11/14/2011: Nutrition Supplements – What You Need to Know!

Millions of Americans use dietary supplements in an attempt to strive for better health. In the United States alone, the dietary supplement industry is a $23.7 billion enterprise. It is estimated that 64% of American adults use dietary supplements, the top three of which are multivitamins, Vitamin C, and calcium. Twenty-one percent take some type of botanical supplement of which the top three are green tea, garlic, and Echinacea.

In the United States, a dietary supplement is defined under the Dietary Supplement Health and Education Act of 1994 (DSHEA). According to DSHEA, a supplement will contain one or more of the following ingredients: a vitamin, mineral, herb, or other botanical, an amino acid, a concentrate, metabolite, constituent, extract, or any combination of the aforementioned. In addition, it must also be intended to take in the form of a pill, capsule, powder, or liquid, and must not be represented for use as a food or the sole item of a meal or diet. It must also be labeled as a dietary supplement.

The Food and Drug Administration (FDA) is responsible for the regulation of all dietary supplements. Dietary supplements are regulated as foods, not drugs; therefore, they do not need to be preapproved by the FDA prior to entering the market. In June 2007, the FDA ruled that by June 2010, the production of dietary supplements must comply with current good manufacturing practices, be free of contamination, and have accurate labeling. In addition, the supplement industry is now required to report to the FDA all dietary supplement related adverse effects. The FDA’s authority is restricted, however. Supplement manufacturers can launch products without testing as long as they send the FDA a copy of the language on the label and refrain from declaring that the product treats, prevents, or cures a specific disease or ailment.

Herbal Supplements
It is thought that herbal remedies have been used for many centuries. The first documented use of herbs was in 2800 BC in China. They remained popular throughout the world, being used for such purposes as sleep aids, digestive aids, treatment of skin disorders, and general healing agents. They began to decline in popularity in the 1800’s with the advent of pharmaceuticals. They once again began to experience an increase in popularity during World War I at which time there was a shortage of prescription drug availability.

Herbal supplements continue in their popularity. Much more is known about herbal remedies today. Herbal treatments have matured along with the methods of delivering them in great part due to continued research and clinical trials. Many individuals use herbal remedies to prevent specific ailments or as a compliment to more traditional medical treatments. Individuals are also becoming more wary of some pharmaceuticals due to their potential side effects and are instead seeking alternative ways to improve or maintain their health in a more natural manner. Herbs used today are generally cultivated for specific purposes. Some individuals are also beginning to cultivate and grow their own herb gardens.

Herbs are sold in many forms: fresh or dried products, liquid or solid extracts, and tablets, capsules or powders. Herbal products are often promoted as natural and as such, individuals view them as safe. While they are often times safe and beneficial to take, herbs can act in a similar manner to drugs. They can cause physiological damage if not used correctly, taken in amounts not recommended, or taken by individuals with certain medical conditions.

A vitamin is an organic compound required as a nutrient in tiny amounts by an organism. The history of vitamins begins approximately 3500 years ago when ancient Egyptians discovered that giving liver to certain individuals could help treat night blindness. Today, we know that it is the Vitamin A in foods that was responsible for this improvement in an individual’s sight. Despite this, much of the knowledge of vitamins was not used for many centuries. In 1749, a Scottish surgeon names James Lind discovered the nutrient we know today as Vitamin C. He found that citrus fruits helped to prevent scurvy, a deadly disease that results in loose teeth, aching joints, bleeding, and a lack of energy. Unfortunately, his discovery was largely ignored. It wasn’t until 1911 that the first major shift in the perception of nutrition occurred. This was when a Polish chemist, Casimir Funk, discovered vitamins, vital amines. For approximately the next 40 years, most physicians based their studies and diagnosis on vitamin deficiencies.

All naturally occurring vitamins are found only in plants and animals. With only a few exceptions, the human body cannot manufacture its own nutrients. Vitamins must be obtained from food or supplements.

Vitamins have a multitude of functions. They help regulate metabolism, convert fat and carbohydrate into energy, and aid in the formation of healthy bones and tissues. Vitamins in and of themselves do not prevent or cure such diseases as cancer or aging related disorders. They can, however, help fortify the immune system and provide some protection against such illnesses. Each vitamin plays a specific role in the human body. It’s also important to note that one vitamin does not typically act alone. Often two or more vitamins and minerals will interact to successfully create the desired result.

