What You Need to Know About Supplements
By Carrie Carter, M.D.
A Woman's Guide to Good Health
CBN.com Most physicians were trained to dismiss all supplements— except those given solely for mainstream medical conditions such as an obvious nutritional deficiency, to support the needs of a pregnancy, or to provide calcium to women for prevention of osteoporosis. Before accepting or endorsing any supplement or treatment, all physicians are trained to evaluate whether there is solid research data that proves two things about the treatment:
1. That it is effective
2. That it is safe—or not harmful
Yet often that data does not yet exist. The questions have come back around. Can we get all the nutrients and nutrition we need just by taking a special capsule? Can we outsmart Mother Nature and prevent aging and disease with supplements? Some supplements are making headway in these areas. However, others should be struck down by a lightning bolt!
What to Look for in a Supplement—and a Husband
Figuring out what supplement(s) to take is a lot like trying to find the right husband. When deciding on a husband, once you get to the point where you are seriously considering a guy, you may wonder:
● Will he actually do what he says he will do after I marry him?
● Deep down, is he really who he seems to be?
● How will he get along with my family and friends?
In the same way, when considering nearly every nutritional supplement you should ask yourself:
● Does this supplement really do what the promoters say it does once it’s inside the body? (Or does it only work in a test tube?)
● Is the stuff deep down inside the supplement the same as what is listed on the label?
● How will this supplement interact with other supplements and medications I am taking now?
Quality control is a big problem with nutritional supplements. As a trade-off for the privilege of buying whatever supplements whenever we want, there are few—if any— uniform quality controls in place to monitor nutritional supplements. Germany, by contrast, requires that herbal remedies be registered with the government and then standardized so you know what you are getting. Their agency, called Commission E, evaluates the safety and effectiveness of herbs. Because of the Dietary Supplement Health Education Act (DSHEA) passed by Congress in 1994, the FDA does not have the same control over nutritional supplements that they do with food and drug items. In fact, their only control system is to prove that a particular supplement that is already on the market is dangerous (at the taxpayers’ expense rather than the manufacturer’s expense). Many manufacturers are pushing the limits of the law quite far with unsubstantiated claims and false advertising. This is why the fine print on supplement labels reads: These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. Now you know why!
There is a real possibility that you may be accidentally overdosing on certain supplements if you are taking supplements plus fortified foods, bars, or supplement drinks. The saying that you can’t have too much of a good thing doesn’t apply to nutritional supplements. Too much of certain supplements could prove toxic to your body.
Nutritional supplements that have passed scientific scrutiny and quality control are usually safe to take. But from your body’s viewpoint, adding several supplements to your system is not quite the same as eating extra servings of broccoli and blueberries. It’s important to know what you are taking.
Vitamin and Mineral Supplements
The word vitamin in Latin means a ‘‘chemical necessary for life.’’ Vitamins and minerals are nutrients from our environment that we need for all the essential reactions in our cells to occur. Our bodies can make small amounts of certain vitamins, but we cannot manufacture minerals. Every mineral in our body must first come from outside our body. One way to look at our need for vitamins and minerals is to think of each of our cells as an intricate factory. Different vitamins and minerals must be present to complete the particular task at hand at every workstation. Without these necessary components, the whole production line is held up, which can lead to a shut down in the cell and subsequent health problems. The problems could be minor or they could be major, but if the deficiency is major, it could lead to serious diseases such as scurvy, beriberi, or pellagra (these might sound like nice tropical getaways, but believe me, they are trips you never want to take).
Because vitamins and minerals are so essential, every five years the United States Food and Nutrition Board of the Institute of Medicine revises their recommendations for the minimum amounts of each vitamin and mineral needed each day. These values used to be called the Recommended Daily Allowances (RDA), but recently that term was changed to the Dietary Reference Intakes (DRIs).
But several years ago, a number of well-designed and well-respected studies all came to the same disturbing conclusion: Most of us (men, women, and children) are not taking in even the recommended DRI minimum daily requirements of certain nutrients—especially calcium, magnesium, iron, and zinc!3 4 5
In medical school most doctors were taught that if you ate a good diet, you did not need a vitamin and mineral supplement. But the medical community as a whole reconsidered this stance after a medical review of thirty years of research studies revealed strong evidence that suboptimal vitamin and mineral intake is associated with increased risk of chronic and degenerative diseases like cancer, osteoporosis, and cardiovascular disease. Then in 2002, the American Medical Association (AMA) took a very big step and issued a formal endorsement recommending the daily use of a basic multivitamin supplement by all adults to decrease the risk of getting these diseases.6 You’ve come a long way, doc!
