Healthy eating away from home: tips on where to eat and how to shop - by Maxine Sheils

It can be real nightmare eating away from home for someone with a chronic illness like cancer. Today's blog is written by Maxine from Igennus, who kindly shares her top tips to help you maintain a healthy diet when it comes to convenience food.

Eating out has never been more convenient. You’re either dashing to the local patisserie on your lunch break, popping out for a meal with friends at the weekend, or ordering a take-away on a Friday night or even in the middle of the week. Unfortunately for some, this means that you’re more tempted than ever to eat the foods you know aren’t necessarily good for you. Not only that, but as you’re not cooking the foods yourself, you have less idea of what you’re actually eating. Not only are the Igennus HQ staff health orientated, when we have a get together, we regularly have diets such as paleo or low FODMAPs being followed, as well as any intolerances to gluten, wheat and/or dairy which have to be accounted for, and the occasional preference for a vegan meal. Oh the joys for the waiter/waitress who pulled the short straw with our table! However, we’ve had tons of experience at dealing with these situations, leaving us very well equipped, so we thought it would be useful to impart some of this wisdom, with the hope that it will also help you.

Preparation is key

This age old saying is definitely your key to success because like anything, if you’re not prepared, you’re not giving yourself the opportunity to succeed. This applies to all situations. If you buy your lunch from the local supermarket, write a list of what you need before you go, to avoid being tempted by the generously sized aisles selling crisps, sweets and chocolate.

If your weakness is mid-afternoon when you’re having an energy lull, firstly, ensure you’re eating an adequate amount of protein as this will help balance blood sugar levels to avoid the blood sugar dips that leave you reaching for the biscuit tin (you can read more about protein and work out your requirements here). Secondly, having healthy snacks available will reduce the temptation to reach for the sweet jar. If you can, prepare some healthy foods, or buy them from the local supermarket to prepare you for the week ahead. Healthy snacks include a boiled egg (which can be boiled in bulk and stored in the fridge – mark them to avoid messy accidents); carrots and hummus; your favourite nut butter with celery sticks; fruit such as a banana or a handful of berries; a couple of oat biscuits with some cottage cheese; or prepare a trail mix with a mixture of almonds, walnuts, hazelnuts, cashews, brazil nuts, dried coconut chips, sunflower and pumpkin seeds, with a handful providing one serving.

Healthy lunches that can be purchased from local supermarkets include a prepared salad with some cooked chicken and/or mixed beans with added hummus; a tin of Amy’s Kitchen vegan and gluten free chili served over cauliflower rice; a prepared meatballs dish (usually available with the tapas selections) served over courgetti; or some pulled pork served with a portion of prepared wholegrain rice and salad, creating your very own burrito bowl. Some branded ready meals are also great for something quick and warming; Pure offer wonderful gluten and dairy free meals; Kirsty’s, delicious meals which were originally prepared for Kirsty’s son as a way to cater for his gluten and dairy intolerance whilst still providing a nutritious meal, most of which contain a decent amount of protein with low levels of sugar and salt; Amy’s Kitchen provides a variety of organic soups; City Kitchen have some wonderful options including the Malaysian Coconut Beef Curry, Skinny Thai Coconut Chicken and the Skinny Teriyaki Chicken Noodles; Bol also have some delicious, vegan “Super soups” – packed full of vegetables, they contain 3 of your 5-a-day, and for those who prefer meat with their meals, you can simply add some prawns or chicken to these to top up the protein content.

Tips: When buying ready meals, always check the labels; if you haven’t heard of at least three ingredients, put it down (unless one of those is quinoa). If the sugar content is more than 5% of 100grams, put it down. If the salt content is more than 1.5grams per serving, put it down. Try and aim for a protein intake of around a quarter of your daily recommended intake.

