Supplements: Good for Our Health or Dangerous Waste of Money?
Consumers are bombarded with conflicting messages about supplements. Often they are told by doctors that supplements are a waste of time and money. And yet millions of us purchase them every year. In 2019 the global supplement market was valued at almost 50 billion dollars. By 2027 the market is estimated to increase to almost 120 billion (Fortune Business Insights, 2020).
What is meant by supplements?
Supplements include vitamins, minerals, herbs, amino acids, fatty acids, probiotics, hemp oil, digestive enzymes, hormones like melatonin, and much more. The list grows every year as science makes it possible to encapsulate more of nature’s goodies.
Herbal medicine has a long history in many cultures and predates conventional medicine. In a sense, the popularity of herbal medicine is a return to an old and revered healing modality. Instead of going to an herbalist or traditional healer, we buy what we want at mainstream grocery stores, pharmacies, health stores, or the internet. But what we’ve gained in convenience, we’ve lost in knowledge.
Herbs can have a powerfully healing effect on our health. They can also be potentially harmful especially if used long-term and without guidance. For example, while rosemary can help improve memory, it can also induce seizures in people with epilepsy (Bahr et al.,2019). Many commonly used herbal products are contraindicated for anyone on blood thinners – a very common medication.
In addition to herbs, consumers have access to myriad health products these days. Beyond taking trusted products such as vitamin C and maybe a zinc lozenge, it is prudent to seek out professional guidance when it comes to most supplements due to the potential for unintended consequences.
What does the American Medical Association have to say about supplements?
Pushing for more regulations
Wants to make it easier to get unsafe products removed from the market
Wants to make it harder for companies to hide potentially unsafe ingredients behind “proprietary blends”
Wants more communication between patients and doctors about supplements being used
Wants the public to understand that while drug products must be proven “safe and effective” before reaching the market, supplements are not subject to the same rule (AMA, 2020).
What regulations currently protect consumers?
The main regulation designed to safeguard consumers is the Dietary Supplement Health and Education Act (DSHEA) of 1994, signed into law by President Bill Clinton. Here are some key features:
It is the responsibility of the manufacturer to ensure the safety of the product
Supplement companies may not make misleading or unsubstantiated claims
Manufacturers must follow Good Manufacturing Practices
All ingredients must be listed – which I interpret as meaning supplement companies aren’t allowed to hide behind unidentified “proprietary blends” (NIH,1994)
As a licensed nutritionist, I believe there are many good reasons to use supplements.
Do you take prescription drugs? You need supplements.
Most prescription drugs deplete nutrients in your body – a leading cause of drug side effects. For example, most cholesterol-lowering drugs also deplete CoQ10, a critical nutrient for cardiovascular health and energy production. If you take a statin drug, you should definitely consider supplementing with CoQ10 to avoid fatigue and muscle aches.
Similarly, if you take antibiotics, consider a good probiotic. Antibiotics kill both the good and bad gut microbes we need for a healthy GI system. Diarrhea is a common side effect. A simple product such as saccarymycous boulardii solves the problem for most people. While probiotics should be avoided by those with severely compromised immune systems, including HIV.
Some medications cause unwanted weight gain. Often the problem is that the medication is depleting important B vitamins needed for energy production and carbohydrate metabolism. For most people, taking a quality B complex helps. Medications known to deplete B vitamins include birth control pills, antacids, ulcer medications, and anti-diabetic medications.
Special medical conditions? You need supplements.
No one is surprised to see a pregnant woman pop her prenatal vitamins. We recognize her increased need for nutrients. At the other end of the spectrum, no one is surprised to see an elderly person take vitamin D due to lack of sun exposure and concerns about bone health.
The government recognizes the value of supplementation for improving health. In the DHEA regulation of 1994, the government acknowledges “a link between ingestion of certain nutrients or dietary supplements and the prevention of chronic diseases such as cancer, heart disease, and osteoporosis” (NIH, 1994)
Nearly half of all Americans suffer from a chronic disease (Raghuphathi & Raghupathi, 2018). In addition to a healthy lifestyle and good nutrition, supplementation has an important role to play.
But I eat healthy. Isn’t that good enough?
