Should I Rely on Supplements to Increase my Nutrient Intake?
Nutritional supplements are used a lot in alternative medicine, yet they do not receive much scrutiny. A supplement is anything you ingest or apply that isn’t food or medication and is often purchased in grocery stores or online. Others are purchased in stores that exclusively sell supplements, like Vitamin World or GNC. Still, more are sold directly by members of your community in the form of MLMs like Juice Plus, Herbalife, Doterra, or Young Living. In these settings, supplements are being sold, and advice is given by people whose only training often comes from the companies they sell for. This gives the illusion that supplements are safe for just about everyone.
With all the heroic claims made about some supplements, people’s desire to turn to what they perceive as more natural options and a lack of guidance from their medical doctors regarding nutrition, it’s no wonder people find themselves the victims of some pretty slick marketing strategies.
Before we sort through the noise around supplements, I want to ensure you know that “Wellness” is a multi-trillion dollar-a-year industry. Most marketing is designed to help people who are already in pretty good health feel superhuman. The other major category of marketing is aimed at exploiting people who are sick and are looking for answers that they don’t feel their doctor has.
This isn’t to say that supplementation doesn’t have a role to play, but that role is much smaller than most people would imagine.
Also, regardless of quality, supplementation is no substitute for access to good food, a healthy and safe environment, exercise, stress management, sleep, connection, and purpose. These are the keys to healing, and there are no substitutes.
Well, When are Supplements Helpful?
There are specific cases where the use of supplements can be very beneficial, which include:
When someone has a measurable nutrient deficiency. Taking supplements over the short term can help rebuild depleted nutrient stores.
When someone cannot absorb certain nutrients from their diet. This is common in patients who have had bariatric surgery, resections of their small or large intestine, or who have low stomach acid production.
During infancy, childhood, adolescence, pregnancy, lactation, and advanced age, there are higher needs for certain nutrients.
Individuals living with food insecurity.
Individuals eating a limited array of foods.
Times of illness or injury.
People with chronic diarrhea.
People on kidney dialysis (care must be taken here as some nutrients are depleted while others can reach toxic levels quickly).
Persons with Inflammatory Bowel Disease or Celiac disease.
Persons struggling with alcoholism or regular alcohol use.
Those who smoke tobacco or other substances.
People who may become pregnant.
Persons on medications that reduce nutrient absorption or increase utilization of specific nutrients.
Otherwise, if you are an adult with no health problems who isn’t pregnant or nursing and is actively avoiding pregnancy, it’s unlikely you will require supplementation with the exception of Vitamin D. According to the Linus Pauling Institute’s recommendations, 2,000IU of Vitamin D should be consumed daily though fortified/enriched foods and/or supplementation.
Before beginning supplementation, a review of nutrient intake to look for gaps is important. Just like everything else in life, too much or too little of a good thing can be harmful; this extends to vitamins as well. Programs like Cronometer, Wholesome and others can be very helpful in the short-term and take a lot of the guesswork out of evaluating your diet. Just be careful not to overly rely on these programs as they can trigger unhealthy relationships with food. If you have a history of an eating disorder, be sure to discuss the use of any food tracker with your mental health provider(s) before you begin.
When in doubt, talk with your doctor, a nutritionist, or a registered dietitian about a diet review.
If and when it is determined that supplementation is indicated for you, it’s time to ask a few questions.
Taking a Critical Look at Supplements:
Here are a few things to remember when we consider adding a non-food substance to our daily intake. These apply to medications and supplements.
Is it safe?
Is it effective?
Are there any risks in taking this substance?
What are the alternatives?
What does the person trying to sell me on this substance stand to gain?
Let’s review these points and examine what the research says about supplementation in general.
Is it safe?
First, most specific supplement formulations have not gone through rigorous and replicated safety testing. Individual nutrients may have quite a bit of research done on them, and this is easy to find by doing a quick search on PubMed. However, specific supplements often have not been studied themselves.
Second, all nutrients do have a tolerable upper limit for intake. This should be taken into consideration when considering a supplement. Unless recommended explicitly by YOUR DOCTOR, avoid any products labeled as “high potency,” “ultra concentrated,” etc. Also, avoid taking multiple supplements that contain the same nutrients or be very careful in adding up the total amounts to ensure you aren’t exceeding your tolerable upper limit through your food and supplementation.
