C. Barton Moore, M.D., M.P.H. and Janet L. Moore, R.N.

 

We encounter the term "balanced diet" in virtually every popular medium these days. But what exactly is a balanced diet, and is it all we need to sustain good health and long life? Our food comprises carbohydrates, proteins, and fats, generally known as "macronutrients." On some level, we've known since childhood that certain proportions of these carbohydrates, proteins, and fats are recommended. Nevertheless, with so many food choices available to us in North America, determining and achieving this elusive balance in our diet is not always easy.

 

Even though most people are aware of the four food groups as they appear in the Food Pyramid, no consensus exists as to what "balanced" means. According to the Food Pyramid, each of us should consume six to eleven servings of grains per day, along with four to five servings of fruits and vegetables, and two to three servings of protein, with minimal fats and sugars. But, since we don't all agree on what a balanced diet is, it should surprise no one that the following question elicits a variety of answers.

 

Are nutritional supplements necessary in addition to a balanced diet?

 

Let's look at three likely responses:

 

1. No. A balanced diet is adequate; supplements may even be dangerous.

2. Yes. But Recommended Daily Allowance (RDA) supplement levels are adequate.

3. Yes. In the modern world, it is very difficult to meet all the body's needs through diet and RDA-level supplements.

Now, let's consider each of these responses in some detail:

 

 

1. No. A balanced diet is adequate; supplements may even be dangerous.

 

Those who hold this opinion often point to the many people living in isolated, pristine environments who live long, highly functional lives without taking supplements. And certain groups in the United States who make strenuous efforts to eat a healthful diet live up to 14 years longer than the average American does. Although it's true that a good diet does provide for certain nutritional needs that are not attainable in any other way, it is also worth remembering that nutrition is a progressive science. We continue to expand our knowledge about food and seem continually to be discovering that our nutritional needs are greater than we previously thought.

 

Some people say nutritional supplements are dangerous. As an example, elevated lipids can be effectively treated with niacin (vitamin B3). But this condition requires much higher doses (two-three grams per day) than are usually found in a multivitamin. Such a high dosage produces a pharmaceutical rather than merely a vitamin effect. In general, the "therapeutic window" for pharmaceuticals is much narrower than it is for nutritional supplements and, therefore, the chance for overdose and adverse reactions with drugs is much higher.

 

A recent study reported in the Journal of the American Medical Association (JAMA 1998, 279 (15) 1200­5), showed that in one year (1994), hospitalized patients experienced approximately 2,216,000 serious drug reactions. In the same year, an estimated 106,000 patients died from what was thought to be the appropriate use of pharmaceuticals. This represents one of the leading causes of death in the United States, outranking pneumonia, flu, AIDS, and diabetes.

 

A recent study published in the American Journal of Emergency Medicine compiled statistics from Poison Control Centers for eight years (1987-1994). These data reported 4,065 deaths from prescription and non-prescription drugs, compared with only five deaths from nutritionals. Although even "harmless" vitamins can cause problems in unmonitored cases of very high doses, in terms of what people usually use to treat ailments, nutritional supplements are very safe.

 

 

2. Yes. But Recommended Daily Allowance (RDA) supplement levels are adequate.

 

The Recommended Daily Allowance represents the level of nutrient intake that will meets the needs of most healthy people. But RDA levels do not address the needs of the young, the elderly, the sick, the stressed, or of those who are exposed to a toxic environment. For 50 years we've been led to believe that RDA levels are adequate. Adequate for what? Adequate to prevent clinically obvious nutritional deficiencies like scurvy, beriberi, rickets, and pellagra? While RDA levels may have helped us to avoid these deficiencies, they do not address the issues of optimal nutrition. The RDA is the "minimum wage" of nutrition. We are worth more than that--we deserve a raise!

 

 

3. Yes. In the modern world, it is very difficult to meet all the body's needs through diet and RDA supplements.

 

We know that free-radical damage is a major cause of degenerative disease and that antioxidant vitamins and minerals can help us combat that damage. It's not difficult to see that the balanced diet of yesterday cannot possibly meet the ever-increasing demands of today's world. Free radicals fall into three general areas:

 

 

Increased Toxic Exposures

 

The average person is exposed to 500 chemicals at home and 200 chemicals in drinking water that are known to affect nutrient status (Chemical Sensitivity: Vol. II, The Total Load, Shari Rogers, M.D., 1994). Common toxic substances come from foods sprayed with pesticides, transportation fumes, toxic waste from manufacturing, and electromagnetic fields--e.g., cell phones, hairdryers, computers, TV, and electric blankets.

 

 

Poor Lifestyle Choices

 

While the concept of "lifestyle" is a broad one, some of the major unhealthful aspects of our modern lifestyle include the following:

 

*	The pace of our lives is faster, which means more activities and stress, less relaxation, and insufficient sleep.
*	The faster, modern pace of our lives results in less exercise and physical activity.
*	Our higher intake of fast foods means that we consume more fats, sugar, and salt.
*	More than 10 percent of the calories consumed in America come from alcohol, which depletes B vitamins, zinc, and magnesium. ("Human Obesity," Contemporary Nutrition, 1993, 18; 7,8:1­4).
*	Only nine percent of Americans consume the RDA of fruits and vegetables per day. (JAMA, June, 1996).
*	Eighty percent of the carbohydrates Americans consume derive from refined flours and sugars, which actually deplete B vitamins and minerals. So-called "enriched" products do not completely replace these nutrients.

 

Greater Nutrient Depletions and Deficiencies

 

As the polluting effects of industrialization, urbanization, and population growth continue to take their toll on our planet, the very things we need to keep us healthy are themselves eroding. For example:

 

*	Soils are depleted of minerals by commercial farming practices and acid rain.
*	Many prescription and non-prescription drugs deplete nutrients and cause deficiencies.
*	Illness creates requirements for vitamin C, zinc, and other nutrients far beyond what food can supply.
*	Millions of dieting Americans have poor nutrient intake, thus compounding the deficiencies created by the metabolic demands of weight loss.

In summary, the modern world presents us with unique circumstances wherein the nutritional demands of most people in the industrialized West cannot be met by a balanced diet alone. It is, therefore, more important than ever that we equip ourselves for a long and healthy life by eating a balanced diet and by consistently taking high-quality nutritional supplements.

 

Dr. Bart Moore graduated from medical school at the University of Colorado, and completed his residency training in family practice at Florida Hospital in Orlando. Awarded a fellowship from the Kellogg Foundation, he completed his master's degree in public health from Loma Linda University in California.

 

Janet Moore is a registered nurse.