Canteen dinners

Office canteens are not always the healthiest place to eat, but a few food swaps can make a world of difference. For breakfast, rather than a bacon or sausage sandwich, consider porridge (where possible) with a banana, as this will provide a good source of fibre to provide that full feeling for longer, whilst also slowly releasing energy. For lunch, instead of a side of chips, aim for a couple of servings of vegetables or a side salad to further increase your intake of fibre, as well as vitamins and minerals essential for health. Opt for a cooked meal rather than a sandwich, which usually lacks healthy filling and therefore doesn’t provide much satisfaction or nutrition. If the cooked meals in your canteen aren’t that appealing, consider a jacket potato with chili served with a side salad, and instead of reaching for the sausage rolls to snack on, opt for the soup of the day, which should provide you with a steady release of energy from vegetables rather than the refined flour found in pastries. Finally, instead of indulging in several coffees each day, consider making every other drink a herbal tea. Not only will this save you money (especially if you have your own teabags), but it may also reduce your intake of more refined sugars, especially if you sweeten your coffee or opt for a coffee with added syrup flavouring or cream.

Out & about

If you usually purchase your lunch on the go, our favourite convenient eating places include Pret a Manger, Leon (although this is restricted to London and bigger English cities), Itsu (or any Japanese sushi restaurant), Starbucks, any type of “meal-prep” and “high protein” restaurants, Las Iguanas and Nando’s. All of these offer full nutritional information on their website and make it clear whether a dish is free from some of the main allergens, and whether they are suitable for vegans/vegetarians. Whilst there are many other options, these are the ones we know you are more likely to find in your local town.

Pret is at the top of our list with their beautiful array of natural food and organic coffee. They offer multiple gluten and dairy free options as well as lots of vegan-friendly foods. We love all of their salad options, especially the tuna niçoise, crayfish and avocado salad, and the chef’s Italian chicken salad. Our pick of soups include the butternut squash dhansak, the chicken, broccoli and brown rice soup, and pork and lentil ragu. Some of the soups are a little low on the protein count, however, making the egg and avocado/spinach pot the perfect accompaniment. For a quick snack, consider their fruit pots as well as their delicious crisped kale or tamari pumpkin seeds. We also recommend their cold-pressed juices and shots to top up your nutrient intake.

Leon’s naturally fast food provides all the information you need regarding their ingredients, allergens and even the glycaemic load and index of dishes. Our picks include the naked Korean chicken burger, or the original superfood salad with an added chargrilled chicken pot, both of which are high in protein and greens to provide lots of energy whilst you’re on the go. Wash them down with a kombucha brew, or a kefir smoothie, both of which will feed the good bacteria in your gut, supporting digestion and the immune system.

Itsu, and many other sushi chains, offer great options for lunches on the go, containing foods rich in omega-3 fatty acids from oily fish and seeds; good quality vegan protein from tofu and edamame beans; miso, another fermented food that will look after the health of the bacteria in your gut. Our Itsu picks include the vegan dish ‘humble warrior’, containing avocado, broccoli, falafel and seeds; and the poached salmon and egg. We also love their raw chocolate pie, and their small packet of crispy seaweed thins. Itsu even offer wonderful panda boxes for the children.

Tip: be aware of the salt content of some dishes on offer in sushi restaurants as many of the dishes will contain your entire recommended daily intake of sodium.

With food intolerances and dietary requirements, one of the biggest difficulties of eating away from the home is when you’re asked to eat at a restaurant you’re unfamiliar with. Independent restaurants are great as the food is often homemade, fresh and often consists of local produce; however, whilst some independent restaurants offer full nutritional information, many do not. Again, the advice here is to prepare. Call or email the restaurant ahead of time. If you tell them your dietary requirements and ask if they can cater for you, you will know ahead of time and can be prepared when the waiter/waitress takes your order rather than panic, ordering and eating a meal that may not be suitable.

Also, if you’re unfamiliar with an area, a quick google search of ‘healthy eating’ plus the name of the area you are in should bring up some options, as should tripadvisor. Alternatively, happycow.net is a useful resource for finding restaurants offering vegan and vegetarian options for your area or postcode. This is also useful for non-vegetarians as many of the options will be for relatively health-conscious restaurants who also offer non-vegetarian foods. There are also appss available such as ‘find me gluten free’ which can be a great resource when trying to find gluten free. It’s great to use on holiday.

