The facts about dietary supplements, and which ones to consider

Lamar Odom’s recent hospitalization following some questionable activities including use of an “herbal sexual stimulant” has inspired a media frenzy covering the thousands of people sent to the ER annually from dietary supplement use. While I understand that these sorts of headlines inspire disbelief in the general public, it wouldn’t be such a shock if people knew a little bit more about dietary supplements.

What is a dietary supplement?

It’s been my experience that people assume that since supplements are taken by mouth they are basically food, or that taking a dietary supplement is roughly equivalent to eating a food that contains some of the same compounds. I also find that it’s often assumed that since I’m a Registered Dietitian I should know everything about every wackadoo powder that every self-proclaimed shaman on the corner is peddling. That simply isn’t true. Let’s take a closer look.

A dietary supplement is “A product taken by mouth that contains a ‘dietary ingredient’ intended to supplement the diet”.

A “dietary ingredient” may be one of the following:

  • a vitamin,
  • a mineral,
  • an herb or other botanical,
  • an amino acid,
  • a dietary substance for use by man to supplement the diet by increasing the total dietary intake (e.g., enzymes or tissues from organs or glands), or
  • a concentrate, metabolite, constituent or extract.

(More FAQs here)

So, a dietary supplement isn’t really food, but it is ingested.

Regulation and the DSHEA Act

It would be natural to assume that since supplements are ingested, they are regulated and monitored the same way that our foods are. You would be wrong to make that assumption. In 1994, the Dietary Supplement Health and Education Act (DSHEA) was signed into law which took the burden of proving a supplement’s safety before it is marketed. Effectively, a dietary supplement can be sold without proving that it is safe for consumption or that its claims are true. Of course, the FDA can retroactively take action against a supplement manufacturer if it is shown that the supplement is harmful.

You may also think that supplements could fall into the category of “drugs”, as most claim to produce some health effect similar to a drug would, but you would also be wrong. In order for a drug to be marketed and sold in the US, the manufacturer must prove that it works better than a placebo. Supplements require no proof that they actually work in order for them to be sold.

So, it can be on the shelf without being safe or effective.

Supplement news you may have missed

  • Multivitamins: Multivitamins are ubiquitously one of those things that people feel they “should do”, but most often their bottle of multivitamin/mineral supplements is in the back of a cabinet somewhere collecting dust only to be taken out when we’re feeling under the weather. Good news for the vitamin-neglectors, the CDC determined that Americans get plenty of nutrients through the diet and multivitamins are redundant for most.
  • GNC, Target, Wal Mart, Walgreens: These major retailers were discovered to be selling herbal supplements that contained a lot of things, but not what they claimed to have in them.

So…are all supplements bad?

Some supplements are helpful for certain people and for certain life stages. While multivitamin supplements are unnecessary for most, I do get the occasional patient who refuses to eat vegetables and lacks the nutrients they provide. There are people (like bodybuilders) who have increased nutritional requirements because of the beating their bodies take, and for those people it may be helpful to take a multi just to be sure, even though their increased caloric intake should also increase the vitamin/mineral intake. Then, there are the people who are just anxious about health and it gives them peace of mind to take the multi. If it’s not going to cause harm and they really insist on spending the money, I won’t fight it. For the most part, people may need a single nutrient at certain times throughout the lifecycle.

Supplements to consider:

Vitamin D – Most people that I see who get tested for vitamin D get results that are low. We make vitamin D when outside in the sun, but all of my patients spend most daylight hours indoors! It’s pretty tough to get vitamin D through food because it’s in so few dietary sources, so supplementation is a good idea here.

Folic Acid – Folic acid is extremely important for preventing neural tube defects (NTD) in fetuses. Women of childbearing age should consider taking folic acid since NTDs occur early in pregnancy and most pregnancies are unplanned. Of course, it’s also important once you know you’re pregnant, so it’s included in high amounts in prenatal vitamins.

Iron – Women are at risk for becoming iron deficient. If this happens, iron supplementation is a great way to go because the foods that are highest in the most bioavailable (your body can use it efficiently) iron are also high in saturated fat (i.e. red meat). Iron supplements should get your numbers right up in the normal range!

Omega-3s – Omega-3 fatty acids are a specific type of unsaturated fat that is found in high concentrations in some fish and certain nuts and seeds. It can help correct cholesterol levels, especially raising HDL. If you’ve got low HDL cholesterol and don’t eat a ton of omega-3s, it’s worth looking into.


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