The Young Are Healthier with Folate
The statistics make it clear that pregnant women who are deficient in the B vitamin called folate (also known as folic acid) have a higher risk of having a baby with the birth defect spina bifida, also called neural tube defects. So a dose of at least 400 mcg per day is highly recommended— not only for pregnant women but for all women who could become pregnant, since critical baby development often occurs during the weeks before a woman knows she is pregnant. Also, women on birth control pills are more often depleted of folate. There is also much new evidence that low levels of folate can increase heart disease (see chapter 9), so folate is important for all women as a part of a balanced multivitamin/ multimineral supplement.
Older and Now Wiser
Our older population especially needs to be on a daily multivitamin/mineral supplement. As we age, our bodies generally have more difficulty pulling the nutrients out of our food and into the bloodstream; plus, we have an increased need for certain nutrients. Many recent studies confirm that the elderly are healthier when they take a vitamin and mineral supplement regularly. A recent study in the Journal of Nutrition took one hundred healthy adults over sixty-five years of age and divided them into two groups, then compared one group that was put on a daily multivitamin/multimineral supplement with another group that was put on a placebo (sugar pill). After one year the group that took the daily supplement scored much better on tests of mental function (except long-term memory) than they did before starting the supplement, while the group that took the placebo showed no improvement.7
Avoid the a la Carte Method
A common practice is to pick and choose single nutrients to supplement, like only taking vitamin C, niacin, or calcium. I don’t recommend this. Vitamins and minerals work in concert to maintain healthy function in your cells, and it’s important to maintain the proper balance of nutrients. For instance, certain nutrients—like calcium—need their ‘‘buddies’’ huddled around them so they will be properly absorbed. Otherwise they won’t do you much good. So take a balanced vitamin and mineral supplement.
It is best to not only select a balanced vitamin and mineral supplement but ideally one that pays some attention to the plight of poor minerals and their poor absorption history. In some of the higher quality/higher priced combination supplements, this need is addressed by including minerals that have been changed to a state that is easier to absorb. One such product is the Vitality Pak by Melaleuca: The Wellness Company, which uses a patented process called ‘‘fructose compounding’’ to attach the minerals to fructose molecules, which helps the minerals to be absorbed inside the body.8 Another process called ‘‘chelation’’ is used by the USANA company to make the minerals in their Essentials multivitamin, mineral, and antioxidant supplement more absorbable.9 This process links an amino acid (protein part) to the minerals to help absorption be more effective.
Choosing a Vitamin and Mineral Supplement
There are many factors to consider when choosing the right vitamin and mineral supplement for you.
1. Decide what you want your supplement to do for you. Is your sole desire to make sure you are receiving the DRIs of the vital vitamins and minerals? Or are you seeking a supplement to prevent degenerative diseases, which usually means taking more than the DRI for most nutrients?
2. Take into account the fact that many of us require higher amounts of nutrients than the minimum in the DRI. This might be because of stress, illness, age, or whether we smoke or are exposed to a toxic environment— which probably covers most of us.
3. How much are you willing to spend per month? Our options range from a few dollars to as high as $70– 100 per month. Many outstanding formulations are available for $35–40 per month.
4. What information is available about the quality of the supplements you are considering? This factor justifies why certain supplements are worth spending a dollar a day. Look for information such as:10
● Is the formula based on the latest research in human nutrition?
● Are the nutrients of the highest quality and in forms that are easy for the body to use?
● Is there evidence that GMPs (Good Manufacturing Practices) are followed for quality assurance?
● Is the formula tested for potency and purity? Does it say USP guidelines are used?
● Does the formula pass disintegration tests so nutrients are available to be absorbed?
If you choose to use a supplement limited to the DRI range of different nutrients, www.Consumerlab.com offers information on which products meet their criteria. A few products that made the grade are several Centrum formulations (Advanced Formula_ Centrum_ High Potency, Centrum_ Performance_ Complete, and Centrum_ Silver _), as well as thirty-three other brands and formulations. You can view all the latest results and supplement evaluations on www.ConsumerLab.com. 11
In general, major name brands and major store brands are recommended because they are more likely to have inside the bottle what is written on the label, and many of these companies utilize the same manufacturers.