Whilst we could write a small book on our most loved foods in each restaurant (between us, we’ve been to lots), our main recommendation is to check out your eating options ahead of time, have a look at the menu and nutritional information, and apply the same tips offered above for purchasing ready meals; i.e. check the protein, salt and sugar content, as well as the ingredient list to ensure there’s a minimum at most of chemicals and additives included. Fortunately, people are more aware than ever of dietary requirements, making it a lot easier for the rest of us to choose a delicious and suitable meal to enjoy with our friends. Enjoy!

Top tips for optimal energy levels - by Maxine Sheils BSc DipCNM

This Sunday's blog post has been written by Maxine from Igennus. This week she shares a few suggested tweaks to help you boost your energy through this chilly period...

Maintaining energy and motivation in the colder months can be tough at the best of times but when you are also actively fighting cancer, going through treatment or in recovery, the extra strain you are under can make this time of year seem exhausting. Whilst it’s important to give your body the rest it needs when you’re unwell, there are other ways of helping combat low energy. Many people may be tempted to turn to quick ‘pick me ups’ such as caffeine, cakes or a nap to help get them through the day but when used in excess they could exacerbate the problem. It can be hard to tell the difference between wanting and needing to rest so by looking at other areas of your diet and lifestyle that may be adding to feelings tiredness, you may be able to identify a few simple tweaks to help boost your energy, and support your health, this winter.

Diet: balancing your macronutrients to support energy stabilisation

The diet is paramount to energy levels as we eat to fuel the body in order to function optimally, therefore you need to ensure your diet is supporting your body as much as possible. A simple way of increasing your energy is to eat regularly, i.e. every 3-4 hours; ensure you are eating 3 meals per day and add 1-2 snacks in between, especially for any prolonged periods between meals, or if you are unable to eat much in one go due to nausea or low appetite.

Look at your body as a fire, requiring fuel (from food) to keep the energy of the fire going. Carbohydrates work as the paper to your fire, they’re great for a quick boost but they’re  quickly burnt up; protein is the wood to the fire, providing more longevity; fat is the coal to your fire and will keep you going for much longer. When it comes to carbohydrates, it is important to distinguish between simple carbohydrates, consisting of one or two sugar molecules (found in cakes, biscuits, sweets, white bread and pasta, fruit juices and fizzy drinks) and complex carbohydrates, consisting of many sugar molecules joined together, found in starchy vegetables such as sweet potato, legumes and whole grains. Simple carbohydrates are burnt quickly by the body providing instant energy but leave you craving more to boost your energy again. This is what we call ‘the blood-sugar rollercoaster’ and when you’re on it, it’s extremely difficult to get off. Complex carbohydrates, on the other hand, are burnt up slower than simple carbohydrates, providing a steady release of energy, and with a few food swaps, you should be able to even out the highs and lows to eventually maintain a healthy supply of energy to the body.

Starting the day with wholegrain toast (complex carbohydrates) topped with a poached egg for protein, and some avocado for fat; white pasta for lentil pasta or courgetti (spiralised courgette); white rice for brown rice, quinoa or cauliflower rice; biscuits for a protein smoothie, and cakes for homemade granola bars is a great way to optimise the nutrition in your foods without the need to eat huge amounts more.

Try to ensure you consume a source of protein with each meal/snack, as well as include healthy fats from oily fish, nuts and seeds, olive oil, olives and avocados in your diet, to help to maintain a steady flow of energy throughout the day.

Looking at your caffeine intake is another important factor, as many rely on this to provide them with an energy shot. Whilst one or two cups of coffee can carry many health benefits, some people are slow metabolisers of caffeine (thanks to inherited genes), meaning it takes much longer for the liver to detoxify caffeine from the body. If you drink caffeinated drinks and struggle to fall asleep, you could well be a slow metaboliser, with a lack of good quality, restorative, sleep driving low energy levels. Try minimising your intake to just one caffeinated drink before midday to see if this has a positive effect on your energy. Make sure to drink adequate water, ideally purified or mineral water, as dehydration can also be a factor in low energy. For those who don’t enjoy drinking water, try infusing it with lemons which will further increase hydration levels and help support the immune system.

