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Supplements: what the fuss is about

Distinguishing real benefits from vague claims can help consumers.

By Celine Blancas-Evidente, M.D.

JULY 2013

Beth, 35, believes in the use of supplements. She takes her daily multivitamin supplement with antioxidants to help her “age gracefully.” She has tried cranberry pills, along with her antibiotics, for her recurrent bout of urinary tract infections. On various occasions, she has tried glutathione capsules for her skin, melatonin tablets to help her sleep, and even glucosamine when she had joint pains at one time. She has also used herbal supplements for her cough and colds. Beth is comfortable adding supplements to whatever her doctor will prescribe as she says they help in keeping her healthy and that there’s “no harm in trying.” But is there?

Supplements for good health?

According to the U.S. Dietary Supplement Health and Education Act of 1994 (DSHEA), supplements include vitamins, minerals, herbs, botanicals, and other substances intended for ingestion in a tablet, capsule, powder, soft gel, or liquid form. Dietary supplements and herbal remedies aren’t classified as drugs. They aren’t intended to treat, diagnose, prevent or cure disease.

In 2007, the U.S. FDA issued Good Manufacturing Practices to ensure that supplements are produced in a quality manner, don’t contain contaminants or impurities, and are accurately labeled. But even if manufacturers are responsible for ensuring the safety of their products before they’re marketed, they’re also exempt from regulations and testing required for prescription drugs. Any reports of adverse events are required to be reported back to the U.S. Food and Drug Administration. However, randomized controlled trials regarding efficacy and safety are rarely performed.

Acceptable standards

Luisito Llido, M.D., an active consultant of the Clinical Nutrition section of St. Luke’s Medical Center in Quezon City, says supplements are acceptable if they fulfill the following criteria:

• Beneficial claims are based on clinical grounds through case reports or clinical trials.

• Clinical studies were performed using accepted criteria and methodologies by the medical community.

• Safety issues like oral or intravenous use have been documented or performed.

• Testimonials are made by medical personae—such as doctors—and backed by a recognized medical group.

• Documents of such claims are available from books or the internet and can be double checked for authenticity of claims.

• Reference studies or reports are available, and can be retrieved and analyzed.

Some supplements may be necessary for certain groups. Dr. Llido says nutrition supplements help in achieving adequate intake among malnourished patients, especially those who are critically ill, diagnosed with cancer, geriatric patients, or afflicted with chronic liver or renal disease. Selected nutrition supplements help in addressing specific nutrient deficiencies, such as micronutrients like vitamins B, C, E, and trace elements such as selenium or zinc. They can also provide nutrients considered conditionally essential, like glutamine, cysteine, arginine, or immune nutrients like fish oils and antioxidants.

Get to know your supplements

Leslie Ann Reyes, a senior dietitian at Cardinal Santos Medical Center, says nutrient supplements can be used to help meet a nutrient requirement, address a gap or to treat a diagnosed deficiency disease. She enumerates some common supplements with supported studies:

• psyllium fiber

• vitamin D and calcium for menopausal women to prevent bone problems

• vitamin D, B12 and calcium for the elderly

• co-enzymeQ10 for diabetes

• niacin to treat hypertriglyceridemia

Other supplements may have potential benefits but still need more studies to back them up, such as acai berry, saw palmetto, placenta, goji juice, mangosteen extract, glucosamine and chondroitin, garlic oil and grapeseed oil.

Tips for supplement users

The U.S. FDA helps consumers make informed decisions and evaluate information about supplements. Basic points to consider include checking with your doctor first and thinking about one’s total diet—supplements shouldn’t replace the balance of the variety of foods in a healthy diet. Too much of some nutrients can cause problems, and interactions with prescription medicines are also common.

When searching online for information, check who operates the site, the purpose of the site, the source of information, any references, and how current the posted material is. The U.S. FDA cautions readers to be skeptical of overly emphatic language and several exclamation points—such as “Miracle cure!!!” Are the claims too good to be true? Does the product effect seem exaggerated or unrealistic? Cure-alls are unlikely to be backed by scientific evidence.

Reyes advises that special precautions should be taken because of some nutrient-nutrient or nutrient-drug interactions. For example, high doses of iron can decrease zinc absorption, and vice versa. Calcium antagonizes iron absorption and should be taken separately. Iron is best absorbed with vitamin C. Chronic alcohol consumption increases the need for vitamin B. Some supplements can affect the bioavailability of drugs. Supplements containing vitamin K should be avoided by patients taking anticoagulant medicine like warfarin.

What are the local regulations about supplements? Learn more in the July issue of HealthToday.

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