Should You Take Dietary Supplements?

Your body doesn’t make many of the essential nutrients it needs, so you must get most of them from your diet. But what happens if you don’t get all of those needed nutrients even from a diet rich in superfoods? Maybe you don’t eat as many servings of fruits and vegetables as you need every day, or maybe you don’t eat the most nutritious foods. In either case, you may need more nutrients than your diet provides, and you may want to consider using dietary supplements.

Let’s be clear: Supplements are no substitute for real food, superfoods, or a healthy, balanced diet — and they aren’t appropriate for everyone. They shouldn’t be used as meal replacements. Supplements can be packed with vitamins, minerals, and antioxidants, but they don’t contain natural sources of fiber, carbohydrates, and proteins necessary for bodily functions. Used judiciously, however, they may help you to fill in the gaps in an otherwise superfood-rich diet.

In this article, we take the mystery out of supplements. We explain their benefits and their potential hazards and give you some guidance to help you decide whether they’re right for you. And we offer tips on what to look for — and where to look — when choosing the supplements you want.

How Dietary Supplements Work

Federal law defines a dietary supplement as “a product (other than tobacco) that is intended to supplement the diet that bears or contains one or more of the following dietary ingredients: a vitamin; a mineral; an herb or other botanical; an amino acid; a dietary substance for use by man to supplement the diet by increasing the total daily intake; or a concentrate, metabolite, constituent, extract, or combinations” of these ingredients.

The law also specifies that a supplement must be in the form of a pill, tablet, capsule, or liquid, must not be intended to replace food, and must be labeled as a “dietary supplement.” Beyond that, though, manufacturers have a lot of leeway in how they make and market their supplements.

That doesn’t mean supplements are bad. In fact, some of them go beyond mere supplementation and may help to prevent — or, in some cases, even treat — certain diseases. However, your body isn’t nearly as efficient in absorbing nutrients from supplements as it is in absorbing nutrients from food. So supplements can’t take the place of a healthy, balanced diet (liberally dosed with superfoods, of course).

Difference Between Foods and Supplements

The main difference between vitamins and minerals found in the foods you eat and the nutrients found in dietary supplements is how your body absorbs and uses them. This activity is known as bioavailability: the rate at which a substance is absorbed and made available to your body.

Nutrients are broken down in the stomach and passed into the small intestine, where they’re absorbed and then metabolized by the liver or kidneys. From there, the nutrients are delivered to different parts of your body. It’s a long journey, and the body has plenty of opportunities to alter the way the supplements end up being used.

Studies have shown that many dietary supplements aren’t absorbed as well as the nutrients in the foods you eat (although, as with every rule, there are exceptions — folic acid, for example, is actually better absorbed than its natural form, folate).

Because of the difference in absorption rates, you may have to take six or even a dozen capsules a day to get the same amount of nutrients you’d get from eating a healthy diet. (And that’s assuming your body absorbs all the nutrients in the capsules, which doesn’t usually happen.)

Most manufacturers attempt to make capsules and pills so that they dissolve in the right spots, therefore maximizing absorption and improving bioavailability. Still, many pills and capsules have low bioavailability (which is one reason that getting your nutrition from food is often a better option).

Supplements are most useful when they provide the same nutritional value as a large quantity of food — especially when it’s virtually impossible for you to eat that much of a particular food or food group on a regular basis. That’s why fiber supplements are so popular; because foods that have a lot of fiber are quite filling, many people find it impossible to get their recommended daily intake through diet alone.

Determining Whether You Need Supplements

It’s amazing how easy it is to be convinced to take an herb or vitamin based on a recommendation from a friend, colleague, or your doctor. After all, everyone wants to feel better and remain healthier. If someone says that he or she takes 10,000 milligrams of vitamin C and feels capable of moving a mountain, it’s human nature to think, “Well, I should give it a try, too!”

The truth is that in some instances it makes sense to get additional nutrients through supplements. But in other cases, taking supplements can actually aggravate an existing health problem.

When Supplements Make Sense

Some medical conditions and lifestyle factors can be alleviated by increasing your intake of certain nutrients. Here are some common situations that may call for higher-than-normal nutrient intake levels:

Smoking: Smokers are thought to need an almost 50 percent higher intake of daily nutrients than non-smokers. Cigarettes (and even pipe and chewing tobacco) are loaded with chemicals that react badly with the body. These chemicals can cause inflammation and disease, but the effects can be mitigated by consuming higher doses of certain nutrients, like vitamin C.

Disease: Several diseases can harm your body’s ability to absorb and use nutrients, so you may need supplements to counter these effects. For example, gastrointestinal ailments may decrease nutrient absorption, and you may need to take supplements intravenously (under a doctor’s supervision, of course). Inflammatory conditions may require more antioxidants to help reduce swelling. Some nutrients (many of them found in the superfoods we cover throughout this book) can help slow the progress of cancer and other diseases as well as increase overall well-being.