Using simple lifestyle techniques to increase energy levels

Exercise is a great way to boost energy levels as it gets the blood pumping around the body, carrying nutrients to cells to produce more energy, and increases levels of feel-good and energy-promoting neurotransmitters, dopamine and serotonin. Whilst the thought of exercise might seem off-putting or impossible, it does not need to be a chore. Just start with what you can, be it a short walk to the local shops, five minutes around the block on your lunch break, or a weekend walk in the park is all you need to start with. Use this time to listen to your favourite artist, an audio book, or take part in a guided meditation and you’ll soon increase the length of time you spend walking. Over time, as as energy and other symptoms permit, you may want to try increasing your pace, some gentle stretch or signing up to a local gym to try out a fun exercise class, but the important thing is to take it in your own stride and enjoy being active.

With everything, life is about balance so it’s also important to notice when you need some down time and to ensure it’s productive. It is all too common today to be stressed, with stimulation from mobiles, laptops, televisions, the radio, from the moment we wake up to the moment the lights are turned off. Listen to your body and notice when you are in need of ‘switching off’. When we are stressed, the sympathetic nervous system is stimulated, putting us in ‘fight or flight’ mode. Taking a moment to have a few deep breaths, or a short mindfulness exercise can relax the body and switch the nervous system from ‘fight or flight’ to ‘rest and digest’ mode, vital for restorative rest and recovery. 

Nutrients that will provide additional support for energy production

Omega-3: EPA & DHA

Omega-3 fatty acids EPA and DHA are required to aid the function and structure of every cell in the body, allowing nutrients to flow into the cells and toxins to flow out. If cells are lacking such vital nutrients, it is easy to see why a general feeling of fatigue and low energy may follow; your cells simply aren’t able to function optimally. Consuming two portions of oily fish such as mackerel, anchovies, salmon and herring will aid with increasing EPA and DHA levels, however a typical western diet consists of high levels of omega-6 arachidonic acid (AA) from foods such as grains, and animal produce fed a diet rich in grains. An imbalance of omega-3 to omega-6 within the body, in favour of omega-6, can lead to silent inflammation, which can in turn affect energy balance, as well as affect immune function and cellular health. Supplementing with high dose omega-3 fish oil will help to restore the balance of omega-3 to omega-6 to a healthy ratio, and maintain optimal levels to keep inflammation in check.

Our recommendations: Pharmepa Restore & Pharmepa Maintain and Opti-O-3 blood spot test.

CoQ10

The body naturally produces an enzyme called Coenzyme-Q10 (CoQ10) which aids in the production of energy in the body. As we age, the body’s ability to produce CoQ10 decreases, peaking in our 20s and declining after this point. Low levels of CoQ10 are also associated with many health conditions such as cardiovascular disease, diabetes, cancer, muscular dystrophies, CFS and ME; so it may be worth considering supplementation with CoQ10 to support the body with energy production.

Our recommendation: VESIsorb Ubiquinol-QH

B vitamins

B vitamins are important for energy production: vitamin B1 is required to turn carbohydrates from your diet into energy; vitamins B2, B3 and B5 aid with energy production from carbohydrates, protein and fats consumed; B6 helps break down stored energy from muscles and the liver; B12 is critical for producing cellular energy in the body. A complex containing the full spectrum of B vitamins will ensure optimal wellbeing and assist in energy production.

Our recommendation: Super B-Complex

Personalising your nutritional requirements

We hope that the above arms you with lots of information to start tackling your energy levels. We hope you start to see the benefits over the coming months by putting some simple practices into place. Igennus have witnessed confirmation over the years that the path to individual health is unique and you cannot generalise a plan as a ‘one size fits all’. We are aware that many factors could be at play and effectively preventing you from progressing with certain areas of your health. MyOnlineCLINIC has been developed from years of experience of working with customers, and provides a platform for everyone to gain access online to an experienced clinical nutritionist who can look at your personal circumstances, health and needs, and guide you towards feeling revitalised, refreshed and ready to take control of your health.

