While It's difficult to estimate exactly
how much people spend on supplements.
One group estimates that in the United
States we spend almost 23 billion dollars
a year on dietary supplements and related
products.
The situation in the European Union is a
little bit different than that of the
United States.
In the EU, a lot of the supplement-based
information and consumer information is
derived from the EU Food Supplement's
Directive of 2002.
This was a directive that established
purity criteria.
And in the EU, one of the major
differences between the situation in the
US.
Is that, in the EU, supplements have to
be proven safe before they can be sold to
the general public.
In the EU, products have to be labeled.
This is not a medicinal product.
If it is similar to a medicinal product.
In the U.S.
things are a little bit different.
Supplement regulation and the governance
of supplement sales is loosely directed
by what was called DSHEA and that's the
Dietary Supplement Health and Education
Act of 1994.
The original intent of this piece of
legislation was that the governments in
the U.S.
wanted to start to reign in and to
regulate and legislate to some degree,
the growing interest in and sales of
dietary supplements, so the DSHEA Act
defined supplements in the U.S.
as a vitamin, a mineral.
An herb or a botanical, except for
tobacco.
An amino acid, or a combination of any of
those that are used in supplementation to
the diet.
Supplements in the US are regulated as a
category of foods.
And not of drugs.
What's interesting about the United
States scenario, is that supplements do
not have to be proven.
As either effective or being safe, before
being sold.
So you or I, essentially if we wanted to
get in the supplement business could
start selling supplements tomorrow over
the counter without really doing any leg
work to prove that it was safe or even
that what we said was in the bottle, was
in the bottle.
Enforcement in the US is at best spotty
and the industry is still largely And
regulated.
The DSHEA Act in the United States
Regulations say that if you're going to
sell a supplement, it has to have a
supplement facts panel on it.
So this is one that you might see.
it tells you amount per serving in this
column and then what the percent of the
daily value is.
So this supplement here, it might be some
sort of multivitamin supplement.
It's a pretty good supplement.
Because you can see that for the majority
of the nutrients, it's close, providing
close to 100% of the recommended value.
What's a problem though is that with some
supplements, you see things like 1,000,
or 2,000, 3,000% of your daily value.
We tend in the United States to live in a
society where people think, huh, if 100%
is good, 1,000%.
It must be ten times as good.
But that certainly not the case with
supplements.
These are very very concentrated sources
of vitamins and minerals and in some
people with some conditions at different
metabolic situations could actually prove
very dangerous to be taking very high
levels of this over the counter product.
One thing that you want to be concerned
about as a consumer is the quality of the
dietary supplement if you do choose to
purchase them.
In the US, quality standards exists,
although questionably reinforced, the
identity, the purity, the strength, the
composition of the active ingredient in
the dietary supplement that you are
taking may not entirely known.
In the U.S.
there are independent extra-govenemental
organizations that add additionally
quality testing.
So you sometimes see labels listed on the
supplement that say that they have been
proving to be safe, or this is a pure
product, or this meets the industry
standards.
And it's a third party non governmental
group.
That provides that seal of purity or
whatever but often times or all the time
the supplement manufactures do have to
pay for that, so its not something that
US government mandates but many
supplement companies do employ.
There are certainly concerns about taking
certain dietary supplements.
There is the possibility that some of
them might contain lead or other
contaminants.
They may in certain populations displace
income that could otherwise be used for
prescription drugs.
In the U.S.
we're talking, primarily about the older
population.
There are certainly unscrupulous
manufacturers out there, who target and
market directly to, older people on
limited incomes.
If you have x amount of dollars a month
to spend, and you need to buy healthy
food, you may need to buy prescription
drugs Drugs.
For most of these people, you should not
be spending what limited amount of income
they have on dietary supplements that
haven't been proven to be safe, or
effective.
One situation that we're starting to pay
more attention to in the healthcare
environment, is the fact that users of
supplements don't always disclose them to
their healthcare Healthcare
practitioners.
Part of the problem is that many
healthcare practitioners, they don't ask
what types of supplements you use.
They might ask you about all the drugs
that you're on, prescription drugs, but
they don't ask you about your
supplements.
So it is important that if you do take
dietary supplements and go to the doctor
or the clinic to your healthcare
practitioner, that you mention the
dietary supplements that you're on.
Because many of them can be
contraindicated with other parts of your
medical.
Treatment for example medicines that you
might be taking would not be advisable to
be taking other supplements at the same
time.
The herbal supplements that some people
take.
contain dozen of compounds and active
ingredients that may not be known.