Medications: Certain medication classes can interfere with the absorption of vitamins and minerals by disrupting either the transport or metabo- lism of certain nutrients. Anti-seizure medications, oral contraceptives, anti-inflammatories, and chemotherapy drugs are among those known to interfere with nutrient absorption.

Occupational exposures: People who are exposed to chemicals in their work environment often have higher rates of vitamin deficiency. Toxic levels of metals (see the “Seeing secrets held by hair” section later in this chapter) can cause deficiencies in both minerals and vitamins.

Malnourishment: If you don’t eat enough fruits and vegetables or if your diet is high in trans fats, sugar, and other highly processed foods, you’ll probably need to take daily supplements until you get established on a proper diet. People with anorexia or bulimia also fall into this category. Vegetarians and vegans don’t necessarily fall into the malnourished category, but they do have some special needs based on their food intake. If you don’t eat meat or any animal products, you may need to consider supplementing your intake of vitamin B12, iron, calcium, vitamin D, and zinc.

Alcohol or other drugs: Most drugs, including alcohol, cause a depletion of important vitamins and minerals. Alcohol can cause irritation of the stomach, which affects nutrient absorption. In addition, the empty calories from alcohol often replace healthy food intake, which can make vitamin and mineral deficiencies worse.

Age: You can use more of certain nutrients as you get older. Studies have shown that people over age 60 can use almost 30 percent more B6, and vitamin D and calcium also should be taken in higher quantities. As always, make sure you discuss supplements with your doctor before you start taking them.

Pregnancy: This is an important time to get some extra nutrition. The female body shares nutrients with the fetus, so needing more than usual makes sense. Folate is particularly important for healthy fetus development.

Although supplements can provide moderate amounts of various nutrients, the best way for your body to utilize nutrients is through a balanced, healthy diet with superfood additions. This, along with a healthy lifestyle, keeps your body in the best position to remain disease free.

When supplements don’t make sense

Supplements can be beneficial, but they aren’t right for everybody all the time. Hard as it may be to believe, in some situations, supplements do more harm than good. Some vitamins, when taken in excess, can interfere with medications and can also cause some general symptoms of malaise.

If you take any medications, you should check with your doctor to make sure the supplements you plan to take won’t affect the potency or effect of your medications. Following are a few medical conditions that can be aggravated by dietary supplements:

Some dietary supplements can slow down or speed up the metabolism of prescription medications, so you should have your doctor review your supplements to make sure there are no interactions. Here are some that warrant medical clearance before you take any supplements:

  • Blood thinners
  • Anti-seizure medications
  • Blood pressure medications
  • Diabetes medications
  • Psychiatric medications (including antidepressants)

Testing for Your Supplement Needs

You can have your nutrient levels tested to see whether you need supple- ments. Your doctor may be able to order blood or hair tests that can reveal deficiencies or excesses of certain nutrients or exposure to substances that may indicate the need for supplements.

The role of nutrients in health is well-established, but regular testing is still not common practice and insurance companies are slow to respond to the demands of consumers. Some insurance companies cover a portion or all of the costs for vitamin and mineral testing, but it depends on the company and selected plan, so check first.

Some symptoms, such as fatigue, weight gain or weight loss, headaches, and joint pain, may indicate a serious health problem. But they also could be caused by nutritional deficiencies or overabundance of certain nutrients. If your doctor doesn’t find any medical explanation for such symptoms, you may want to explore nutrition as a possible solution.

Doing blood analysis

Wouldn’t it be nice if you could have your blood drawn and end up with a printout of exactly what you need, don’t need, and have the right amount of? Fine-tuning nutritional needs with simple blood tests is a process that’s well underway. If your doctor suspects nutritional deficiencies based on your symptoms and medical history, blood tests can offer concrete data to help determine which dietary changes or supplements make sense.

Blood testing is one way to determine what your body needs — and what you may not be getting from your diet. Some blood tests give you a specific break- down of nutrient levels, such as the amounts of vitamins, minerals, amino acids, and fatty acids your body contains. This direct testing helps identify deficiencies or abundances in your nutritional make-up.

Routine medical blood tests can indirectly reveal nutritional issues, even though they aren’t testing for any specific deficiencies. When regular blood tests show values that are out of normal ranges, doctors often look for vari- ous diseases as the cause. But sometimes these same results can be caused not by disease, but by nutrient imbalances. Additional testing for specific vitamin and mineral levels can be very helpful — and may lead to much dif- ferent treatment options.

