The bottles are lined up on the shelf: calcium, vitamin B6, iron, beta-carotene, folic acid, echinacea, melatonin and garlic. Every morning right after breakfast, Veronica has her daily dose of pills. “I don’t take any prescribed medicines,” she says, “but this is my way of staying healthy.”
Veronica is not alone; at least 50 percent of American adults take one or more dietary supplements every day. And while they do it for good health, some evidence shows they may sometimes be putting their health in danger by doing so.
“Dietary” is the operative word. Everyone knows that diet plays a major role in good health. It’s far better to control your cholesterol and blood pressure with fruits, vegetables and whole grains rather than a drug. But for one reason or another, most of us end up falling short of eating the perfect diet, and that’s where supplements come in.
Doctors frequently prescribe supplements such as calcium, vitamin D or iron as part of a treatment plan. And that’s the way they should be used. Based on your medical history and all of the medications you’re taking, your doctor can objectively judge the benefits and risks of a supplement and the proper dose you need.
Self treatment with supplements is another matter. Even doctors go to another doctor for treating a medical problem. As the old saying goes, “the doctor who treats himself has a fool for a patient.”
At the very least, you should tell your doctor about all the supplements you’re taking since they could cause a dangerous interaction with each other or with prescription drugs you’re taking. This information is crucial any time you’re scheduled for a surgical procedure since some supplements increase the risk of bleeding or alter the response to anesthesia.
Regulated as Food
Many Americans do self treat, of course, based on the idea that supplements are “natural” and “only food.” In a way, Congress endorsed that point of view in 1994 with passage of the Dietary Supplement Health and Education Act, stipulating that vitamins, minerals and herbal products are to be regulated as foods and not subject to the rigorous standards for approval required of drugs or food additives. Since that time, the number of supplements on the market has increased seven-fold.
Unfortunately, some of the products placed on the shelves are not as safe as the food you put on your plate–at least in the form produced and in the quantities you might consume. Ephedra or ma huang, a popular product for weight loss and for enhancing sports performance, resulted in the death of a major league baseball player in 2003. Articles showing the potential health risks of ephedra and possible interactions with other drugs later prompted a ban of supplements containing the substance.
Other substances such as chaparral, colloidal silver, coltsfoot, comfrey, germanium, kava, lobelia and yohimbe have been linked to serious health concerns and should be taken with medical advice and proper caution.
There have also been reports of product labels that misrepresented ingredients and of some products that contained chemicals, steroids or prescription drugs such as Viagra not listed on the label. While the FDA has ramped up its efforts to monitor such practices, the consumer buying a supplement still does not have the same assurance of quality and purity that comes with a prescription drug.
The manufacturer, for example, does not have to prove that a product is safe before placing it on the market. If the product is found to be unsafe or if the marketing claims prove to be false, the product can be taken off the market; in the meantime, though, let the buyer beware. That, of course, is not the case with prescription drugs.
Even well known vitamins, minerals and nutrients might not be as beneficial or safe in supplements as they are in foods. A study undertaken to determine possible anti-cancer effects of selenium and vitamin E recently found that men taking 400 IU daily of vitamin E had a significantly increased risk of prostate cancer [Journal of the American Medical Association, October 12, 2011].
The finding was surprising and scientists have no explanation for the increased risk. Vitamin E is an antioxidant that is believed to be beneficial for cardiovascular health and have anti-cancer effects. Although the dose (400 IU) is much higher than that found in food, even higher doses are commonly used by many Americans.
As the authors pointed out, none of the claims for vitamin E have been supported by randomized, controlled studies, and there “is good reason to avoid the dose of vitamin E...that was used in the study.”
Previously, randomized studies of vitamin E and beta-carotene found no clear health benefits and an increased risk of lung cancer among smokers taking beta-carotene. Vitamin E has also been linked to an increased risk of hemorrhagic stroke.
Selenium is a trace mineral essential for proper function of the brain and immune system. The recommended daily allowance is 55 micrograms daily for adults age 19 and over, 60 micrograms for pregnant women and 70 micrograms for women who are breast feeding.
The soil through most of the United States is rich in selenium, however, and selenium can be obtained from meat, corn, wheat and other grains. A recent research review [The Lancet, February 28, 2012] concluded that most Americans get enough selenium through diet alone. A few previous studies suggested that persons who get additional selenium through supplements are at increased risk of type 2 diabetes, although this effect has not been proven.
Finally, results from the Iowa Women’s Health Study found several widely used supplements associated with an increased risk of death. Among women aged 55 to 69 years, those taking vitamin B6, folic acid, iron, copper, zinc and even multivitamins were more likely than other subjects to have died over a 22-year period. The risk was dose dependent.
This study was observational and did not prove cause and effect. Women who took supplements may have taken the supplements because of medical conditions or nutritional deficiencies.
We live in a country where good food is abundant and only a very small minority have nutritional deficits, mostly due to chronic medical conditions or age. These deficits should be treated by a physician. Others wishing to maintain good health should continue to focus on diet but use dietary supplements with caution.
REFERENCES:
Mark J. Bolland, et al, “Calcium supplements with or without vitamin D and risk of cardiovascular events,” British Medical Journal, May, 2011.
Agnes L.F. Chan, Ph.D., MAMM, BscPharm, et al, “Multavitamin supplement use and risk of breast cancer,” The Annals of Pharmacotherapy, 2011;45(4):476-484.
Jennifer Corbett Cooren, “Supplements offer risks, little benefit, study says,” The Wall Street Journal, October 11, 2011.
Brenda Goodman, M.A., “Selenium supplements may increase risk for type 2 diabetes,” WebMD Health News, February 28, 2012.
Emma Hitt, “Vitamin supplements associated with increased risk for death,” Medscape Medical News, October 10, 2011 (Archives of Internal Medicine, 2011;171:1625-1633).
Shereen Jegtvig, “Benefits and risks of taking dietary supplements,” About.com Nutrition, updated February 12, 2012.
JoAnn E. Manson, M.D., DrPH, “Dietary supplements and mortality rates in women: a cautionary tale,” Medscape Ob/Gyn, November 15, 2011.
Jennifer Nelson, M.S., R.D., and Katherine Zeratsky, R.D., “Nutrition-wise blog,” MayoClinic.com, August 12, 2010.
Roxanne Nelson, “Vitamin E supplements may raise the risk for prostate cancer,” Medscape Medical News, October 11, 2011 (JAMA, 2011;306:1549-1556).
NIH Office of Dietary Supplements: “Dietary supplements: what you need to know,” reviewed June 17, 2011.
Jessie A. Satia, et al, “Long-term use of beta-carotene, retinol, lycopene, and lutein supplements and lung cancer risk: results from the VITamins and lifestyle (VITAL) study,” American Journal of Epidemiology, 2009;169(7):815-828.
David A. Taylor, “Botanical supplements: weeding out the health risks,” Environmental Health Perspective, 2004;112(13).
06/27/2012
For more information, sample newsletters or to get on our mailing list contact:
Community Relations
West River Regional Medical Center
1000 Highway 12
Hettinger, ND 58639-753