Food comes first: The facts about dietary supplements
There are very few proven health benefits to taking dietary supplements, unless you have a nutritional deficiency.
Dietary supplements are largely unregulated – resulting in misleading health claims and a multi-billion dollar industry.
It is always best to meet your nutritional needs with a healthy, well-balanced diet.
It seems like everywhere we turn these days, there are questionable health claims about dietary supplements. You’ve probably seen some of them: an antioxidant formula that prevents cancer; Vitamin C capsules that stop colds; ginseng powder that boosts energy; Co-q-10 tablets that protect your heart.
But are any of these claims actually true?
Unlike traditional medications, which are strictly regulated by the FDA, dietary supplements are largely unregulated. In fact, in the world of supplements, pretty much anyone can create a product, make a claim about it, and sell it — regardless of the science (or lack of) behind it — and plenty of people are doing just this.
Consumers certainly would like the claims to be true; the size of the US supplements market will reach around $57 billion by 2024, and an online search of ‘dietary supplements’ reveals 133 million hits. With so little regulation, so much interest, and so much money involved, it’s no wonder that the marketing of supplements can be misleading.
So, before you spend your time and money on supplements that a) you may not need, and b) might even be harmful, read on for insights from Jennifer Troupe, a registered dietitian at Providence Medical Group in Missoula, Montana.
What are the evidence-based benefits of taking dietary supplements?
“There’s not a lot of evidence supporting supplementation, unless you have a deficiency,” Troupe explains. For most healthy individuals who eat a varied diet that includes all the food groups (protein, whole grains, fruits/vegetables, and dairy), there’s a very low likelihood that dietary supplementation is either necessary or will provide any health benefits.
However, some individuals do develop nutritional deficiencies, or are diagnosed with specific conditions that supplements can benefit. Supplementation for Vitamin D deficiency, for example, can be effective in the prevention of osteoporosis and possibly prevent chronic diseases such as diabetes and cancer; however, more research needs to be completed in these areas. The current recommended intake for people 1 year of age to 70 years of age is 600 IU’s. 800 IU’s are recommended for those over 70. There is quite a bit of discussion currently regarding these recommendation as to their adequacy. For example, the Endocrine Society recommends at least 1,000 IU’s /day for children and adolescents and 1,500 -2,000 IU’s/day for adults.
If you are concerned you might have a nutritional deficiency, see your primary care provider, who can order blood work to test your levels. Also, a registered dietitian can complete an assessment regarding your nutritional intake, identify deficiencies, and then help you improve your diet, including any recommended supplementation, if appropriate.
Are there any supplements that are generally recommended?
Research on multi-vitamins has bounced back and forth over the years, as to whether people should take them or not. Troupe generally recommends that for someone who is healthy, eats a balanced diet, a basic multi-vitamin as a “back-up plan” may be helpful, but it’s important to understand that you shouldn’t take vitamins in place of eating fruits and vegetables. Fresh produce has bioactive compounds such as phytochemicals that dietary supplements simply don’t have.
If you do decide to take a daily multi-vitamin (or any other supplements), check the label to make sure the nutrients do not exceed 100% of the recommended daily value. While you may have heard that excess vitamins are simply excreted through your urine, this isn’t always the case. Excess nutrients can be dangerous and even toxic, specifically for fat-soluble vitamins such as vitamins A, D, E, and K.
Because some people suffer from iron deficiency, Troupe recommends that iron levels be monitored, particularly if you’re feeling fatigued. Iron is especially important for women of childbearing age. If your levels are low, work with a registered dietitian to modify your diet. Iron supplementation may also be needed.
When pregnant or planning to become pregnant, Troupe advises women take a daily pre-natal vitamin with at least 400 mcg of folic acid to help prevent neural tube defects in infants.
She also considers Calcium and Vitamin D supplementation for individuals who have a hard time getting these nutritionally or have limited sun exposure as is the case with Vitamin D, though her first preference is to meet these needs with food if possible.
Other important points:
B12 supplementation is sometimes necessary, as we age or in people with type 2 diabetes who take metformin.
One common misconception is that Vitamin C prevents colds. It doesn’t, although it may shorten the duration of illness if taken early.
There is very little evidence that most herbal supplements (i.e. ginseng, bilberry, ginkgo, fenugreek, etc.) provide any health benefits.
Where can I learn more?
“As a dietitian, I favor protecting the public, and my patients, from spending money on something that they may not need,” says Troupe. She suggests the following websites for further research:
Therapeutic Research Center Natural Medicines – Discover whether a supplement is needed and/or effective. You can also check for drug interactions. They even have an app for your smart phone.
National Center for Complementary and Integrative Health – This patient-friendly site provides scientific evidence and relevant fact sheets on a wide variety of dietary supplements. Also investigates other natural healing remedies like yoga and acupuncture.
The United States Pharmacopeial Convention (USP) – This organization reviews dietary supplements and sets federally recognized standards of quality. They won’t confirm that a product actually meets the advertised health care claim, however, they do confirm that what the company says is in the product is actually in there.
Bottom line: Do supplements prevent disease?
If you eat a healthy diet that includes all the food groups and at least the minimum number of servings such as the USDA’s Choose MyPlate, then probably not — but if you avoid certain food groups or suffer from a chronic disease, they might have an impact but only after a true vitamin or mineral deficiency has been established.
Troupe adds, “What does prevent chronic disease and illness is good rest, exercise, limiting alcohol, maintaining a healthy weight and eating a diet from all the food groups.”
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This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.