From A to Zinc: A Deep Dive into Dietary Supplements

Written by Alexandria Yarborough, PharmD

Dietary supplements are wildly popular. It seems as if everyone you know has heard they need to take [x vitamin] for [insert ailment here]. Consumers have a desire for good health, and the supplement industry has a strong desire for good sales.

A visit to choose a supplement can be overwhelming. It’s difficult to make a choice among the vast assortment in the vitamin aisle. But do you really need them? Do they work? And if so, which ones are best?

By definition, dietary supplements are concentrated sources of vitamins, minerals, or other substances with a nutritional or physiological effect (e.g., amino acids, essential fatty acids, probiotics, plants, and herbal extracts) intended to supplement the regular diet. They are taken in order to produce a response in the body such as lowering cholesterol or providing increased energy to your workout.

Yet, despite their route of administration and drug-like appearance, dietary supplements have been classified as foodstuffs and not medicines. So, in formal terms, supplement users are consumers rather than patients, but the question remains whether it is sick or healthy individuals who should be the primary users. 

According to National Health Statistics Reports, 58.5% of adults reported taking a dietary supplement in the past month. The market for dietary supplements continues to expand exponentially and manufacturers develop products for health problems affecting almost all organs of the body, as well as for non-existing conditions (for example, supplements for bladder elasticity).

Only one-quarter of users take supplements recommended by their physician, meaning the overwhelming majority use dietary supplements of their own accord. The total price tag exceeds $50 billion per year—money that nutrition experts say might be better spent on nutrient-packed foods like fruit, vegetables, whole grains and low-fat dairy products.

“Pills are not a shortcut to better health and the prevention of chronic diseases,” says Larry Appel, MD, director of the Johns Hopkins Welch Center for Prevention, Epidemiology and Clinical Research. “Other nutrition recommendations have much stronger evidence of benefits—eating a healthy diet, maintaining a healthy weight, and reducing the amount of saturated fat, trans fat, sodium and sugar you eat,” Appel said. “If you follow a healthy diet, you can get all of the vitamins and minerals you need from food.”

What Are Dietary Supplements?

According to the U.S. Food and Drug Administration (FDA), dietary supplements are intended to supplement the diet and are different from conventional food. Generally, they are not intended to treat, diagnose, cure, or prevent diseases.

Dietary supplements can help you improve or maintain your overall health, and assist in meeting  your daily requirements of essential nutrients. It’s important to note that a dietary supplement is a product that is neither considered a food nor a drug. They include vitamins and minerals such as essential fatty acids, enzymes/coenzymes (ex. Coenzyme Q10), bacteria (ex. Lactobacillus acidophilus), and hormones (ex. Melatonin).

Alexandria Yarborough, PharmD, is a Community Pharmacist and Pharmacist in Charge at Sam’s Club in South Carolina. She has almost a decade of experience in the field of pharmacy.

Benefits of Dietary Supplements

While the benefits of some supplements are well established, other supplements need more studies to be done. Also, keep in mind that supplements should not take the place of the variety of foods that are important for a healthy diet.

Advocates  of dietary supplements promote their advantages of providing patient autonomy, having no prescription requirement, and that they are often more affordable than medication prescribed by a doctor.

However, due to the majority of supplements being considered unnecessary and harmful, it is appropriate to consider these proponents also components. In other words, although something may be commonly known as safe and effective, it has the potential to become extremely dangerous.

Who Should Be Taking Them?

Dietary supplements are not recommended for everyone to use but rather to be used by those with a prolonged nutrient deficiency in their diet or a diagnosed deficiency in the body. Examples include vegetarians, picky eaters, food insecure adults, post-menopausal women, and people living with certain conditions such as cystic fibrosis or post bariatric surgery patients. 

Also, there are certain life stages that require supplementation for a limited amount of time, but not indefinitely.  Short-term use of supplementation would be supported during the teenage years, throughout pregnancy, or while in a rehabilitation program.

