Americans spend an astonishing $32 billion annually on 85,000 different vitamins, minerals and other dietary supplements. But are all of these products effective, safe, and necessary? Research has confirmed that some of these supplements, such as folic acid and fish oil, can be beneficial. But many others aren’t backed by conclusive peer reviewed research.
Dietary supplements, also known as nutritional supplements, are sold in supermarkets, health food stores, dedicated retailers, online, and even in TV and radio infomercials. They’re defined as a product that contains one or more dietary ingredients intended to be taken by mouth as a pill, capsule, tablet, or liquid. Ingredients can include vitamins, minerals, herbs, botanicals, amino acids, and other substances or their constituents. They must be clearly labeled as dietary supplements.
Many Americans take dietary supplements to maintain or improve health. Data from the National Health and Nutrition Examination Survey (NHANES), which was collected between 2003 and 2006, indicates that 53 percent of us took at least one dietary supplement. A 2015 survey by the Council for Responsible Nutrition (a supplement industry lobbying group) pegs that figure at 68 percent. These surveys confirmed that multivitamins are the most commonly used supplement identified in these surveys, but other popular supplements include fish oil, vitamin D, CoQ10, calcium, B vitamins, and vitamin C.
Unfortunately, supplement marketing can be misleading. This can cause consumers to accept unsubstantiated health claims, or to underestimate the risk associated with supplement use.
Here are answers to common questions about dietary supplements. The goal is to help you make smart choices about supplements, and to help you learn to evaluate their quality and safety.
1. Can vitamins and minerals make up for a poor diet?
Wholesome foods deliver nutrients in a perfectly balanced and complete manner that our bodies have evolved to absorb. According to the 2015 Dietary Guidelines for Americans:
“Nutritional needs should be met primarily from foods. Individuals should aim to meet their nutrient needs through healthy eating patterns that include nutrient-dense foods … [which] contain essential vitamins and minerals and also dietary fiber and other naturally occurring substances that may have positive health effects.”
Dietary supplements may provide excessive or insufficient amounts of particular nutrients. The reality is that a pill can never replace the benefits of a diet that includes plenty of fresh fruits and vegetables, whole grains, and some meat, eggs, fish, dairy, and high quality fats. To learn more about healthy eating, take a look at choosemyplate.gov or schedule an appointment with your physician.
2. Who needs vitamins and supplements?
Most of us can get everything we need from a nutritious diet; however, there are specific situations in which a dietary supplement may be of benefit:
- During childbearing years it is recommended that women who are or may become pregnant take a folic acid supplement, consume foods fortified with folic acid, or both. This is important to reduce the risk of certain birth defects, which often occur before a woman even knows she is pregnant. Prenatal vitamins contain folic acid. Look for brands with methyl folate, a more absorbable form of folate.
- Pregnant women and adolescent girls are at increased risk for iron deficiency anemia. A simple blood test can diagnose this condition, which is reversible with dietary changes or an iron supplement.
- Seniors, breast-fed infants, and people with dark skin may need extra vitamin D. People with liver disease, cystic fibrosis, celiac disease, and Crohn’s disease may also benefit. Finally, those who are obese or have had gastric bypass surgery may need extra vitamin D. Because we in the Pacific Northwest lack sunlight during the winter and it can be difficult to obtain adequate amounts through food, many health care providers offer a blood test to help determine whether we need to supplement vitamin D.
- People who have multiple food allergies, a medical condition, or a vegan diet, might benefit from a multivitamin/multimineral. For example, vegans need to supplement with vitamin B12 because animal foods are the main dietary source of this essential nutrient.
- Seniors may benefit from taking vitamin B12 and (as noted above) vitamin D, which become more difficult to obtain in adequate amounts from food as we age.
- Individuals who eat very restrictive, low-calorie diets because of poor appetite, drug and alcohol use, or an eating disorder may need supplements to reduce risk of nutrient deficiencies and malnutrition.
- Bariatric surgery can impair your ability to absorb many nutrients, increasing the risk of malnutrition. A registered dietitian and doctor will work with you to ensure good nutrient status post-surgery.
3. How are vitamins and supplements regulated?
Many people assume supplements are harmless because they are “natural.” This is not necessarily true. More than 500 supplements have been found to be adulterated with pharmaceuticals or closely related compounds. These include stimulants, bodybuilding steroids, antidepressants, weight loss medications, and drugs aimed at treating erectile dysfunction — all with potentially dangerous side effects.
Part of the problem is that, unlike pharmaceuticals, dietary supplements can be sold without proof of safety, effectiveness, or purity. The Food and Drug Administration (FDA) is the federal agency responsible for evaluating safety of dietary supplements — after they reach the market. The FDA keeps track of side effects reported by consumers and health care providers, performs safety research, and monitors health claims on product packaging. If a product is found to have a false health claim or to be unsafe, the FDA can issue a warning to the manufacturer or require it be removed from the marketplace.
4. What are some safety considerations when choosing supplements?
A recent study found that dietary supplements are responsible for about 20,000 visits to the ER every year. Supplements may have side effects, interact with medications, or not have adequate research ensuring safety for certain groups of people.
It is important to discuss supplementation with your doctor or dietitian if you are taking any medication, have any medical conditions, are expecting to have surgery soon, are pregnant or breastfeeding, or are trying to become pregnant. Most dietary supplements have not been tested on pregnant and nursing women, infants, or children. Always follow the directions on the label for correct dosage.
5. How can I evaluate the quality of a supplement?
Do your research! There are several good resources:
- The National Center for Complementary and Integrative Health (NCCIH) and the National Institutes of Health’s (NIH) Office of Dietary Supplements (ODS) offer free information.
- The NIH has created MedlinePlus, a health information website for consumers that offers information about effectiveness, usual dosage, and drug interactions of dietary supplements.
- The Natural Medicines Comprehensive Database provides unbiased, current facts and ratings on the safety and effectiveness of over 1100 natural medicines.
- ConsumerLab is a private publisher of reviews and independent test results on health, wellness, and nutrition products.
- The United State Pharmacopeia (USP) and National Science Foundation (NSF) are independent, nongovernmental organizations that evaluate supplements. Though they don’t verify the effectiveness of a product, the USP and NSF stamps are given to supplements whose identity, strength, and purity have been confirmed.
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by Alyssa DeBord, MS, RDN, CLC | Registered Dietitian and WIC Coordinator
The Women, Infants and Children’s program (WIC) is a supplemental food and nutrition program for pregnant women, new moms, and children 0-5 years of age. Through WIC, women and children receive financial assistance in purchasing food, counseling and information on healthy eating, breastfeeding support and information and referrals to health care and other community resources. Eligibility is based on income; more information can be at www.doh.wa.gov/YouAndYourFamily/WIC/Eligibility. WIC is provided at the following Kaiser Permanente locations: Bellevue, Burien, Capitol Hill, Rainier Valley, and the Teen Pregnancy and Parenting Clinic. To learn more or to schedule an appointment please call (206) 326-2060.