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Navigating the wild world of dietary supplements

August 08, 2018 | UCI Health
woman taking supplements

Supplements are a $40-billion-a-year industry in the United States.

People use them in hopes of:

Some really help. Others are a waste of money. Still others can be dangerous if used improperly or in conjunction with other medications.

What’s a consumer to do?

Consult a reputable health professional, says Dr. Pearl Zimmerman, who specializes in preventive medicine at the UCI Health Susan Samueli Integrative Health Institute.

Don’t take supplements 'willy nilly'

“Sometimes patients come into my office with a big box of all the supplements they’ve ordered,” Zimmerman says. “I believe it’s important to test and not just take supplements willy nilly.”

She checks her patients’ nutrient profile and works with them to personalize the right supplement or combination of supplements for their needs. When starting a new supplement, it is important to start taking a low dose for three days and watch for any negative as well as positive effects.

“Everything we put in our bodies whether it’s food, medication or supplements contributes to our health,” Zimmerman says. “Many supplements are plant-based, so they tend to not have too many adverse effects.”

Know what you’re buying

However, that doesn’t mean the thousands of supplements on the market are all safe or that you’re necessarily getting what you pay for. The FDA regulates supplements, but unlike medicines, the agency does not require that a supplement’s efficacy be proved or even that it is tested for content and purity before entering the marketplace.

Sometimes supplements don’t contain the amount of ingredients they say they do, Zimmerman cautions, citing some gummy vitamins and vitamin D supplements as examples.

Other times they may contain toxic ingredients, as researchers discovered in 2017 in an analysis of calcium supplements. Still others may use “inactive” filler ingredients labeled only as starch that contain corn, wheat or rice, which can affect people with allergies.

The issue is even more complex than determining whether a supplement’s ingredients are safe. How does a consumer know which is the right supplement for their targeted ailment? What is the right dose? Will there be interactions between supplements or with medications?

Do your research

For example:

  • Vitamin B can help with leg cramping or burning and tingling sensations. Take too much of it and you end up causing the very problems you’re trying to cure.
  • Women who take dandelion to detoxify their livers might end up with an unhappy surprise because this herbal weed interferes with oral contraceptives.
  • St. John’s Wort decreases a patient’s response to chemotherapy regimens as well as decreasing the effectiveness of birth control pills.

Zimmerman recommends consulting for cautions on supplements, including interactions with drugs or other supplements.

She also says that WebMD and websites have interaction checkers that cover some major medications and supplements.

It is also best, she says, to work with a doctor or healthcare professional and to rely on “professional-quality” supplements, products trusted by doctors and carried on professional sites that do third-party testing for content and purity. Companies who perform third-party testing include:

  • NSF International
  • United States Pharmacopeia (USP)
  • Informed-Choice
  • ConsumerLab
  • Banned Substances Control Group (BSCG)

Think of food as medicine

Before turning to supplements, start thinking of your food as medicine, Zimmerman says. She recommends a daily diet that consists of:

  • Six servings of organic vegetables
  • Two of organic fruit
  • 1 gram of protein per kilogram of body weight
  • Avoid sugars and processed foods, which can cause recurrent gut bacterial and yeast problems as well as lead to malabsorption of nutrients.

Until recently, physicians were not typically trained in the efficacy of supplements. Today, more physicians acknowledge that some supplements can have important impacts on people’s health. Many people — whether because of problems with malabsorption or autoimmunity, genetics or other diseases — do need the support of supplements, Zimmerman says.

“Even with something as seemingly simple as a multivitamin, patients are best served by consulting with an integrative medicine practitioner,” she says.

“For instance, some people are missing enzymes needed for folate and B12 to be able to work in our bodies. People taking vitamins that aren’t in the right form for their genetic make-up could potentially experience fatigue, insomnia and even infertility. It’s important to personalize supplementation by using nutritional and genetic testing so that you aren’t guessing what you need, wasting money taking supplements you don’t need — or worse, taking supplements that hurt you.”

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