So especially in pregnancy and for people
on multiple medications say when in doubt
you leave the herbal supplements out.
A few more things to help make you a
savvy supplement user.
Keep in mind that the word, natural,
means nothing.
You see natural posted all over foods and
supplements, and other health care
products.
In the United States, there's no
regulation for using the word, natural.
Some other terms that are somewhat
misleading, purposely misleading.
Are things like high potency, pharmacy
grade, or prescription strength.
You might buy a supplement that's more
expensive, because it says it's of the
highest pharmacy grade.
It's kind of an ironic statement.
Where, in the United States, supplements
are sold over the counter.
So you don't need a prescription strength
version of it, and there's no definitions
for these terms as well.
Self diagnosing yourself with a problem
and taking and taking a supplement if
you're having a health condition is a
harmful practice.
More expensive supplement do not equate
to better quality.
And again, some over the counter
supplements may have various dangerous
potential interactions.
And are contraindicated with many types
of prescription medications.
Some examples of contraindications.
Vitamin K.
Vitamin K is a supplement.
Reduces your ability of your blood
thinner to work.
So if you're on the blood thinner drug,
Coumadin.
That's helping prevent your blood from
clotting.
And you take a high dose of vitamin K,
which promotes blood clotting.
Those two things don't work together.
Saint John's Wort can expedite the
breakdown of many drugs.
There are many documented cases.
While it's not certainly an epidemic.
But individuals who are taking oral
contraception, or antidepressants.
They started taking Saint John's Wort.
And they had the opposite of the
intended.
Effect.
The contraception is not effective, the
antidepressents are not effective.
Antioxidants like vitamin C and vitamin E
have been shown to reduce the
effectiveness of certain chemotherapy
therapies.
In the United States there are tolable
upper intake levels set by the Institute
of Medicine for certain vitamins and
minerals.
Well, there are not ULs, upper limits,
for all of the vitamins and minerals.
But for the ones that you do see listed
here in this table, it's a good idea to
pay attention to them.
Because what it means, is that if you
regularly go above this tolerable upper
intake level, you could potentially be
putting yourself at risk.
Because there is science that shows, as
very high levels.
Above the UL.
These certain vitamins and minerals can
prove harmful.
Let's look at a number of different
claims that certain supplements make.
And see whether or not they really have
any bearing.
Or whether or not they're true.
Sometimes, you see products that claim
to, quote unquote, promote joint health.
What does that mean? Well, joint health
supplements are big business.
In the US there's roughly 800 million
dollars in joint health supplement sales
per year.
And most of that has to do with the
supplements glucosamine and chondroiton
which you see sold or marketed together.
Which to be honest have mostly negative
results in very large-scale studies that
have been done.
To test whether or not they help with,
joint health.
One of the most well-known studies, was
the GAIT trial; glucosamine, chondroitin,
and arthritis intervention trial of 2006.
Which, bottom line, found no clear
benefit, for most people taking these
products.
In the, in the majority of these studies,
any of the benefit that was realized, was
attributable, to the placebo effect.
In 2009, there was a random Randomized
study that showed glucosamine and
chondroitin were no more effective than
the placebo was to slow cartilage damage
from osteoarthritis.
And again in 2010 there was a different
study done by a group of Norwegian
researchers who tested glucosamine for
chronic low back pain and degenerative
lumbar osteoarthritis and found that
there was no significant difference
between glucosamine and placebo.
So at the end of the day glucosamine is
not or hasn't been proven to be harmful,
but it certainly has been proven not to
help improve joint pain.
Another claim you sometimes see
supplements that advertise or say that
there going to improve your memory or
your focus, in the U.S.
Americans spend about 250 million dollars
per year on these products.
Is it worth it? Or are they wasting their
money.
The largest study done, and one of the
supplements that's used primarily for
memory and for focus, is the study, or is
using the supplement gingko.
There was a large scale study done called
the GEM trial.
Gingko Evaluation of Memory.
And in this study, it was a randomized
study.
Double blind, placebo controlled, and
looked at over 3,000 people.
who were age 72 to 96, at 6 different
academic medical centers.
They were given either twice daily doses
of 120 milligrams of ginkgo extract, or
they were in a placebo group.
And at the end of the 6 year trial the
researchers found that those that were
taking the ginkgo had no remarkable or no
not much less cognitive decline then the
placebo group did.
Earlier gem findings have debunked.
The benefit of gingko against Alzheimer's
and Dementia.
And according to the author of one of
these studies from the University of
Virginia.
He say's I, and he as a researcher said
this, have got no good reason to suggest
that you continue to take gingko beyond
Beyond your own blind faith.
