There are numerous food supplements on the market, but whom are they
for? When are they beneficial, ineffective or even harmful? In this article we
explore the general recommendations on taking food supplements.
What are food suplements?
The idea behind food supplements, also called dietary or nutritional supplements, is
to deliver nutrients that may not be consumed in sufficient quantities. Food
supplements can be vitamins, minerals, amino acids, fatty acids, and other
substances delivered in the form of pills, tablets, capsules, liquid, etc.
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Supplements
are available in a range of doses, and in different combinations. However, only a
certain amount of each nutrient is needed for our bodies to function, and higher
amounts are not necessarily better. At high doses, some substances may have
adverse effects, and may become harmful. For the reason of safeguarding
consumers’ health, supplements can therefore only be legally sold with an
appropriate daily dose recommendation, and a warning statement not to exceed that
dose.
Supplement use varies in Europe. For example it is common in Germany and
Denmark (43% and 59% of the adult population respectively) but is less so in Ireland
and Spain (23% and 9% respectively). Women use supplements more than men.
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Who needs food supplements?
Supplements are not a substitute for a balanced healthy diet.
1
A diet that includes plenty of fruits, vegetables, whole grains,
adequate protein, and healthy fats should normally provide all the nutrients needed for good health. Most European countries
agree that messages aimed at the general public should focus on foodbased dietary guidelines.
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Supplements do not feature
in these guidelines, but there are certain population groups or individuals who may need advice about supplements, even when
they eat a healthy balanced diet, i.e. women of childbearing age, individuals on specific medications.
Partly due to our modern lifestyle, not everyone manages to eat a healthy diet. In Europe, dietary surveys have suggested
that there are suboptimal intakes for several micronutrients.
2,8
The EUfunded EURRECA project found inadequate intakes for
vitamin C, vitamin D, folic acid, calcium, selenium and iodine.
9
A recent comparison of national surveys showed widespread
concern about vitamin D intakes, whereas certain age groups are more likely to have low intakes of minerals.
2
For example,
there is concern about adequate intakes of iron amongst teenage girls in Denmark, France, Poland, Germany and the UK.
2
Poor iron status in young women also increases the risk of infants being born with lowbirth weight, iron deficiency and delayed
brain development.
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Folate status is also critical for women who may become pregnant. They are advised to take folic acid
before conception, and continue for the first 12 weeks of pregnancy. An adequate folate status can decrease the risk of having
a baby with neural tube defects such as spina bifida. Recent research suggests that 50–70% of Europeans have poor
status.
2,11,12
Since vitamin D status is dependent not only on dietary intake but also exposure to UV light, there may be a
stronger case for advising supplements for vitamin D in Northern European countries. In some countries (including UK, Ireland,
the Netherlands and Sweden) there are already recommendations for certain groups in the population to take a vitamin D
supplement, although there are calls for more research.
Other common concerns are shown in Table 1, although groups considered at risk are not the same in different countries.
Table 1: Examples of population groups requiring specific advice about supplements
Particular risks for specific population groups
Food supplements: who needs them and when?
Population group
Nutrients
People over age 50
Vitamin D, Vitamin B
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, folate
Frail elderly may benefit from a lowdose
multivitamin supplement.
Women of childbearing age
Folic acid and vitamin D, possibly iron
Children under age 5
Vitamin A, vitamin C, vitamin D, although
children with a good appetite who eat a wide
variety of food may not need them.
Breastfeeding women
Vitamin D
People who cover their skin,
are darkskinned, or are
housebound
Vitamin D
Vegans
Vitamin B
12,
vitamin D
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Despite having a role in the health of some individuals, not all supplements are useful for everybody. In fact, for some people,
it is not advisable to take certain supplements, in particular in high doses. Some studies show multivitamins can contribute to
an increased risk of excessive nutrient intakes, and it has been suggested that multivitamins should be formulated with greater
consideration for the intakes of micronutrients from foods.
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Individuals should pay particular attention to reading the label and
assure that a supplement is suitable for them. For pregnant woman, for example, supplements containing vitamin A (retinol)
including fish liver oil may be harmful and cause birth defects if the recommended dose is greatly exceeded, or exceeded over
an extended period of time.
Studies have also highlighted that smokers should be wary of some supplements, in particular high doses of betacarotene.
The European Food Safety Authority (EFSA) has considered the evidence in this area and has concluded that exposure to β
carotene below 15 mg/day is safe in the general population, including smokers.
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Conclusion
Some population groups are advised to take specific supplements. The overall message is: follow a healthy, balanced diet,
carefully read labels of supplements and fortified foods, and avoid taking multiple doses that exceed the Recommended Daily
Amounts (RDAs). In case of doubt, seek advice from a dietitian or medical doctor before choosing a dietary supplement.
