An essential question that’s frequently being asked these days is whether conventional, balanced and without supplements diet can cover all the needs of the human body for a healthy lifestyle until old age. Nutritionists and health professionals argued for years that people can get the most important food requirements that their body needs each day from a conventional, balanced and regular daily diet. Today’s dietary guidelines from health and nutrition agencies cover more than 40 nutrients that are subdivided into 6 categories:
carbohydrates, fats, proteins, vitamins, minerals and water.
A balanced diet is a variety of foods from the different food groups (vegetables, legumes, fruits, grains, protein foods, meat, and dairy). Variety involves eating different foods from all the food groups that helps to ensure that you receive all the nutrients necessary for a healthy diet, with that being said, do we need dietary supplements to sustain a state of well-being ?..well, let’s start by defining dietary supplements…
What Are Dietary Supplements?
Dietary supplement can be defined as any vitamin, mineral, added chemical substance, herbal product, botanicals, amino acids, or other ingestible preparation that is added to the diet to benefit human health. Dietary supplements are used worldwide and represent a broad category of ingestible products that are distinguishable from conventional foods and drugs. All developed countries have special legislation concerning dietary supplement (for example, U.S. Dietary Supplement Health and Education Act, 1994). In countries, such as Australia and Canada, dietary supplements and drugs are regulated similarly, and only ingredients deemed acceptable by the Therapeutic Goods Administration of Australia or the Natural Health Products Directorate of Canada can be sold as dietary supplements.
History of Dietary Supplements:
Way before having packaged supplements and vitamins within arm’s reach, the ancient human civilization’s diet was mostly plant foods that could be easily gathered and seafoods. Hunting later contributed meat products and that was the diet for most humans until about 10,000 BC, at which time the development of agriculture and animal husbandry provided more meat and grains for the whole family. Nobody knew about vitamins, minerals, proteins, carbohydrates and fats and their role in human nutrition and healthy living. The various people in the continents of the Earth developed nutritious local cuisines with mostly local products that sustained their health, whereas by trial and error choose a variety of foods and cooking methods that lead to physical strength, and health. The common wisdom of native cultures knew which foods and herbs had special properties for energy, nutrition and extra health benefits for pediatrics, pregnant women and geriatrics. Everyday diets make up for deficiencies as far back as native cultures. Native Americans, for example, knew to drink a tea made from pine bark and needles, containing high concentration of ascorbic acid, for treating/preventing scurvy, which was later found by science to be a vitamin C deficiency disease. In 1749, Dr. James Lind discovered citrus fruits prevented scurvy (thanks to the high vitamin C content).
Ancient Egyptians were the first to handle botanicals and this was documented in Eber’s Papyrus (is an Egyptian medical papyrus of herbal knowledge dating to circa 1550 BC. Among the oldest and most important medical papyri of ancient Egypt, it was purchased at Luxor (Thebes) in the winter of 1873–74 by Georg Ebers.), where many botanicals were documented for example; Thyme, Poppy, Aloes, Caraway, Peppermint, Henna, and Castor seeds which were used in assassination on account of the toxic Alkaloid “Ricin” that they contain.
The discovery of the role of vitamins was a milestone in the medical world and its association with heath, nutrition and disease.
By the 1920s and 1930s, significant strides were being made in the world of vitamin research and mass marketing (synthesized vitamin C in 1935 and marketed as vitamin C supplement under the name Redoxon). In the nearly 75 years since the vitamin C pill was marketed, major steps have been made in the vitamin and other dietary supplement products.
Increased public interest was stimulated as a result of claims (proved to be false later) made in the USA by Nobel-laureate Linus Pauling in the 1970s, that “megadoses’of at least 10 times the RDA (Recommended Dietary Allowances) of ascorbic acid could prevent or cure the common cold, flu, and cancer.In 1976, Pauling and Dr. E. Cameron contacted experiments and reported that a majority of 100 “terminal” cancer patients treated with 10,000 mg of vitamin C daily survived three to four times longer than similar patients who did not receive vitamin C supplements.
