The Low Down on Dietary Supplements


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Here is a not-so-fun fact: since supplements aren’t considered drugs, they aren’t put through the same strict safety and efficacy requirements that drugs are. Therefore, the Food and Drug Administration (FDA) is not authorized to review dietary supplement products for safety and effectiveness BEFORE they are marketed. They do provide regulations and guidelines that manufacturers are responsible for to make sure their products are safe before they go on the market (1). Basically, supplements are considered to be safe unless proven unsafe. So…I guess we are leaving the safety of these supplements to the honor code? If only that were good enough.


In 2015, 4 large retailers (GNC, Walmart, Target, and Walgreens) were accused of mislabeling and falsely advertising some of their supplements. They were marketing herbal supplements, that were found to have contained cheap fillers like powdered vegetables and houseplants, or ingredients that could pose a threat to people with allergies (2). (See article here: https://www.washingtonpost.com/news/morning-mix/wp/2015/02/03/gnc-target-wal-mart-walgreens-accused-of-selling-fake-herbals/?noredirect=on&utm_term=.2c42639c4a77)


With the uncertainty of the quality of supplements on the market, it is important to be smart consumers. I am sure you have seen ads on your social media of supplements that market, what deem to be simple solutions, for quick fat burn, increased energy levels, or some other type of quick weight loss. Although I think supplements can be very beneficial, like when nutrient deficiencies are identified, we have to be diligent about knowing how to choose the right ones. Programs like the USP Dietary Supplement Verification Program help to ensure that the supplements we purchase are true to what supplement manufacturers are marketing.


When you see the USP Verified Mark on a dietary supplement label, it indicates that the product:

  • Contains the ingredients in the potency and amounts listed on the label. Lab tests done on some supplements have shown that the contents don't match the label and some contain significantly less or more than the claimed amount of key ingredients. USP Dietary Supplement Verification helps assure customers that they are getting the value they expect from a product they are purchasing.

  • Does not contain harmful levels of specified contaminants. Some supplements have been shown to contain harmful levels of certain heavy metals (e.g., lead and mercury), microbes, pesticides, or other contaminants. At specific levels these contaminants can lead to serious health risks.

  • Will break down and release into the body within a specified amount of time. If a supplement does not break down properly to allow its ingredients to be available for absorption in the body, you will not get the full benefit of its contents. USP Dietary Supplement Verification tests products against performance standards.

  • Has been made according to FDA current Good Manufacturing Practices using sanitary and well-controlled procedures. Assuring safe, sanitary, well-controlled, and well-documented manufacturing and monitoring processes indicates that a supplement manufacturer is conscious about their quality and that the supplement will be manufactured with consistent quality from batch to batch (3).

It is worth mentioning that just because there is a seal verifying a supplement, it still doesn’t go through the same rigor of testing as drugs and doesn’t guarantee that supplements have a certain therapeutic value4. So if you’re looking for a supplement to increase your energy levels, for example, turning to Vitamin B12 injections may not work unless you are deficient in the vitamin. You can find a list of other certification organizations here to understand their guidelines for verifying supplements. The following supplement manufacturers are USP verified: Kirkland, Nature Made, Tru Nature.


Supplements vs. Whole Foods

The Dietary Guidelines for Americans make it clear that nutritional needs should be met primarily through diet. However, for some people supplements may be a useful way to get nutrients that might otherwise be lacking. First, here are some more facts.

Supplements aren't intended to be a food substitute because they can't replicate all of the nutrients and benefits of whole foods, such as fruits and vegetables. So depending on your situation and eating habits, dietary supplements may not be worth the expense.


Whole foods offer three main benefits over dietary supplements:

  • Greater nutrition. Whole foods are complex, containing a variety of the micronutrients your body needs — not just one. An orange, for example, provides vitamin C plus beta carotene, calcium and other nutrients. It's likely these compounds work together to produce their beneficial effect.

  • Essential fiber. Whole foods, such as whole grains, fruits, vegetables and legumes, provide dietary fiber. Most high-fiber foods are also packed with other essential nutrients. Fiber, as part of a healthy diet, can help prevent certain diseases, such as type 2 diabetes and heart disease, and it can also help manage constipation.