References
1. European Commission, Food supplements section
http://ec.europa.eu/food/food/labellingnutrition/supplements/
2. Mensink GB, Fletcher R, Gurinovic M, et al. (2012). Mapping low intake of micronutrients across Europe. British Journal
of Nutrition 14:119.
3. Beitz R, Mensink GB, Rams S, et al. (2004). Vitamin und Mineralstoffsupplementierung in Deutschland (Use of vitamin
and mineral supplements in Germany). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 47:1057–
1065.
4. Tetens I, BiltoftJensen A, Spagner C, et al. (2011). Intake of micronutrients among Danish adult users and nonusers
of dietary supplements. Food & Nutrition Research 55:7153.
5.
Kiely M (2001). North/South Ireland Food Consumption Survey. Summary Report on Food and Nutrient
Intakes, Anthropometry, Attitudinal Data & Physical Activity Patterns. Irish Universities Nutrition
6. Rovira MA, Grau M, Castañer O, et al. (2013). Dietary supplement use and healthrelated behaviors in a Mediterranean
population. Journal of Nutrition Education and Behavior 45(5):386391.
7.
EUFIC Review (2009). FoodBased Dietary Guidelines in Europe.
8. Troesch B (2012). Dietary surveys indicate vitamin intakes below recommendations are common in representative
Western countries. British Journal of Nutrition 108(4):6928.
9. EU project EURRECA website:
10. Radlowski EC & Johnson RW (2013). Perinatal iron deficiency and neurocognitive development. Frontiers in Human
Neuroscience 7:585.
11. Ovesen L, Andersen R & Jakobsen J (2003). Geographical differences in vitamin D status, with particular reference to
European countries. Proceedings of the Nutrition Society 62(4):813821.
12. PérezLópez FR, Brincat M, Erel CT, et al. (2012). EMAS position statement: Vitamin D and postmenopausal Health.
Maturitas 71:8388.
13.
EFSA (2012). Statement on the safety of βcarotene use in heavy smokers. EFSA Journal 10(12):2953.
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Despite the integrity of the majority of the food industry and their
commitment to consumer protection and consumer confidence, the issue
of food fraud has gained attention in recent times. Although EU food law
is very detailed with respect to food safety (including controls and tests
in areas such as residues and other contaminants of food and feed),
there is no framework in place specifically to target food fraud, other
than the general stipulation that consumers may not be misled. To
address this issue, effective measures are being identified to further
strengthen European rules and controls. Several of these are reflected
in the EU Action Plan to tackle food fraud.
Food fraud
Food fraud is committed when food is deliberately placed on the market with the
intention of financial gain through consumer deception.
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Recent examples
include the undeclared substitution of horse meat in beef products, the addition
of melamine to milk and infant formula and the adulteration of chili powder with
Sudan Red. To date, there is no clear definition of “food fraud” in European
legislation.
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Routine monitoring and surveillance programmes are performed by national
regulatory authorities across Europe to monitor foods on the market and to
ensure that they comply with the requirements of food law and are safe to eat.
Horse meat in beef products
On January 15th 2013, the
Food Safety Authority of Ireland (FSAI)
reported findings from an authenticity study of meat
products, which revealed the presence of horse DNA in frozen beef burgers sold in several Irish supermarkets.
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Of the 27
frozen beef burgers tested, 37% tested positive for horse DNA. One of the sampled beef burgers contained 29% horse meat.
These burgers were labelled as containing beef, not horse meat.
The FSAI uncovered what eventually transpired to be a panEuropean problem of adulterated beef products across many
Member States. These findings resulted in extensive investigations and led to the recall of millions of burgers and ready meals
from supermarket shelves around Europe.
Antifraud measures
The EU already has extensive controls and legislation in place to govern food traceability and labelling.
4,5
However, the horse
meat incident shed new light on fraudulent practices and the necessity to strengthen controls. The European Commission (EC)
proposed an action plan to address the shortcomings identified in Europe’s food supply chain.
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This action plan aims to restore
consumers’ and trading partners’ confidence, by strengthening several controls against fraudulent practices. This action plan
was used as a basis for the Motion for a European Parliament Resolution on food crisis, fraud in the food chain and control
thereof (2013/2091(INI)).
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The EC action plan consists of a series of actions which fall within the following five areas (some of
these actions have already been implemented; others are to be implemented by 2014);
1. Food Fraud
The aim is to reinforce the EC’s capacity to address food fraud and therefore protect the interests of consumers. Upon
discovering that some processed foods labelled as 100% beef actually contained horse meat, food safety authorities
throughout Europe were able to swiftly exchange information through an existing database called
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As a result, the fraudulent products were swiftly traced and withdrawn from the market. The
EC envisages extending the scope of RASFF to help fight food fraud, by creating a dedicated IT tool, which will facilitate the
rapid and crossborder exchange of information on intentional violations of food chain rules.
