#Gbites: Dietary Supplements
By Natalie Gentile, MD and Dan Goldstein
Do Supplements Live Up To The Hype?
Dietary supplements are all the rage these days. 77% of Americans were reported to have taken some form of supplement in 2019, according to industry trade group, Council for Responsible Nutrition.1 This year had the greatest proportion of people taking supplements recorded to date, reflecting a trend that more and more people are taking at least one regular supplement.
The most popular dietary supplement is a general multivitamin, taken by 58% of the U.S. population.1 Vitamin D, vitamin C, protein, calcium, B complex and omega-3 represent the other most common supplements, taken by between 16 and 31% of Americans.1 Many also take an antioxidant vitamin like vitamin E, turmeric or green tea.1 Vitamin C is also considered an antioxidant.
Many of us choose to take a dietary supplement as a preventative measure against illness, while others may do so in hopes of addressing a specific nutrient deficiency or medical condition.2 Despite the overwhelming prevalence of dietary supplements along the countertops of American households, questions have been asked about the efficacy of taking nutrients through a pill.3,4 The almost $31 billion of revenue taken in by the supplement industry in 2018 may serve as a red flag for the more conscious consumer.5 Globally, this industry is expected to grow to a worth of $194.63 billion by 2025.6
Unlike medications, dietary supplements do not receive much regulation or oversight from the FDA.3 This is primarily due to the 1994 Dietary Supplement Health and Education Act, which markedly restricted the FDA’s grip over supplement manufacturers. Today, the supplement industry persists in a highly unregulated environment. What these Wild West-like conditions have resulted in is a situation where the majority of supplements available on the market have not been studied for their efficacy or safety. Not only are we unsure of whether a supplement is useful or even safe, but often times the ingredients and dosage advertised on the label do not reflect what is actually contained within the pills, oil or spray inside the package.3,7 One study looking into the contents of black raspberry supplements found absolutely no trace of black raspberries in 37% of the samples tested.8 Many supplements do not contain what they say they do and are often also made with fillers or other additives—some of which may actually be harmful to health.3 Hundreds of dietary supplements have been identified to contain various prescription medications, which is of obvious cause for concern.7 Heavy metal contamination is also common.7 About one in four supplements available to consumers has some issue with its quality.7 Unsurprisingly, tens of thousands of adverse reactions to dietary supplements occur each year and often go unreported.9 Supplement manufacturers are not required to screen the ingredients before their products are put out for sale, which presents a serious public health dilemma. In the words of the author of the study on black raspberry pills, “a consumer who assumes the US dietary supplement market is free from risk is unfortunately naive.”8
When we look at the little research that has been done on the efficacy of supplements, what we find is less than reassuring.4 While the studies are conflicted, there is at least some evidence that those who take a daily multivitamin may actually be at an increased risk of all-cause death.10 Now this is not to say that multivitamins will kill you, but at the very least, they do not seem to offer much in the way of health benefits.4
It should be noted that not all dietary supplements are of questionable utility. In fact, there are a number of cases in which I do advise supplementation. For all adults and children, I recommend taking a vitamin B12 supplement once a day, preferably from a vegan, whole foods source. If you are interested in learning more about why to take B12 and what kind of supplement and dosage to buy, read last week’s article on the topic. Vitamin D is another nutrient that should be supplemented periodically. Vitamin D is normally manufactured by a healthy person with sufficient sun exposure. However, for those living in northern latitudes, a vitamin D supplement is necessary during the winter months as well as for those who do not get adequate sun exposure. Pittsburgh is the perfect example of a place where individuals ought to supplement with vitamin D during the darker, winter months. 2,000 IU of D per day is appropriate for most people, but those who are overweight may want to take a dose of 3,000 IU or even 4,000 IU in elderly people with a high-fall risk. D2 and D3 are both fine, just make sure you are purchasing a vegan source. Also, omega-3 in the form of a DHA+EPA supplement is appropriate for pregnant women and everybody ages 60-65 and above. Look into our article on omega fatty acids for more information.
Aside from B12, D and omega-3 in older adults and pregnant women, most healthy people do not need to take any additional supplements. There are some specific cases, however, where an individual with a diagnosed deficiency or medical condition should take a specific dietary supplement under the supervision of a medical professional. In these cases, always be sure to do your research before beginning a new supplement regime.
