Food Supplements Europe (FSE) recently helped organize a virtual conference with media company Euractiv titled “The role of food supplements in improving health in the EU.” The panel discussion and online Q&A session, held April 28, covered topics such as nutrient deficiencies, the need for greater nutrition literacy, and how supplements can meet nutrient gaps in a way that can help reduce the burden on national health systems.

The lineup of speakers included: Sara Cerdas, member of the European Parliament and the ENVI Committee; Kerli Ats, member of Diversity Europe, the European Economic and Social Committee, and director of the Estonian Farmers’ Federation; Dr. Philip Calder, president of the Federation of European Nutrition Societies and Professor of Nutritional Immunology at the University of Southampton; and Dr. Bernd Haber, FSE board member.

Addressing attendees at the event, Haber called for policy stakeholders to put aside differences they have with the nutrition industry, and work together to develop integrated strategies that can tackle nutrition-related public health burdens.

“We understand there are different views about the importance of supplementation. However, it is also clear that there is much common ground between us. The longer we spend debating this topic between ourselves, the less time there is to focus on addressing the real problems at-hand. That’s why FSE invites anybody with an interest in this area to work with us to find solutions to these issues,” Haber said.

He pointed to a groundswell of clinical studies examining the health benefits of vitamin D.

“Many studies show clearly that vitamin D supplementation can reduce the risk of falling in the elderly population and avoid the resulting costs to healthcare services and the personal misery to so many people,” Haber said. “This role has been recognized by the European Food Safety Authority and World Health Organization. So, why is the intake of vitamin D through supplementation not more recognized and promoted in nutrition policy in the EU? This is the type of issue that needs serious discussion today among those involved in developing policy.”

Supplements are not the answer to every problem, he acknowledged. “We all share the same claim: to help EU citizens live healthier and happier lives. FSE is proposing a collective approach that puts our combined energy and expertise into identifying and implementing policies that deliver on this goal.”

Harmonization & Nutrition Literacy
Cerdas called for pan-EU harmonization of legislation as a key to establishing a safer marketplace. “Food supplements are not homogenous,” Cerdas said. “There are different terms and different definitions being used for dietary supplements, different regulatory agencies enforcing different sets of regulations, and differences in perspectives across professionals and consumers. Harmonization will be key to handle misinformation, and better translate evidence from paper to practice.”

Ultimately, “policy should provide people with the literacy and tools they need to make healthier choices,” Cerdas continued. “This has to go hand-in-hand with regulation and accessibility to care. It’s quite a demanding goal, and there might not be many resources for it, but as a politician, I’ll support regulations for these products guided by those ideas.”

For the EU supplements market to function properly, legislation should be applied uniformly “to support good products and remove unsafe products from the market,” according to Ats. “We advocate updating the definition of what a dietary supplement is, and setting up a strong food monitoring system that can collect adverse reactions. Ingredient safety should always be a top priority and substantiated by science. Information shown to consumers also needs to be accurate for them to take these products safely and particularly we need to step up the way consumers are communicated with in e-commerce.”

Calder said that while urging consumers to have a balanced diet most optimal for them to meet their nutritional needs is of paramount importance, policy makers need to understand that most people in the EU find it too difficult.

“When we think in nutritional terms, the word essential means nutrients that we need to get from the diet, which we can’t make ourselves,” he said. “Many other nutrients might not be classically essential, but our bodies struggle to make enough, such as vitamin D or omega-3s. We know that deficiencies in all of these nutrients leads to disease, but we also need to look at the gray area between sufficient and deficient, as subclinical deficiencies are also linked to impaired bodily functions.”

Across Europe, “most people have lower than recommended intakes of many of these nutrients, including vitamins D and E, folate, iodine, selenium, iron, and omega-3s,” Calder continued. “It is of course most desirable to get all of the nutrients we need from different foods, but we’re here to discuss when people can’t achieve this, and where supplements play a role.”

Quality and Safety First 
All four of the speakers, coming from government, consultancy, and the nutraceutical industry, agreed that the quality and safety of dietary supplements is of paramount importance when it comes to the way the EU develops its regulations.

For instance, Cerdas said, there are obvious differences between supplements prescribed by qualified healthcare professionals to people with deficiencies or in hospital settings, compared to many of the thousands of products appearing in grocery store shelves.

Part and parcel to safety, Cerdas said, is that consumers are accurately informed about the proper uses of supplements. Over-supplementation, or general misuse of these products, is a significant concern, she said.

According to Haber, however, consumer research by FSE “shows that most EU citizens are primarily using supplements in order to support their overall health. As more and more evidence comes out showcasing additional benefits of optimal nutritional status, we expect more consumers to start taking supplements.”

Things get more complicated when discussing the role of herbal and botanical supplements in human health, Calder noted. “The scientific community knows very little about the physiological actions of the wide variety of extracts, compared to vitamins. There are no recommended intake levels for any of these supplements, and the level of scientific understanding across different extracts varies substantially.”

Where Nutrition and Medicine Meet
The role that GPs and other health practitioners can play in improving nutrient status of patients was a prime topic of discussion at the event. Areas in which the medical community and those more aligned with nutrition can cooperate on both policy and practice are aplenty, according to the speakers, but not without certain challenges.

“I can’t speak for all GPs and health practitioners worldwide but the main message seems to be that a policy which supports a diversified and complete diet with the necessary intake of needed micronutrients is most important,” Cerdas said. “GPs can and do provide advice on nutrition, but only for specific clinical questions, and that differentiation between everyday use and specific clinical conditions is why GPs aren’t necessarily telling us to go to a supplement store.”

However, the medical community’s trust in dietary supplement companies seems to be opening up, noted Haber, with more frequent use of nutrient testing on patients than before, and an increase in physician recommendations to use supplements.

“I think it depends on the cultural setting,” Calder said, noting that in most cases, doctors are driven by mainstream and evidence-based recommendations, which is why prenatal supplementation is so strongly recommended.

“If it’s in a medical context, [doctors] will go with it, but they tend to shy away from recommendations for using them to support general health,” Calder said. “At one stage in time, nutrition was one of the hottest areas of medicine, with many common diseases of the 19th and early 20th centuries being related to nutrient deficiencies. We’re not talking about frank deficiency today, but a gray area of insufficiency. So, we’re not talking about acute disease, but impaired health functions which may, over time, increase disease risk.”

The medical community is also concerned about low-quality supplements and products that may interfere with medications, Ats noted.

Complicating this matter is the fact that food and medical agencies are separate, and have separate understanding about potential interactions between supplements and medications, noted Cerdas. “Both medical agencies and nutritionists are more well-aware of these interactions, compared to retailers and grocery stores. This is one key reason why supplements shouldn’t be merely viewed in the same context as food.”