vegan diet will ultimately become nutrient deficient or nutrient impaired. Over the course of years, decades and lifetimes, these nutrient impairments and deficiencies will promote increased morbidity (disease incidence) and mortality (death rates).
Clearly, overt nutrient deficiency diseases such as scurvy (lack of vitamin C), pellagra (lack of niacin or vitamin B3), and beriberi (lack of thiamine or vitamin B1) ultimately can be fatal. However, in the western world we rarely or never see these potentially fatal nutrient related diseases. What clinicians often see are nutrient insufficiencies that promote obesity, ill health and disease. In regards to health in the western world, it is probably more important to focus upon the foods that we should avoid (modern processed foods) than upon the foods that we should eat.
My point is that anyone consuming a contemporary “Paleo Diet” will never become deficient in these or any other nutrient. In fact, data from our laboratory indicates that modern diets based upon Stone Age hunter-gatherer food groups (fresh fruits, vegetables, grass produced meats, organ meats, fish, seafood, free ranging eggs, and nuts) are incredibly nutrient dense1, 2 and far surpass the DRI of governmental recommendations for the 13 nutrients most lacking in the US diet.1, 2 Accordingly, no supplementation is required of people who are adherent to modern diets which emulate the food groups our ancestors ate.
A few key caveats should be mentioned:
- Most westerners, particularly those living at northern latitudes, do not receive sufficient sunlight exposure required for our bodies to produce adequate blood concentrations of vitamin D. Hence, I recommend vitamin D3 supplementation (at least 2,000 IU or more daily) for people unable to get out into the sun on a regular basis.
- Our hunter-gatherer ancestors consumed the entire carcass (brains, liver, marrow, gonads, etc.) of the terrestrial and aquatic animals they killed — accordingly these foods are rich sources of long chain omega 3 fatty acids (EPA and DHA). If patients do not or have not consumed fatty fish (salmon, mackerel, sardines, and/or herring) regularly, then I recommend these people should supplement with fish oil.
- People who have practiced a vegetarian and/or vegan diet for long periods of time will certainly be deficient in a wide variety of nutrients.3 Accordingly, health care practitioners advising their patients should require a broad panel of blood parameters from a reliable laboratory and provide nutrient prescriptions based upon individual nutrient deficiencies or insufficiencies. However, the best clinical strategy is to prescribe a diet rich in these nutrients (ergo the Paleo Diet). Nutrient deficiencies or insufficiencies rapidly disappear when people stop consuming nutrient poor foods (refined sugars, refined grains, refined vegetable oils, salted foods, processed foods, whole grain cereals, refined cereals, high glycemic load carbohydrates and legumes). Hence, prescriptions of supplements by health care practitioners should typically involve the short term (months) and never the long term, once nutrient dense diets are adopted by your patients.
Loren Cordain, Ph.D., Professor Emeritus
1. Cordain L, Eaton SB, Sebastian A, et al. Origins and evolution of the Western diet: health implications for the 21st century. Am J Clin Nutr. 2005;81(2):341-354.
2. Cordain L. The Nutritional Characteristics of a Contemporary Diet Based Upon Paleolithic Food Groups. JANA. 2002;5(3):15-24.