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HEALTH| 26.05.2021

“Up to 75 percent of Spaniards take some kind of nutritional supplement; most of them prescription”

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As MAPFRE is committed to health and well-being, we address these topics in a recent interview with Eduard Baladia, coordinator of the Spanish Academy of Nutrition and Dietetics, which collaborated in a recent study with Fundación MAPFRE. He highlighted that the best-selling nutritional supplements during the COVID-19 pandemic have been vitamin C and D, antioxidants, selenium and zinc—all nutrients associated with immunity.

How have we changed in terms of what we eat? Would you say we feed ourselves better or worse?

Human behavior is generally complex, and people often respond differently to the same stimuli. According to published studies [i], the increase in “eating at home” due to us not being able to go to bars and restaurants has somewhat improved the way some people eat, whereas anxiety, burnout and depression may have worsened the eating habits of others. What’s more, emotional eating (change in consumption based on emotions) and eating disorders have also been present. I would say that we have had a little bit of everything: some eating habits have improved, others have worsened, some people have resorted to comfort eating, and some have experienced negative feelings after eating. It is worth noting that other lifestyles that have an impact on health and food have also changed. For example, the population is generally considered to be less physically active, and this aspect is closely related to eating habits. Finally, we must bear in mind that the pandemic has affected continuity for people receiving treatment, and this can also increase the burden of their respective illnesses.

“That we have had a little bit of everything: some eating habits have improved, others have worsened, some people have resorted to comfort eating, and some have experienced negative feelings after eating”
72 percent of consumers acknowledge that they spend less money at bars and restaurants than they did before the pandemic. Another fact: spending on vitamins, minerals and food supplements soared in 2020, at a rate of 75.4 percent (according to data from an IRI study) in value compared to the previous year. What other key aspects stand out in this period?

Interpreting consumption data can be difficult. I would like to think that spending less at bars and restaurants simply means that these establishments have remained under numerous access restrictions, and that this therefore leads to improved nutrition at home. In fact, some studies have found that this is indeed the case in one sector of the population. However, this is also likely due to increased poverty or a decreased income for families. We must also talk more about the increase in social inequalities created by the pandemic and, as a result, we must discuss food insecurity and families living on the brink of poverty in Spain. The pandemic has increased social inequalities, meaning that so much more work needs to be done with equity considerations in mind, as this undoubtedly impacts access to healthy foods. Those with lower incomes, the most vulnerable sectors, are the ones who will suffer the most and the ones whose diets will be most affected, both in terms of excessive eating (overweight and obesity) and lack of food (insufficient intake).

The use of supplements has increased prolifically. In my view, this is unfortunately due to three aspects: the inability of scientific and governmental communities to provide credible and effective advice to the population, due to the deep-rooted magical belief we have as humans in searching for a magic potion that will make us more immune, and finally, to a lack of proper regulatory legislation in this field.

The supplements that saw increased sales, such as vitamin C and D, antioxidants, selenium and zinc, are all nutrients associated with immunity. However, just because they are associated with immunity doesn’t mean that taking supplements will increase or improve our immunity, it just means that a deficiency in these nutrients could worsen our immune system, though we don’t know to what extent. An initial diagnosis to determine a deficiency sufficient enough to alter the immune system would first be required (and, in many cases, the level of deficiency necessary to impact the immune system is not clear). Only then would a supplement be recommended as required for instances where a deficiency has been detected.

“The pandemic has increased social inequalities, meaning that so much more work needs to be done with equity considerations in mind”
You have conducted an exhaustive study that revealed shocking data with regard to the unfounded consumption of supplements, which can also lead to serious complications. What health effects do these products have?

