Should Individuals use Dietary Supplements?
By Jodi L. Norton
I believe the use of dietary supplements should not be taken lightly. In general, most of society (myself included) has consumed many dietary supplements for one symptom or another with no ill effect. This is not to say that negative effects don’t exist. On the contrary, many individuals suffer ill affects directly due to the use of “nutritional supplements”. From my own experience and the data I have reviewed regarding this debate I realized that I find myself in the middle of this divergence of views.
Many vitamins can cause gastric disturbances, like heartburn and nausea, especially when taken on an empty stomach. Kidney stones can result from an excess of vitamin C and too much of the various B vitamins can lead to hypotension, CNS alterations (perhaps fatal) and itching, tingling and vasodilatation (Martini 958). Due to the many diverse effects of dietary supplements, I believe healthy individuals should rely on their diet to fuel their body with the necessary vitamins (i.e. using natural garlic in your foods) (Weil, A. 1990). And according to the American Medical Association the “most promising data in the area of nutrition and positive health outcomes relate to dietary patterns, not nutrient supplements.”
In order to present a clear picture detailing the need or lack of dietary supplements one must first understand some facts pertaining to vitamins. The body needs only a tiny amount of vitamins for normal functioning. And consumers need to know that just because a supplement is labeled “natural” does not mean it is safe.
For instance, many people take garlic supplements, usually in pill form, as a natural remedy to reduce cholesterol levels. Sounds pretty harmless, doesn’t it? However, garlic has a blood thinning affect and if someone is already on prescription blood thinners, such as warfarin (Coumadin) and/or over-the-counter aspirin, the combination could pose serious health risks, such as excessive bleeding in the event of a minor surgery or injury. And the worst outcome from this combination of blood thinners is death (Weil, A. 1990).
Vitamins are classified as fat-soluble or water-soluble. Fat-soluble vitamins are stored in the body and over time can lead to toxicity. In this situation more is not better and clearly goes against the common attitude that if a little is good, a lot must be better. Vitamin toxicity can produce effects just as unpleasant as too little. Most individuals do not need vitamin supplements if they are able to eat a balanced diet that contains all the ingredients necessary to maintain homeostasis. Nevertheless, taking vitamins and minerals to supplement the diet may be desirable to many. There is some merit to this practice, especially as we age or become chronically ill. The process of digestion, absorption, and assimilation become less efficient as we age or become affected by disease (Rolfes S. 2009).
Water-soluble vitamins, unlike fat-soluble vitamins, do not build up and are easily excreted from the body via urine. A good example of this is water-soluble vitamin C which can help the adrenals during periods of high stress. Vitamin C can be consumed in large amounts orally or intravenously with little ill affect on the body. However, vitamin C toxicity can still occur depending on the route of administration and the tolerance of the patient. Large amounts of this vitamin consumed orally can lead to gastrointestinal symptoms especially diarrhea. Whereas, toxic levels of Vitamin C given intravenously can lead to kidney stones and other more concerning complications.
Other serious health risks can occur when a consumer gathers knowledge about dietary supplements from local health food clerks that typically have no medical training. Dr. Weil states that “MANY HEALTH FOOD STORES might better be called pill stores, given how little food they stock in relation to all the vitamins and supplements. Claims made for these products are extravagant. If they were all true, we could forget about proper diet, exercise, relaxation, and all other preventive strategies and just take pills.” Ironically, informed clerks might know more about dietary products than many physicians since most medical training brushes over dietary supplements and other natural therapies. And at best most medical students have only taken one course in nutrition. It is also possible that physicians, like patients, are influenced by the media. One solution is to educate traditionally trained physicians in integrative medicine---where they learn the benefits and risks of dietary supplements, other nontraditional treatments, and learn to focus on prevention rather than disease-oriented medicine. Dr. Andrew Weil was a pioneer in this type of approach and founded the Program of Integrative Medicine at the University of Arizona in Tucson.
I was fortunate to be able to take part in the start of the “Program” as his student-researcher and learned more than I could have imagined while the first group of “allopathically-trained” physicians completed their two-year fellowship program focused on integrative medicine. There were two situations that occurred regarding dietary supplements that unfortunately became the norm. The first was shocking. All patients were asked to bring in a list of their medications and dietary supplements as well as all the bottles. The number of dietary supplement bottles was overwhelming. It was common practice for Dr. Weil and/or one of the fellows to decrease not increase the variety of supplements patients were taking. Also, many cancer patients would come to Dr. Weil to ask about what vitamins or other supplements they should take before, during and after various cancer treatments. The majority of cancer patients were told not to take vitamins and other supplements before or during treatment in fear that the cancer cells would thrive in such a healthy environment and the chemotherapy would not be as effective at killing those cells. However, once the patient was in remission Dr. Weil and the fellows were then able to make recommendations to gain strength back and turn the focus to prevention where dietary supplements played a pivotal role.
The use of supplements was questioned when it came to quality as well.
According to the U.S. Department of Health and Human Services/Food and Drug Administration (http://www.fda.gov/Food/DietarySupplements/default.htm), marketing companies have the obligation to “ensure” that the dietary supplements they sell are safe. However, they are not required to disclose any information pertaining to safety (or lack of) on their labels or otherwise, nor are they required to suggest serving size/dosage that the consumers should follow. Although the public could use research to evaluate a product before purchasing, since the manufacturer is not required to disclose risk factors or side effects, a lot of the reports come from prior consumers that have experimented with the product. So, if in fact serious side effects exist, people would first have to incur them in order to be reportable. Clearly, supplements affect people differently which can lead to varying benefits as well as side-effects.
From my own experience and the data I have reviewed regarding this debate I realize that individuals taking dietary supplements should be informed consumers. Dietetics professionals can be an excellent resource to consumers as they “with their comprehensive training in biological sciences, diet, and behavior, are uniquely positioned to lead in this expanding area of health care.” Furthermore, the American Dietetic Association (ADA) reports that “dietetics professionals have the responsibility to serve as the resource for consumers making decisions regarding dietary supplementation.” The final decision comes to the consumer. Consumers need to research all dietary supplements they want to use, just like you would if you were buying a used car. Only in this case the stakes are higher because the supplements will be flushed through your body. And remember just because the dietary supplement is labeled “natural” does not mean it is safe for consumption.
DIETARY SUPPLEMENT REFERENCES
Lichtenstein A, Russell, R. Essential Nutrients: Food or Supplements? Where should the Emphasis Be? 2005; 294: 351-358.
Martini F. Fundamentals of Anatomy & Physiology. U.S.A. Benjamin Cummings; 2004.
Rolfes S, Pinra K, Whitney E. Nutrition: Understanding Normal and Clinical Nutrition. California: Wadsworth; 2009.
Thomson C. Practice paper of the American Dietetic Association: Dietary Supplements. Journal of the American Dietetic Association. 2005; 105: 460-470.
U.S. Department of Health and Human Services/Food and Drug Administration. Available at: http://www.Fda.Gov/Food/DietarySupplements/default.htm. Accessed October 25, 2009.
Weil, Andrew. M.D. Natural Health, Natural Medicine: A Comprehensive Manual for Wellness and Self-Care. Boston: Houghton Mifflin; 1990.