Alfonso Carabel, nutritionist: "Our immune system needs the stimulation of natural stressors: cold, heat, fasting, physical activity and microorganisms"

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Almost without realizing it, we have gone from taking iron, calcium and some other vitamins at specific times of the year, to having a pantry full of nutritional supplements in a 'Yankee' style. To what extent is this vitamin 'overabundance' necessary or the result of marketing overstimulation? "Like everything in the healthcare world, it depends. From my point of view, I think that marketing has a lot to do with the mass purchase of supplements, but it is true that, nowadays, our habits, both movement and nutritional, are far from ideal. There are times when, although the intention is good, due to time or logistics, it is difficult for us to do physical activity and eat what we need. That's when certain supplements can make sense to make up for these deficiencies that we have in our day-to-day lives," explains Alfonso Carabel Vázquez, head of the Nutrition Service at Olympia, the Quirón Group's Wellness Medical Center.

In theory, say those in the know, if we ate well and food was as it should be, we wouldn't need to take anything, but it is clear that this is not the case. Although generalizing is not good, and even less so when health is involved, what are the main nutritional deficiencies that a 'normal' person (not a superathlete) who practices sport regularly, works, has a family, etc., can have? "Generally, deficiencies are not usually nutritional. What we find most are deficiencies in physical activity and quality rest. It is from this situation that shortcomings or excesses are derived. In any case, each person is different. There is the one who stops eating carbohydrates from one day to the next, trains, has a family, pressure at work and cannot sleep and the one who, on the contrary, is 100% sedentary and eats 200 grams of sugar without leaving the sofa at home. Or the one who is vegan and eats 50 grams of fiber a day and the one who eats only meat... There's a lot of diversity when it comes to shortcomings."

However, there are certain values that are characteristic of today's population. "Because of our lifestyle, it's easiest to be deficient in vitamin D, because our exposure to the sun is minimal and we're always very covered, especially when it's cold. Omega 3 is also very easy to have low, even if we take care of its consumption. It is normal not to have an adequate omega 3/omega 6 ratio. So supplementation is highly recommended."

In the case of vegans, in addition, "we must be more vigilant about vitamin B12 and iron because, although there are vegetables that provide a good amount of iron, their proportion is low, which means that, if we follow a low-calorie diet, we will hardly reach the recommended requirements".

In the midst of all this immense offer of vitamins and nutritional supplements of different formats, flavors and, most importantly, qualities, how can we know what is good for us to take (if anything)? "The first thing would be to analyze our particular needs. It is very important to know what our life is like; what caloric expenditure we have; how much and what kind of physical activity we do; if we sleep well and if we have any dietary restrictions (by choice or by pathology). Once we are clear about this, if there are things that, due to an excess of expenditure or a lack of consumption or because of aspecific sports objective, we have a greater requirement or need an extra contribution, we can look for the ideal supplement," advises this specialist.

There is a problem with this issue, because nutritional supplements, as they are not drugs, are not subject to the controls that they have to pass to go on the market, they do not have to be prescribed by a specialist for consumption and, sometimes, they do not have a very clear dosage or their side effects are not known exactly. Carabel, in his capacity as an advisor on the development of 226ERS products, tries to shed some light on the matter. "Indeed, they are not drugs, but they do have a dosage. This is important to know, the molecules of the supplements have to be taken in the functional quantity. There are supplements that can be harmless if taken in excess, but others that, due to their metabolism, are not. For example, excess vitamin C is excreted in the urine as it is water-soluble, but vitamin D is fat-soluble and, in excess, can lead to toxicity. For this reason, it is important to know our initial values with a complete analysis before supplementing; and, in this way, know the dosage we need so as not to generate excesses".

Now that, after covid, we are more aware than ever about the importance of having strong defenses, what does our immune system need to not falter? "Above all, stimuli. We live in a small bubble in which the body receives few stimuli from the main natural stressors, which are cold, heat, fasting, physical activity, and exposure to environmental microorganisms. Having controlled exposures to these environments is very good for us, because we make our bodies alert and use systems that we have developed over thousands of years to survive. YES, when it's cold we're on the stove and, when it's hot, we're on air conditioning, we're in a very constant temperature range. We need to make our body work to generate adaptations, including the immune system. In terms of supplementation, vitamin D and a prebiotic, either in dietary fibre or as a supplement, will help us to have a well-regulated microbiota."

Collagen is on everyone's lips. How does it have to be for it to really deliver what it promises? "In supplements, the ideal is to consume hydrolyzed collagen, since its bioavailability is greater and will improve its absorption."

And what do we do with protein? "You have to eat the proteins you have to eat, no more, no less. Its consumption is the most constant in a diet compared to the rest of the macronutrients. That is to say, at the energy level, the requirements vary greatly depending on the exercise performed and with that the amount of proteins and fats we need will be determined. But we always need protein to restore our muscle mass. If with a normal diet it is difficult for us to reach the protein requirements (between 0.8 and 2 grams of protein per kilogram of our weight), it makes sense to consume supplements."

Another of the great concerns of the population, in general, is sleep. Can we take melatonin at our own risk? In theory, it is not addictive, but is it advisable to take it for a long period of time? "It is a safe supplement and does not cause problems due to its prolonged use, but we must monitor the dosage and know that we do not have any metabolic pathology since there have been cases in which it could interfere with the metabolism of insulin. In these cases, the best thing to do is to seek advice from a specialist and know how and when to take it," he concludes.

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