What Supplements Do I Need? Have you noticed a supplement ad and thought, “That’s amazing, I need that?” Well, if you have, you’re not alone. Supplements are now the most common form of alternative medicine with Americans spending more than $30 billion on supplements each year. Advertisements for supplements are compelling. It’s not unusual for supplement ads to suggest boosting memory, building muscles, burning fat fast, and more. Unfortunately, most are no better than a placebo and many have been found to have illegal and potentially harmful ingredients. While it would be nice to believe the Government is on top of this problem, the reality is far bleaker. Few products sold as supplements are tested and then usually only after problems are reported. Of particular concern are stimulants that aren’t approved for human use and are believed to increase blood pressure and heart rate. In at-risk people they can contribute to heart attacks and strokes. One of the stimulants, DMAA, was used in the1940s as a nasal decongestant but later withdrawn from the market. Another, oxilofrine, was never approved in the U.S. although it was approved in some European countries for low blood pressure. Other stimulants like BMPEA and DMBA, have never been approved for use in humans. No doubt you imagine that once the FDA issues a public warning, a dangerous supplement will dutifully be removed from the market. In practice, that doesn’t always happen unless the source is a well known and reliable supplier. Smaller distributors may never be detected and, if found, may relabel their products or move their products to locations where they are less likely to be detected. In one study, it was found that even after an FDA recall, two-thirds of the supplements available for sale still contained unapproved drugs. Perhaps you are imagining that these problems only affect a few products sold by a few shady outfits. If this is your view of the pretty boxes lining the supplement shelves you may want to reconsider. Following a recent study by the FDA, 776 dietary supplements were found to contain prescription drug ingredients with 157 containing more than one unapproved ingredient. Many of these products remained on the shelf long after the FDA issued public warnings about the products. Of the non-compliant products, most tended to be products marketed for sexual enhancement, weight loss or muscle building. Noxitril is typical of supplements in the sexual enhancement category. You may wonder what such an amazing product contains. Well, so does everyone else. While some of the ingredients can be identified, how much of each ingredient is in a pill remains a mystery. What we may reasonably conclude is that whatever the ingredients, they fall far short of the objective if the Amazon reviews can be believed. Granted, Amazon reviews fall short of quality research but will have to do since it’s the best we have. From reviews posted it would appear that Noxitril is less effective than a placebo. As one reviewer put it, “Well think about it. If this product worked like they advertise would they have to advertise?” Dietary supplements such as vitamins, botanicals, and enzymes also have a poor track record. The problem is that most are classified as a food. Hence, supplement manufacturers don’t have to demonstrate safety or effectiveness before their products go on the market. At best, they may not do anything and at worst they may be fraudulent or tainted. For most dietary supplements there is no evidence to validate they are better than a balanced diet. In spite of the bleak odds for getting a benefit from over the counter supplements, more than 50% of adults take them. Credit creative marketing for the ability to sell most supplements since a rational reason is hard to imagine. The Food and Drug Administration (FDA) does not review dietary supplements before they come onto the market. Furthermore, Federal law does not require dietary supplements to be proven safe before they are marketed. In effect, supplements can be marketed and sold without any evidence that they are safe, pure, or effective. Federal researchers estimate that tainted supplements cause about 23,000 emergency department visits nationwide each year, and about 2,000 hospitalizations each year. There might be value in some supplements if you live on the Standard American Diet. The far better solution would be a plant-based whole food diet that has strong evidence of effectiveness. Regrettably, the message that plant-based foods are healthy has been used by the supplement industry to market a wide range of concentrated plant foods. Of course, any process that concentrates a food has to remove something. Usually that ‘something’ is part of what made the original plant-based whole food nutritious. As for herbs, some are nutritious plant foods and some are dangerous. Fortunately, there are resources to help you make wise choices. Resources that can help you find the information for wise decisions can be found at the Nutrition.gov website pages for herbal supplements and the web page for dietary supplements. For most, the best supplements are more fruits, vegetables, legumes, whole grains, and daily exercise. Beyond that, unless there is a medical indication, other supplements are rarely needed by most people. Now that you have been empowered with knowledge about supplements, you too can walk past the long isle of supplements at pharmacies and grocery stores with the same question I have – why do people buy all this crazy stuff? Have more questions, I’d be glad to help with answers. Just bring your question to your next appointment or if you like, let’s chat about them on a walk around the lakes Saturday morning. Nancy Neighbors, MD Huntsville, Alabama About Choosing Supplements • Avoid the most frequently tainted supplements which typically include supplements for muscle building, weight loss, and sexual health by checking on supplements in the Council for Responsible Nutritions’ online voluntary product registry or at SmartCeuticals.org • Be wary of bold claims and celebrity endorsements. Even when not dangerous, most supplements are a waste of money. Put your money where it counts – vegetables, fruits, whole grains, etc. • Be especially wary of supplements that claim to treat a disease. • Talk to your doctor before starting any type of supplement. Some interfere with prescription medications. • Look for products that are certified by reputable labs and third parties. The United States Pharmacopeia certifies supplements with the USP seal. Other third-party seals include UL from Underwriter Labs and NSF International. |