What doctors want you to know about supplements
Have you taken any dietary supplements today? Odds are, you have: According to the Centers for Disease Control and Prevention, over half of Americans take one. And supplement use tends to increase with age, with nearly a quarter of adults 60 and over downing four or more. The word “supplement” is a broad category that includes vitamins and minerals (think: vitamin D and calcium) as well as botanicals (like turmeric and green tea extract). Some people have vitamin or mineral deficiencies and rely on supplements to manage them, said Pieter Cohen, an internist at Cambridge Health Alliance who studies supplements. But beyond that, experts tend to be skeptical. Supplements can come with risks, Dr. Cohen said. According to one paper, medical reactions to supplements send an estimated 23,000 people to emergency rooms each year in the United States. And while medications need approval from the Food and Drug Administration for safety and effectiveness before they’re sold, dietary supplements don’t require such approval. “The supplement industry is essentially unregulated, so you’re basically taking a gamble any time you’re taking one of those products,” said Brian Hitt, assistant professor of neurology at the School of Medicine at the University of California, Irvine. Even when they aren’t harmful, they might not do anything at all, Dr. Hitt said. “You’ll find across the board that science-based providers don’t recommend dietary supplements,” he added. Here’s what experts want you to know before you reach for a supplement. Don’t get your information from social media.Supplement manufacturers are not permitted to make what’s called a disease claim, Dr. Cohen said. They can’t, for example, say, “‘This supplement will cure Alzheimer’s disease,’ or ‘This supplement will prevent diabetes,’” he explained. But on social media, there’s little enforcement, Dr. Cohen added, “so if some influencer decides to start saying that their grandmother’s Alzheimer’s was cured using this botanical, there’s nothing to stop them.” It’s safest to ignore those claims, he said. “Rather than the quick fix promised by someone on social media, ask yourself, what is your underlying health concern?” Dr. Cohen said. “And is it realistically going to be fixed by taking a supplement?” Go over those issues with your doctor instead, he added. Research your supplements.Supplements might not contain the exact substance or the dosage that’s advertised on the label, Dr. Cohen said. So before you take anything, he added, vet its safety with a “high-quality third-party certification program” like the U.S. Pharmacopeia, or USP, or the National Sanitation Foundation, or NSF. “When you’re ordering, make sure the bottle actually contains the USP and NSF stamp on it,” Dr. Cohen said. “It needs to be on the actual product, too, not just on the website,” he said. Sometimes it isn’t, he added. You can also research your supplement on the website of the National Institutes of Health’s Office of Dietary Supplements, he said. Don’t take more than the recommended dosage.Some people reason that if one dose of a supplement is helpful, more must be better, said Meena Bansal, system chief of the Division of Liver Diseases for the Mount Sinai Health System. But overdoing it can harm organs such as your liver, she added. Dr. Bansal has seen an increase in the number of patients who have taken too many turmeric capsules, for example, assuming that because it’s used in food, it’s basically harmless. “But I’ve had patients with acute liver injury be hospitalized for it,” she said. An estimated 20 percent of liver damage is related to herbal and dietary supplements. Your dosages for supplements, Dr. Cohen said, “should be taken as seriously as you would over-the-counter medications.” Steer clear of long lists of ingredients.If you’ve vetted your supplement and want to try something, your safest bet is to “purchase a supplement with just a single ingredient on the label,” Dr. Cohen said. Single ingredients allow for easier monitoring when it comes to interactions and side effects, he added. They are also more likely to be certified, Dr. Cohen said. Aside from multivitamins, he said, “it’s hard to find a USF- and NSF-certified product that will include multiple botanicals.” Dr. Cohen added that supplement companies might list ingredients without the effective dosage — or leave out ingredients entirely. “We found in study after study that those long lists are sometimes hiding ingredients that may be banned or prohibited,” he said. “And if the bottle does not tell you the amounts of everything that’s in it, then that’s one to get rid of,” Dr. Hitt added. Take a ‘brown bag’ to your doctor.The next time you are visiting your primary care physician, Dr. Cohen suggested, you should gather up your dietary supplements, put them in a bag and have your doctor review them. All the experts were in favor of this “brown bag” approach. “It’s very important to physically bring in the bottles to your doctor, because there’s so many different brands and formulations,” Dr. Cohen said. “It’s very hard for us to be able to understand what’s going on unless I’m taking a look at the actual bottle.” And include your prescription medications in that bag, so your doctor can spot any harmful drug interactions, said Charlene Gamaldo, a neurologist at Johns Hopkins University. It’s important for both of you to “scrutinize the labels of these products” and then make an informed decision based on your own health, she said, adding, “I always remind patients that no company has done a research study on you personally.” Like this email?
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