The Council for Responsible Nutrition (CRN) recently revealed findings from its 2021 Consumer Survey on Dietary Supplements. The survey found that four in five Americans use supplements regularly—a new high-water mark in supplement use. Maybe not so surprisingly, they found that the use of vitamin D, zinc, and vitamin C have increased significantly over the past 12 months (thanks COVID-19).
With more than 80% of Americans now using dietary supplements, these products have become widely accepted. Celebrities like hockey legend Wayne Gretzky, pro-running back Ray Rice, and reality TV star Khloe Kardashian are now endorsing supplements on mainstream media. The supplement aisle in most grocery stores resembles a candy shop with rows and rows of eye-grabbing colorful labels and luring claims. Do you ever stop to ask, is this right for me? Or am I unnecessarily fueling a 151 billion-dollar industry?
What are Dietary Supplements?
A dietary supplement is an umbrella term that includes ingredients such as vitamins, minerals, proteins, amino acids, botanicals, enzymes, and herbs. They are often marketed and sold as capsules, powders, tablets, soft gels, gummies, extracts, teas, and beverages.
Unlike drugs, supplements are not permitted to be marketed to treat, diagnose, prevent, or cure diseases. That means supplements should not be making claims like “lowers cholesterol.” People do, though, often seek them out for health and wellness benefits, including immune health, bone, and joint health, gut health, energy, performance enhancement (focus, athletic, and sexual), cosmetic improvement (hair, skin and nails health or weight loss), or to fill a nutrient gap. Dietary supplements can be purchased over the counter (in general stores or online) or prescribed by a physician.
How Do I Know if I Need Them?
Before diving deep into the supplement aisle and filling your cart, you should start by asking yourself if you need supplementation in the first place. It’s possible to get all the nutrients you need to live a long and healthy life from whole foods. For those who eat a nutrient-dense diet and are clinically healthy, dietary supplements may have little to no benefit. However, if you find it challenging to eat a nutrient-dense diet or fall under a category that puts you at greater risk for a nutrient deficiency, supplements can be valuable for filling gaps.
If you are unsure of your nutrient status, a nutrition status test is an excellent place to start. Nutrition status tests can be done at your doctor’s office, or you can purchase an at-home test to know if and where you are falling short. If it’s determined a supplement would benefit you, a doctor, Registered Dietitian, or other trusted healthcare provider can help you find the right product and dosage for your needs.
Groups at higher risk for nutrient deficiencies:
- Pregnant or breastfeeding women
- Eat a restricted or limited diet (vegan/other health concerns that limit food intake)
- Over the age of 50
- Have had gastric bypass or other surgeries affecting the gastrointestinal tract
- Have certain health conditions that affect nutrient absorption (IBD, Celiac, Cystic Fibrosis, Liver disease, Alcohol dependence, etc.)
- Take certain medications, such as diuretics or proton pump inhibitors that can affect the absorption of certain nutrients
- Live in a food desert or don’t have access to nutrient-dense foods
Who Regulates the Supplement Industry?
While dietary supplements are made to improve health, diving into the murky waters of the supplement industry does not come without risk. The U.S. Food and Drug Administration (FDA) does not have the authority to review dietary supplement products for safety and effectiveness before they hit the shelves. That means the manufacturers of nutritional supplements are responsible for ensuring their products are safe, effective, and labeled correctly before they go to market. The FDA is only responsible for acting against a supplement IF adverse side effects are reported, or the supplement is proven to be adulterated or misbranded after it reaches the public.
Does this make you raise your brow in concern? Good, it should. While many trustworthy and safe companies are out there providing quality products, there are some dishonest and unsafe companies that are trying to make a quick buck. Unfortunately, with limited regulation and oversight, many precarious supplements have, and will, end up on your local store shelves. Therefore, it’s crucial for you, as the consumer, to do your due diligence and ensure you are providing your body with a safe and effective supplement. There are a few things you should consider before browsing the supplement aisle.
Before you Begin Supplement Shopping
Find out if the supplement of interest has been researched. Some nutrients have decades of clinical research to support their health statements. While others claim to have been recently discovered “in the depths of the Amazon rainforest” and promise enticing and extreme benefits. If there is research that the nutrient of interest supports health, note the dosage and usage found in the studies to be effective. If there is no research to support the claims being made, you may be at best wasting your money, or at worst, risking your health by taking a supplement that has yet to be studied and found safe and effective.
What’s on a supplement label may not be what’s in the bottle. In addition to ensuring the product is safe, dietary supplement manufacturers are also responsible for the product’s purity and the accuracy of the nutrient label and ingredient list. Since no standardized regulatory agency makes sure that the label matches what is in the bottle, you are left to trust the manufacturers. This means that even if you read the nutrition label and approve of the ingredient list, the components inside the bottle may be different. One 2018 quality improvement study found that over 20% of the supplements tested contained more than one unapproved ingredient.
