Do You Need Supplements?


Venture into any large drugstore these days and encounter a veritable A to Z of supplements—everything from vitamins and minerals to prebiotics, probiotics, and fish oil. The question is: are these pills panaceas or are they not as necessary as sometimes touted—and what’s right for you?

The answer largely depends on your own personal health needs, according to Dr. Michael Smith, medical director, WebMD; Dr. Cate Shanahan, author of “Deep Nutrition” (Flatiron Books, 2017);; and Cordialis Msora-Kasago, MA, RD, and media spokesperson, Academy of Nutrition and Dietetics. Here’s what they had to say.

What are supplements?


“Supplements are products taken because they contain at least one dietary ingredient believed to improve health,” Msora-Kasago says. “These may include vitamins, minerals, amino acids, herbs, and botanicals.” Shanahan further breaks such products down into three categories, which she calls “sensible,” “silly,” and “sucker.” She includes essential nutrients and herbals with easily discernible benefits (such as kava and melatonin) in the first subcategory. Products with “wildly crazy” doses (such as many multivitamins) or herbals that people take despite no observable advantages she classifies as “silly.” She describes compounds based on “faulty science,” such as chromium and resveratrol, “suckers.”

Are supplements regulated?


Unfortunately, the answer is not entirely. “Unlike drug manufacturers, the makers of supplements don’t have to show their products are safe and effective before selling them on the market,” Smith says. That’s why Msora-Kasago recommends purchasing from reputable sources and choosing supplements whose label includes a mark from independent organizations, such as U.S. Pharmacopeia (USP), NSF International or ConsumerLab.com. “Although voluntary,” she explains, “this certification indicates that the supplement meets FDA manufacturing requirements and is free of harmful contaminants, has the specified ingredients in the quantities indicated on the label, and will release ingredients in the body within a certain period.”

Is there evidence that supplements work?


The data on the efficacy of supplements has been mixed, according to all three experts. On the pro side, Msora-Kasago provides one example of the effectiveness of one type of supplement: probiotics. “Individuals experiencing severe diarrhea while taking antibiotics have reported significant improvements after adding some probiotics to their diets,” she says. Similarly, Shanahan says, “We know that when people are deficient in a nutrient, taking supplements [in the “sensible” category] in reasonable amounts reliably raises their tissue levels and alleviates symptoms of deficiency.”

Still, since study results have been varied, “The U.S. Preventive Services Task Force does not endorse taking supplements to prevent disease,” Smith says. He and Msora-Kasago counsel that if a health claim seems too good to be true—such as weight loss without diet or exercise—it probably is. “Although it is illegal to claim that a supplement can treat, cure, or prevent disease, some marketing communications often give the impression that their products function in such a manner,” Msora-Kasago says.

Can supplements be dangerous?


“Make sure nutritional supplements do not go beyond the tolerable upper intake Level (UL) in the RDA,” Msora-Kasago advises. “Read the label and choose a supplement that meets 100 percent of the Daily Value of nutrients, as that is generally considered safe. Consuming supplements in quantities that consistently exceed the recommended amounts can contribute to the development of conditions, such as kidney stones, liver and nerve damage, and birth defects.” For example, Shanahan says, taking more than 500 milligrams of calcium is linked with a higher rate of bone spurs, kidney stones and calcified arteries.

Further, supplements can interact with other medications or foods you are taking or pose health risks for certain health conditions. That’s why the experts recommend speaking with your doctor or a registered dietician before beginning a new regimen.

Are nutrients best sourced from supplements or food?


All three experts agree that food is the best way to glean nutrients. “As the name implies, supplements are intended to add to the diet, not replace it,” Msora-Kasago says. “There is no substitute for a healthy diet.” After all, nutrients often complement each other for maximum absorption. For instance, vitamin C helps the body absorb iron, while vitamin D assists the body in absorbing calcium.

Shanahan also points out that the body uses nutrients gleaned from food better than those sourced from supplements. As an example, she cites calcium, which she says “ends up in the wrong place when it comes from a pill: the kidneys where you get [kidney] stones, the tendons where you get bone spurs and the arteries.”

And of course, “mega dosing” by eating only certain foods or food groups—or excluding them—can have unintended consequences. Still, Smith says, as we age, our bodies do not absorb nutrients as well from food. “For that reason, it could be worthwhile to work with your physician to see if you should take a supplement,” he says.

What do you recommend supplement-wise?


Smith and Msora-Kasago advise patients to begin with a healthy diet. That said, Smith has found that some benefit from supplements (such as the vitamins: D and B, and the minerals: calcium and magnesium), particularly the elderly and those who find it challenging to eat healthfully.

Shanahan often recommends vitamin D, magnesium oxide, and zinc picolinate; for those with thyroid conditions, she often encourages taking iodine. “I may recommend a supplement if a lab test indicates deficiency and if, despite dietary modifications, an individual is unlikely to take in adequate amounts of a nutrient,” Msora-Kasago says. She cites women with heavy menstrual cycles, who might benefit from iron supplements, and vegans, who might improve their health via doses of vitamin B12 (to prevent anemia).

Do supplements have a shelf life, and how should they be stored?


Some products (such as minerals) are probably good indefinitely, Shanahan says. That said, “supplements lose potency with time, and although not dangerous, taking a product past its shelf life will not give you the most benefits,” Msora-Kasago explains. She advises checking the dates supplied by the manufacturer to determine the shelf life: “The ‘use by’ date suggests that the ingredients in the supplement will remain at 100 percent potency until that printed date. The ‘date of manufacture’ indicates the date on which the supplements were produced, and supplements are generally good for about two years.”

To maintain their potency, keep supplements dry and in the dark, Shanahan suggests. Fat-soluble vitamins, she says, last a bit longer when chilled. Probiotics and fish oil may need to be refrigerated, Msora-Kasago adds.

What’s the bottom line?


Rely on a healthy, varied diet to glean nutrients. That said, if you are elderly, pregnant or postpartum or not taking in sufficient nutrients from your diet, speak with your doctor or a registered dietician about supplementing with sensible products, such as probiotics, magnesium, calcium and vitamin D. Just be a discerning consumer: Choose products from reputable sources, and make sure they include safe and effective doses and not ingredients that could interact with your medications or pose a threat to your individual health conditions.

Hope or hype?

It’s a “buyer beware” world out there. Although some products might not be effective, others could possibly improve our health. After all, millions have attested to positive results, thanks to their supplements of choice. As with any choice, carefully analyze the potential benefits and risks. Ideally, consult with a doctor or nutritionist. Ask questions, pay attention, and proceed with caution. Then, watch and listen to your body to see how you react to your products of choice.

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