I find that a large percentage of supplement takers wrestle with ‘‘breaking the DRI laws,’’ as if there is a cop hiding around the corner ready to give them a ticket for ‘‘driving under the influence’’ of too many vitamins! Yes, it is wise to be cautious about overloading your body with these nutrients. But most vitamins and minerals are not harmful in amounts that far exceed the DRI, and many studies show that many nutrients at higher than DRI levels may decrease the development of degenerative diseases.
Vitamin A: Tricky Business Some nutrients can be harmful in very high amounts. Vitamin A, for example, is a tricky one. There are two different substances listed together on supplement labels as ‘‘vitamin A,’’ but only one of them, retinol—or true vitamin A—is thought to be harmful in high amounts. The other substance, beta-carotene, is considered nontoxic, according to many research studies. Why the confusion? Beta-carotene is pre-vitamin A, or vitamin A’s parent, and though the ‘‘parent’’ is harmless, the ‘‘child’’ can be toxic!
The toxicity issue for true vitamin A is a big deal for women in pregnancy, for daily doses of 10,000 I.U. or more have been associated with the birth defect spina bifida, and in adults overdoses can cause permanent liver disease. There is also concern for women who are postmenopausal. In a recent eighteen-year study of more than seventy-two thousand post-menopausal women, researchers found that those who took over 3,000 mcg/day of retinol were nearly twice as likely to suffer a hip injury or fracture in a fall. However, those who took high quantities of beta-carotene did not have an increase in hip fractures.12
Safe Upper Limits for Common Vitamins and Minerals
The Food and Nutrition Board of the Institute of Medicine establishes and updates the recommended amounts of vitamins and minerals, which are now called the DRIs (Dietary Reference Intakes) rather than the RDAs, for adults to consume daily. The board also establishes and updates the Upper Intake Levels (ULs) of vitamins and minerals that are considered ‘‘safe’’ for most adults. These levels are conservative on purpose to leave a margin of safety.
||Dietary Reference Intake
||Upper Intake Levels
|Vitamin A (retinol)
||3,000 IU (900 mcg)
||10,000 IU (3000 mcg)
|Niacin (Vit. B3)
|Folate (Folic Acid)
||1,000 mcg or 1 gram
||600 IU (15 mcg)
||2,000 IU (50 mcg)
||22 IU natural or
||none currently set
|| 33 IU synthetic
||none currently set
(Source: Food and Nutrition Board of the Institute of Medicine and the Council for Reponsible Nutrition, www.crnusa.org/ about_recs.html)
So what vitamin and mineral supplements make the grade in the “over the DRI’’ category? There are many excellent choices available, and again, I recommend you select a well-known, established brand or a major store brand. Compare the label to the Upper Intake Levels in the table to see how it measures up. I have positive personal experience with both Melaleuca’s Vitality Pak 13and USANA’s Essentials.14 A reminder: Do not be surprised that you do not see any of your ‘‘over the DRI’’ supplements listed on the Consumer Lab approved list. It does not mean these supplements are inferior. The Consumer Lab only included supplements with DRI levels, so they are not even considered for evaluation.
Countless consumers of these higher quality, ‘‘over the DRI’’ products nearly all respond the same way when asked why they take these supplements over lower-priced versions: ‘‘Because I feel better on these, and I never felt different on other vitamins that I have tried. Now I have more energy, and I am sick less often.’’
A ‘‘DRI level’’ supplement or an ‘‘over the DRI’’ vitamin and mineral supplement? I hope this helps you choose the one that best suits your unique needs.
Many of the antioxidants are vitamins and minerals such as vitamin C, E, beta-carotene (often listed as vitamin A), selenium, zinc, copper, and manganese. Many studies confirm that supplements of this dream team functioning as antioxidants can make a significant difference in our health, but we still need more studies. One reason is the disturbing findings of a study done to test the effect of beta-carotene and the incidence of lung cancer. Those in this study who were longtime smokers and took beta-carotene had a higher incidence of lung cancer than those who did not take the supplement. No one is sure why the results came out this way, and in fact, it may not have anything to do with beta-carotene. Perhaps this group of smokers already had precancerous cells in their lungs that naturally progressed during the study and beta-carotene could not undo the damage already in place. We need more studies to know for sure.