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2. Testing Programme
i) DNA testing of products:
A coordinated, EUwide testing program was conducted for horsemeat DNA.
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Testing was conducted of food destined for the
end consumer and marketed as containing beef. Thousands of DNA tests were carried out by the competent authorities and by
food business operators (producers, processors and distributors) in 27 EU countries. Less than 5% of these tests revealed
positive traces of horsemeat DNA.
ii) Testing for phenylbutazone residues:
Testing was also conducted for phenylbutazone in equine carcasses.
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Phenylbutazone is an antiinflammatory drug used as a
painkiller in veterinary medicine. It is not authorised for use in foodproducing animals in the EU. Results revealed that
approximately 0.5% of the equine carcasses tested were found to be contaminated with phenylbutazone.
Overall, the European Commission concluded that ‘the positive samples found in relation to horsemeat DNA combined with the
very low levels of phenylbutazone detected represents a small part of the overall production in EU’.
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In addition, a joint
statement published by the European Food Safety Authority (EFSA) and the European Medicines Agency (EMA) on 15 April 2013
concluded that the risks associated with phenylbutazone were of “low concern for consumers”.
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3. Horse passport
The issuing of horse passports and the overall monitoring and regulation of horses in Europe came to the fore as a result of the
horse meat fraud. Currently, horse passports may be issued by numerous bodies within each Member State
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; however, the
EC is now proposing to transfer the issuing of passports entirely to the competent authority within each Member State in order
to reduce the number of passport issuing bodies.
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Additionally, the recording of horse passports in a central national database
will be mandatory. The intention is that this database will be used at abattoirs to verify the authenticity of the passport for each
horse and to record its date of slaughter. Legislative changes have already been proposed.
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4. Origin labelling
European Union Action Plan to tackle food fraud
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The EC plans to introduce more effective labelling rules.
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Better food labelling allows consumers to make an informed
purchasing choice. The proposals include an extension of the mandatory origin labelling rules (the exact requirements are to
be defined by the European Commission; however, in the case of some meats it may include indicating place of rearing and
place of slaughter).
5. Official controls, implementations and penalties
The EC has proposed that where financial penalties are used in relation to food fraud, they are at a level which is higher than
the economic gain expected from the fraud. They have also proposed that Member States conduct mandatory unannounced
official controls (including inspections and testing) directed at combating food fraud.
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Conclusion
The horse meat incident has been an important lesson for food businesses and regulators across Europe. It has demonstrated
the importance of proper controls and dissuasive measures. The coordinated official controls, increased random testing and
tougher financial penalties brought about by the implementation of the 5point action plan should lead to a positive outcome for
consumers; making it both more difficult and sufficiently deterrent for those who deliberately try to cheat and commit fraud
along the food chain.
For more information:
Council of the European Union (2013). Commission actions in the field of food fraud.
References
1. Everstine K, Spink J, Kennedy S (2013). Economically motivated adulteration (EMA) of food: common characteristics of
EMA incidents. Journal of Food Protection 76:72335. doi: 10.4315/0362028X.JFP12399.
2.
on the food crisis, fraud in the food chain and the control thereof (2013/2091(INI)).
3.
Food Safety Authority Ireland (2013). Press release: FSAI survey finds horse DNA in some beef burger
4.
Regulation (EC) No 178/2002 of the European Parliament and of the Council of 28 January 2002 laying
down the general principles and requirements of food law, establishing the European Food Safety
Authority and laying down procedures in matters of food safety (L 31/1).
5.
Regulation (EU) No 1169/2011 of the European Parliament and of the Council of 25 October 2011 on the
provision of food information to consumers.
6.
European Commission website, Food and Feed Safety section.
7.
European Commission MEMO/13/524 (2013). 2012 Report on Europe’s Rapid Alert System for Food and
8.
European Commission (2013). Press release: Commission publishes European test results on horse DNA
and phenylbutazone: no food safety issues but tougher penalties to apply in the future to fraudulent
9.
European Food Safety Authority (EFSA) (2013). Joint Statement of EFSA and EMA on the presence of
residues of phenylbutazone in horse meat. EFSA Journal 11(4):3190.
10.
Commission Regulation (EC) No. 504/2008 implementing Council Directives 90/426/EEC and 90/427/EEC
as regards methods for the identification of equidae.
11.
