Mark Knoll

By Mark A. Knoll, DC
Medical Director

I was recently with my wife at a doctor’s appointment. One aspect of her visit was this doctor’s review of her current medications and nutritional supplements. As he surveyed the long list of nutritional supplements that she takes, he asked her in bewilderment, “Why do you take all these vitamins?” She replied that they are part of her regimen of health maintenance. He then opined: “Vitamins are totally unnecessary as long as a person eats a normal healthy, balanced diet.” I was surprised of his opinion as this doctor was in his mid-thirties.

A few weeks later I came across an opinion piece in The Journal of the American Medical Association (JAMA). This piece was entitled, “Vitamins and Mineral Supplements: What Clinicians Need to Know”1. Highlights of this article are as follows: Vitamins are taken by 48% of adults, typically to maintain health and prevent disease. Most randomized clinical trials have not demonstrated any clear benefits for primary or secondary prevention of chronic disease not related to nutritional deficiency. Clinicians should highlight the many advantages of obtaining vitamins and minerals from food instead of from supplements.

Not surprisingly, the opinions in JAMA are very similar to those of my wife’s doctor. So, where exactly is the disconnect? Why do those in the natural health profession believe that nutritional supplements are an important part of a health regimen, but medical doctors find nutritional supplements totally unnecessary? Is it possible that MD’s in 2018 continue to have some of the same biases and misunderstanding regarding natural health that were present 30 years ago? Is the drug company bias so strong that it completely clouds their objectivity? Is it because the randomized clinical trials on vitamins and minerals are performed with inferior products? Or is it possible that those of us in natural health care have somehow been deceived?

In order to find some answers, I turned to some experts in the field of nutrition. One such person is Michael Murray, ND. In his book, Encyclopedia of Nutritional Supplements, Dr. Murray states that numerous studies have demonstrated that most Americans consume a diet, inadequate in nutritional value2. He goes on to state, “While most Americans are deficient in many vitamins and minerals, the level of deficiency is usually not to a point where obvious nutrient deficiencies are apparent. A subclinical or marginal deficiency indicates a deficiency of a particular vitamin or mineral that is not severe enough to produce a classic deficiency sign or symptom. In many instances the only clue of a subclinical nutrient deficiency may be fatigue, lethargy, difficulty in concentration, a lack of well-being or some other vague symptom.

James Chestnut, DC, an evidence-based doctor of chiropractic, clearly understands the nutritional deficiencies that most Americans face. In his book, The Wellness Prevention Paradigm, Dr. Chestnut uses an analogy he calls the “Rocks in our backpack stressor analogy”3. Stressors can be things such as poor diet, sedentary lifestyle, relational issues and environmental stressors. These are all examples of rocks in a person’s backpack. Dr. Chestnut identifies four nutritional supplements that he believes are essential for a wellness lifestyle. These include:

  • Fish Oil: A natural EPA: DHA ratio, natural triglyceride form, full fatty acid complements fish oil for essential fatty acids
  • Vitamin D
  • Probiotic: A non-dairy, wheat free, soy free, multistrain, probiotic that contains strains that are part of the normal human flora
  • Certified Organic Whole Food Micronutrient formula

So, after investigating both sides of this issue, I believe the disconnect occurs here. Medical doctors identify nutritional deficiencies based on clinical signs and symptoms. Because severe vitamin deficiencies, like scurvy, are extremely rare in America, medical doctors don’t realize the need for nutritional supplements. However, natural health experts tell us that the proliferation of fast food, a stressful lifestyle and food supplies that are nutrient deficient, creating the need for vitamin and mineral supplementation.

So, realize this is another area where the chiropractic and medical professions may disagree. I encourage you to use this information as an opportunity to discuss this subject with your medical colleagues. Help them to understand that just because an article in a prominent journal states an opinion, it doesn’t necessarily make it so.

  1. Manson, JoAnn, Bassuk, Shari. “Vitamins and Mineral Supplements: What Clinicians Need to Know” Journal of the American Medical Association (2018) ↩︎
  2. Murray, Michael. Encyclopedia of Nutritional Supplement (1996) ↩︎
  3. Chestnut, James. The Wellness Prevention Paradigm (2011) ↩︎