Supplements: The Real Story Natural or Synthetic? Foods or Tablets?

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 [1]. 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 [3]. Linus Pauling emphasized this fact, and explained how ordinary vitamin C, inexpensively manufactured from glucose, could improve health in many important ways [4]. 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 [5].

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 [6]. 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 .

Deficiency of vitamin C is very common. According to US Department of Agriculture (USDA) data, [7] 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. ( )

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 [8]. 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 [9] 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.[10] 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 [11]. 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. [12]

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 .

Food Factors

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 .

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:

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 at—Miracle-Cure/tabid/371/articleID/171328/Default.aspx or [ 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 at

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. ; scroll down to “Deficiency.”

10. Free, full text paper at (or )

11. Dean, C. (2007) The Magnesium Miracle. Ballantine Books, ISBN-13: 9780345494580



Nutritional Medicine is Orthomolecular Medicine

Orthomolecular medicine uses safe, effective nutritional therapy to fight illness. For more information:

Ingredient in red wine may prevent some blinding diseases

Resveratrol – found in red wine, grapes, blueberries, peanuts and other plants – stops out-of-control blood vessel growth in the eye, according to vision researchers at Washington University School of Medicine in St. Louis.

The discovery has implications for preserving vision in blinding eye diseases such as diabetic retinopathy and age-related macular degeneration, the leading cause of blindness in Americans over 50.

The formation of new blood vessels, called angiogenesis, also plays a key role in certain cancers and in atherosclerosis. Conducting experiments in mouse retinas, the researchers found that resveratrol can inhibit angiogenesis. Another surprise was the pathway through which resveratrol blocked angiogenesis. The findings are reported in the July issue of the American Journal of Pathology.

“A great deal of research has identified resveratrol as an anti-aging compound, and given our interest in age-related eye disease, we wanted to find out whether there was a link,” says Washington University retina specialist Rajendra S. Apte, MD, PhD, the study’s senior investigator. “There were reports on resveratrol’s effects on blood vessels in other parts of the body, but there was no evidence that it had any effects within the eye.”

The investigators studied mice that develop abnormal blood vessels in the retina after laser treatment. Apte’s team found that when the mice were given resveratrol, the abnormal blood vessels began to disappear.

Examining the blood-vessel cells in the laboratory, they identified a pathway – known as a eukaryotic elongation factor-2 kinase (eEF2) regulated pathway – that was responsible for the compound’s protective effects. That was a surprise because past research involving resveratrol’s anti-aging effects had implicated a different mechanism that these experiments showed not to be involved.

“We have identified a novel pathway that could become a new target for therapies,” Apte says. “And we believe the pathway may be involved both in age-related eye disease and in other diseases where angiogenesis plays a destructive role.”

Previous research into resveratrol’s influence on aging and obesity had identified interactions between the red-wine compound and a group of proteins called sirtuins. Those proteins were not related to resveratrol’s effects on abnormal blood vessel formation. Instead, the researchers say that in addition to investigating resveratrol as a potential therapy, they also want to look more closely at the eEF2 pathway to determine whether it might provide a new set of targets for therapies, both for eye disease and other problems related to abnormal angiogenesis.

Apte, an assistant professor of ophthalmology and visual sciences and of developmental biology, says because resveratrol is given orally, patients may prefer it to many current treatments for retinal disease, which involve eye injections. The compound also is easily absorbed in the body.

In mice, resveratrol was effective both at preventing new blood vessels and at eliminating abnormal blood vessels that already had begun to develop.

“This could potentially be a preventive therapy in high-risk patients,” he says. “And because it worked on existing, abnormal blood vessels in the animals, it may be a therapy that can be started after angiogenesis already is causing damage.”

Apte stresses that the mouse model of macular degeneration they used is not identical to the disease in human eyes. In addition, the mice received large resveratrol doses, much more than would be found in several bottles of red wine. If resveratrol therapy is tried in people with eye disease, it would need to be given in pill form because of the high doses required, Apte says.

There are three major eye diseases that resveratrol treatment may help: age-related macular degeneration, diabetic retinopathy and retinopathy of prematurity. Age-related macular degeneration involves the development of abnormal blood vessels beneath the center of the retina. It accounts for more than 40 percent of blindness among the elderly in nursing homes, and as baby boomers get older, the problem is expected to grow, with at least 8 million cases predicted by the year 2020.

In diabetic retinopathy, those blood vessels don’t develop beneath the retina. They grow into the retina itself. Diabetic retinopathy causes vision loss in about 20 percent of patients with diabetes. Almost 24 million people have diabetes in the United States alone.

Retinopathy of prematurity occurs when premature babies with immature retinas experience an obstruction in blood flow into the retina. In response, those children often develop abnormal blood vessels that can cause retinal detachment and interfere with vision. Worldwide, that condition blinds 50,000 newborn babies each year.

Apte says the pathway his laboratory has identified may be active not only in those blinding eye diseases, but in cancers and atherosclerosis as well. If so, then one day it might be possible to use resveratrol to improve eyesight and to prevent cardiovascular disease and some types of cancer, too.

Khan AA, Dace DS, Ryazanov AG, Kelly J, Apte RS. Resveratrol regulates pathologic angiogenesis by a eukaryotic elongation factor-2 kinase-regulated pathway, American Journal of Pathology, vol. 177, pp. 481-492. July, 2010. DOI:10.2353/ajpath.2010.090836

Omega-3 Kills Cancer Cells

Docosahexanoic acid (DHA), an omega-3 fatty acid found in fish oils, has been shown to reduce the size of tumors and enhance the positive effects of the chemotherapy drug cisplatin, while limiting its harmful side effects. The rat experiments provide some support for the plethora of health benefits often ascribed to omega-3 acids.

