The Skinny on Supplements
Before launching my next “Best of” series on the sweeping and sometimes suspicious world of supplements, let’s first define our terms, clarify the difference between supplements and prescription medications, and level set on the potential benefits and downsides of supplements.
The term supplement encompasses any product that adds nutritional value to your diet or augments health. Under this broad umbrella fall more specific types of supplements including vitamins & minerals, botanicals, nutraceuticals, amino acids products, enzyme supplements, etc. These can come in a variety of forms, including tablets, concentrates, capsules, gummies, and powders, as well as drinks and energy bars.
In a consumer survey performed by the Council for Responsible Nutrition in 2019, the ten most popular dietary supplements among US adults were: multivitamins, vitamin D, vitamin C, protein, calcium, vitamin B or vitamin B complex, omega-3 fatty acids, green tea, magnesium, probiotics, iron, vitamin E, and turmeric. And the entire supplement market has been booming as consumers search for health-fortifying and immunity-boosting remedies in the COVID era.
The main difference between drugs and supplements is how they are viewed and handled by the Food and Drug Administration (FDA).
Drugs—prescription medications provided by a licensed doctor—must go through various clinical trials to prove their efficacy and safety. Only then will the FDA approve them for release to the public. Unsafe until proven otherwise.
This stands in contrast to supplements, which are self-regulated by the manufacturer without the same burden of safety and efficacy data before they can be mass marketed. Safe until proven otherwise.
Products sold as dietary supplements come with a “Supplement Facts” label that lists the active ingredients, the amount per serving (dose), as well as other ingredients, such as fillers, binders, and flavorings. The manufacturer suggests the serving size. Despite a general paucity of solid data, dietary supplement labels may include various types of health-related claims.
Only once a dietary supplement is on the market does the FDA has certain safety monitoring responsibilities. These include monitoring mandatory reporting of serious adverse events by dietary supplement firms and voluntary adverse event reporting by consumers and health care professionals. However, these reports are often spotty. And proving widespread adverse health consequences based on case reports (as opposed to large sample clinical trials data) is difficult. This means despite the FDA’s best intentions, health-harming supplements can remain on shelves for years.
Often, a supplement may be harmless in isolation, but can cause problems in its interaction with prescription medications. The concomitant intake of supplements, foods and drugs can influence drug profiles, which may result in adverse drug reactions and altered efficacy. St. John’s wort, for example, interacts with many medications in ways that can interfere with their intended effects, including antidepressants, birth control pills, antiretrovirals used to treat HIV infection, and others. Garlic, ginkgo biloba, ginseng, and Vitamin E can all increase bleeding risk, which can be dangerous for patients on blood thinners. Kava and valerian—popular sleep aids—act as sedatives and can increase the effects of anesthetics and other medications used during surgery.
This information is not meant to frighten, but rather to educate a savvy health consumer.
And to be clear, this is not to say that supplements are “bad” and do not have a proper place in a holistic health plan. Indeed, supplement are often essential to fill in gaps and deficiencies in important macro and micronutrients. Consider the use of folic acid supplements by women of childbearing age to reduce the risk of neural tube defects in a growing fetus. And after patients of mine undergo bariatric surgery, they take supplements to mitigate the risk of various vitamin and mineral deficiencies.
First and foremost, supplements supplement nutritional needs.
And, as we will discuss in upcoming articles, some supplements may even reduce disease risk and improve health outcomes.
But they do not treat disease.
Some of the most used dietary supplements with a growing clinical evidence base include omega-3 fatty acids, multivitamins, Vitamin D, and coenzyme Q10 (CoQ10), and probiotics. Before delving into each of these in detail, it is important to understand the limitations on the quality of this evidence. Often the quality of the data on supplements is substandard given that most of these studies are not placebo controlled randomized clinical trials (the gold standard of evidence). And biases exist. Just consider the fact that people taking dietary supplements generally have a healthier diet and lifestyle, which may inadvertently inflate the impact of the supplement.
When it comes to evaluating whether or not a supplement is right for you, start by being an informed consumer.
Contact the manufacturer for information about the product you intend to use.
Be aware that some supplement ingredients, including nutrients and plant components, can be toxic. Also, some ingredients and products can be harmful when consumed in high amounts, when taken for a long time, or when used in combination with certain other drugs, substances, or foods.
Do not substitute a dietary supplement for a prescription medicine or therapy, or for the variety of foods important to a healthful diet.
Do not assume that the term "natural" in relation to a product ensures that the product is wholesome or safe.
Be wary of hype and headlines. Sound health advice is generally based upon research over time, not a single study.
Learn to spot false claims. If something sounds too good to be true, it probably is.
And PLEASE—tell your health care providers about any complementary health products or practices you use, including dietary supplements.
Hopefully this coming series of articles on popular supplements will serve as a helpful guide in determining which ones are worth it, and which ones to leave on the shelf.