Elderberries on a countertop in the shape of a heart
Elderberries on a countertop in the shape of a heart

By Susan Elrod, PhD

As much as you might love the flavor of elderberries and other fruits, many people consider taking supplements to gain the benefits from plant-based polyphenols. After all, why not? If those polyphenols are so wonderful for us, why not get more of them by taking a concentrated amount in a pill?

The answer is pretty complicated. Individual studies of supplementation of antioxidants and/or extracts may show benefits in some conditions. However, in order for such supplementation to be recommended to the general population, the majority of evidence must support the benefits of supplements. In some cases, supplementation is highly recommended, as with iron supplementation for children and infants at risk for anemia, or calcium supplementation for pregnant women.1National Guideline Clearinghouse (NGC). Guideline summary: WHO guideline: daily iron supplementation in infants and children. In: National Guideline Clearinghouse (NCG) [Web site]. Rockville (MD): Agency for Healthcare Research and Quality 2National Guideline Clearinghouse (NGC). Guideline summary: Calcium supplementation in pregnant women. In: National Guideline Clearinghouse (NGC) [Web site]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2013 Jan 01. In terms of vitamin or antioxidant supplementation, however, the evidence simply isn’t there. The strongest evidence for plant-based prevention of cardiovascular disease and cancer is in consumption of a wide range of fruits and vegetables, whereas there is not enough evidence to recommend supplementation for this purpose. In fact, experts specifically recommend against supplementing with β-carotene, Vitamin E, or selenium for prevention of cardiovascular disease or cancer.3National Guideline Clearinghouse (NGC). Guideline summary: Vitamin, mineral, and multivitamin supplements for the primary prevention of cardiovascular disease and cancer: U.S. Preventive Services Task Force recommendation statement. In: National Guideline 4National Guideline Clearinghouse (NGC). Guideline summary: Risk reduction of prostate cancer with drugs or nutritional supplements. In: National Guideline Clearinghouse (NGC) [Web site]. Rockville (MD): Agency for Healthcare Research and

So why is it that, if polyphenols and antioxidants are so good for us, it’s best not to use supplements? Well, as discussed in an earlier article, there are myriad polyphenols in any given fruit or vegetable, and it can be difficult to discern which one is responsible for benefits associated with consumption of that fruit or vegetable. In fact, it is far more likely that the benefit of a fruit or vegetable is due to the complex interplay between the various polyphenols, rather than one or even a few individual polyphenols. In medicine, a synergistic effect occurs with some compounds: the combination will be more effective than either alone. With such a wide range of polyphenols in plants, it is highly likely that such synergy may yield medical benefits, and that use of a single polyphenol will suppress that benefit.5Williamson, E.M. Synergy and other interactions in phytomedicines. Phytomedicine, 2001, 8(5): 404-409. Incidentally, this is why it is advisable to consume a wide range of fruits and vegetables: the greater diversity of your plant-based diet, the greater diversity of your polyphenol consumption and the greater likelihood that you’ll derive benefit from multiple different mechanisms. Furthermore, whole foods contain fiber and other compounds that may contribute to the food’s medical benefit, especially in the case of cardiovascular benefits.6World Health Organization (WHO). Increasing fruit and vegetable consumption to reduce the risk of noncommunicable diseases. In: World Health Organization (WHO) [Web site]. 15 June 2017. [cited 2017 Oct 06].

So as wonderful as those polyphenols are for you, it’s better to get them the more delicious way: in the whole fruit or vegetable rather than in a pill.

1 National Guideline Clearinghouse (NGC). Guideline summary: WHO guideline: daily iron supplementation in infants and children. In: National Guideline Clearinghouse (NCG) [Web site]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2016 Jan 01. [cited 2017 Oct 06]. Available: https://www.guideline.gov
2 National Guideline Clearinghouse (NGC). Guideline summary: Calcium supplementation in pregnant women. In: National Guideline Clearinghouse (NGC) [Web site]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2013 Jan 01. [cited 2017 Oct 06]. Available: https://www.guideline.gov
3 National Guideline Clearinghouse (NGC). Guideline summary: Vitamin, mineral, and multivitamin supplements for the primary prevention of cardiovascular disease and cancer: U.S. Preventive Services Task Force recommendation statement. In: National Guideline Clearinghouse (NGC) [Web site]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2014 Feb 01. [cited 2017 Oct 06]. Available: https://www.guideline.gov
4 National Guideline Clearinghouse (NGC). Guideline summary: Risk reduction of prostate cancer with drugs or nutritional supplements. In: National Guideline Clearinghouse (NGC) [Web site]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2012 May 17. [cited 2017 Oct 06]. Available: https://www.guideline.gov
5 Williamson, E.M. Synergy and other interactions in phytomedicines. Phytomedicine, 2001, 8(5): 404-409.
6 World Health Organization (WHO). Increasing fruit and vegetable consumption to reduce the risk of noncommunicable diseases. In: World Health Organization (WHO) [Web site]. 15 June 2017. [cited 2017 Oct 06]. Available: http://www.who.int/elena/titles/fruit_vegetables_ncds/en/