Nevertheless, to test whether those claims were correct, the Mayo Clinic conducted three double-blind studies involving a total of 367 patients with advanced cancer. The studies, reported in 1979, 1983, and 1985, found that patients given 10,000 mg of vitamin C daily did no better than those given a placebo.In fact, recent laboratory studies have found that vitamin C may interfere with the effectiveness of five anti-cancer drugs.
What are the Top 10 Benefits of Dietary Supplements?
Normally, you should be able to get all the nutrients you need from a balanced diet.
However, taking supplements can provide additional nutrients when your diet is lacking or when certain health conditions cause you to develop an insufficiency or deficiency.
1) In most cases, multiple-vitamin supplements provide all the basic micronutrients (vitamins and minerals) your body needs. These multiple vitamins are generally safe because they contain only small amounts of each nutrient.
Individual nutrients can also be sold as dietary supplements, but usually in larger amounts than what’s found in a typical multiple-vitamin. They may be used to treat a deficiencies caused by illness, pregnancy, poor nutrition, digestive disorders, and many other conditions, such as Iron deficiency.
2) They’re used therapeutically to treat specific health conditions or risk factors. For example, large doses of niacin may be used to raise good cholesterol, and folic acid has been used to reduce the risk of a birth defect called spina bifidia (is a birth defect where there is incomplete closing of the backbone and membranes around the spinal cord).
3) Omega 3 fatty acids: For many years, scientists were puzzled by the fact that heart disease among Greenland Eskimos was extremely rare despite their consumption of a high fat, high-cholesterol diet. Research revealed that the Eskimos were protected by diets largely based on seals, whales, and fish, all of which provide high intakes of omega-3 polyunsaturated fatty acids, especially EPA and DHA.
(Bang & Dyerberg, 1973) epidemiological studies in many countries, including the United States, demonstrated that even people who eat moderate amounts of fish get some degree of protection against heart disease. In the Physicians Health Study, researchers identified 94 men “in whom sudden death was the first manifestation of cardiovascular disease.”
These men were matched with 184 controls, and blood levels of long chain omega-3 fatty acids (also called n-3 fatty acids) were assessed. Men with low blood levels of omega-3 fatty acids were three to five times more likely to suffer sudden death from heart disease than men with higher blood levels of omega-3 fatty acids. The researchers suggest that omega-3 fatty acids may protect against death from heart disease by decreasing the heart’s tendency to arrhythmia.
(Albert, Campos, et al., 2002) People with higher levels of omega-3 fatty acids in their red blood cell membranes (five percent compared to three percent) had a 70 percent lower risk of cardiac arrest. The researchers suggested that an increase in membrane levels of omega-3 fatty acids in some way lowers the subjects’ vulnerability to arrhythmia or ventricular fibrillation. (Siscovick, Raghunathan, et al., 1995)
4) Calcium and Vitamin D for bones: There is no question that a generous intake of calcium plus vitamin D will help build optimum bone mass during childhood and adolescence and will also slow the rate of bone loss that naturally occurs with aging. These combined effects help protect against the development of osteoporosis, a disease caused by failure to build adequate bone mass or by progressive bone loss during aging. Most people do not get enough calcium or vitamin D from diet alone, and in many individuals osteoporosis is only recognized when a fracture occurs. Substantial research has shown supplements to be effective in maintaining or increasing bone density.
According to the non-profit National Osteoporosis Foundation (NOF), about 10 million Americans already have osteoporosis, and another 34 million have low bone mass that puts them at risk for osteoporosis. (National Osteoporosis Foundation, 2012) Every year, there are more than two million fractures due to osteoporosis. The cost of treating these fractures in 2005 was $19 billion, which amounts to $52 million a day. The NOF notes that “many Americans do not get the amount of calcium they need every day.” (National Osteoporosis Foundation, 2012) NOF’s recommended solution for this problem is for people to modify their dietary habits to increase consumption of dairy products and other foods providing calcium, but it is recognized that “calcium-fortified foods and calcium supplements are helpful for people who are unable to get enough calcium in their diets.”
