Dr MEGAN ROSSI: Why you don’t need all those vitamin pills!

Vitamin and mineral supplements are big business, whether they’re multivitamins, special ‘blends’ for particular purposes (sleep, for example) or single nutrients.

There is no doubt that a few are useful, such as vitamin D, for instance, which the NHS recommends everyone should consider taking in autumn and winter because of our limited exposure to sunlight in those seasons and it’s tricky to get enough vitamin D from food.

In my clinic there are sometimes cases when I do recommend specific supplements — but this is on a case-by-case basis and the formulations are backed by clinical trials.

The reality is that you don’t need most, if any, of those bottles of supplements you see in the supermarket and High Street stores or online. They can also be pretty expensive.

But it’s hard not to be seduced by the marketing — especially for products that claim to ‘support’ your digestive system.

Who doesn’t want a healthy gut? Not least because we know it plays a key role in so much of our health, from our heart to our hormones and mental wellbeing.

One thing that comes up time and again when a new client comes to my clinic is the question of digestive enzymes. Inevitably I am asked: ‘Should I take a supplement?’

Because so many patients have experienced years of gut problems before coming to me, unsurprisingly they have turned to Dr Google, typed in their symptoms — often bloating or heartburn — and self-diagnosed a deficiency in their digestive enzymes. And so they have turned to increasingly popular over-the-counter enzyme capsules in the hope of a cure.

Typically, it’s young women with irritable bowel syndrome (IBS), or those later on in life who have heard that as we age we don’t produce enzymes as effectively. But IBS isn’t caused by deficient digestive enzymes — and the idea that we always produce fewer enzymes as we age is simply not true: if you stay in good health, your enzymes work just fine.

They have basically wasted money on pills that they don’t need — and that wouldn’t work even if they did have a deficiency, because they are only available in low doses over the counter, and often from plant sources such as pineapple, which are not scientifically proven to have any measurable benefit in the human gut.

Who doesn’t want a healthy gut? Not least because we know it plays a key role in so much of our health, from our heart to our hormones and mental wellbeing

If you have fallen into this digestive enzyme-popping camp, it’s not your fault — the marketing for such products is insidious, flooding your every Google search and preying on anxieties (but that’s what this column is about, arming you with the science to steer you through the hype).

Another concern people express is that drinking water with meals ‘dilutes’ our digestive enzymes.

The truth is, the content of your stomach is constantly monitored so it can adjust to our different meals — it’s amazingly adaptable, we need to give our bodies more credit!

Of course, enzymes do play an important role in digestion.

Enzymes are a type of protein our bodies produce that helps to break down the food we eat.

The first enzymes food encounters are in the mouth. When we chew, we produce saliva, which contains amylase, an enzyme that breaks down complex carbohydrates into ‘simple’ carbs (i.e. sugar).

Try chewing a piece of bread for a long time and holding it in your mouth — you’ll find after a while it begins to taste much sweeter. That’s the starch breaking down into glucose, the simple sugar.

As food progresses through our stomach and small intestine it encounters lipases, enzymes that break down fats; proteases, which break down protein; lactase, which breaks down lactose in dairy — and so on. These enzymes break down food into smaller molecules so our body can absorb nutrition from it.

So what happens if we don’t have digestive enzymes — or don’t have ‘enough’ of them? In that rare case — which accounts for 0.0001 per cent of situations and is known as exocrine pancreatic insufficiency — food isn’t absorbed properly, meaning it’s effectively wasted.

Symptoms include tummy upset, bloating, diarrhoea and so on — but if you had this, you would also be malnourished, losing weight and functioning poorly in general.

Digestive enzyme deficiency rarely occurs in isolation but rather as a side-effect of something else, such as pancreatitis (an inflamed pancreas) or cystic fibrosis.

In such a case, your doctor would prescribe a high-dose combination of enzymes that you’d take with every meal to ensure your body could break down the nutrients to feed it.

There is a second scenario which is more common: lactose intolerance. This is where levels of the lactase enzyme, which is produced in the gut lining, drop off as a child weans from their mother’s milk. Fortunately, over-the-counter lactase enzymes do the trick.

However, unless you have been diagnosed with one of these conditions, stay away from these unnecessary pills — not least because, while they are generally useless rather than dangerous, if you are on any medication, in particular blood thinners or diabetes drugs, there is a risk of interaction.

So save your money, stay safe and soothe your gut instead, with my three science-backed tips for beating bloat:

1. Chew your food properly — digestion starts in the mouth. Aim for 15 to 20 chews per mouthful.

2. Avoid the sugar alcohols that are commonly found in sugar-free foods and chewing gum, such as mannitol, malitiol, sorbitol, xylitol and isomalt. Even healthy bodies don’t produce the enzymes for these, so they aren’t absorbed properly, which can trigger gut issues.

3. Try peppermint oil capsules. Studies in people with IBS have shown that peppermint oil can relax your gut muscles and therefore may help relieve bloating from trapped gas.

The studies recommend taking them up to three times a day, 30 to 60 minutes before a meal, with a goal of tapering down after four weeks — but it’s always good to chat to your healthcare team first.

askMegan 

I’ve got diverticula and have been told to give up seeds and nuts. But aren’t they good for fibre, of which I’ve been told to increase my intake?

Mary Walker, by email.

First things first, a diverticulum (the singular of diverticula) is when a weak spot in your intestine, usually the colon, pushes out, forming a small pouch with a narrow opening.

Most people develop at least one diverticulum with age, owing to weakening of the intestine, and they are usually harmless. About 20 per cent of those with diverticula will develop symptoms such as tummy pain, usually in the lower left side — less than 3 per cent experience the acute form, diverticulitis, where the pockets become inflamed.

We used to think people with diverticular disease should avoid eating nuts, seeds and popcorn because they could become trapped in the diverticulum. But in fact there’s no evidence to support this, so the advice has now been updated. If you have diverticulitis, you might be advised to stick to a short-term, lower-fibre diet. But you can then return to a high-fibre diet, putting nuts, seeds and popcorn back on the menu (try my super-seedy crackers, recipe below).

Try this: Seedy crackers 

A pantry staple in my house, these are packed with plant-based protein and healthy fats, and are high in fibre to keep you and your gut microbes satisfied for longer. I keep a stash of these in my bag to keep me going between meals on busy days.

Makes 12

80g rolled oats

40g mixed seeds

Pinch of salt

1 tbsp olive oil

Preheat oven to 170c fan/375f/gas 5. Blitz oats in a blender to form coarse crumbs, then mix with seeds and salt in a bowl. Add oil and 60ml of warm water. Combine with your hands to form a wet dough. 

Leave to rest somewhere warm for ten minutes. Line an oven tray with baking paper and place the dough in the middle. Cover with another sheet of baking paper and, using a rolling pin, spread the dough into a thin layer — the thinner the better.

Remove the top paper and, using a cookie cutter, cut out circles. Bake for 20-25 minutes or until lightly brown.