Thursday Thoughts: Dietary Supplements

It's Thursday, so you know what that means...

Thursday Thoughts

If you are new to my blog, or haven't been reading on Thursdays, this is a segment where I post my thoughts about various nutrition and health related topics, or maybe even something else if it is really an intriguing topic.  Most of my current views and opinions come from experience working as a dietitian and as college instructor in nutrition courses.  Most of that learning is science based or observational from the clinical setting.  In general, I hate overgeneralizations, so for many of the things I post, I expect there is one or two exceptions because broad sweeping generalizations are always bound to miss out on something. 

This week I want to talk about a subject that can get quite touchy for some people.  As a dietitian and someone with a science background, there are some important things to consider when looking at dietary supplements.  Here are my thoughts:

1) Dietary supplements are just that...supplements.  They are not replacements.  These are nutrients, and hopefully essential nutrients, that need to be supplemented because someone can not get them in the required amount from the diet.  If someone is lacking in a nutrient that the body needs (essential, which means it is needed by the body and must come from the diet), the first thing to consider should always be diet.  If the diet is lacking, that is an easy fix, assuming the person has no food allergies or extreme dislikes.  Too often I hear doctors or other people tell someone that they are lacking in something so they need to buy a pill to fix it.  Dietitians and other trained nutrition professionals however will usually start by assessing the diet and looking at food sources.  The body will better process those from food sources versus synthetic capsule forms.  

2) The body can only absorb nutrients when they are needed, and excess is excreted in the urine, expect in the cases of fat soluble which can build up in excess in the body.  This is one of the cool things about eating multiple meals throughout the day with a variety of foods.  The body will automatically have a stream of multiple nutrients throughout the day allowing for better absorption.  Therefore, you may notice many supplement pills requiring multiple doses per day.  This can lead to an expensive habit.  In my opinion, that money is better spent on nutritious food.

3) Dietary supplements lack regulation.  I know everyone has their own opinions on government regulation, but without some regulation there might be a little room for error and fluctuation in products that are not always safe.  I personally feel that if I am putting something inside of my body, I want to know someone checked on this first.  That goes for my food supply, my drinking water and any medications or supplements.  I want to have some idea that those pills contain the quantity listed in the bottle.  Sure, regulation does not always mean quality and things happen, new research comes out, but having these products regulated will help people from being scammed and potential risk from toxicity on products.  I must admit the industry has come a long way and now there are good manufacturing practices and outside inspections.  When looking for supplements you can find some with the seal from the United States Pharmacopeia (USP) which has inspected some products and can verify the product.  In the end, while some products are good, there remains some products that are bad, and the fact the industry continuously fights to keep them without regulations indicates that they may have something to hide.  There should not be a fear of going out of business or not being used because of prescription medications.  If they have fears like this, it is because they know there are issues with the validity of use of some of the products.  While the FDA may not have the funds to regulate these, something needs to be done to ensure people looking for help in these products do not get scammed.

4) In some cases, a supplement is needed.  If a person is really deficient in something, and they can't obtain this in the diet, then they have a legitimate reason to supplement.  If their dietary needs for a nutrient are higher, it may be harder to maintain a certain calorie intake and get the levels of a nutrient needed, so it might be necessary to supplement in the diet.  Some good examples are B12 and the elderly and folic acid in pregnancy, even iron for a diagnosed case of iron deficiency anemia.  Well, with anemia, iron is a heavy metal, and in my opinion, that should be prescribed.  When a supplement is needed, I encourage the prescription form especially if the person has insurance, but if not, do your research to select a product of quality.

5) My biggest problem with this topic is the supplement store itself.  Many products are listed to do this or do that.  The research for the products are on the active ingredient, not that specific product or formulation, so do not be tricked by sales people claiming that the product does something.  It can be shown in research to have a correlation with something, but these products should not be advertised as curing diseases, and even treating.  Many of these store employees have no training in nutrition or related sciences and can't answer basic questions about anatomy and physiology, much less chemistry or pharmacology.  I have, on more than one occasion, heard an employee diagnose a patient with a condition, without actually obtaining a medical history or looking over labs, and listening to the person rattle off a few symptoms.  I was not aware that someone without a degree in science (sometimes without a high school diploma as they could be a senior in HS still) could diagnose someone and prescribe them a treatment plan.  Just because the product is listed as all natural does not mean it is safe to take.  I have even asked for peer reviewed journal articles that support the claims made by one of these employees, and on multiple occasions I have been handed the store advertising materials for the products.  This is scary and worrisome.  Many of these employees just give the customer the same information they were given by their manager.  Some work on commission.  Not all employees lack the knowledge, but most of those I have chatted with have.  There was only one time where I found that the employee was a student at the University nearby and studying nutrition.  I was amazed when he confessed he could not work there much longer because he did not agree with some of their practices when it came to these products and since he knew more about nutrition for his studies, he knew somethings in these products were falsely advertised.

Do I have a problem with all supplements? No.  Do I think everyone needs a supplement? No.  I think that some people may and others may use it as a cop out to choose less healthy foods because the pill acts as "insurance".  However, if it makes someone feel better to use the supplement as "insurance" and they are actively trying to get all their nutrients from food, then if taking the pill is not going to harm them, there is nothing wrong with this, but I like to make sure the person can afford the supplement (multi-vitamin usually) and does not forgo healthy food just to be able to buy supplements.  I think sometimes they are misused, but with some education and investigation, they can be used to benefit someone, when the circumstances are right.

I know I only addressed supplements like vitamins, minerals and herbs, but I wanted to mention there are food versions that supplement the diet.  Maybe I will address those another day.

QUESTIONS: What are your thoughts on supplements?  What topic would you like to hear my thoughts on?