This area of blood testing is growing because knowing how well your body is doing nutritionally can allow you to maximize diet and supplementation. If you aren’t a big fan of having your blood drawn, you can always seek other testing modalities, such as hair and saliva. Saliva testing is very reliable for evaluating hormones and is starting to be used for vitamins and minerals. This may become an important test option because it’s less invasive than other types of testing.

These tests are becoming a very important tool as doctors are finding how important the use of dietary and nutritional therapy can be. Testing can range from $100 to $1,000, depending on how much data you’re trying to collect. In the future, this type of testing may become a part of annual blood testing, but for now it’s not a bad investment to get some form of testing done, either yearly or when you’re not feeling well.

Seeing secrets held by hair

If you watch crime shows on television, such as CSI or Forensic Files, you know that your hair can reveal a lot about your body. Hair analysis is the Environmental Protection Agency’s test of choice for determining exposure to toxic metals and levels of trace minerals because the mineral content in your hair accurately reflects the amount of that mineral in your entire body. These days, hair is regularly tested to determine levels of minerals, metals, and other substances, including vitamins and even poisons.

Most chiropractors and homeopathic physicians offer hair testing or other similar tests, and more conventional doctors are discovering the benefits of hair testing. If your doctor doesn’t do this type of testing, he or she should be able to recommend a lab or clinic that does.

Hair analysis can differ from lab to lab, raising questions about the accuracy of the results. If you choose to have your hair tested to determine whether you need supplements, and if so, which ones, be sure to have the test done by a reputable lab.

Several body functions can be affected by heavy metals and minerals, including hormone function, blood sugar control, and other metabolic pathways. Common metals that can interfere with metabolism, vitamin and mineral balances, and organ function at high levels include the following:

  • Lead: High levels of lead can cause severe problems with nerve function, reproduction, and kidney function. Lead poisoning once was fairly common because of the prevalence of lead in paint, although that’s less of a concern today. Still, lead levels need to be monitored and considered in health evaluations. Furthermore, levels that were once considered safe are now often associated with symptoms of lead poisoning.
  • Mercury: Mercury can accumulate in your body and cause problems with your liver, gastrointestinal tract, and central nervous system. The most common way to ingest potentially harmful levels of mercury is through eating fish from mercury-contaminated waters (see Chapter 7 for more on mercury in fish).
  • Aluminum: Dietary aluminum is very common, but mostly in such small quantities that it’s irrelevant. However, people who have kidney disease or other conditions that prevent their bodies from excreting aluminum can accumulate high levels of this metal and develop symptoms. Some of these symptoms mimic those of Alzheimer’s disease, such as memory loss and mental confusion. Some urban water supplies have higher amounts of aluminum; check with your local water company to see whether your water has high aluminum levels. Aluminum is also a common addition to antacids, so you should take them sparingly.
  • Cadmium: This metal is mostly found in industrial work areas. It is highly toxic and has led to disease and death in welders. Some paints also contain cadmium.

Hair analysis is a good option, even if you’re feeling fine. If you discover imbalances in your nutrient levels before you have symptoms, you can adjust your diet (and perhaps use — or stop using — supplements) to correct them.

Considering Your Intake Options

There are some important differences in the way supplements are made and how they’re consumed. One of the main objectives of nutritional companies is to find the best ways to get nutrients into your cells. In the search for maximum absorption, manufacturers have begun to move away from pills and capsules in favor of other forms, such as liquids, dissolving tabs, and injections. Snack bars and healthy drinks also are great alternatives because they get you closer to real, whole foods. They’re a good choice when you’re on the go and just don’t have time for a traditional meal.

Taking tablets, capsules, or liquids

Most people assume that all supplements are created equal, but this is far from the truth. Manufacturing processes can affect how well your body absorbs the nutrients, and with the loose regulations currently in place, manufacturers can easily produce supplements that give you little or no actual benefit. Turn to “Knowing What to Look For,” later in this chapter, for more on researching products and manufacturers. Here’s a quick look at some things to think about when you’re deciding whether to take supplemental tablets, capsules, or liquids:

  • Tablets are made by mixing organic or inorganic materials and then using machines to compress them into shape. Manufacturers use different types of materials to hold the supplements together, and those materials can affect how efficiently your body absorbs the nutrients you’re after. Even the process used to compress the pills can affect absorption.
  • Capsules are gelatin containers that commonly dissolve faster than tablets. However, capsules often have significant amounts of filler material, and the kind of filler varies depending on the manufacturer. These filters can affect absorption, too.
  • Liquids generally claim to have better absorption rates than tablets or capsules. However, as with tablets and capsules, liquid supplements contain other substances that may inhibit the release of the actual nutrient into your system. Taste is a factor, too; you’re unlikely to take a liquid supplement regularly if the taste makes you gag.