The FDA has begun to build a list of tainted products for reference (those that have been identified at least). A few independent organizations have worked to bridge this enormous gap in accountability by conducting quality tests of supplements and facilities. These organizations, called Third-Party Testing companies, test the product and display a quality assurance seal. A Third-Party Testing Seal indicates the product was manufactured correctly, contains the ingredients listed on the label, and does not contain harmful levels of contaminants. These seals do not guarantee that the product is safe or effective, but you can at the very least purchase a supplement knowing the ingredient list is accurate. Some of these organizations include ConsumerLab.com, NSF International, and U.S. Pharmacopeia.
Some dietary supplements may cause you harm if you have a particular medical condition or take other medications or supplements. Combining supplements with medications or taking a supplement if you have a known contraindication could lead to life-threatening consequences. For example, vitamin K is involved in blood clotting and decreases the effectiveness of warfarin and similar blood-thinning drugs. For some people, those blood-thinning drugs are vital to survival and increases in vitamin K may lead to injury. Deeply researching the supplement of interest and speaking with a trusted healthcare provider is encouraged so that you can fully understand the risks and get the most out of your supplement.
Having too much of a good thing can be dangerous in some cases. Taking excess vitamin A during pregnancy, for example, can increase the risk of congenital disabilities in infants. Be sure to consider the tolerable upper limit (UL) for the nutrient of interest, the amount provided by the supplement, and the amount supplied by other foods you consume throughout the day. Mega-doses of vitamins and other nutrients are not recommended.
The term “natural” doesn’t always mean “safe.” The herb St. John’s wort, for example, is a natural product sometimes used to ease depression, anxiety, or nerve pain, but it can also speed the breakdown of many drugs – such as antidepressants and birth control pills – making them less effective. Kava, another natural tropical shrub plant, has been found to cause liver damage in some cases. And vitamin A may increase the risk of lung cancer in smokers. Don’t let the marketing fool you, do your research and understand the risks and benefits of artificial and natural supplements.
5 Questions to Guide Your Supplement Purchase
- Do I need this? Am I nutrient deficient or insufficient? The only way to know if you have a nutrient deficit is to get tested. Nutrient testing can be done at home or with your healthcare provider. Regular annual testing is recommended for everyone. If you fall under a category that is considered “high risk” for nutrient deficiencies, testing more frequently may be encouraged. If your current nutrient status is optimal, supplementation will likely be unnecessary. If you find you are deficient, move onto question two.
- Has this nutrient been researched? Be sure there is scientific evidence to support positive health outcomes of a specific nutrient or supplement. If there is not, then you may be wasting your money, or worse, jeopardizing your health. If there is, move onto question three.
- What is the proper dose to take? If there are studies that demonstrate positive health outcomes, they will also identify the amount and method of dosing. For example, suppose a study determines that 5,000 IU of vitamin D per day is required for a particular benefit, but the supplement you purchase provides only 2,000 IU per day. In that case, you are not likely to get the results you seek. Take note and ensure the supplement you purchase provides the amounts required to have the effect you desire. Also, note how to take the supplement. Some nutrients are best absorbed with food, while others can be taken on an empty stomach. If you are spending money on a supplement, it’s best to ensure you get the best bang for your buck.
- Are there any safety risks? It’s always best to speak to a healthcare provider before beginning a new supplement. This is even more important if you have any medical conditions or are taking any other supplements or medications.
- Is this supplement third-party tested? Finding a supplement that is third-party tested ensures that what is on the label is what is in the bottle. It’s your job to protect your body. Find products from companies that are trusted and validated to better protect your health.
Where Can I Learn More About the Supplements I Want to Take?
When it comes to taking dietary supplements, the responsibility lies on you, the consumer. You must look out for your best interest. Take some time before making any supplement purchase and do some reading. And remember, you don’t have to do it alone. Lean on professionals in the field. Speak to your nurses, doctors, dietitians, and other healthcare professionals to discuss your goals and concerns for starting a new supplement.
Using some of the non-commercial sites listed below is a great place to begin your research journey. Here is a list of some helpful websites for your reference:
- NCCIH Clearinghouse: https://nccih.nih.gov/
- PubMed: https://pubmed.ncbi.nlm.nih.gov/
- Office of Dietary Supplements (ODS), National Institute of Health (NIH): https://ods.od.nih.gov/factsheets/WYNTK-Consumer/ AND https://ods.od.nih.gov/factsheets/list-all/
- Center for Food Safety and Applied Nutrition (CFSAN): https://www.fda.gov/AboutFDA/CentersOffices/OfficeofFoods/CFSAN/
- Federal Trade Commission (FTC): https://www.ftc.gov/
- Dietary Supplement Label Database: https://dsld.od.nih.gov/
- U.S. FDA: https://www.fda.gov/food/dietary-supplements
It’s important to remember that supplements cannot in any way replace a healthful, well-balanced diet. Yet, there is a time and place for supplementation. For some, a high-quality dietary supplement can make all the difference. Arm yourself with knowledge before navigating and supplement isle, and you will find the right product for you.