So essentially we're spending 250 million
dollars year on products that are
marketed to help our memory, and we can
show absolutely no scientific data that
these products actually work.
Again, they haven't been proven to be
harmful for you, but as is the case with
most supplements, they're a pretty big
waste of money.
The last claim that we'll look at are
those which prevent aging.
Isn't that what we all want? To live a
nice, full, longer life.
Well, eating a good diet and exercising
regularly is a lot of work.
Can I just buy a product to help prevent
my aging? In the U.S.
again, about 250 million dollars a year
is spent.
On these products.
One of the primary ingredients in these
anti-aging property er products that you
see marketed is called resveratrol.
And resveratrol is an anti-oxidant
compound foud in red wine.
It appears to inhibit enzymes that
regulate cell energy.
In 2006, there was a study done that got
everyone excited about Resveratrol.
It showed an improvement in health and
longevity of overweight, aged mice.
Now, in 2008, another study came out that
said, it may help to slow age-related
deterioration and functional decline of
mice on a standardized diet.
It doesn't increase longevity, when
started at middle age.
Now, one of the problems with these
studies about Resveratrol, is that, we
are humans, and they are mice.
And animal study outcomes don't always
extrapolate perfectly, to human
populations.
Another issue, is that, the clinical
studies of Resveratrol, would equate to,
the amount of Resveratrol that they were
using in a study, 1 g a day, is roughly
equivalent To 667 bottles of red wine.
So it's, of course, not realistic for
humans to be consuming that level of
resveratrol from the naturally occuring
sources in our diet, which would be
redwine.
So, manufacturers, what they love to do,
is to extract that compound and put it
into a supplement and sell you that.
So, of course, you wouldn't get the
harmful effects of all of that red wine.
But really, at the end of the day, there
have been no studies done that prove the
long term Efficacy or safety of
Resveratrol.
This is perfect example of the
exploitation of preliminary animal study
data done for profit long before the
science has unquestionably proven that
this is safe or effective for using
humans.
To be honest, the majority of supplements
that are sold are not necessary, and they
tend to be a big waste of money, and in
come cases, can be dangerous.
But there are certainly groups for which
dietary supplements are important.
Who might need a supplement and why?
People who diet heavily, who are on very
calorie restricted diets they probably
need to include a multivitamin or mineral
supplement.
People who are vegans or consume no
animal products.
They need vitamin B12 supplements.
As the only appreciable source of vitamin
B12 in the diet comes from animal foods.
If you don't consume dairy, you might
need to consider a calcium supplement.
Infants and children.
If you in an area with no fluoridation in
your water, they may need a fluoride
supplement.
And for those that don't spend the lot of
time out of doors, they may require a
vitamin D supplement.
Pregnant women are advised to get 400
micrograms of folic acid a day from
either prenatal vitamins or fortified
foods or supplements.
Older adults may require supplemental
vitamin B12.
What happens when you get older is that
your body produces less hydrochloric acid
and one of the components of hydrochloric
acid is something called intrinsic
factor.
Intrinsic factor helps your body to
vitamin B12, so when you get older, even
if you're eating animal foods with
vitamin B12 in them, your body might not
be as effectively absorbing that B12 as
you did when you were younger.
Darker skinned individuals may need
vitamin D supplements as you require more
exposure to UV light.
With an, if you have dark skin, than if
you have light skin, in order to produce,
or to activate the right amount of
Vitamin D in your body.
People who smoke cigarettes have higher
Vitamin C needs, people who have used
alcohol have higher B Vitamin needs, and
individuals that are on certain type of
medications, many medications interfere
with normal vitamin and mineral
metabolism.
Metabolism, and you may require vitamin
and mineral supplements there.
So, it's not to say that all supplements
are a waste of time or money or are
harmful.
Cause there are certainly groups for whom
dietary supplements are helpful.
In summary, just because you don't need a
prescription to buy a dietary supplement,
doesn't mean that a supplement is
necessarily harmless.
For most of these products, don't waste
your time and your money if you don't
need to.
It is true that changing your diet and
excersizing regularly is harder, than
popping a supplement pill.
And to be honest, most individuals can,
and should be obtaining all of the
appropriate vitamins and minerals that
they need from foods and shouldn't rely
on a supplement to help fill in the gap.
When supplements are indicated, they
should be taken with caution.
And only under the supervision of a
qualified medical professional.
If you're interested in learning more, I
would encourage you to look at some of
these websites, to learn a little bit
more about dietary supplements.
As well as their safety and their
efficacy.
