The amount of money spent on health care in the U.S. is astounding, a total that has been increasing yearly. So much effort put into attaining health: wouldn’t it make more sense to maintain it? This is a philosophical issue in many ways, but most Americans agree: we don’t practice enough health maintenance.

What makes for a healthy body? An argument for well-being should include a discussion of psychological health, but that won’t touched in this brief treatise. Many would answer by listing diet and exercise, and they would be doing well with this response. Sounds simple, doesn’t it? The complexities associated with each of the two topics could fill a book. Actually, that is a factual statement; it has filled many, each topic demanding its own section in the book store.

Despite these many excellent tomes, the level of ignorance amongst the public regarding proper nutrition is far too high. Many would argue this is partially the result of the misinformation dispensed by the federal government. Still, to this day, we continue to deal with the repercussions of the AMA’s food pyramid from the 80s, touting the importance of carbs as the foundation of your diet.

We have learned a lot about healthy eating. Still, it would be accurate to say there is much more to discover about our diet and its relationship with health. We know enough to say that what we eat effects our health, but we haven’t gotten to the point of being able to say specifically how foods cause or prevent disease. We know that a deficiency of certain substances can lead to disease. Everyone has heard of scurvy. In this day and age, such dramatic deficiencies in nutrition are not common. But how good is the nutritional intake of the average American? In a recent CDC study, 76 percent of adults don’t eat enough fruit and 87 percent of adults don’t eat enough vegetables.

This specific topic has been previously discussed herein, regarding the level of nutrients in foods today. Numerous studies have shown that this is a real cause for concern. How to combat this, other than eating the best diet possible and finding the best sources for your food that you can? One common thought is to supplement your foods with vitamins, those essential nutrients required for good health, since we may not be getting them in sufficient quantities in what we eat.

Americans love vitamins and consequently it has grown to become a nine billion dollar industry. The general thinking is that no matter how healthy you eat or what kind of diet you follow, it can be difficult for your body to get all the nutrients it needs from food, all the time. About half of adults take vitamins daily, according to the available data.

The National Health and Nutrition Examination Survey, the world’s most comprehensive nutritional database, concluded most women between the ages of 19 and 50, on average, aren’t getting enough of various essential nutrients. We know fairly conclusively that inadequate nutrition raises our risk for heart disease, stroke, cancer, and other health conditions. Several observational studies have found vitamin users to have a lower risk of heart disease. However, several others have found no connection. Overall, the evidence is mixed and unclear.

As to any dangers associated with taking vitamins, once again, there is no clear evidence. Certainly, in nature, too much of anything is a bad thing. Advocates of vitamin supplementation point to the lack of any proof that taking a vitamin for years carries any risk. The lack of evidence that vitamins are harmful doesn’t mean they’re safe. We simply don’t know the answers, as is the case with so many of the questions about nutrition and disease, diet and health.

Over the years, we have learned there are 13 vitamins and at least 16 minerals that are essential to health. Many of them participate in complex enzymatic reactions in the body. Some function as a hormone or a signaling molecule. The body needs these nutrients for reproduction, maintenance, growth and regulation of bodily processes. Regardless, many physicians are confident a healthy diet supplies everything the body needs, while others find compelling reasons to take a vitamin to assist in disease prevention (especially cancer and eye disease).

Bioavailability is a term referring to the amount of a nutrient that is available to the target tissue once it has been consumed or administered. There are a multitude of factors influencing how much of a given nutrient your body can use. Some of the more important things affecting bioavailability include the substance’s source, i.e. what materials are used to make it. Also important are the other foods eaten at the meal. Included in this discussion should be how the foods are processed and cooked. Bioavailability is also altered by genetics. Nutrigenomics is the term coined for this issue; how our genetics affect the processing of nutrients.

Because dietary supplements are not regulated by the Food and Drug Administration, vitamins may contain higher or lower levels of some nutrients than the label states. In some cases, they may not even contain all of the nutrients listed. There have been many cases of fraud in the supplement industry, so it is important to purchase from a reputable manufacturer. When possible, look for a company that does research or has published studies on the topic of nutrition, or at least has consultants involved in nutritional research.

One way to check on vitamin quality is to see whether a product is certified by one of several nonprofit organizations that check supplements for purity and quality. A company named Consumer Lab tests hundreds of vitamins each year and found that 30 percent of vitamins have a quality problem whereby the pills don’t have the stated amounts of the listed ingredients.

Vitamins and minerals interact in complex ways we do not yet fully understand. Yet it is believed for those who are chronically stressed, or have less than optimal immune system function, vitamins may provide some subtle assistance. Age is also an important factor in considering potential benefits of vitamin supplementation. Absorption of certain vitamins decreases as we age, in part because our body produces less stomach acid. Up to 30 percent of people over the age of 50 appear to produce inadequate amounts of stomach acid, leading to improper absorption of certain vitamins, especially B-12.

In summary, the evidence about vitamins is not all in. Large scale studies are ongoing, yet it remains difficult to draw definitive conclusions on such a complex subject. Vitamin therapy, and its benefits, will require further updates from future research. Still, we know a varied diet, based on vegetables such as the well-known Mediterranean diet, seems to be the average person’s best nutritional plan for health. Vitamin supplementation carries low risk and low cost. It may help to fill potential gaps in the diet that many people probably have. Taking vitamins is like an insurance policy, an inexpensive one, that increases the odds that your body gets the vitamins and minerals it needs. We buy insurance for the craziest things, health insurance being one of the costliest. Is it worth the cost of vitamins to supply the body with all those nutrient it needs?

Many obviously think so. But then again, we just don’t know.

Editor’s note: Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula, with a move of his Marquette office to the downtown area. McLean has lectured internationally on wound care and surgery, being double board certified in surgery, and also in wound care. He has a sub-specialty in foot-ankle orthotics. Dr. McLean welcomes questions or comments atdrcmclean@outlook.com.