Use the code YESTOLIFE for 15% off all Igennus products bought at their online shop: https://shop.igennus.com

Maxine is a Nutritional Therapy graduate of the College of Naturopathic Medicine in Manchester who has recently joined Igennus as a Customer Support Nutritionist and is based here in Cambridge. Her interest in nutrition was sparked after working as an Au Pair in Australia to a family who were living on a raw food diet where coincidentally, she started to endure severe digestive problems. She joined CNM as a student to further her new found passion and was able to support her own body in regaining health. Maxine is passionate about nutrition and her ability to help others achieve their optimal health. She specializes in female hormonal problems such as endometriosis, thyroid problems, stress, autoimmunity and digestive disorders. Her degree in Psychology provides her with a strong ability to understand and motivate others to achieve their health goals.

Supplements: can you get everything you need with a balanced diet? - by Dr Nina Bailey BSc, MSc, PhD, RNutr

This Sunday's blog is written by Dr Nina Bailey from Igennus. Nina is a leading expert in marine fatty acids and their role in health and disease. Here she discusses supplements and if they are absolutely necessary for maintaining your health and preventing disease.

Headlines like this constantly pop up on social media and can leave many of us confused and unsure about the pros and cons of supplementation.  As with many of the headlines we read, the complete ‘story’ is rarely told, the ‘facts’ often distorted or, in some cases (depending on the author/source), can be simply untrue.  As with most things in life, there are two sides to every story.  We are often told that supplements (omega-3, multivitamins, minerals and so on) are simply a waste of money, and as a nutrition scientist I both agree and disagreewith this statement.

I do agree that not all supplements are formulated for efficacy (and hence will not be effective) and that there will of course be some individuals who, because of their diet and lifestyle or current health situation (note that I don’t say ‘choices’, which I will expand on later!), don’t need to supplement. Mostly, I disagree because we cannot make sweeping statements that appear to apply to the whole of the population!  We are all unique, and the nutrient requirements of one person will differ quite significantly from the next depending on their general lifestyle, their working habits, activity levels and sleep status. Do they drink regularly? Do they smoke? Are they under stress at work or home?  The simple fact is that no two people are the same, or lead the same life, and so of course there will be individuals who require additional nutrients or micronutrients at certain points or stages in their lives.  If the products they take are expertly formulated to deliver safe, viable doses, in forms that are known to be both bioavailable and effective, then the health benefits are unquestionable.   What we often hear from so-called ‘experts’, however, is that a balanced diet allows us to obtain the nutrients we need so avoids the need for supplements!

Just eat food!

So, can we really get all the nutrients we need from our diet? Absolutely!  We should indeed be able to sustain ourselves with the nutrients we require for everyday function via the food we choose to eat!  But wait, before we actually ditch our pot of multivitamins and minerals or fish oil supplement, let’s just take a moment to look at what is considered to be a balanced diet and, importantly, some of the factors that may (or may not) influence our ability to maintain a nutrient-rich variety of foods.

A diet that promotes health and prevents disease is one that contains an abundance of natural, unprocessed, seasonal, organic, fresh whole plant foods; a broad range of wild, grass-fed or pastured organic animal proteins; plus an array of ‘good’ fats.  If this is your diet (and has been for decades), then thumbs up to you, as it’s highly likely that your vitamin and mineral levels, along with your omega-3s, are nicely optimised.  But wait: you work long hours in the city, commute an hour each way, you find time to work out twice weekly yet survive on less than 7 hours sleep at night!  Okay, so now we need to look again, as it’s highly likely that some aspects of your life may be exerting a high level of emotional and physical stress on certain metabolic pathways (not even to mention the impact of likely unavoidable factors such as pollution).  With stress there is inflammation and with inflammation we are at a higher risk of developing poor health.  You may (or may not) feel generally ‘healthy’ (so you get a bit tired at times and perhaps get the odd cold, but nothing more than that)  but the inner workings may (invisibly) disagree.

