Supplements: What’s Beneficial? How do I Choose?

A Recent Study

A few weeks ago I was asked by one of the local hospitals to give a lecture on supplements and choosing the right one for particular conditions. I was already considering the difficulties in providing such a talk to a broad audience, as supplements are quite specific and have diverse considerations for prescribing. To top things off, the news had just come out that a recent study in the Archives of Internal Medicine had found an association between “several commonly used dietary vitamin and mineral supplements” and “increased total mortality risk”¹.  In other words, the study suggested that perhaps certain supplements weren’t helping people, but actually harming them.

The media went wild and made their own interpretation of the study results, suggesting a much broader conclusion regarding a wider range of supplements being bad for our health. There was little to no mention about certain unknowns surrounding the study, such as supplement quality, quantity, or the possibility that those with poor health may be more likely to seek supplements in order to improve their conditions. In other words, some media sources jumped to conclusions that the study did not suggest.

However, in my lecture I chose to take the topic head on, as I understand that it can be frustrating for patients to comprehend fully what is helpful for their health vs. what can cause harm. It’s especially confusing when one source may be overstating health claims and another source is overstating potential harm. As a Naturopathic Physician, I feel that the truth lies somewhere in the middle.

 

Evaluating Quality

The first thing that I teach people when considering whether to take a new supplement is how to evaluate its quality. For example, if I am going to be taking a new turmeric supplement to reduce inflammation, there are some very basic things I’d want to consider, such as what steps the manufacturer takes in product testing, what is the absorbability of the product, and what else is in the product besides the active ingredient that I am seeking. While I understand that cost is a consideration for many of us when deciding what supplement to take, I remind people that if they have to chose between taking a poorly manufactured and questionable product that may have harmful ingredients vs. no supplementation at all, I would recommend that they don’t take the supplement and instead chose a different route of approaching their health problem.

Supplements have become a big business and just like any other industry there are those who are reputable and want to provide their customers with the highest quality product, and there are those who just want to make a quick buck. Some advice I was given by a dispensary manager one time that has stuck with me is that while you can never be 100% sure that a more expensive product has done the quality testing that they claim or are providing the exact ingredients that they claim, you can be almost positive that the cheapest supplement within the range has done little to no quality testing on their product. In other words, quality testing on supplements is an expensive process, one that very cheap products may not be able to perform and still remain as a viable company. Before taking a new supplement you should be able to find out through the company’s website or by contacting the company to find out exactly where they are getting their ingredients and what processes they are going through to test the quality of their product. Alternatively, you can contact someone trained in supplement prescribing and discuss with them the potential risks and benefits associated with particular brands.

 

Absorption

Next, we should evaluate the absorbability of the product before taking it. After all, if the product passes right through us without being absorbed, we are simply wasting money and not deriving any benefit. Quality supplement companies will actually measure the breakdown of tablets frequently to ensure appropriate disintegration as the product passes through the digestive system. Certain ingredients may be added that have been shown to increase uptake of particular vitamins or nutrients. For example vitamin D is often combined with calcium, as it promotes its absorption. The same is true for vitamin C and non-heme (vegetarian) sources of iron. Therefore, it is important not only to evaluate the main ingredient within the supplement, but all associated ingredients.

Most supplements contain other active and / or inert ingredients to either help in the product absorption into the body, support other pathways in the body, or just are useful in the manufacturing process to ensure that mass production is possible. When I sit down with patients to evaluate their supplements, they are often surprised to find that they may be getting double, triple or even higher doses of certain nutrients, as they are often repeated in many of their formulas. Some supplements such as vitamin C can simply lead to loose stool if taken in excess. Others, such as vitamin B6 or potassium can have much more dangerous side effects if taken in too high quantities.

 

Inactive Ingredients

Excipients are the inactive substances in supplements which should also be evaluated when considering what product to choose. These ingredients are defined into subcategories such as ‘binders, fillers, and glues’. They also may provide bulk to the product, flavor, or coloring. While some ingredients are hypoallergenic and well tolerated by most individuals, some are irritating and potentially toxic to others. For example, some companies include lactose in their products to ensure smooth flow of vitamin powders through machines. Therefore those with allergies may have reason to be careful and do a great deal of label reading before purchasing a product. I advise my patients to know what each ingredient within their supplement does and why it was added. I remind them that if you are ingesting something for the purpose of your health, then you should be fairly certain that the ingredients won’t potentially cause further harm to your system.

 

Knowing What’s Right

            Patients often comment to me that when they visit their local health food or supplement store, they are unable to determine which of the supplements to choose from because they all are claiming to help their particular condition. Let’s take for example cardiovascular health. A typical supplement store may have a huge supply of products stating claims of reducing blood pressure and helping control cholesterol, but which one should you choose?

The most important advice that I can give patients on this part of the process is to ensure that your supplement does not have any contraindications with your current medication. Do not leave this up to the person working at the store to decide for you. While some stores will do a cursory review of the interactions, others may state that the supplement is “safe” without fully understanding the mechanisms of either the supplement or the medication. Medications such as Warfarin, a common blood thinner, have a long list of proposed interactions with other medications and supplements. Something as seemingly innocuous as fish oil may combine with such medications to create potentially dangerous side effects. When it comes to combining supplements with medications, the safest route is to sit down one-on-one with a qualified health care professional that can help you to research and confirm the product’s safety.

Following this critical step, it is then important to become educated on the variety of products available in the market to treat a particular condition. For example in the case of blood pressure control, you might be trying to decide between adding a bulking fiber to your diet, taking garlic capsules, adding the herbal medication Hawthorn, fish oils, or other alternatives to diuretics and beta-blockers. Some important questions that I consider before deciding on the best alternative therapy are:

1. How advanced is the patient’s condition? Would the supplement that I am prescribing treat the patient’s primary concern to the level that is necessary to maintain health? (For example: Garlic pills may be completely appropriate in mild hypertension, but an insufficient primary solution for those in Stage II hypertension)
2. Are there any other health conditions that I need to take into consideration, such as kidney or liver disease, diabetes, heart disease, etc? Some supplements can increase demand on already weakened systems or alter blood sugar and / or blood pressure.
3. 3.     How many times per day will the patient have to take this supplement and for how long? Some people are looking for or requiring a quick fix and do not wish to wait 4-6 months in order to see results. In this case, we would want to either choose a supplement or a complex that can provide rapid results, or there are times where I advise patients that pharmaceutical medications may be their best option to achieve the results that they need in the time frame that they require.

Making the Right Choice Now

            As you may be able to gather from reading the above information, I don’t take the topic of supplementation lightly; and with the recent news regarding the potential negative effects of some supplements on your health, I hope that you also feel that this is an important decision as well. It’s not uncommon for a patient to bring in bags of supplements costing hundreds of dollars to ask my advice on finding a few quality supplements to help their health condition.

Mursu, J., Robien, K., Harnack LJ., Park K., & Jacobs DR. (2011). Dietary supplements and mortality rate in older women: the Iowa Women’s Health Study. Archives of Internal Medicine. 171(18): 1625-33.