Supplementation should be used in a targeted manner, with specific products used for specific reasons. As such, it’s useful to reflect on some populations that are more likely to benefit from supplementation than others. Of course, this list could never be comprehensive as there are more situations that warrant supplementation than could fully be elucidated.
It should be taken as given that specific individuals within the populations below do not necessarily need supplementation as this would depend very much on some aspects of the specific applications of an approach and in essence, the actual foods that any individual eats.
As you learned in module 3, there are a number of different micronutrients present in animal derived foods which are either partially lacking, in a poorly absorbed form or completely absent from plant based foods. Examples of this include iron, vitamin A, calcium and some B vitamins, especially B12.
Deficiencies (or insufficiencies) in these key nutrients could be problematic, and due to the dietary choices made by vegetarians and vegans they are more likely to experience these issues than the general population would be. Food supplements (either individual nutrients or a broad spectrum multivitamin) would possibly be worth consideration here if large amounts of plant-based sources are not included in the diet.
Furthermore, vegans and vegetarians are unlikely to consume enough EPA or DHA for optimal health and due to the low conversion rate of ALA to these, vegans or vegetarians may wish to supplement with an algae based product. Finally, though the amount of protein which can be consumed by vegans is more than adequate in most cases, those on restricted calorie intakes or those with especially high needs may find that protein supplementation could be of use.
While it could be argued that this is less than ideal, there is a strong case that protein powders and EPA/DHA supplements offer an affordable alternative to regular consumption of oily fish for EPA/DHA and large amounts of highly priced animal produce for those with an elevated protein need. By swapping daily EPA/DHA supplementation and 1 serving of a protein powder for these more expensive foods, an individual can still expect to meet their macro and micronutrient needs, but should notice a marked reduction in their food bill. This, of course, also applies to those who simply don’t enjoy eating fish or large amounts of other protein-containing foods.
As we mentioned in module 3, a restrictive diet is one which is not balanced, though this may not mean that someone is lazy or uneducated. Those who are intolerant to dairy are missing an important food group, as are coeliacs and those who choose to adopt a ketogenic approach. In addition to these demographics, people who have a very low overall food intake for the purpose of losing fat. For example, while a 90kg individual will have no problem consuming enough micronutrient dense foods while losing fat, a 55kg individual may not, and therefore supplementation could be warranted.
If you have restrictions on your diet for any reason, it’s important to make sure that those restrictions will not reduce your ability to achieve nutritional sufficiency and if they do supplementation could be a solution. Of course, the specific nutrients required would depend on the imbalance at hand, and this must therefore be taken on a case by case basis.
An individual with an extremely high activity level will necessarily need to consume a lot more calories than someone with a typical lifestyle and after a certain point consuming whole foods becomes problematic. If an individual is struggling to consume whole foods to the calorie level that they need, then supplementation with carbohydrate or protein powders, potentially blended into high calorie shakes can be an answer. Additionally, there is some evidence that minerals such as magnesium, zinc and iron are common deficiencies amongst athletes and so these supplements may warrant looking at (though testing for deficiency is worthwhile before making assumptions here).
Once an individual has found a training regimen congruent to their goals and has achieved a dietary approach which is in support of that (alongside sleep and stress management), supplementation can be a useful tactic for squeezing out the last few percentage points for performance. The specific supplements used will of course vary from sport to sport and individual to individual, and so we recommend looking at the ergogenic aids section of this module to make informed decisions regarding supplementation.
As you learned in module 3, for those living outside of a narrow band around the equator, sun exposure for at least some of the year is less than is needed to synthesise adequate vitamin D. Supplementation of 400iu of vitamin D3 during winter months is now recommended by the UK Government and there is some evidence that taking more may be of merit, so long as you are cognisant of the 10,000iu TUL mentioned in Module 3.
Antibiotics are a fantastic medical tool. They can kill harmful pathogens and return you to health, rendering previously fatal illnesses little more than a few days off work and an inconvenience. Unfortunately, they are not without side effects, including reduction and the imbalancing of your digestive bacterial population (cases of sickness and diarrhoea can do the same). Post antibiotic probiotic use may have efficacy for reducing or eliminating these issues.
There are certain conditions such as chrons or ulcerative colitis, as well as gall bladder removals and bowel surgery which can hamper your ability to absorb nutrients. If you or someone you are advising has a digestive or bowel related condition, speaking to a doctor is a very good idea as supplementation may be required.
Post-menopausal women (and for men in their 60’s) can find that bone loss can be a problem, so calcium and Vitamin D supplementation could be a very valuable addition if your diet or lifestyle do not provide it. Additionally, there is some evidence that supplementation with zinc and magnesium may ease menopausal symptoms.
Around pregnancy and lactation women are encouraged to supplement with folic acid and vitamin D3. No other supplements are recommended for routine use, though fish oils may promote healthy development and protein powders are considered safe in the context of a balanced diet.