It may not be that you are nutrient deficient per se, but you may need more nutrient[s] than someone eating a similar diet but who has less of an inflammation-encouraging stress burden than you do! The key thing to take on board here is that we and our life situations are all different and so are our nutrient requirements. This way of thinking is the focus of personalised nutrition, which concentrates on the individual rather than the population as a whole, whose standard guidelines tell us that we should all be consuming ‘X’ amount of vitamins or ‘Y’ amount of calcium, regardless of age, sex, activity levels or even stress!  Eating more nutrient-rich foods may be the answer on an individual basis or, alternatively, we could move to supplementation.  But here is the crux of the matter, because taking a poorly formulated supplement may well cause your body more harm than good.   Unless your product is formulated using carefully selected, highly bioavailable, body-ready nutrients in doses that aim to support (not overload) the numerous metabolic and cellular processes that occur on a continuous basis, then you may as well not bother.

Let us look back to headlines published by the Daily Mail in 2016, where it stated that calcium supplements ‘dramatically increase risk of heart attacks’ but without clarifying that it is the type of calcium that was the issue. Given that the majority of calcium supplements contain calcium in the carbonate form (aka limestone) it is actually not surprising that this form of calcium builds up in the arteries (rock is terribly hard to digest and absorb…).   In addition, supplements are not foods, and should not [in terms of how we ‘dose’] be treated as such, yet consumption guidance on many calcium supplements means that individuals are taking  a large dose, all at once, that the body is simply unable to process.    In contrast, taking naturally-derived calcium [such as algae-sourced, pre-digested] over the day as a split-dose will lead to calcium accumulation within the bones (where you need it) and not the arteries, with significant benefits to bone mineral density, which is generally the purpose of taking a calcium supplement. (Kaats et al., 2011)

So what is the perfect diet?

This is a subject close to my heart and while the jury is out on defining a recognised, validated diet that meets the requirements of the whole population (simply because it is unlikely to exist), you can read about how to optimise your diet to give you the best possible nutrient-dense ingredients to reduce the risk of chronic disease here.    It’s also recognised by experts in nutrition that it’s not about how much of a food we eat, but more about focusing on the quality of the foods we consume. For example, it’s well established that food budgets can lower the nutritional adequacy of an individual’s diet.  Indeed, people’s food choice and diet variety of foods integral to a healthy diet (i.e. fruit, vegetables, fish) can be perceived as a luxury, with healthier alternatives (organic, grass-fed and so on) to common foods often carrying a price premium, making them essentially unachievable for some.  While many of us may wish to follow a perceived nutrient-rich, balanced diet, various economic ‘barriers’ can be influential on our dietary choices.  It is, for example, estimated that half of the weekly income is needed for a person on income support to eat a healthy diet, while the considerably higher cost of therapeutic diets places an even greater burden on older people with limited incomes. (Conklin et al., 2013) Thus I highlight the importance of my earlier comment about an individual’s diet and lifestyle situation rather than their diet and lifestyle choice as it is well established that socio-economic factors will influence how well a person will, or can, eat. (Maguire & Monsivais 2015) The assumption that we are all (or could be) consuming a balanced diet is therefore not feasible and supplementation may well be a convenient (and more affordable) option for many.  What is clear is that while we are consistently reminded of the benefits of a balanced diet, the figures for diet-related chronic diseases would suggest that the majority of us are non-compliant!

Diet related disease

In 2006-07, poor-diet-related ill health cost the NHS in the UK £5.8 billion, (Scarborough et al., 2011) and 10 years on, that figure has undoubtedly continued to grow.  Diabetes and obesity are key diseases that lead to other diet-related chronic diseases and it is well accepted that nutritional strategies that focus on the prevention of obesity and diabetes can reduce the prevalence of other major chronic diseases. In addition, cancer, cardiovascular disease, liver disease, kidney disease, digestive disease, and mental illness are consequences as well as causes of other diet-related chronic diseases.  All diseases have multifactorial causes, and most result from decreased antioxidant status, increased inflammatory status, impaired carbohydrate/lipid/one-carbon metabolism, impaired functioning of neurons and DNA transcription, hypertension, and/or modified gut flora. (Fardet & Boirie 2013)  Thus, it can be said that increasing antioxidant status, decreasing inflammation and/or supporting the complex systems that influence health via diet (and/or supplementation) can only aid in reducing disease risk.