Vitamin D is also critical, and it is hard to get enough vitamin D from foods alone. The skin makes vitamin D in response to sunlight, but concerns about skin cancer have led many people to stay out of the sun, cover up, or use sunscreen or sunblock, thus dramatically limiting vitamin D production. Therefore, NOF recommends that “people who do not get enough vitamin D should consider taking a supplement.” (National Osteoporosis Foundation, 2012)
5) B vitamins and cardiovascular disease: An abundance of research suggests a relationship between blood homocysteine levels and heart disease risk, as convincingly summarized in a 1995 metaanalysis of 28 studies. (Boushey, Beresford, et al., 1995) Homocysteine is produced in the body as a byproduct of the one-carbon cycle, which generates methyl groups for the synthesis of innumerable compounds essential to life and health, including DNA itself.
Homocysteine normally gets recycled and does not accumulate to a large extent. The nutrients directly involved as cofactors that keep the one-carbon cycle operating efficiently include several of the B vitamins, notably folate, vitamin B-6 and vitamin B-12. When these B vitamins (and some other compounds) are present in adequate amounts, homocysteine is kept at a relatively low level in the body. A number of observational studies found that populations with low homocysteine levels had a lower incidence of heart disease than populations with higher levels of homocysteine. It was clearly demonstrated that giving extra amounts of the B vitamins lowered homocysteine levels, and so it seemed likely that such supplementation would reduce the risk of cardiovascular disease in the population as a whole.
However, a recent trial illustrates the importance of distinguishing between effects of B vitamins in people depending on their baseline level of Homocysteine.
6) Vitamins and Diabetes Mellitus type 2: type 2 diabetes mellitus is an oxidative stress disease; vitamin B12 and folic acid deficiencies in diabetic subjects have been found associated to oxidative stress, in relation to a resulting hyperhomocysteinemia. As a result of this association, it is conceivable that vitamin B12 deficiency should be considered a risk factor for diabetic complications. One of the most frequent complications related to type 2 diabetes mellitus is peripheral neuropathy, and its development has been associated to hyper-homocysteinemia, which is more frequently found in patients with diabetes.
Retinal edema and increased light sensitivity in diabetic retinopathy have been found to improve with the supplementation of pyridoxine, folate and B12 combined supplementation also in association with hyper-homocysteinemia.
7) Vitamin E and Heart disease: Vitamin E is the primary fat-soluble antioxidant in the body, and has been shown to protect lipids from per-oxidation. This is particularly relevant to heart disease risk, since it is believed that the initiating factor that ultimately leads to atherosclerosis is the oxidation of LDL cholesterol and its incorporation into foam cells or fatty streaks deposited inside blood vessels. Two studies published in 1993 created widespread excitement about the possibility that vitamin E supplementation could dramatically reduce the risk of heart disease.
One was based on data from the Nurses’ Health Study, involving more than 87,000 women. Dr. Meir Stampfer and colleagues at Harvard Medical School and the Harvard School of Public Health reported a 41 percent reduction in risk of heart disease among nurses who had taken vitamin E for more than two years. The average vitamin E intake in the lowest risk group was 200 IU.
The researchers noted that a beneficial effect of vitamin E on heart disease “is plausible because of the substantial evidence indicating the importance of oxidation of LDL in atherosclerosis.” (Stampfer, Hennekens, et al., 1993)
8) Antioxidants and cancer: Numerous epidemiologic studies had shown that people with higher intakes of antioxidant nutrients had a lower risk of many different types of cancer, and beta-carotene appeared to be especially promising. For example, Dr. Peter Greenwald of the National Cancer Institute observed that “about 20 studies in various parts of the world suggest an inverse association between eating foods containing vitamin A or beta-carotene and various types of human cancer; risk is thereby reduced 30-50 percent,” and by 1986, the National Cancer Institute was already sponsoring 21 clinical trials. (Greenwald, Sondik, et al., 1986) Most involved vitamin A and/or beta-carotene, but some also involved vitamin E, vitamin C, folic acid, or other nutrients.