Sadly, our soils are being depleted of valuable nutrients. Conventional agriculture practices tend to prioritize yield and pest resistance over nutrition. The result is an industrialized process that weakens the health of the soil and then relies on chemical fertilizers to fix the problem. Over time, our soil has become noticeably depleted resulting in crops with a lower nutritional value. In a landmark study published in 2004, an analysis of garden crops grown between 1950 and 1999 showed a decline in many critical nutrients including calcium, iron, and vitamin C (Davis et al., 2004).
Okay. Maybe we all need a good multivitamin?
Most people would probably benefit from a good multivitamin to cover their bases and make up for the fact that our soil is not as healthy as it was a few generations ago. But which one?
Well, if you’re a smoker, you need to avoid any supplement containing beta-carotene. Most multivitamins contain beta-carotene. I am only aware of one high-quality multivitamin without beta-carotene and it’s by Allergy Research.
And if you rely on popular brands such as Centrum, you’re getting a lot of artificial coloring, additives, and the cheapest form of each nutrient. Out of curiosity, I took a close look at Centrum Silver for Women, and discovered that it used calcium carbonate, which is poorly absorbed by most people. It also uses magnesium oxide, the form of magnesium that works best as a laxative. The B vitamins are not in the methylated or activated form. I also did not like the fact that the product includes 8 mg of iron (Centrum, n/d). I don’t recommend iron supplementation without an iron panel because excess iron in the body can stir up problems.
Risks of taking supplements
As previously mentioned, some supplements, especially herbs, do not mix well with medications commonly prescribed including for blood pressure as well as diabetes. It is also dangerous to mix serotonin precursors such as 5-HTP and tryptophan due to the risk of serotonin syndrome.
As Americans, we tend to think if a little bit is good for us then a lot must be better. When it comes to supplements, the “more is better” philosophy can be dangerous. Recently, I’ve become aware of several people taking high doses of vitamin B6 as part of an internet-inspired COVID protocol. They ended up with neuropathies that took months to improve.
It is estimated that up to 70% of older women have taken calcium, usually to help protect bone health. While calcium helps support bone health, it’s potential effects on the cardiovascular system are unclear and worrisome (Tankeu et al., 2017). For my osteoporosis clients, I usually suggest a modest amount of calcium paired with K2, a special vitamin known to direct calcium to the bones and away from the cardiovascular system.
There are many questionable voices on the internet promoting fads. Many of these voices also sell the very products they promote. When researchers who tout the benefits of pharmaceutical drugs are funded by the same companies selling them, it gives us pause. We should exercise the same caution with anyone with a dog in the race, so to speak.
One of the biggest fads today is the notion that high doses of vitamin D will cure every health problem under the sun. The ranges of vitamin D have shifted over the years, depending on where you look. Not surprisingly, the Vitamin D Council recommends a much higher range than the NIH.
Most people don’t understand that the majority claims made about vitamin D are based on observational studies. When scientists look at a group of people with a specific condition and observe that their vitamin D levels are low, that observation does not prove that low vitamin D caused the problem. To prove causation, scientists rely on random controlled trials (RCTs). Researchers start with two groups; one group receives vitamin D and the other receives a placebo. Not even the researchers know which group is which. Looking at a meta-analysis of RCTs, there is scant evidence to support high-dose vitamin D for the most common chronic conditions (Thordoratou et al., 2014).
Most people promoting high-dose vitamin D don’t understand that vitamin D is also a negative acute-phase reactant. That means it goes down with inflammation. Since all chronic health conditions involve inflammation, it is natural to see lower vitamin D levels in that population. Once the inflammation is under control, vitamin D status should naturally improve.
Low vitamin D status among the chronically ill is often the consequence of inflammation, not the cause. To further complicate matters, some people do in fact suffer from a true vitamin D deficiency, especially if they are elderly or if they avoid the sun.
