Finding what your body needs from supplements and food
According to Forbes Magazine, the dietary supplement market is one of the world’s fastest-growing industries. In 2012, consumers around the globe spent more than $32 billion on these products; by 2021, that figure is expected to expand to $60 billion or more.
You can stir up a good food fight in any group of nutrition experts simply by asking whether all these products are (a) necessary, (b) economical, or (c) safe. But when the argument’s over, you still may not have a satisfactory official answer, so this brief chapter aims to provide the information you need to make your own sensible choices.
Introducing Dietary Supplements
Your daily vitamin pill is a dietary supplement. So are the calcium antacids many American women consider standard nutrition and the vanilla, chocolate, or strawberry liquid your granny chug-a-lugs each afternoon before setting out on her power walk. In fact, according to the Food and Drug Administration, any tablet, capsule, powder, or liquid you take by mouth that contains a dietary ingredient is a dietary supplement. That includes
Vitamins
Minerals
Herbs and spices, such as Echinacea, which presumes to ward off colds, and ginger, which is said to relieve seasickness
Amino acids (the “building blocks of protein” described in Chapter 6)
Enzymes, such as lactase, the one that turns lactose (milk sugar) into lactic acid (see Chapter 2 for how enzymes empower your digestive tract)
Organ tissue, such as that dried liver
Some hormones, such as melatonin, the purported sleep aid
Metabolites (substances produced when nutrients are digested)
Extracts
Dietary supplements may be single-ingredient products, such as vitamin E capsules, or they may be combination products, such as multivitamin and mineral pills, or the ubiquitous and controversial “energy drinks” whose “energy” is mostly caffeine-fueled. In a country where food is plentiful and affordable, you have to wonder why so many people opt to rely on these products instead of just plain food.
Examining Two Reasons to Use Dietary Supplements
Many people consider supplements a quick and easy way to get nutrients without much shopping and kitchen time and without all the pesky fats and sugars in food. Others take supplements as nutritional insurance. (For more on recommended dietary allowances of vitamins and minerals, see Chapters 10 and 11.) And some use supplements as substitutes for medical drugs.
In general, nutrition experts, including the American Dietetic Association, the National Academy of Sciences, and the National Research Council, prefer that you invest your time and money whipping up meals and snacks that supply the nutrients you need in a balanced diet of real food.
Nonetheless, every expert admits that supplements may be valuable for people with specific nutritional needs and as an insurance policy in certain circumstances.
When food isn’t enough
Some metabolic disorders and diseases of the digestive organs (liver, gallbladder, pancreas, and intestines) and some medicines interfere with the normal digestion of food and the absorption of nutrients, meaning you may need supplements to make up the difference. People who suffer from certain chronic diseases or who have experienced a major injury (such as a serious burn), or who have just been through surgery may also need more nutrients than they can get from food.
To be safe, check with your doctor before opting for a supplement you hope will have medical effects (make you stronger, smooth your skin, ease your anxiety, and so forth). Your doctor, the person most familiar with your health, knows what medications you’re taking and can caution you about potential side effects.
Supplementing aging appetites
As you grow older, your appetite may decline and your sense of taste and smell may falter. If food no longer tastes as good as it once did, if you have to eat alone all the time and don’t enjoy cooking for one, or if dentures make chewing difficult, you may not be taking in all the foods that you need to get the nutrients you need, and dietary supplements may be the answer.
Meeting a woman’s special needs
At various stages of her reproductive life, a woman may benefit from supplements. For example:
Before menopause: Women, who lose iron each month through menstrual bleeding, rarely get sufficient amounts of iron from a typical American diet providing fewer than 2,000 calories a day. For them, and for women who are on a weight-loss diet, iron supplements may be the only practical answer. Deciding which iron pill to choose? Check out Chapter 11.
During pregnancy and lactation: Before and during pregnancy, supplements of the B vitamin folate are known to decrease a woman’s risk of giving birth to a child with a neural tube defect (a defect of the spinal cord and column). While pregnant, women often need supplements to provide the nutrients they need to build new maternal and fetal tissue; once the baby is born, supplements provide the nutrients needed to produce healthful breast milk.