The other broad class of antioxidants is plant-based phytochemicals. Again, doctors wrestle with the same issue here: for many of these substances we do not have a lot of research in humans to be able to confidently say what these substances as supplements can and cannot do. I know it is a cautious answer, but for this class of supplements as a whole, that is the current bottom line. There are, however, impressive research studies with grape seed extract-based supplements in test tubes, animals, and humans that point to grape seed as a very safe supplement and very effective antioxidant. We will look at grape seed extract in more detail in the next chapter.
Although there are excellent nutritional supplements that can be very helpful, there is no substitute for a balanced, healthy diet. We know a lot about nutrition, but we still have limited knowledge of all the minute substances in food and the intricate interactions that take place when all these substances come together into our bodies to nourish us. We know that antioxidants in foods protect our cells from harm. However, we must be cautious about jumping to conclusions regarding isolated substances. We may think we can feed them alone to the masses and save them from cancer, but we still know so little about what makes food tick. We may not yet have uncovered the crucial substances that make all of food’s magic happen. In other words, it would be like analyzing the Mona Lisa and discovering it was made with paint and then thinking an artist should be able to recreate it based on that knowledge. We, likewise, do not have the full knowledge necessary to determine whether certain supplements will work as well inside the human body as the same substance in a food source. We still need more clinical research studies to confirm that they work reliably before we can announce that every one of us should take these on a daily basis.
I personally choose to take a variety of antioxidant supplements daily (both grape seed extract-based and a vitamin-mineral combination), because there is a very good likelihood that they help and a low likelihood that they will harm me. You need to make your own choice. But choose nutritious foods first and then think about additional supplements. A supplement should be exactly that—a supplement to a healthy diet.
Taken from A Woman’s Guide to Good Health by Carrie Carter, M.D. Used by permission of Fleming H. Revell, a division of Baker Publishing Group, copyright © 2006. All rights to this material are reserved. Materials are not to be distributed to other Web locations for retrieval, published in other media, or mirroried at other sites without written permission from Baker Publishing Group.
Carrie Carter, M.D., has been a primary-care physician for over fifteen years. She is an award-winning author of two books, a magazine columnist, and a national speaker, and she has appeared as a medical expert on over one hundred national and regional radio and TV programs.
3. K. Alaimo et al., "Dietary Intake of Vitamins, Minerals, and Fiber of Persons Ages Two Months and Over in the United States," Third National Health and Nutrition Examination Survey, phase I, 1988-91, Advance Data (258) (1994 Nov 14): 1-28.
4. J.A. Pennington, "Intakes of Minerals from Diets and Foods: Is There a Need for Concern? (Results of the Total Diet Studies)," Journal of Nutrition 126 (9 suppl) (1996):2304S-2308S.
5. J. Hallfrish and D.C. Muller, "Does Diet Provide Adequate Amounts of Calcium, Iron, Magnesium, and Zinc in a Well-Educated Adult Population?" Experimental Gerontology 28 (4-5) (1993): 473-83.
6. R.H. Fletcher and K.M. Fairfield, "Vitamins for Chronic Disease Prevention in Adults: Clinical Applications," Journal of the American Medical Association 287 : 3127-29.
7. "Taking a Multi May Improve Cognitive Function," Environmental Nutrition, December 2001, 8.
8. The Vitality Pak ($23 a month), availabe from Melaleuca: The Wellness Company, online (www.melaleuca.com) or by phone (800-282-3000).
9. Essentials ($35 a month), available from USANA, online (www.usana-nutritionals.com) or by phone (888-953-9595).
10. Interview with Tim Wood, Ph.D.: Vice President for Research and Development of USANA, Inc., January 28, 2002.
11. Used by permission. If you log on to www.ConsumerLab.com, you can purchase a single product category subscription ($5.25), which gives you access to all their information on the multivitamins and multimineral products, or any other single product category of your choice for thirty days. Or you can subscribe for twelve months ($15.95) and have access to all product category reviews for one year.
12.Diane Feskanich et al., "Vitamin A Intake and Hip Fractures Among Postmenopausal Women," JAMA 287 (2002): 47-54.
13. See endnote 7, chapter 8.
14. See endnote 8, chapter 8.
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