Yes. Data suggest that up to 75 percent of Spaniards are taking some kind of supplement. Following an extensive review of the literature, we discovered another problem whereby most supplements lacked sufficient studies to confirm the potential benefits attributed to them, and even worse, to certify that they are safe. Moreover, in some cases, we found quite common adverse effects after using nutritional supplements, such as gastrointestinal problems—nausea, abdominal pain, vomiting—and, in some cases (although not that common) we found significantly worse negative health impacts, such as liver and kidney problems. In addition to the lack of certainty surrounding potential benefits, and sometimes even signs of adverse effects, it is worth noting that if the people taking supplements are sick or ill and do not undergo proper treatment, in other words, they use supplements thinking that they’re effective when in reality they aren’t, this could lead to a situation whereby the severity of disease increases for these people and their quality of life worsens, which can ultimately impact on health and social costs (years of life lost).

What is the consumer profile for this type of product?

There are actually several profiles, depending on the type of product and purpose for which they are taken. Nutritional supplements (vitamins and minerals) and probiotics appear to be most commonly consumed by women aged between 26 and 35, and they also appear to be more commonly used among people with a college degree and those who have been on a diet.

Plant extracts and weight-loss products were also consumed more among women, were more common within a wider age range, between 18 and 50 years, and somewhat more common among university students and people who have been on a diet.

In contrast, sports products were more commonly consumed among men aged 18 to 45, whereby energy bars, protein powders, sports drinks and caffeine were the most consumed products.

Most people take them with the intent to improve their overall health.

What control measure or regulation do you miss? Nordic countries administer vitamins to combat conditions caused by lack of sunlight due to their climate. Why do you think that those countries don’t have such a high incidence of vitamin D deficiency, but in Spain, a sunny country, 40 percent of adults and 80 percent of those aged over 65 suffer from deficiencies?

Nordic countries fortify some basic foods with certain vitamins, such as vitamin D, to ensure a minimum intake. This prevents major deficiencies that would surely occur in such countries. The high incidence of vitamin D deficiency in Spain suggests several things: an overestimation of this incidence, a lack of physical activity outdoors, potentially overestimating the possibility of sun exposure (there is much less sun in some regions of Spain than in others, and some regions receive so much sun that people shouldn’t be exposed to it at high temperatures). Finally, I am sure that vitamin D deficiency is increasing among the elderly population who live alone or in care homes and who are unable to leave their homes. However, I don’t think fortifying basic foods in Spain is a cost-effective approach, and I’m even more certain that systematic supplementation should not be carried out in the form of vitamin D supplements. In any case, I think it’s best to assess each case by analyzing and estimating vitamin D intake, and provide supplements to people identified to be at risk of deficiency.

As an expert in the field, what should we do to take better care of our nutrition? What remains to be done?
In general, instead of searching for a miracle health potion, as a very good friend of mine and an excellent dietitian, Julio Basulto, said, we should be looking for a lifestyle that allows us to preserve the health with which we are born. This includes taking care of our nutrition, taking care of our physical activity, avoiding alcohol and not smoking, improving personal and working relationships, and so on.

Achieving this not only requires individual responsibility, but social responsibility (whereby your social environment—family, friends, work environment—helps you lead that healthy life). It also requires social responsibility from the government (legislation to promote healthy eating habits and physical activity, in addition to being able to make appointments with dietitians through the public health system), as well as a greater social responsibility from the corporate world (a more ethical industry that adjusts even unlegislated aspects to favor consumer health).

There are several gray areas surrounding legislation on supplements: nutritional supplements can currently be sold even though efficacy and safety tests are not required, sports products lack specific legislation, and plant extract-based products can be sold simply on the basis that they have been used for many years, rather than under the umbrella of science. We have a long way to go in terms of protecting consumers from a legal point of view. We cannot allow the burden of responsibility to lie with individuals (in terms of being well informed so as to subsequently make a decision).

How valuable do you think good dietitians are? Why aren’t they common figures in our lives?

A good dietitian doesn’t sell a single method that gives you better health. They don’t sell products unless they are strictly necessary and they’re scientifically proven for this purpose. In any case, it is worth emphasizing that most dietitians in our country have to live off their private consultations. This means that dietary-nutritional advice is provided by the best professionals in the field and is only available to those who can afford it. This conflicts with providing equitable health care in terms of nutrition, meaning that the most vulnerable are undoubtedly those who are most affected by these professionals not being part of the health system.