Professor A. M. El-Mowafy led a team of researchers from Mansoura University, Egypt, who studied DHA’s effects on solid tumors growing in mice, as well as investigating how this fatty acid interacts with cisplatin, a chemotherapy drug that is known to cause kidney damage. El-Mowafy said, “DHA elicited prominent chemopreventive effects on its own, and appreciably augmented those of cisplatin as well. Furthermore, this study is the first to reveal that DHA can obliterate lethal cisplatin-induced nephrotoxicity and renal tissue injury.”

DHA is an omega-3 fatty acid that is commonly found in cold-water fish oil, and some vegetable oils. It is a major component of brain gray matter and of the retina in most mammalian species and is considered essential for normal neurological and cellular developments. According to the authors, “While DHA has been tentatively linked with protection against cardiovascular, neurological and neoplastic diseases, there exists a paucity of research information, in particular regarding its interactions with existing chemotherapy drugs”. The researchers found that, at the molecular level, DHA acts by reducing leukocytosis (white blood cell accumulation), systemic inflammation, and oxidative stress – all processes that have been linked with tumour growth.

El-Mowafy and his colleagues have called for greater deployment of omega-3 in the fight against cancer. They write, “Our results suggest a new, fruitful drug regimen in the management of solid tumors based on combining cisplatin, and possibly other chemotherapeutics, with DHA

ScienceDaily (Apr. 5, 2009)

Why Fish Oils Help With Conditions Like Rheumatoid Arthritis How They Could Help Even More

New research from Queen Mary, University of London and Harvard Medical School has revealed precisely why taking fish oils can help with conditions like rheumatoid arthritis.

In a paper published in Nature October 28, researchers describe how the body converts an ingredient found in fish oils into another chemical called Resolvin D2 and how this chemical reduces the inflammation that leads to a variety of diseases.

The research also suggests that Resolvin D2 could be the basis for a new treatment for diseases including sepsis, stroke and arthritis. Unlike other anti-inflammatory drugs, this chemical does not seem to suppress the immune system.

The researchers, who were funded by the Arthritis Research Campaign, the Wellcome Trust and the National Institutes of Health, looked at a particular ingredient of fish oils called DHA. They were able to show how the body converts DHA* into Resolvin D2 and discover its exact chemical structure.

Mauro Perretti, Professor of Immunopharmacology at Queen Mary, University of London, led the UK team. He said: “We have known for some time that fish oils can help with conditions like arthritis which are linked to inflammation. What we’ve shown here is how the body processes a particular ingredient of fish oils into Resolvin D2. We’ve also looked in detail at this chemical, determining at least some of the ways it relieves inflammation. It seems to be a very powerful chemical and a small amount can have a large effect.”

“This research is important because it explains at least one way in which fish oils can help in different types of arthritis. We can also work on this chemical and see if it can be used not only to treat or even prevent arthritis, but also as a possible treatment for a variety of other diseases associated with inflammation.”

Arthritis, and many other diseases, are caused by inflammation. This means that the body’s natural defenses against infections are mistakenly directed at healthy tissue.

Previous research has shown that a crucial step in this process occurs when white blood cells, called leukocytes, stick to the inner lining of the blood vessels, called the endothelium.

Researchers studied these blood cells and how they interact with the endothelium in the lab. When they added Resolvin D2 they found that the endothelial cells produced small amounts of nitric oxide, which acts as a chemical signal discouraging the white blood cells from sticking to the endothelial cells and preventing inflammation.

*DHA (docosahexaenoic acid) is an omega-3 fatty acid. Fish oils are a rich source of DHA.

ScienceDaily (Oct. 28, 2009)

Diet High In Omega-3 Fatty Acids May Help Prevent A Leading Cause Of Blindness Among Elderly

Current research suggests that a diet high in omega-3 fatty acids may help prevent one of the leading causes of legal blindness among the elderly. The related report by Tuo et al, “A high omega-3 fatty acid diet reduces retinal lesions in a murine model of macular degeneration,” appears in the August 2009 issue of the American Journal of Pathology.

Age-related macular degeneration (AMD), loss of vision in the center of the visual field (macula) due to retinal damage, is one of the leading causes of legal blindness among the elderly. Approximately 10% of people from 66 to 74 years of age will develop some level of macular degeneration, making it difficult for them to read or even recognize faces.

A diet high in omega-3 fatty acids has been found to protect against a variety of diseases including atherosclerosis and Alzheimer’s disease. Retrospective studies have suggested that diets high in fish oil or omega-3 fatty acids may also contribute to protection against AMD. A group led by Dr. Chi-Chao Chan at the National Eye Institute in Bethesda, MD examined the direct effect of omega-3 fatty acids on a mouse model of AMD. A diet with high levels of omega-3 fatty acids resulted in slower lesion progression, with improvement in some lesions. These mice had lower levels of inflammatory molecules and higher levels of anti-inflammatory molecules, which may explain this protective effect.

Tuo et al suggest that “a diet enriched in EPA and DHA can ameliorate the progression of retinal lesions in their mouse model of AMD” and that “the results in these mice are in line with the epidemiological studies of AMD risk reduction by long chain n-3 fatty acids.” The results “further provide the scientific basis for the application of omega-3 fatty acids and their biologically active derivatives in the prevention and treatment of AMD.” In future studies, Dr. Chan and colleagues plan to use this murine model “to evaluate [other] therapies that might delay the development of AMD.” Their ongoing projects include the “testing of systematic delivered pharmacochaperones and antioxidative molecules, as well as intraocularly delivered gene therapies.”

ScienceDaily (July 25, 2009)