I emphasize working with YOUR DOCTOR; many people online will give medical advice veiled as education and will not take responsibility for you should you have an adverse reaction or need individualized help beyond their general protocols. I’ve seen people get hurt this way, and I hope it never happens to you. This extends to books on medical conditions, too: they always preface their recommendations with the importance of working with your doctor, which is very accurate.
Third, we must consider the quality of the supplement you are considering. Unfortunately, here in the United States, the overview of supplement manufacturing is quite limited. Supplements cannot claim to treat conditions, and manufacturers must follow Good Manufacturing Practices. According to the FDA on their Current Good Manufacturing Practices page, “CGMP regulations generally address matters including appropriate personal hygienic practices, design, and construction of a food plant and maintenance of plant grounds, plant equipment, sanitary operations, facility sanitation, and production and process controls during the production of food.” They are designed to maintain minimum standards at the manufacturing level but not to ensure the supplements' quality.
Additional scrutiny can be found in products that contract with neutral third-party agencies to ensure the quality of their ingredients and finished products. The US Pharmacopeia, NSF International, and ConsumerLab are the most respected organizations that award certifications for products that meet their higher standards. When deciding between two supplements, I recommend spending the extra money on a certified one. This means that what is found in the bottle and what is listed on the bottle will match.
Another thing to consider in the safety category is to be careful where you purchase your supplements. Amazon and eBay have policies against sellers carrying counterfeit products, but their ability to enforce these policies is limited due to the high number of third-party sellers. I’ve had patients bring bottles of supplements they purchased on Amazon into my office only to find that the pills inside the bottle look nothing like the ones we get directly from the manufacturer. Buyer beware! If you see a supplement being sold online for less than you would get it from your doctor or directly from the company, ask the manufacturer if that website is an authorized distributor of their product. If the answer is no, don’t buy it there.
Is it Effective?
The first step in knowing if a supplement will be effective is if it is indicated for your situation. This is where talking with a provider well versed in nutritional medicine, such as a licensed Naturopathic Physician, registered dietician, nutritionist, or MD/DO with extra training in nutrition, is vital. They can combine the most up-to-date research information with their knowledge of physiology, your response to past treatments, and your current condition.
The next step is determining if there is an objective way to measure the supplement's effects. Often, supplements will make someone feel better over a short period of time due to the placebo effect, which is an extension of our mind over matter abilities. When you believe or want something to work, it often does. Conversely, with the nocebo effect, if you believe something will not work or you will experience side effects, this can be the case, too. Our mind/body connection is astounding!
If there are no objective measures to determine efficacy, working closely with your healthcare team, who can ask you targeted questions and track your symptoms over time, is the best way to assess efficacy. When living in our bodies, our perception of what is “normal” is often skewed. In situations such as depression, it can feel like nothing is helping even if our symptoms have greatly improved during a course of treatment. Getting an objective third party on your team is crucial.
What are the risks of taking this supplement?
Beyond the risks of exceeding tolerable upper limits, all supplements have potential risks. This can include allergic reactions, interactions with medications you are taking, lactation issues, and others such as digestive upset. Knowing your potential risks and when you may find yourself in danger is essential.
For example, a common side effect of high-dose niacin can be skin flushing, headache, and a rapid heart rate. Another example includes taking zinc on an empty stomach, causing intense nausea. Vitamin B12 can turn your urine fluorescent yellow, which isn’t harmful but can be disconcerting if you don’t expect it. Additionally, if you are prone to migraine headaches, higher doses of magnesium can trigger one or can bring relief. Finally, iron supplements are commonly constipating, while high Vitamin C or Magnesium doses can lead to diarrhea. It’s important to know what to expect.
In addition to the risks associated with the intended ingredients in a supplement, we also need to consider the fillers, binders, and capsule ingredients. Be sure to look for a list of allergens tested for and verified absent from your supplements. Often, people do well on a supplement until an ingredient has been changed, creating an allergic or hypersensitive reaction, so when you find a supplement that works well for you, try to stick to it. If you develop a new symptom while taking a supplement you tolerated well in the past, check with the manufacturer to see if they changed any ingredients.
What are the Alternatives to This Supplement?