Don’t not self-prescribe while pregnant. Even simple nutrients may be hazardous for your baby. For example, megadoses of vitamin A while pregnant may increase the risk of birth defects.
Through adulthood: True, women older than 19 can get the calcium they require (1,000 milligrams per day) from four 8-ounce glasses of nonfat skim milk, three 8-ounce or four 6-ounce containers of yogurt made with nonfat milk, 22 ounces of canned salmon (with the soft edible bones; definitely not the hard bones in fresh salmon!), or any proportional combination of the above. However, expecting women to do this nutritional balancing act every single day may be unrealistic. The simple alternative is calcium supplements.
Boosting a special diet
Vitamin B12 is found only in food from animals, such as meat, milk, and eggs. (Some seaweed does have B12, but the suspicion is that the vitamin comes from microorganisms living in the plant.) Once upon a time, vegans (people who eat only plant foods — no dairy foods or eggs allowed) would almost certainly have had to get their B12 from supplements. Today, fortified grains may do the trick, but some vegans still add B12 to be sure.
Using supplements as insurance
Some healthy people who eat a nutritious diet still choose supplements to make sure they’re getting adequate nutrition.
At first glance, it seemed they might be right. In 2002, the American Medical Association (AMA), which for decades had turned thumbs down on vitamin supplements, changed its collective mind after a review of 26 years’ worth of scientific studies relating vitamin levels to the risk of chronic illness. Robert H. Fletcher and Kathleen M. Fairfield, the Harvard-based authors of the study, which was published in the Journal of the American Medical Association (JAMA), noted that while true vitamin-deficiency diseases such as scurvy and beriberi are rare in Western countries, suboptimal vitamin levels — sciencespeak for slightly less than you need — are a real problem. If “slightly less than you need” sounds slightly less than important, consider this:
Suboptimal intake of folate and two other B vitamins (B6 and B12) may raise your risk of heart disease, colon cancer, breast cancer, and birth defects.
Suboptimal vitamin D intake means a higher risk of rickets and osteoporosis.
However, there is no evidence that swallowing large amounts of some vitamins will reduce your risk of cancer. In fact, in 2009, a report in The Archives of Internal Medicine summarizing data from an analysis of more than 150,000 women showed that taking multivitamins every day had no effect on the risk for breast cancer, colorectal cancer, endometrial cancer, lung cancer, ovarian cancer, heart attack, stroke, blood clots, or mortality. The study’s author, Marian L. Neuhouser, a nutritional epidemiologist with the Fred Hutchinson Cancer Research Center in Seattle, was quoted as concluding that “buying more fruits and vegetables might be a better choice.” Tastes better, too.
Exploring Supplement Safety: An Iffy Proposition
As its name implies, the Food and Drug Administration (FDA) regulates drugs and food. Before the agency allows a new food or a new drug on the market, the manufacturer must submit proof that the product is safe. Drug manufacturers must also meet a second test, showing that their new medicine is efficacious, meaning that it works and that the drug and the dosage in which it’s sold will cure or relieve the condition for which it’s prescribed.
Nobody says the drug-regulation system is perfect. Reality dictates that manufacturers test a drug only on a limited number of people for a limited period of time. So you can bet that some new drugs will trigger unexpected, serious, maybe even life-threatening side effects when used by thousands of people or taken for longer than the testing period. For proof, look no further than the multiple recalls FDA has issued over the last decades. But at least the FDA can require that premarket safety and/or effectiveness info be displayed on foods and drugs. Unfortunately, the agency has no such power when it comes to dietary supplements. In 1994, Congress passed and President Clinton signed into law the Dietary Supplement Health and Education Act, which limits the FDA’s control over dietary supplements. Under this law, the FDA can’t
Require premarket tests to prove that supplements are safe and effective.
Limit the dosage in any dietary supplement.
Halt or restrict sales of a dietary supplement unless evidence shows that the product has caused illness or injury when used according to the directions on the package; in other words, if you experience a problem after taking slightly more or less of a supplement than directed on the label, the FDA can’t help you.