Some studies suggest that supplements like vitamins and antioxidant can be harmful, so are supplements actually safe?

When used appropriately, yes, supplements are safe.  What is ‘appropriately’ I hear you ask?  When we read negative headlines it’s always worth looking at the source of the information behind them.  What is clear from many dietary intervention studies is that many nutrients work synergistically and that when given in very high doses, there is indeed a potential for them to cause problems by disrupting nutrient pathways.  Nutrients are not drugs, and should not be treated as such in research trials.  The antioxidant vitamin E, for example, is a popular antioxidant that has been associated with a reduced risk of cancer, yet a study published in 2011 found that the risk of prostate cancer actually increased among the men taking vitamin E compared to the men taking a placebo.  Scary stuff and you could easily think that this therefore makes vitamin E supplementation a bad idea for everyone – right?  Not so!  Let’s look more closely at some of the facts in this case.    Firstly, the trial used a synthetic vitamin E, a mixture of eight a-tocopherol stereoisomers in equal amounts (stereoisomers are molecules that have the same molecular formula but their atoms have a different arrangement).  Only one of these stereoisomers, (12.5% of the total mixture), was RRR- or d-a-tocopherol, the natural form.  A number of studies have shown significant differences between natural-source and synthetic vitamin E.  They have also shown that natural-source vitamin E is more efficiently used by the body than its synthetic counterpart and that the body has a preference for natural-source vitamin E over synthetic vitamin E.  (Burton et al., 1998) Had this trial used naturally-derived vitamin E the outcome may well have been very different.  Indeed, other trials have reported that both dietary and supplemental (as natural α-tocopherol) vitamin E are not only inversely associated with prostate cancer risk (high levels/high intake offer protection) but may also contribute to improved prostate cancer survival in those men with the disease. (Watters et al., 2009)

Secondly, when we give high doses of a single antioxidant such as vitamin E to an individual who may already be low in antioxidants, this can have the potential to cause vitamin E to become a pro-oxidant with the capacity to increase inflammation and therefore have health-negative outcomes; it is useful, therefore, to understand how antioxidants actually ‘work’ and the factors that influence their actions.  Antioxidants act to stabilise free radicals usually by donating an electron, hydrogen or other chemical group that, essentially, calms the free radical down and stops it going on the rampage.  However, depleted antioxidants have the capacity to become pro-oxidants thereby ‘switching teams’ to become free radicals themselves unless another antioxidant (such as CoQ10, lipoic acid or vitamin C) steps in to donate one of its electrons, thus converting vitamin E back from a pro-oxidant to an antioxidant.  So – numerous antioxidants act together, essentially working as a tag team to keep the body free from free radicals;  however, if someone hasn’t been eating their veggies, they may be low in antioxidants and so dumping a high-dose vitamin E into the mix may cause a rise in the pro-oxidant version.  Therefore rather than supplementing with single antioxidants, it is more effective to supplement with a mix so they have the capacity to recycle each other.  The antioxidant story is a complex subject that was recently clarified by fellow nutritionist Sophie Tully and you can read more about the pros and cons of taking antioxidant supplements and how to optimise the benefits for you rather than the population on a general level here.

