Supplements: The Real Story. Natural or Synthetic? Foods or Tablets?
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It's a nutritional "Catch 22": The public is told, confusingly: "Vitamins are good, but vitamin supplements are not. Only vitamins from food will help you. So just eat a good diet. Do not take supplements! But by the way, there is no difference between natural and synthetic vitamins."
Wait a minute. What's the real story here?
A recent health study reported that the risk of heart failure decreased with increasing blood levels of vitamin C . The benefit of vitamin C (ascorbate) was highly significant. Persons with the lowest plasma levels of ascorbate had the highest risk of heart failure, and persons with the highest levels of vitamin C had the lowest risk of heart failure. This finding confirms the knowledge derived over the last 50 years that vitamin C is a major essential factor in cardiovascular health [2,3]. The study raises several important questions about diet and vitamin supplements.
Was it Food or Supplements?
The report discussed vitamin C as if it were simply an indicator of how many fruits and vegetables were consumed by the participants. Yet, ironically, the study's results show little improvement in the risk for heart failure from consuming fruits and vegetables. This implies that the real factor in reducing the risk was indeed the amount of vitamin C consumed. Moreover, the study appears to utterly ignore the widespread use of vitamin C supplements to improve cardiovascular health. In fact, out of four quartile groups, the quartile with the highest plasma vitamin C had six to ten times the rate of vitamin C supplementation of the lowest quartile, but this fact was not emphasized. This type of selective attention to food sources of vitamin C, while dismissing supplements as an important source, appears to be an attempt to marginalize the importance of vitamin supplements.
Many medical and nutritional reports have maintained that there is little difference between natural and synthetic vitamins. This is known to be true for some essential nutrients. The ascorbate found in widely available vitamin C tablets is identical to the ascorbate found in fruits and vegetables . Linus Pauling emphasized this fact, and explained how ordinary vitamin C, inexpensively manufactured from glucose, could improve health in many important ways . Indeed, the above-mentioned study specifically measured the plasma level of ascorbate, which was shown to be an important factor associated with lower risk of heart failure [1, 2]. The study did not measure blood plasma levels of the components of fruits and vegetables. It measured vitamin C.
A known rationale for this dramatic finding is that vitamin C helps to prevent inflammation in the arteries by several mechanisms. It is a necessary co-factor for the synthesis of collagen, which is a major component of arteries. Vitamin C is also an important antioxidant throughout the body that can help to recycle other antioxidants like vitamin E and glutathione in the artery walls [2,3]. This was underscored by a report that high plasma levels of vitamin C are associated with a 50% reduction in risk for stroke .
Yes, Synthetic Vitamin C is Clinically Effective
We can almost hear "Unsubscribe" links being clicked as we state it, but here it is: synthetic vitamin C works, in real people with real illnesses. Ascorbate's efficacy has little direct relation to food intake. A dramatic case of this was a dairy farmer in New Zealand who was on life support with lung whiteout, kidney failure, leukemia and swine flu . He was given 100,000 mg of vitamin C daily and his life was saved. We have nothing against oranges or other vitamin C-containing foods. Fruits and vegetables are good for you for many, many reasons. However, you'll need to get out your calculator to help you figure out how many oranges it would take to get that much, and then also figure how to get a sick person to eat them all.
It is established that liver function improves with vitamin C supplementation, and it is equally well known that adequate levels of vitamin C are essential for the proper functioning of the immune system. Vitamin C improves the ability of the white blood cells to fight bacteria and viruses. OMNS has more articles expanding on this topic, available for free access at http://orthomolecular.org/resources/omns/index.shtml .
Deficiency of vitamin C is very common. According to US Department of Agriculture (USDA) data,  nearly half of Americans do not get even the US RDA of vitamin C, which is a mere 90 mg.
Synthetic Vitamin E is Less Effective
For some other nutrients, there is a significant difference in efficacy between synthetic and natural forms. Vitamin E is a crucial anti-oxidant, but also has other functions in the body, not all well understood. It comprises eight different biochemical forms, alpha-, beta-, delta- and gamma tocopherols, and alpha-, beta-, delta-, and gamma-tocotrienols. All of these forms of vitamin E are important for the body. Current knowledge about the function of vitamin E is rapidly expanding, and each of the eight forms of natural vitamin E is thought to have a slightly different function in the body. For example, gamma-tocotrienol actually kills prostate cancer stem cells better than chemotherapy does. (See here.)
Synthetic vitamin E is widely available and inexpensive. It is "DL-alpha-tocopherol." Yes, it has the same antioxidant properties in test tube experiments as does the natural "D-alpha-tocopherol" form. However, the DL- form has only 50% of the biological efficacy, because the body utilizes only the natural D isomer, which comprises half of the synthetic mix . Therefore, studies utilizing DL-alpha-tocopherol that do not take this fact into account are starting with an already-halved dose that will naturally lead to a reduction in the observed efficacy.
Then there are the esterified forms of vitamin E such as acetate or succinate. These esterified forms, either natural or synthetic, have a greater shelf life because the ester protects the vitamin E from being oxidized and neutralized. When acid in the stomach cleaves the acetate or succinate component from the original natural vitamin E molecule, the gut can then absorb a good fraction and the body receives its antioxidant benefit. But when esterified vitamin E acetate is applied to the skin to prevent inflammation, it is ineffective because there is no acid present to remove the acetate ester.
Based on USDA data  an astonishing 90% of Americans do not get the RDA of vitamin E, which is, believe it or not, under 23 IU (15mg) per day.