As a result, the FDA has found it virtually impossible to take products off drugstore shelves even after reports of illness and injury. The classic example is that of supplements containing the herb ephedra, once sold for their reputed ability to enhance weight loss and sports performance. More than 600 reports of illness and at least 100 deaths were linked to the use of ephedra supplements. The herb was banned by professional football and college athletics in the United States and by the Olympics. However, the FDA didn’t act until February 2003, following the death of Baltimore Orioles pitcher Steve Bechler, who reportedly had been using ephedra products to control his weight. Bechler’s untimely death rang warning bells across the country, including in Washington, D.C., where the FDA ruled that henceforth every bottle of ephedra must carry strong warnings that the popular herb can cause potentially lethal heart attacks or strokes. In the sports world, ephedra was immediately forbidden in minor-league but not major-league baseball. The FDA then banned all ephedra products, and despite a challenge from an ephedra manufacturer, the ban was upheld by the U.S. Court of Appeals for the Tenth Circuit in 2006.
A more recent example occurred in 2015 when a number of health food stores voluntarily stopped selling products containing an herb called acacia rigidula because studies showed that the supplement also contained an amphetamine-like stimulant called BMPEA, which had never fully been studied in humans. The FDA, however, said its review “does not identify a specific concern at this time,” a conclusion strongly disputed by experts, including the Council for Responsible Nutrition.
Of course, ephedra and acacia-with-BMPA are not the only problematic herbal supplements. For a list of some well-known offenders, see Table 13-1, which lists several herbals that interact with common medical drugs.
Table 13-1 Some Potentially Hazardous Herbal Products
Herbal product
Possible Side Effects and Interactions
Cayenne
Increased risk of bleeding for people taking blood thinners such as warfarin (Coumadin) and clopidogrel (Plavix)
Dong quai
Increased risk of bleeding for people taking blood thinners such as warfarin (Coumadin) and clopidogrel (Plavix)
Echinacea
Decreased effectiveness of immunosuppressant drugs, leading to transplant rejection
Garlic
Increased risk of bleeding for people taking blood thinners such as warfarin (Coumadin) and clopidogrel (Plavix)
Increased effect of hypoglycemic drugs used to control blood sugar levels
Decreased effectiveness of immunosuppressant drugs, leading to transplant rejection
Decreased effectiveness of oral contraceptives
Ginko
Increased risk of bleeding for people taking blood thinners such as warfarin (Coumadin) and clopidogrel (Plavix)
Ginseng
Increased risk of bleeding for people taking blood thinners such as warfarin (Coumadin) and clopidogrel (Plavix)
Glucosamine
Increased insulin resistance in people using hypoglycemic drugs used to control blood sugar levels
Licorice
Decreased effectiveness of the blood thinner warfarin (Coumadin)
St John’s Wort
Added rise in serotonin levels, leading to possible fever, muscle rigidity, and altered mental responses for people using antidepressants such as fluoxetine (Prozac and paroxetine (Paxil)
Valerian
Increased sedative effects in people using alcohol, and other sedatives
The Mayo Clinic and the University of Miami School of Medicine
Choosing the Most Effective Supplements
Okay, you’ve read about the virtues and drawbacks of supplements. You’ve decided which supplements you think may do you some good. Now what you really want to know is how to choose the safest, most effective products. The following guidelines can help:
Pick a well-known brand. Even though the FDA can’t require manufacturers to submit safety and effectiveness data, a respected name on the label offers some assurance of a quality product. It also promises a fresh product; well-known brands generally sell out more quickly. The initials USP (U.S. Pharmacopoeia, a reputable testing organization) are another quality statement, and so are the words “release assured” or “proven release,” which mean the supplement is easily absorbed by your body.
Look for the expiration date. Over time, all dietary supplements become less potent. Always choose the product with the longest useful shelf life. Pass on the ones that will expire before you can use all the pills, such as the 100-pill bottle with an expiration date 30 days from now.