Different supplements come in different forms. For example, you may have a tablet of vitamin E and a capsule of fish oils. You may also have to consider the size of the tablet or capsule because often people complain that supplements are too big to swallow. Liquids are nice because there’s no problem with swallowing, and you often can dilute liquid supplements in water or other drinks to offset the taste.

Reputable companies use the right materials and tested delivery methods to give you the best availability of nutrients. Don’t spend too much time investigating the actual delivery form; instead, spend that time looking into the company making the supplement.

Safety Precautions

For the most part, dietary supplements are very safe. However, taking large doses of dietary supplements without medical guidance isn’t a good idea. Believe it or not, it’s possible to overdose on vitamins and minerals.

In addition, some dietary supplement companies make false or misleading claims for their products. Remember, dietary supplements are only loosely regulated, and the claims they make aren’t evaluated by the Food and Drug Administration (FDA) or any other agency. Dietary supplements do not have to be tested to prove they are beneficial or safe before they’re sold.

Here are some things to be wary of when you’re shopping for supplements:

Outlandish claims: Be alert to over-the-top claims you see in advertisements or on labels. Phrases like “miracle cure,” “medical breakthrough,” or “newest discovery” should raise red flags for you and encourage you to do more research before you buy. You can (and should) ask your doctor about any supplements you’re thinking of taking.

Poor manufacturing: Remember that the supplement industry is not tightly regulated, so to avoid poor manufacturing, look for nationally known brands with label statements about testing and certification. If you’re not sure whether a supplement is tested and certified, call the company and ask for a certificate of analysis showing that they have properly formulated the supplement. See the later section “Knowing What to Look For” for info on researching products and manufacturers.

Unstated health interactions: Many labels don’t warn you of potential health risks or interactions with other supplements or medications. That’s why you should always consult your doctor before you begin taking any supplements.

Consulting your doctor before taking any supplements is particularly important if you’re about to undergo any medical procedures, because some nutrients can affect bleeding and how your body reacts to anesthesia. To be safe, bring your supplements with you so your doctor can read the labels and identify any potential concerns.

Knowing What to Look For

Once you’ve decided you want to supplement your diet, the sheer volume of supplement options and brands can be bewildering. Are store or generic brands as good as national brands? How can you be sure a given supplement is actually effective? What should you look for?

Here are some tips to make your search a little less daunting:

  • Ask your doctor, family, and friends for recommendations. If people you trust are happy with the supplements they take or recommend, this is a good starting point for your own purchase.
  • Ask your doctor if a quality generic or store brand is available. Your doctor may know of quality generic or store brands that are significantly cheaper than big-name brands but just as effective.
  • Do some research online. The Internet makes it easy to find information about dietary supplements. Search by brand name, ingredient, or nutrient, and be sure to evaluate both negative and positive information. A simple search of a manufacturer’s name can turn up review sites where consumers share their experiences with a particular product.

You also can check out manufacturers at www.consumerlab.com. This site lists products that have been tested and certified, so you know that they contain the stated amounts of nutrients and that they’re safe.

Online communities and blogs can also be great sources of information on supplements, including reputable products. Check out www.ods.od.nih.gov, or type “dietary supplement blog,” or “healthy supplement blog” into your browser’s search engine.

  • Look for food-based supplements. Food base is concentrated plant material to which vitamins and minerals are added. Supplements with a food base contain enzymes and nutrients that boost absorption of the vitamins and minerals. This is probably the best type of supplement you can buy, but the tablets are larger, and you may have to take more of them.
  • Check the expiration date. Supplements typically have a long shelf life — the length of time they can be stored and remain safe, effective, and usable — but you should always check the expiration date before you buy. There’s no point in buying 500 multivitamins that expire in six months.

Although many manufacturers claim that synthetic vitamins are chemically identical to the real thing, your body knows the difference between synthetic and natural vitamins. Numerous studies have shown that the human body uses natural vitamins more effectively and more efficiently than synthetic versions. This is another reason why supplements can only complement your diet; they can’t take the place of real foods — or superfoods.

Knowing Where to Look

Virtually every grocery store has a selection of vitamins and more popular dietary supplements on its shelves. But that doesn’t mean you’ll get the best product or the best price. Discount retailers like Walmart and Target typically have a larger selection of supplements, including both national brands and their own store brands. And many cities large enough to have a mall also boast a health store of some sort.

No matter where you live, you can go online to order supplements from reputable manufacturers. Larger stores usually get volume discounts that can be passed on to the consumer, so you’re likely to find better prices at big-box stores. Online stores have less overhead, which can also lead to lower costs. One option is to research supplement manufacturers and prices online, and then check your local brick-and-mortar stores to see whether they offer similar or better prices.

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