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Dietary Supplements

Dietar y Supplements
Majority of adults in US take 1+ dietary supplement either every day or occasionally May include vitamins, minerals, herbals, botanicals, amino acids, enzymes, others Can be in tablet, capsule, powder, drink, energy bar forms
Na#onal Ins#tutes of Health, Oce of Dietary Supplements, Dietary Supplements: What You Need to Know, 2011

Supplement Sales
Dietary supplement sales in the US are $22.5 billion per year (2006)

Source: Natural Products Founda#ons Dietary Supplement Informa#on Bureau, 2009. Image: Jose Paolo S. Borromeo

European Union
EU Food Supplements DirecMve of 2002 Establishes purity criteria Must be proven safe before sale Must be labeled this is not a medicinal product if similar to medicinal product

United States
Dietary Supplement Health and EducaMon Act of 1994 (DSHEA) Includes vitamins, minerals, herbs, botanicals (except tobacco), amino acid or combinaMon of any of these used to supplement the diet Regulated as a category of foods, not drugs Dont have to prove ecacy or safety before sale FDA regulates aYerwards if safety issues arise Enforcement is spoZy, industry largely unregulated

Dietar y Supplement Facts Panel

Quality
Quality standards exist although may be quesMonably reinforced IdenMty, purity, strength, composiMon Independent, extra-governmental organizaMons may add addiMonal quality tesMng: U.S. Pharmacopeia, ConsumerLab, NSF InternaMonal

Concer ns
May contain trace amounts of lead and other contaminants May displace income that could otherwise be used for Rx drugs and healthy foods Users do not always disclose to pracMMoners; pracMMoners do not always ask about supps Herbals can contain dozens of compounds and acMve ingredients may not be known

Supplement Savvy
Natural means nothing High-potency, pharmacy-grade, prescripMon-strength Self-diagnosing is harmful More expensive supplements beZer quality Some may interact with prescripMon and over-the-counter medicaMons

Contraindications
Vitamin K can reduce ability of blood thinner Coumadin to prevent blood from clofng St. Johns wort can expedite breakdown of many drugs including oral contracepMves and anMdepressants and reduce eecMveness AnMoxidants such as vitamins C and E may reduce eecMveness of certain chemo therapies
Na#onal Ins#tutes of Health, Oce of Dietary Supplements, Dietary Supplements: What You Need to Know, 2011

IOM Tolerable Upper Intake Levels


Nutrient Vitamin A Vitamin C Vitamin D Vitamin B6 Vitamin E Calcium Choline Copper Folate (Vitamin B9) UL 3,000 mcg 2,000 mg 100 mcg 100 mg 1,000 mg 2,000 mg 3,500 mg 10,000 mcg 1,000 mcg Nutrient Iron Magnesium Manganese Molybdenum Niacin (Vitamin B3) Phosphorus Selenium Zinc UL 45 mg 350 mg 11 mg 2,000 mcg 35 mg 4,000 mg 400 mg 40 mg

No UL for: thiamin, riboflavin, pantothenic acid, biotin, vitamin B12, vitamin K, chromium or carotenoids

Claim: Promotes joint health


Joint health = $800 mil/annual sales Glucosamine & chondroiton mostly negaMve results 2006, Glucosamine/ChondroiMn ArthriMs IntervenMon Trial (GAIT) found no clear benet for most paMents 2009, RTC found glucosamine + chondroiMn no more eecMve than placebo to slow carMlage damage from OA 2010, Norwegian researchers tested glucosamine for chronic LBP & degeneraMve lumbar OA, no signicant dierence between glucosamine & placebo
NEJM 2006 Feb 23;354(8):795-808; JAMA 2010 Jul 7;304(1):45-52

Claim: Improves memor y, focus


Ginkgo EvaluaMon of Memory (GEM) Randomized, double-blind, placebo-controlled trial of 3,069 people age 72-96 at 6 academic medical centers Twice-daily doses of 120 mg ginkgo extract did no beZer than placebo to slow cogniMve decline over 6 years Earlier GEM ndings: debunked benet against Alzheimers & demenMa DeKosky, UVA author, Ive got no good reason to suggest you conMnue to take it beyond your own blind faith
JAMA 2009 Dec 23;302(24):2663-70; JAMA 2008 Nov 19;300(19)2253-62.

Claim: Prevents aging


Resveratrol: anMoxidant found in red wine Appears to inhibit enzymes that regulate cell energy 2006, Improves health & longevity of overweight, aged mice 2008, May slow age-related deterioraMon and funcMonal decline of mice on a standard diet doesnt increase longevity when started at middle age Clinical studies of resveratrol in humans use 1 g/day = 667 boZles of red wine Long-term eects & safety are unknown Great example of exploiMng preliminary animal study data for prot before science unquesMonably can prove benets
Cell Metab 2008 Aug;8(2):157-68;

Who May Need a Supplement?


Group Dieters Vegans, no dairy Infants, children Why? <1600 kcal per day may benet from vitamin/mineral supplement Vitamin B12, calcium and vitamin D Fluoride, vitamin D, iron

Pregnant women 400 mcg folic acid from forMed foods or supplements; prenatal vitamins Older adults Darker skin CigareZe smokers Alcohol abusers MedicaMon Vitamin B12 (gastriMs, decreased IF producMon), calcium and vitamin D Vitamin D Vitamin C helps prevent cigareZe smoke-induced oxidaMve damage B vitamins alcohol inhibits B vitamin absorpMon and metabolism Many medicaMons may interfere with normal vitamin/mineral metabolism

In Summar y
Just because you dont need a prescripMon doesnt mean a supplement is harmless Dont waste Mme and money on supplements if you dont need to Changing diet and exercise paZerns IS harder than popping a supplement pill Most individuals can obtain all nutrients from foods alone When supplements are indicated, they should be taken with cauMon and under the supervision of a qualied medical professional

For More Infor mation


Oce of Dietary Supplements, Dietary Supplement Fact Sheets: hZp://ods.od.nih.gov/factsheets/list-all/ UC Berkeley, Berkeley Wellness LeZer Dietary Supplements Guide: hZp://www.wellnessleZer.com/ucberkeley/best-of-wellness/ dietary-supplements-guide/ MedlinePlus, Herbal Medicine: hZp://www.nlm.nih.gov/medlineplus/herbalmedicine.html NCCAM, Using Dietary Supplements Wisely: hZp://www.nccam.nih.gov/health/supplements/wiseuse.htm