Nutritional Supplements: The Good, the Bad and the REAL Truth

By Barbara Day, M.S., R.D., C.N.

Recently I attended the Food as Medicine: A Feast of Science & Wisdom  conference in Washington, DC. (The Center for Mind-Body Medicine www.cmbm.org) The conference purpose was to integrate nutrition into clinical practice, medical education and community health.  The information in this blog was extracted from an excellent presentation by Kathie Madonna Swift, MS, RD, LDN.  entitled,  “Simplifying  Supplements.” For more information about her excellent approach to health through integrative nutrition check out her website at www.swiftnutrition.com.

 

What is a Dietary Supplement?

A dietary supplement is a product that is intended to supplement the diet which contains a vitamin, a mineral, an herb or any botanicals or an amino acid or a combination of any of these  This dietary substance is used to supplement the diet by increasing the dietary intake through a concentrate, metabolite, a constituent or a combination of any of the ingredients.  The label clearly states that the substance is a dietary supplement.

Supplements: Big Business Big Money

Dietary supplements are big business in the United States. In fact, sales are about $28 billion a year. About 50% of Americans use supplements.  The most popular supplements are:  multivitamins/minerals, fish oil, vitamin D, calcium, and Coenyzyme Q10.

Researchers Weigh in on Whether You Should Take a Multiple Vitamin/Mineral Supplement

The National Institute of Health says that very little evidence to suggest that taking a supplement will prevent chronic disease.  The Academy of Nutrition & Dietetics says you don’t need a multivitamin/mineral supplement but suggests eating a wide variety of nutritious food is best way to prevent chronic disease.  You might guess the Linus Pauling Institute recommends consuming a multivitamin/mineral supplement daily to ensure adequate intake that are not always present in daily diet. The Harvard School of Public Health recommends a multivitamin/mineral supplement BUT admits it is less important for health than eating a healthy diet. It is also recommended to avoid mega-dose vitamins and mega-fortified foods. The take home message is that there is strong evidence to take a supplement in special populations but no evidence of benefit in the general populations. But all groups recommended eating a healthy diet was the best strategy.

Who are current supplement users?

According an article written by Oato et al in JAMA in 2008, here’s the list of who are current supplement users:

  • Aging 50+
  • Health seekers
  • Athletes & body builders
  • Higher education
  • More females than males
  • Health conscious – higher fruits and vegetables, non-smoker, lower BMIs, regular physical activity and higher nutrient intakes
  • Children with special health care needs
  • Chronic disease – hyperlipidemia, cancer, dementia
  • Healthcare professionals like registered dietitians, physicians, etc. (80% of the people in attendence of the conference said they took supplements)

Who REALLY Need Supplements

Bailey et al, in a review of the vitamin intakes among US adults in dietary supplements, reported in the Journal of Academy Nutrition and Dietetics published in 2012,  suggested the following types of people or scenarios that might require the nutritional supplements:

  • Aging
  • Very active people
  • Chronic illness
  • Decreased nutrient density: Food processing, Cooking methods, Reliance on convenience foods
  • Prescriptions that cause nutrient depletion
  • Alcohol dependent
  • Lack of sunlight
  • Vegans/strict vegetarians
  • Genetics
  • Environments factors like pollution, heavy metals, etc.

What consumers want to know!

Consumers want to know: How do I know if I need a supplement; Which ones should I take? How much should I be taking; Which form is best – tablet, capsule, powder, or liquid? Are there precautions I should know about?; Which brands are best?; How will I know if it’s working? 

I typically use the website www.consumerlab.com before I recommend a brand name to my clients. ConsumerLab.com takes the supplements off the shelf and determines if the supplements contain the active ingredients amount that the label says it contains.

Some facts worth noting: iron causes constipation, selenium can be toxic for some.

For your personal supplement Rx you need to know:

  1. The type you need to take: should you take calcium citrate, carbonate, gluconate, lactate, etc.
  2. Which form is best taken: should you take tablets, liquid, powders.
  3. What is the purpose of the supplement in your health strategy: are you taking the supplement for a deficiency or just as a band-aid treatment.
  4. What is the dose: do you take the supplement once a day, twice a day.
  5. Should you take with food or not with food.
  6. When should you take the supplement: at breakfast, at night, split doses.
  7. Are you taking the nutrient in another supplement: If you are taking an multivitamin/mineral plus an additional supplement make sure you are not taking too much like calcium.
  8. Are there any reactions to the prescription drugs you are already taking.