Therefore, more emphasis should be given to dietary changes, including the benefits of eating more fruits and vegetables, where vitamins and minerals occur naturally in combination with other nutrients that cannot be replicated in food supplements.

When Supplements Become Harmful

Incorrect supplementation use results in an estimated 23,000 ER visits each year in the United States. Unfortunately, millennials were the main age group affected as the average age of patients who were treated for supplement-related adverse events was 32 years old. 

Emergency department admission was warranted due to side effects from taking larger doses than recommended and drug interactions with prescribed medications and other supplements. The most common adverse effects were mild-to-moderate allergic reactions, swallowing problems, abdominal symptoms such as nausea and vomiting, and cardiac symptoms (palpitations, chest pain, or tachycardia). 

Manufacturers often add vitamins and other supplement ingredients to foods you eat, especially breakfast cereals. As a result, you may get more of these ingredients than you think, and more is not necessarily better. Supplements commonly interact with prescription medications. They can increase the risk of bleeding or, if taken before surgery, can change your response to anesthesia.

Here are a few additional examples:

• Vitamin K reduces the ability of the “blood thinners” to prevent blood from clotting.

• St. John’s wort can speed the breakdown of many medicines and reduce their effectiveness (including birth control pills, heart medications, and transplant drugs).

• Antioxidant supplements (vitamins C and E) can reduce the effectiveness of some types of cancer chemotherapy.

• Too much vitamin A can cause headaches, liver damage, reduce bone strength, and cause birth defects. 

How Are They Regulated?

In the US, no documentation of safety is required before the introduction of a dietary supplement to the market, although the law clearly states that manufacturers are responsible for the safety of a product. It is believed that supplements are released onto the market to be tested by the end-users. Manufacturers can sell these products without any evidence of their purity, potency, safety, or efficacy (effectiveness).

For most claims made on product labels, the law does not require that the claim is accurate or truthful. The FDA may withdraw a product from the market ONLY after it has been deemed unsafe, when it can take action against products that are adulterated, misbranded, or likely to produce harm. Despite legal requirements, labels of dietary supplements cannot be treated as a source of reliable information about the products’ contents. 

For example, the brain health supplement market is on the rise and upon review, 10 out of 12 products contained non-declarable components (small amounts of substances that manufacturers are not required to list), and 8 did not contain at least 1 of the ingredients listed on the label. Overall, it is estimated that approximately 20% of the supplements contain at least one banned substance.  

How to Be an Informed Consumer?

Being able to understand the health effects of using supplements is an important public health issue. Due to a climate of increased government scrutiny and consumer concerns, the United States Pharmacopeia (USP) Dietary Supplement Verification Program was established to showcase the dietary supplement manufacturer's commitment to produce quality products for consumers. 

Dietary supplement products that meet the program's strict testing and evaluation criteria are awarded the distinctive USP Verified Mark. Since the program's inception, the USP Verified Mark has appeared on more than 700 million labels/packages of dietary supplements. Seeing the USP Verified Mark on a dietary supplement label indicates that the product:

• Contains the ingredients listed on the label, in the declared potency and amounts. 

• Does not contain harmful levels of specified contaminants such as heavy metals or microbes.

• Will break down and release into the body within a specified amount of time.

• Has been made according to FDA current Good Manufacturing Practices using sanitary and well-controlled procedures. 

In addition, independent organizations such as ConsumerLab.com and NSF International are reliable alternatives to the USP to evaluate supplement quality. Each organization has a program that allows manufacturers to pay a fee to have their products tested; those that conform to the organization’s quality specifications can bear that organization’s seal of approval on their label.

It should be stated that dietary supplements are not recommended for everyone but rather to be used by those with a prolonged or diagnosed deficiency. More focus should be given to a healthy diet, including a variety of fruits and vegetables, where vitamins and minerals occur naturally. However, if you do decide to take supplements you should make sure to make an educated, informed decision in order to avoid serious health consequences.

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