A supplement is never the one factor that will determine your health unless you have a diagnosed deficiency such as scurvy, cannot produce a substance your body usually does on its own, or if your digestive tract has been damaged or altered, interfering with absorption. Some people do not tolerate supplements, as the nutrients are in higher doses and different forms than food. The cheaper the price of a supplement, especially store brands, the more likely the vitamins are in a form that is associated with poor absorption and digestive issues.
All vitamins and minerals can be procured through food or sunlight in the case of Vitamin D, and this is preferable. Vitamins and minerals found in food are not on their own; they are found with other needed nutrients and the energy you need for life. Eating a Standard American Diet and then tossing in a handful of supplements will still leave you with nutrient gaps. We have yet to invent a food substitute that can do half of what real food can do.
Also, no supplement will contain a high enough dose of calcium, magnesium, potassium, or phosphorus - the pills would be too big to swallow. There is also a lack of vitamin K and choline in multivitamin/multimineral supplements, so food will continue to be your best source of these nutrients.
The wellness industry has done a great job of creating the illusion that we cannot get the nutrients we need from food. This is untrue if you eat whole grains, beans, lentils, nuts, seeds, fruit, vegetables, and animal products. If you are on a restricted diet, talk with your healthcare team and evaluate your diet to find the gaps and create a targeted plan.
What Does the Person Trying to Sell Me This Supplement Stand to Gain?
When you are making a purchase, you are giving someone your money. Just because someone works in the wellness industry doesn’t make them less motivated by profits. In the best-case scenario, your doctor recommends a supplement, and you buy it from someone else, and they never receive a cut of the profits.
Unfortunately, due to the abundance of poor-quality supplements out there, many doctors like myself do need to sell supplements. Some of the best supplements out there are not sold to the general public and must be obtained through someone with a medical license. This creates an ethical dilemma when doctors receive a profit through supplement sales.
If you find you are spending high amounts of money on supplements, you notice a repetition of multiple nutrients across your supplements that put you at risk of exceeding your tolerable upper limits, or if you are prescribed new supplements at every visit, you may want to ask your doctor to review your treatment plan more thoroughly or consider a second professional opinion.
Applications
Whew, that was a lot to cover, and many of you may find yourselves possessing supplements of questionable quality. Don’t beat yourself up about it. Take this as a learning opportunity and forge ahead with your new knowledge.
When recommended a supplement (or medication), ask the following questions:
Why do I need this substance, and how do I personally stand to benefit from it?
How do I know it’s working?
How long do I need to take it?
What are the risks involved with this substance?
What are the alternatives to this substance?
Once you are satisfied with the answers, it’s time to find a product to purchase. These are the steps you can go through to choose what supplement to buy:
What are the approved distributors? This saves you from buying a counterfeit product.
What certifications do they meet? USP, NSF, CL, CGMP
Will my nutrient gaps be covered if I take this particular product?
If I take this product, will I exceed my tolerable upper limits?
Is the cost of this product sustainable for me?
I hope these steps help you on your journey with your health.
I will share reliable, relevant information with you as we continue through this year together. By the end of the year, you may know more about nutrition than many Medical Doctors!
As always, this information will remain free and accessible to anyone who wants it. Please share it! Please ask questions! And please share resources and research you think I missed or are interested in hearing me cover!
Next Week
Next week, we will cover fad diets and fad diets masquerading as scientifically proven ones. Stay tuned!
To our health!
References and Recommended Resources for Further Exploration
FDA Good manufacturing Practices for Food and Dietary Supplements: https://www.fda.gov/food/guidance-regulation-food-and-dietary-supplements/current-good-manufacturing-practices-cgmps-food-and-dietary-supplements
OSU Linus Pauling Institute - Meeting Micronutrient Needs Professional Continuing Education Course: https://workspace.oregonstate.edu/course/meeting-micronutrient-needs-healthcare-continuing-education?hsLang=en
USDA list of tolerable upper limits: https://www.nal.usda.gov/sites/default/files/fnic_uploads//UL_vitamins_elements.pdf
US Pharmacopeia website: https://www.usp.org/
ConsumerLab website: https://www.consumerlab.com/
NSF International website: https://www.nsf.org/
Facts and Statistics on US average health measures: https://www.hhs.gov/fitness/resource-center/facts-and-statistics/index.html
National Center for Biotechnology Information (site to search for research articles): https://www.ncbi.nlm.nih.gov/