Magnesium Deficiency is Widespread
Magnesium is another example. Over two-thirds of the population do not get the RDA of magnesium. Deficiency can cause a wide variety of symptoms, including osteoporosis, high blood pressure, heart disease, asthma, depression, and diabetes. Magnesium can be purchased in many forms. The most widely available form is magnesium oxide, which is not very effective because it is only about 5% absorbed . Magnesium oxide supplements are popular because the pills are smaller -- they contain more magnesium, but won't help most people. Better forms of magnesium are magnesium citrate, magnesium malate, and the best absorbed is magnesium chloride. It's always good to consult your doctor to determine your ideal intake. Testing may reveal unexpected deficiency. 
Well, Which? Natural or Synthetic?
While the natural form of vitamin E (mixed natural tocopherols and tocotrienols) is at least twice as effective as the synthetic form, this is not true of vitamin C. The ascorbate that the body gets from fruits and vegetables is the same as the ascorbate in vitamin C tablets. On first thought, this may sound confusing, because there are many so-called "natural" forms of vitamin C widely available. But virtually every study that demonstrated that supplemental vitamin C fights illness used plain, cheap, synthetic ascorbic acid. Other forms of ascorbate, for instance, the sodium or magnesium salt of ascorbic acid, are digested slightly differently by the gut, but once the ascorbate molecule is absorbed from these forms, it has identical efficacy. The advantage of these ascorbate salts is that they are non-acidic and can be ingested or topically applied to any part of the body without concern about irritation from acidity.
Further, it is known that essential nutrients are symbiotic, that is, they are more effective when taken as a group in proper doses. For example, vitamin E is more effective when taken along with vitamin C and selenium, because each of these essential nutrients can improve the efficacy of the others. Similarly, the B vitamins are more effective when taken together. Readers with dosage questions will want to consult their healthcare provider, and also look at freely available information archived at http://orthomolecular.org/resources/omns/index.shtml .
Natural food factors are also important. Bioflavonoids and other vitamin C-friendly components in fresh fruits and vegetables (sometimes called "vitamin C complex") do indeed have health benefits. These natural components are easily obtained from a healthy, unprocessed whole foods diet. However, eating even a very good diet does not supply nearly enough vitamin C to be effective against illness. A really good diet might provide several hundred milligrams of vitamin C daily. An extreme raw food diet might provide two or three thousand milligrams of vitamin C, but this is not practical for most people. Supplementation, with a good diet, is.
The principle that "natural" vitamins are better than synthetic vitamins is a widely quoted justification for actually avoiding vitamin supplements. The argument goes, because vitamins and minerals are available from food in their natural form, that somehow one might suppose that we are best off by ignoring supplements. Apparently this is what the authors of the above-mentioned study had in mind, because the report hardly mentions vitamin supplements.
In the real world of today's processed food, most of us don't get all the nutrients we need in adequate doses. Most people are deficient in several of the essential nutrients. These deficiencies are responsible for much suffering, including heart disease, cancer, premature aging, dementia, diabetes, and other diseases such as eye disease, multiple sclerosis and asthma. The above-mentioned study showing the efficacy of vitamin C in reducing heart failure is but one of the many studies showing the value of vitamins. Others are discussed and available at http://orthomolecular.org/resources/omns/index.shtml .
For vitamin E, the natural form, taken in adequate doses along with a nutritious diet, is the best medicine. However, for most vitamins, including vitamin C, the manufactured form is identical to the natural one. Both are biologically active and both work clinically. It all comes down to dose. Supplements enable optimum intake; foods alone do not.
Don't be fooled: nutrient deficiency is the rule, not the exception. That's why we need supplements. When ill, we need them even more.
1. Pfister R, Sharp SJ, Luben R, Wareham NJ, Khaw KT. (2011) Plasma vitamin C predicts incident heart failure in men and women in European Prospective Investigation into Cancer and Nutrition-Norfolk prospective study. Am Heart J. 162:246-253. See also here.
2. Levy TE (2006) Stop America's #1 Killer: Reversible Vitamin Deficiency Found to be Origin of All Coronary Heart Disease. ISBN-13: 9780977952007
3. Hickey S, Saul AW (2008) Vitamin C: The Real Story, the Remarkable and Controversial Healing Factor. Basic Health Publications, ISBN-13: 978-1591202233.
4. Pauling L. (2006) How to Live Longer And Feel Better. Oregon State University Press, Corvallis, OR. ISBN-13: 9780870710964.
5. Kurl S, Tuomainen TP, Laukkanen JA, Nyyssönen K, Lakka T, Sivenius J, Salonen JT. (2002) Plasma vitamin C modifies the association between hypertension and risk of stroke. Stroke. 33:1568-1573.
6. Watch the Channel 3 New Zealand news report here and here. [Note that each video is proceeded by a commercial, over which we have no control, and with which we have no financial connection whatsoever. ]
7. Free, full text paper here.
8. Papas A. (1999) The Vitamin E Factor: The miraculous antioxidant for the prevention and treatment of heart disease, cancer, and aging. HarperCollins, NY. ISBN-13: 9780060984434
9. Here - scroll down to "Deficiency."
11. Dean, C. (2007) The Magnesium Miracle. Ballantine Books, ISBN-13: 9780345494580
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The peer-reviewed Orthomolecular Medicine News Service is a non-profit and non-commercial informational resource.
First published in February 2012