EC WORKING DOCUMENT (2013) implementing Council Directives 90/427/EEC, 94/28/EC and
2009/156/EC as regards methods for the identification of equidae (Equine Passport Regulation) and
repealing Regulation (EC) No 504/2008.
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Even though food and health are key priorities in most European countries, this has not led to significant
improvements in diet and lifestyle. Innovative approaches are needed. INPROFOOD project aims to improve
research in Europe by promoting bottomup development of societal engagement concepts.
This three year project started in November 2011 and involves 18 partners from 13 countries. It focuses on finding new ways
to connect the innovative ideas of industry and academia with the needs of civil society. To achieve this objective, INPROFOOD
is looking into the current processes and structures for food and health related research at both national and European level,
paying particular attention to the role of societal engagement. At the same time, INPROFOOD is developing stakeholder
engagement programs to gather the needs of the different actors involved in food and health research and to establish a
continuous dialogue with them. Using that information, concrete initiatives of societal engagement in food and health research
will be tested and evaluated in the course of the project. Finally, a strategy and action plan will be developed to tackle the food
and health related challenges in Europe.
Current processes in research programming
One of the first research activities of the project was to investigate how public food and health research is currently
programmed in Europe, including how the research agenda is set, who is involved in that process, which areas or topics are
considered and how they are prioritised, as well as how resources are allocated. This work consisted of both desk research as
well as interviews in the following countries: Austria, Denmark, England, Germany, Greece, Italy, the Netherlands, Portugal,
Scotland, Slovakia, and Spain. Only desk research was carried out in Denmark, and attempts to interview key actors in the
decision making process in Greece and at a European level were unsuccessful.
The preliminary results of the desk research suggest that it is often unclear how research is programmed since in many of the
countries, a detailed description was lacking. Although nearly all countries have an explicit innovation policy, an overarching
strategy for food and health research is not common. Instead, the food and health component is embedded in broader
strategies or programmes. The extent to which national policies derive from European policies varies between the partner
countries.
Stakeholder involvement is not required for research programming in the public sector across all countries examined. It does
occur, but it tends to involve industry, government, and research institutions, and seldom civil society.
Looking at resource allocation for publically funded food and health research, the results show that, for all countries examined,
the funding comes from the national ministry or government departments related to education, science, or research. In many
cases this goes via intermediary organisations and in collaboration with other ministries as well. Portugal, Spain, Germany, and
Italy also have regional government funding instruments for research.
To complement these data and gain greater insight into the processes, the INPROFOOD partners have carried out interviews
with the people involved at each stage of the research cycle (on a specified food and nutrition innovation topic). These
interviews are currently being analysed.
Stakeholder views – European Awareness Scenario Workshops
In order to tackle the question of how to best design research programming to fulfil the needs of society, the INPROFOOD
consortium has brought together stakeholders in several European Awareness Scenario Workshops (EASWs). The EASW is a
recognised methodology for promoting discussion and participation. Workshops have been held in thirteen European countries,
with the following objectives: to discuss decision making in research programming, relevant research topics, the evaluation of
research proposals and property rights on research results , and to sketch scenarios for stakeholder involvement in research
that aims for the socially and environmentally sustainable production of healthful food.
The first analysis of stakeholder views, gathered in the 36 workshops, indicates that society at large benefits when research
agendas are built on a broad range of interests. Domination by influential players which may have preestablished stakeholder
links could hinder fair chances for receiving funding. The proposals to receive funding should be evaluated by independent
reviewers, have clear evaluation criteria, and the process should be totally transparent. Decisions on research topics should be
based on a broad and systematic involvement of different stakeholders. The duration of current research projects was often
seen as too short, and the administrative requirements can be burdensome. One of the outcomes was that results of publicly
funded research should be publicly available, regardless of whether the findings are positive or negative. The findings from
these workshops will be further analysed and published at a later date.
Next steps
Other engagement activities are currently being organised by the INPROFOOD partners. Play Decide Games, designed to
promote discussion, will be tested with adolescents in 15 science centres across 11 European countries. A European Open
Space Conference aimed to get stakeholders’ input on how to shape the future of research on food and health took place on 15
November 2013 in Brussels.
The INPROFOOD results are being disseminated widely to encourage mutual learning and to promote dialogue among
stakeholders, particularly on how to involve European citizens
Further Information
Public engagement for inclusive food and health research
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INPROFOOD is coordinated by the University of Hohenheim, Life Science Center. The project receives funding from the
European Community's Seventh Framework Programme (FP7/20072013) under the grant agreement no. 289045. Please
for any questions.
To become part of the INPROFOOD Community, and receive valuable updates, information and invitations to our highlevel
events, join the stakeholder network by registering at
www.inprofood.eu/bepartofit/
.
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