Monday, September 20, 2010

Safe Supplements

What to know before popping the pills

Darshan Mehta, MD, MPH

Vitamin D, Fish Oil, St. John's Wort -- the options are endless. Dietary supplements are a billion dollar industry in the United States, and the Internet is awash with stories about how supplements can improve your health.

While they can certainly help to boost intake of vitamins and nutrients known to improve health, not all supplements are created equal, says Darshan Mehta, MD, MPH, medical director for the Benson-Henry Institute for Mind Body Medicine at Mass General. Production quality and drug interactions are important to consider before starting a new supplement. Here, Dr. Mehta helps sort the benefits from the risks.

What are dietary supplements?

The term dietary supplement is an umbrella term that includes vitamins, minerals, herbs, botanicals, amino acids, enzymes and animal extracts. The Dietary Supplement Health and Education Act of 1994 changed the way supplements are regulated in United States, aligning them more closely with food rather than pharmaceuticals. Given this designation, the Food and Drug Administration does not regulate the industry as strictly as medications.

"There is no requirement on the supplement manufacturer's part to prove the safety or effectiveness of its product," explains Dr. Mehta. "The FDA must prove the product unsafe."

The FDA does regulate the marketing of dietary supplements. A company cannot make claims that a supplement treats or cures a medical condition. For instance, a manufacturer of fish oil can say it is good for the heart, but it can not say that it treats heart disease.

"The marketers of these products can get very clever, and it can get confusing from a consumer standpoint," says Dr. Mehta. "Therefore, it can be difficult for people to make informed choices."

Talk about supplements

Before starting a new dietary supplement, three questions should be considered:

  • What is the purpose of taking this supplement?
  • Is this supplement effective for the desired purpose?
  • Is this is a good quality product? Consumers should look for the symbols GMP (Good Manufacturing Practices), NSF (National Safety Foundation), or USP (United States Pharmacopeia) on the product labels.

Dr. Mehta also stresses the importance of consulting a physician before starting a new supplement. While they are generally regarded as safe, there are adverse reactions that can occur by combining supplements, using them with medications (prescription or over-the-counter), substituting supplements for medications, or taking too much. Healthcare professionals have resources available to check if there are any potential medication interactions or risks associated with a supplement. 

Some supplements can also cause certain medications to work less effectively in the body, explains Dr. Mehta. For example, St. John's Wort -- a popular supplement for depression symptoms -- metabolizes in the body through the same enzymes that many medications use, which can diminish the effects of the medication.

Despite such risks, in a study published in the Journal of Alternative and Complementary Medicine, Dr. Mehta found that two-thirds of individuals do not disclose their use of dietary supplements to their healthcare providers. He also found that Asian Americans were much less likely to disclose their use than other ethnicities.

"We wondered if physicians were asking their patients about their herbal and dietary supplement use. As physicians we should think of these as pharmacologic agents, and include them when we ask our patients about their medications," says Dr. Mehta. "And as patients, you should never feel afraid to talk to your doctor about wanting to use supplements. Doctors should not be dismissive of the topic."

The bottom-line: Supplements can be helpful, but no supplement is helpful for all people, he explains. Most importantly, they are not substitutes for a healthy diet, exercise and stress reduction.

The National Institutes of Health's Office of Dietary Supplements is a credible source of information regarding the safety and efficacy of dietary supplements.

The Benson-Henry Institute for Mind Body Medicine is a non-profit scientific and educational organization dedicated to research, teaching, and clinical application of mind/body medicine and its integration into all areas of health.

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