Vitamins are classified into one of two categories, water soluble and fat soluble. Water soluble vitamins are the B vitamins (Thiamine, Riboflavin, Folate, Cobalamin, Biotin, Pantothenic Acid, and Pyradoxine) and Vitamin C. These vitamins are not stored in the body and as a result, foods that supply these vitamins need to be eaten on a daily basis. Vitamins A, D, E, and K are fat soluble vitamins. They are digested and absorbed into the human body with the help of fats in various foods. Fat soluble vitamins can be stored in the body. The stored amounts of these vitamins may be utilized if they are not consumed in foods on a daily basis.

Food minerals are a part of the chemical content of foods. These substances are found in small amounts in foods and help our body’s organs, systems, and bones perform vital functions. For example, calcium helps grow and maintain healthy bones while zinc helps our immune system function optimally.

There are two classifications of minerals, macro-minerals and trace minerals. An individual needs more of such macro-minerals as calcium, potassium, sodium, and phosphorus. On the other hand, one needs smaller amounts of trace minerals such as zinc, iron, copper, and fluoride. As with vitamins and herbs, one can get ill by ingesting too large a quantity of any one mineral.

Fish Oil Supplements
Fish oil is an omega-3 fatty acid that is derived from the fatty tissues of fish. It contains two types of omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) which help reduce inflammation within the body. There is evidence that taking the recommended amount of DHA and EPA in the form of fish or fish oil supplements may provide such cardio-protective benefits as lowering triglycerides and blood pressure. It may also slow the build-up of atherosclerotic plaque.

It’s important to note, however, that omega-3 fatty acids may increase the risk of bleeding. Larger intakes of fish oil supplements may increase the risk of hemorrhagic strokes. Higher intake has also been associated with nosebleeds and blood in the urine. Additionally, fish oils are thought to decrease platelet aggregation and prolong bleeding time. They also may reduce von Willebrand factor.

Other contraindications of fish oil supplements are gastrointestinal upset including diarrhea, potential vitamin E deficiency when taken for longer periods of time, and increased LDL cholesterol by 5 – 10%.

Fish oil supplements may also interact with several classifications of prescription drugs such as aspirin, anticoagulants, anti-platelet drugs, and non-steroidal anti-inflammatory drugs. They may also have adverse effects with some blood pressure lowering medications as well as with the LDL lowering properties of statin drugs. Individuals who choose to take fish oil supplements should always ensure that all their healthcare providers are aware of their intake.

Using Dietary Supplements Wisely
Keep in mind that a manufacturer of dietary supplements does not have to prove the safety or effectiveness of its products. It is for this reason that the consumer must be diligent with regards to ensuring that what they are taking is appropriate and, at the very least, not harmful. There are several things a consumer can do prior to taking a supplement. First, discuss all supplements being taken with a physician or pharmacist. They need a complete picture of what an individual is doing in order to best manage their care. They also need to know if someone is considering replacing a prescription medication with one or more dietary supplements as this can have definite repercussions with regards to care.

Prior to taking a dietary supplement, read all label instructions. If unsure of an appropriate dosage, discuss this with a physician or pharmacist as well. Remember, that just because a specific supplement or supplement dosage works for one person, that doesn’t mean it will work for another. Also keep in mind that “natural” doesn’t always mean “safe”. For example, the herbs comfrey and kava are both natural herbs that are known to cause serious liver damage.

Questions to Ask Yourself or Your Health Professional Before Using Any Dietary Supplement (8):

  1. What is the product for? What is its intended to do?
  2. Will this dietary supplement interact with the prescription and over the counter medicines I am taking?
  3. Are there any side effects? If so, what are they?
  4. Are there any precautions or warnings I should know about?
  5. How much should I take, when should I take it, and for how long?
  6. Are there any foods, drugs, or other supplements I should avoid while taking the product?
  7. Are there any reasons I should not take the product, such as a pregnancy, heart condition, or high blood pressure?
  8. Are there any serious symptoms I need to watch out for, such as heart palpitations, dizziness, or night sweats?
  9. Where can I get more information about this product or dietary supplements in general?
  10. Did I read and understand the label?

The IHTC keeps a list of herbal supplements contraindicated in those with a bleeding disorder. You can view a card with this information online, or contact the IHTC Pharmacy Operations & Marketing Director to receive a printed card in the mail.

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