Very little research is available comparing synthetic vs natural forms of individual micronutrients. Natural supplements are typically more expensive.

What are the Supplement – Prescription Interactions

Below are a number of nutrient – prescription interactions you may need to consider and discuss with your physician.

  • Calcium

Biphosphonates

Calcipotriene – Dovonex

Ceftriaxone – Rocephin

Quinolone antibiotics

Levothyroxine – synthroid

Tetracycline

Thiazides

  • Omega 3s

Anticoagulants/antiplatelet drugs

OCAs

Orlistat (Xenical, Alli)

  • Magnesium

Bisphosphonates

Calcium channel blockers

Tetracycline antibiotics

Quinolone antibiotics

Potassium sparing diuretics

  • Vitamin D

Aluminum phosphate binders

Atorvastitin – Lipitor

CyP4503A4 substrates

Verapamil

Source: Natural Medicine Database: Nutrient Depletion Checker

Health Condition-Specific Supplements

Diabetes

  • Antioxidants
  • Fiber such as beta-glucan, glucomannon, psyllium, etc
  • Magnesium
  • Chromium
  • Alpha lipoic acid (ALA)
  • Prickly pear
  • Bitter melon
  • Gymnena Sylvestre
  • Cinnamon – ½ teaspoon added to food but no more than 3 grams/day
  • Asian or American Ginseng

Mental Health

  • Multivitamin supplementation improved mood & feelings of well being
  • Wholesome diet
  • Specific micronutrients: Vitamins: D, B vitamins. Minerals: iron, magnesium, zinc
  • Omega 3 fatty acids
  • 5 HTP (5-hydroxy tryptophan)

Chronic Pain

  • Natural alternative anti-inflammatory supplements:
  • Omega 3 fish oils
  • White willow bark
  • Curcumin
  • Green tea
  • Pycnogenol
  • Baswellia serrata resin
  • Resveratrol
  • Cat’s claw
  • Capsaicin (chili pepper)

 

Are Your Supplements Working?

According to Swift, you should allow at least 90 days to determine if the supplement is working for you. Here’s some questions you could ask yourself about your supplements: Are your signs & symptoms improving? Are you tolerating the supplement (s)? Do you have any adverse reactions? Do you medication changes when taking the supplement? What about the cost of the supplement in your budget? Have you changed your diet since initiating your supplement program? Are your lab indicators improving?

 

Full Disclosure

I am a 61 year old daily exerciser. I am osteopenic and also have psoriasis and psoriatic arthritis.   Even though I am a registered dietitian, I do take a number of nutritional supplements.  I take a multivitamin/mineral pill, 1000 mg of fish oils, 1000 mg of cinnamon, and a calcium chew which contains 500 mg of calcium, vitamin D and vitamin K. All of these supplements have been recommended by my gynecologist.

Barbara Day, M.S., R.D., C.N., is a registered dietitian with a Master’s Degree in clinical nutrition.  The former publisher of Kentuckiana HealthFitness Magazine, Kentuckiana Healthy Woman magazine and radio show host of Health News You Can Use, Barbara has over 30 years of experience in promoting healthy lifestyles to consumers.  Barbara worked as Nutrition Consultant to the Navy SEALs (8 years) and the University of Louisville Athletic Department (10 years). Barbara has private practice, DayByDay Nutrition, www.DayByDayNutrition.com, where she counsels clients on weight loss, cholesterol management, performance nutrition and an array of other medical issues.  Visit Barbara’s new website which is an on-line health & wellness magazine, www.KentuckianaHealthWellness.com. Barbara writes nutrition and health columns for www.LiveStrong.com as well as a weekly nutrition column for the Southeast Outlook. She also designs and presents employee wellness programs to small and large businesses. Barbara is a runner, cyclist, hiker and a mother and grandmother to 12 grandchildren.    

 

 

 

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