The government has established a safe upper limit of 4,000 IU daily. Regardless, many people take 5,000 or 10,000 daily. High dose vitamin D is a bad idea for many health conditions, including:
History of kidney stones
Rapid weight loss – because vitamin D gets released from fat cells and gets dumped into circulation
Kidney disease
High blood calcium
At risk for falling – extremely high once yearly dose of vitamin D has been shown to increase the risk of falls (Sanders, 2010)
Heavy metals exposure – because vitamin D increases the absorption of toxins such as lead and mercury
Therapeutic window
Many nutrients have a narrow therapeutic window. That means a true deficiency increases the risk of health consequences. But taking too much can be dangerous. Selenium is a good example. Vitamin D may be as well. Time will tell.
Conclusion
Supplementation is a good idea for most people. That being said, supplements are no substitute for a good diet and healthy lifestyle. Generally speaking, supplements are safer than prescription drugs. Approximately 128,000 people die from drug reactions in this country every year out of the 170 million people who take prescription drugs (Light, 2014). According to a recent Washington Post article, over 23,000 people end up in the ER from taking supplements. Most of those visits are due to sketchy diet pills and energy boosters– something no reputable nutritionist would recommend (Cha, 2015).
If you take supplements, here are some tips:
Don’t buy your supplements in the same place you buy your laundry detergent.
Always look for a third-party verification insignia on the label to be sure what’s in the bottle
Always be honest with your doctor about all the supplements you take
Consult with a licensed nutritionist for a thorough review of your supplements
I recommend supplements based on the individual needs and health history of each client. I don’t buy into the hype of wellness influencers with agendas to push or products to sell. I take a conservative approach, especially with my elderly clients.
Sources:
AMA policy calls for increased regulation of dietary supplements (2020)
Bahr, T. A., Rodriguez, D., Beaumont, C., & Allred, K. (2019). The Effects of Various Essential Oils on Epilepsy and Acute Seizure: A Systematic Review. Evidence-based complementary and alternative medicine : eCAM, 2019, 6216745. https://doi.org/10.1155/2019/62167
Cemtrum https://www.centrum.com/content/dam/cf-consumer-healthcare/bp-wellness-centrum/en_US/pdf/lbl-00000786-web-ready-centrum-silver-women-tablets-(version1.pd
Cha, A. (2015) Dietary supplements send more than 23,000 people to the ER every year. https://www.washingtonpost.com/news/to-your-health/wp/2015/10/14/more-than-23000-people-wind-up-in-the-er-each-year-due-to-dietary-supplements/
Davis, D., M. Epp & H. Riordan, (2004) Changes in USDA food composition data for 43 garden crops, 1955 to 1999. Journal of American College of Nutrition.
https://www.tandfonline.com/doi/full/10.1080/07315724.2004.10719409?scroll=top&needAccess=true
Fortune Business Insights (2020). Dietary supplements market size, share & COVID-19 impact analysis…
https://www.fortunebusinessinsights.com/dietary-supplements-market-102082
Light, D. (2014) New prescription drugs: a major health risk with few offsetting advantages. Harvard University. Redmond J. Sofna Center for Ethics https://ethics.harvard.edu/blog/new-prescription-drugs-major-health-risk-few-offsetting-advantages
NIH (1994) Dietary supplement health and education act of 1994.
https://ods.od.nih.gov/About/DSHEA_Wording.aspx
Raghupathi, W., & Raghupathi, V. (2018). An Empirical Study of Chronic Diseases in the United States: A Visual Analytics Approach. International journal of environmental research and public health, 15(3), 431. https://doi.org/10.3390/ijerph15030431
Sanders K. (2010). ACP Journal Club: a single, annual, high dose of oral vitamin D increased falls and fractures in older women. Annals of internal medicine, 153(6), JC3. https://doi.org/10.7326/0003-4819-153-6-201009210-02003
Tankeu, A. T., Ndip Agbor, V., & Noubiap, J. J. (2017). Calcium supplementation and cardiovascular risk: A rising concern. Journal of clinical hypertension (Greenwich, Conn.), 19(6), 640–646. https://doi.org/10.1111/jch.13010
Thodoratou, E., Tzoulaki I., Zgaga L., & J. Loannidis (2014) Vitamin D and multiple health outcomes: umbrella review of systematic reviews and meta-analyses of observational studies and randomised trials. BMJ, 348 doi: https://doi.org/10.1136/bmj.g2035