  • Protective substances. Whole foods contain other substances important for good health. Fruits and vegetables, for example, contain naturally occurring substances called phytochemicals, which may help protect you against cancer, heart disease, diabetes and high blood pressure. Many are also good sources of antioxidants — substances that slow down oxidation, a natural process that leads to cell and tissue damage (5).

So why even take supplements?

If you're generally healthy and eat a wide variety of foods, including fruits, vegetables, whole grains, legumes, low-fat dairy products, lean meats, and fish you likely don't need supplements. However, the dietary guidelines recommend supplements in the following situations:

  • Women who may become pregnant should get 400 micrograms a day of folic acid from fortified foods or supplements, in addition to eating foods that naturally contain folate.

  • Women who are pregnant should take a prenatal vitamin that includes iron or a separate iron supplement.

  • Adults age 50 or older should eat foods fortified with vitamin B-12, such as fortified cereals, or take a multivitamin that contains B-12 or a separate B-12 supplement.

  • Adults age 65 and older who do not live in assisted living or nursing homes should take 800 international units (IU) of vitamin D daily to reduce the risk of falls.

Dietary supplements may also be appropriate if you:

  • Don't eat well or consume less than 1,600 calories a day.

  • Are a vegan or a vegetarian who eats a limited variety of foods.

  • Don't obtain two to three servings of fish a week. If you have difficulty achieving this amount, some experts recommend adding a fish oil supplement to your daily regimen.

  • Are a woman who experiences heavy bleeding during your menstrual period.

  • Have a medical condition that affects how your body absorbs or uses nutrients, such as chronic diarrhea, food allergies, food intolerance, or a disease of the liver, gallbladder, intestines or pancreas.

  • Have had surgery on your digestive tract and are not able to digest and absorb nutrients properly.

Talk to your doctor or a dietitian about which supplements and what doses might be appropriate for you. Be sure to ask about possible side effects and interactions with any medications you take.


Bite Into Action!

When deciding to take a supplement, consider these factors:

  • Check the label. Read labels carefully. Product labels can tell you what the active ingredient or ingredients are, which nutrients are included, the serving size — for example, capsule, packet or teaspoonful — and the amount of nutrients in each serving.

  • Avoid mega doses. In general, choose a supplement that provides about 100 percent of the Daily Value (DV) of all the vitamins and minerals, rather than one which has, for example, 500 percent of the DV for one vitamin and only 20 percent of the DV for another.

  • Check expiration dates. Dietary supplements can lose potency over time, especially in hot and humid climates. If a supplement doesn't have an expiration date, don't buy it. If your supplements have expired, discard them.

  • Watch what you eat. Vitamins and minerals are being added to a growing number of foods, including breakfast cereals and beverages. If you're also taking supplements, you may be getting more than you realize of certain nutrients. Taking more than you need is expensive and can raise your risk of side effects. For example, too much iron can cause nausea and vomiting and may damage the liver and other organs.

  • Look for quality certification. There are independent organizations that offer certification programs for supplements to help meet high quality standards for ingredient legitimacy and integrity, among other things. You can find a list of certification organizations here. Companies have to pay a fee to be certified by one of these programs, which is probably why not all companies will certify their supplements.

  • Keep up with supplement safety alerts. The Food and Drug Administration (FDA) keeps a list of dietary supplements that are under regulatory review or that have been reported to cause adverse effects. If you're taking a supplement, it's a good idea to check the FDA website periodically for updates.

References:

  1. https://www.fda.gov/food/dietary-supplements

  2. https://www.washingtonpost.com/news/morning-mix/wp/2015/02/03/gnc-target-wal-mart-walgreens-accused-of-selling-fake-herbals/?noredirect=on&utm_term=.2c42639c4a77

  3. https://www.usp.org/verification-services/verified-mark

  4. https://www.consumerreports.org/vitamins-supplements/what-usp-verified-and-other-supplement-seals-mean/

  5. https://www.health.harvard.edu/staying-healthy/should-you-get-your-nutrients-from-food-or-from-supplements

  6. https://www.eatright.org/food/vitamins-and-supplements/dietary-supplements/vitamins-minerals-and-supplements-do-you-need-to-take-them

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