Choosing the right supplement

It’s a minefield out there! For a consumer, the variety of supplements in health shops, online, or even in supermarkets can be overwhelming. I’m going to use my own experience of involvement in­­­­­ supplement formulation to illustrate the importance of awareness of the choices to be made in doing so:  the focus is to ensure the efficacy and safety of formulas. Uptake and retention of nutrients is optimised by taking measures to overcome bioavailability issues, by using only the most effective ‘body-ready’ forms, or pre-methylated forms of vitamins and minerals.  We incorporate a slow release matrix into our tablets and we actively encourage split-dosing to ensure all-day coverage. We also do not believe in overloading the body with excessive ‘mega’ doses that the body does not need or simply cannot absorb in one dose. The majority of water-soluble nutrients are simply not needed in mega-amounts for an effect and can (such as in the case of folic acid) come with undesired contraindications.  Sometimes the body will simply excrete any excess it does not need or cannot absorb in one dose. For example, with nutrients such as B12 and vitamin C, absorption is far better when the nutrient is delivered at smaller doses at a sustained rate because the transport systems responsible for their uptake quickly become saturated.  This means that as the dose increases, the absorption rate decreases and the majority of the nutrient will simply pass though the body unabsorbed – this is wasteful and financially unacceptable.  In addition, we use vitamin B12 as methylcobalamin(rather than the cheaper poorly absorbed cyanocobalamin form) for enhanced uptake. We use Quatrefolic® which is the body-ready form of folate, as [6S]-5-methyltetrahydrofolate, while most standard supplements contain synthetic folic acid. Incidentally, the article I am responding to referred to the use of folic acid as desirable during pregnancy; I would point out that folic acid is now being updated to folate by many supplement manufacturers because of issues around impaired folic acid metabolism and the role this plays in the development of neural tube defects (such as spina bifida).   We also choose the active form of riboflavin, riboflavin-5-phosphate.  Similarly, vitamin B6 is pyridoxal-5-phosphate, the only form of B6 with cofactor activity.    Taking such important considerations as bioavailability and dose frequency into account, safe supplements are formulated with the aim of delivering unprecedented yet cost-effective health benefits – otherwise what is the point?

Summary

Supplements may not be for everyone, but if we base the argument for not supplementing on the utopian notion that we can obtain all the vitamins and minerals we need from a balanced diet, then it’s highly likely that the majority of us would benefit from a micronutrient top-up!  In addition, given the growing burden that dietary-related chronic diseases are having on our NHS system, it is evident that nutrient deficiencies (= increased nutrient demands) are rife.  It is also evident that with an increasing market, not all supplements will be equal in terms of safety and efficacy and that purchasing from a reputable healthcare company with a team of experienced, and highly qualified nutrition scientists (who are also practising nutrition practitioners) behind the development of their products will ensure that you are in the safest hands possible when choosing products aimed at optimising health. If you’re interested, here is the link to The Independent’s article What vitamins should I take, which prompted this article.

References

Burton GW, Traber MG, Acuff RV, Walters DN, Kayden H, Hughes L, Ingold KU. Human plasma and tissue alpha-tocopherol concentrations in response to supplementation with deuterated natural and synthetic vitamin E.

Am J Clin Nutr. 1998 Apr;67(4):669-84.

Conklin AI, Maguire ER, Monsivais P. Economic determinants of diet in older adults: systematic review. J Epidemiol Community Health. 2013 Sep;67(9):721-7

Fardet A, Boirie Y. Associations between diet-related diseases and impaired physiological mechanisms: a holistic approach based on meta-analyses to identify targets for preventive nutrition. Nutr Rev. 2013 Oct;71(10):643-56.

http://www.dailymail.co.uk/health/article-3834828/Calcium-supplements-dramatically-increase-risk-heart-attacks.html#ixzz4obrK7XZV

Kaats GR, Preuss HG, Croft HA, Keith SC, Keith PL. A comparative effectiveness study of bone density changes in women over 40 following three bone health plans containing variations of the same novel plant-sourced calcium. Int J Med Sci. 2011 Mar 2;8(3):180-91.

Maguire ER, Monsivais P. Socio-economic dietary inequalities in UK adults: an updated picture of key food groups and nutrients from national surveillance data. Br J Nutr. 2015 Jan 14;113(1):181-9.

Scarborough P, Bhatnagar P, Wickramasinghe KK, Allender S, Foster C, Rayner M. The economic burden of ill health due to diet, physical inactivity, smoking, alcohol and obesity in the UK: an update to 2006-07 NHS costs. J Public Health (Oxf). 2011 Dec;33(4):527-35.
Watters JL, Gail MH, Weinstein SJ, Virtamo J, Albanes D. Associations between alpha-tocopherol, beta-carotene, and retinol and prostate cancer survival. Cancer Res. 2009 May 1;69(9):3833-41.