Read the storage requirements. Even when you buy a product with the correct expiration date, it may be less effective if you don’t keep it in the right place. Some supplements must be refrigerated; the rest you need to store, like any food product, in a cool, dry place. Avoid putting dietary supplements in a cabinet above the stove or refrigerator — true, the fridge is cold inside, but the motor pulsing away outside emits heat.
Stick with a safe dose. Unless your doctor prescribes a dietary supplement as medicine, you don’t need products marked “therapeutic,” “extra-strength,” or any variation thereof. Pick one that gives you no more than the RDA for any ingredient.
Avoid hype. When the label promises something that’s too good to be true, you know it’s too good to be true. The FDA doesn’t permit supplement marketers to claim that their products cure or prevent disease (that would make them medicines and require premarket testing). But the agency does allow claims that affect function, such as “maintains your cholesterol” (the medical claim would be “lowers your cholesterol”).
Another potential hype zone is the one labeled “natural,” as in “natural vitamins are better.” If you took Chem 101 in college, you know that the ascorbic acid (vitamin C) in oranges has exactly the same chemical composition as the ascorbic acid some nutritional chemist cooks up in her lab. To be fair, the ascorbic acid in a “natural” vitamin pill may come without additives, such as coloring agents or fillers used in “regular” vitamin pills. In other words, if you aren’t sensitive to the coloring agents or fillers in plain old pills, don’t spend the extra dollars for “natural.” If you are sensitive, do. What could be simpler? (For more on “natural” versus “synthetic” food ingredients, see Chapter 22.)
Check the ingredient list. In the early 1990s, the FDA introduced the consumer-friendly nutrition food label with its mini-nutrition guide to nutrient content, complete ingredient listings, and dependable information about how eating certain foods may affect your risk of chronic illnesses, such as heart disease and cancer.
The FDA’s new supplement labels must list all ingredients. The label for vitamin and mineral products must give you the quantity per nutrient per serving plus the %DV (percentage daily value), the percentage of the RDA (Recommended Dietary Allowance). The listings for other dietary supplements, such as botanicals (herbs), must show the quantity per serving plus the part of the plant from which the ingredient is drawn (root, leaves, and so on). A manufacturer’s own proprietary blend of two or more botanicals must list the weight of the total blend.
Figure 13-1 shows an example of the supplement labels.
FIGURE 13-1: Supplement labels are now consumer-friendly.
Getting Nutrients from Food Rather Than Supplements
Finally, having presented facts in favor of supplements and how to choose the most effective ones, here is why people with no underlying chronic or temporary (think pregnancy) medical conditions or need may be better off getting all or most of their nutrients from food:
Cost: If you’re willing to plan and prepare nutritious meals, you can almost always get your nutrients less expensively from fresh fruits, vegetables, whole grains, dairy products, meat, fish, and poultry. Besides, food usually tastes better than supplements.
Unexpected bonuses: Food is a package deal containing vitamins, minerals, protein, fat, carbohydrates, and dietary fiber, plus a cornucopia of phytochemicals (phyto = plant) that may be vital to your continuing good health.
Safety: Several common nutrients may be toxic in megadose servings (amounts several times larger than the RDAs). Not only are large doses of vitamin A linked to birth defects, but they may also cause symptoms similar to a brain tumor. Niacin megadoses may cause liver damage. Megadoses of vitamin B6 may cause (temporary) damage to nerves in arms, legs, fingers, and toes. All these effects are more likely to occur with supplements. Pills slip down easily, but regardless of how hungry you are, you probably won’t eat enough food to reach toxic levels of nutrients. (To read more about the hazards of megadoses, see Chapters 10 and 11.)
In general, nutrition experts, including the American Dietetic Association, the National Academy of Sciences, and the National Research Council, prefer that you invest your time and money whipping up meals and snacks that supply the nutrients you need in a balanced diet of real food.
To be safe, check with your doctor before opting for a supplement you hope will have medical effects (make you stronger, smooth your skin, ease your anxiety, and so forth). Your doctor, the person most familiar with your health, knows what medications you’re taking and can caution you about potential side effects.