People who take dietary supplements are generally health conscious and are doing so in hopes of legitimately improving their nutritional status. These people should be advised to hold a skeptical eye when browsing the supplement aisle and to revert to a more whole foods-centered approach to nutrition and health. The nutrients supplement-takers are searching for may be found in foods. Foods are, in fact, the source of those nutrients in the first place and are the safer, healthier choice for consumers. Eating a diet comprised of a wide variety of whole foods may help to improve overall health in addition to achieving nutritional adequacy. Vitamins, minerals and other nutrients work within our bodies in complex ways and also interact with other nutrients inside the gut. Humans evolved to take in nutrients through the vessel of real foods and therefore, this is still the optimal source for the vast majority of vitamins, minerals and other nutrients. It is my recommendation to steer clear of the supplement gimmicks and save yourself some cash by filling up your cart with whole plant foods instead.
- Dietary Supplement Use Reaches All Time High — Available-for-purchase consumer survey reaffirms the vital role supplementation plays in the lives of most Americans | Council for Responsible Nutrition. https://www.crnusa.org/newsroom/dietary-supplement-use-reaches-all-time-high-available-purchase-consumer-survey-reaffirms. Accessed December 18, 2019.
- Dickinson A, Blatman J, El-Dash N, Franco JC. Consumer usage and reasons for using dietary supplements: report of a series of surveys. J Am Coll Nutr. 2014;33(2):176-182. doi:10.1080/07315724.2013.875423
- Starr RR. Too little, too late: ineffective regulation of dietary supplements in the United States. Am J Public Health. 2015;105(3):478-485. doi:10.2105/AJPH.2014.302348
- Huang H-Y, Caballero B, Chang S, et al. The efficacy and safety of multivitamin and mineral supplement use to prevent cancer and chronic disease in adults: a systematic review for a National Institutes of Health state-of-the-science conference. Ann Intern Med. 2006;145(5):372-385. doi:10.7326/0003-4819-145-5-200609050-00135
- U.S. revenue vitamins & supplements manufacturing 2019. Statista. https://www.statista.com/statistics/235801/retail-sales-of-vitamins-and-nutritional-supplements-in-the-us/. Accessed December 18, 2019.
- Dietary Supplements Market Worth $194.63 Billion By 2025 | CAGR 7.8%. https://www.grandviewresearch.com/press-release/global-dietary-supplements-market. Accessed December 18, 2019.
- Coates PM, Thomas PR. Dietary supplements. World Rev Nutr Diet. 2015;111:58-63. doi:10.1159/000362298
- Lee J. Marketplace analysis demonstrates quality control standards needed for black raspberry dietary supplements. Plant Foods Hum Nutr Dordr Neth. 2014;69(2):161-167. doi:10.1007/s11130-014-0416-y
- Supplements: A scorecard. Harvard Health. https://www.health.harvard.edu/staying-healthy/supplements-a-scorecard. Accessed December 18, 2019.
- Mursu J, Robien K, Harnack LJ, Park K, Jacobs DR. Dietary supplements and mortality rate in older women: the Iowa Women’s Health Study. Arch Intern Med. 2011;171(18):1625-1633. doi:10.1001/archinternmed.2011.445
- Bischoff-Ferrari HA, Dawson-Hughes B, Baron JA, et al. Calcium intake and hip fracture risk in men and women: a meta-analysis of prospective cohort studies and randomized controlled trials. Am J Clin Nutr. 2007;86(6):1780-1790. doi:10.1093/ajcn/86.5.1780
- Michaëlsson K, Wolk A, Langenskiöld S, et al. Milk intake and risk of mortality and fractures in women and men: cohort studies. BMJ. 2014;349:g6015. doi:10.1136/bmj.g6015
- Feskanich D, Willett WC, Colditz GA. Calcium, vitamin D, milk consumption, and hip fractures: a prospective study among postmenopausal women. Am J Clin Nutr. 2003;77(2):504-511. doi:10.1093/ajcn/77.2.504
- Bischoff-Ferrari HA, Dawson-Hughes B, Baron JA, et al. Milk intake and risk of hip fracture in men and women: a meta-analysis of prospective cohort studies. J Bone Miner Res Off J Am Soc Bone Miner Res. 2011;26(4):833-839. doi:10.1002/jbmr.279
- Shanb AA, Youssef EF. The impact of adding weight-bearing exercise versus nonweight bearing programs to the medical treatment of elderly patients with osteoporosis. J Fam Community Med. 2014;21(3):176-181. doi:10.4103/2230-8229.142972
- Draft Recommendation Statement: Vitamin D, Calcium, or Combined Supplementation for the Primary Prevention of Fractures in Community-Dwelling Adults: Preventive Medication - US Preventive Services Task Force. https://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement/vitamin-d-calcium-or-combined-supplementation-for-the-primary-prevention-of-fractures-in-adults-preventive-medication. Accessed December 18, 2019.