Several intervention trials were undertaken in China, where nutritional status was relatively low. The Linxian study involved almost 30,000 adults who were given an antioxidant supplement including 50 mcg selenium, 30 mg vitamin E, and 15 mg beta-carotene, from 1985 to 1991. The treatment led to decreased risk of cancer. (Blot, Li, et al., 1993) A recent report of a 10-year follow-up of the Linxian study found that people who had received the antioxidant supplement had lower gastric cancer mortality and lower total mortality in the 10 years following discontinuation of the supplement. (Qiao, Dawsey, et al., 2009)
9) Supporting Healthy Aging: The elderly are at risk for nutrient inadequacy, and that inadequacy can have a specific negative impact on many aspects of their health. Antioxidant supplements have been shown to have a positive impact on eye diseases, lung function, skin, and cognitive dysfunction. Adequate nutritional status also affects the condition of the skin and supports muscle function. Calcium and vitamin D supplements can have a powerful impact on bone health, and it is never too late to benefit from improved intakes of these nutrients. Vitamin D can also reduce the risk of falls in older people. Vitamin and mineral supplements have been shown in some studies to improve immune function in the elderly. Low zinc intakes are associated with an increase risk of infections, including pneumonia. Generous intakes of some individual nutrients such as vitamin E have had a positive effect in decreasing upper respiratory infections.
Some experts believe it makes sense to encourage the elderly to use multivitamin and mineral supplements. Some have also advocated providing a multivitamin and mineral product to the elderly in nursing homes, as a matter of policy, to avoid risking the consequences of inadequate intakes.
10) Supporting healthy pregnancy and children: Nutrient needs are increased during pregnancy and lactation, and a prenatal multivitamin with minerals is commonly prescribed to ensure that needs are met.
The recommended intakes for many essential vitamins and minerals increase during pregnancy, and “health care providers generally recommend that pregnant women consume a standard prenatal multivitamin and multi-mineral supplement as insurance against inadequate micronutrient intake.” (Picciano & McGuire, 2009) Because of the evidence that a multivitamin with folic acid taken for a few months before and after conception can reduce the incidence of neural tube birth defects such as spina bifida, such supplementation is recommended for women of childbearing age by the Centers for Disease Control and Prevention (CDC), the American Academy of
Pediatrics, the Institute of Medicine, and the National Healthy Mothers, Healthy Babies Coalition. Because of the known need for additional iron during pregnancy, the World Health Organization and the CDC recommend daily iron supplementation. In addition, the American Thyroid Association recommends that pregnant women get 150 mcg per day of supplemental iodine. (Picciano & McGuire, 2009).
What are the Challenges/Risks of Dietary Supplements?
Globally, the nutrition and supplements market stood at over US$90 billion and in 2013 it was estimated at approximately US$104 billion. The U.S.A market of dietary supplements was estimated in 2015 at US$27.2 billion. Growth is expected to remain strong through the next years with expected increase between 5-6% per year. For comparison global sales of pharmaceuticals have reached a milestone of $1 trillion in 2014, and that’s owing to the exaggerated claims from popular books, consumers and sport magazines, popular newspapers and TV advertisements in developed countries, while the majority of those claims aren’t actually supported by scientific research or evidence.
The mainstream scientific community gradually became intrigued by the potential health benefits of dietary supplements and numerous research projects were initiated in the 1980s. This interest was fueled in part by studies demonstrating that nutrient antioxidants, (vitamins C and A, E and b-carotene, Selenium), have a role in protecting cells from oxidative free radical damage.
Furthermore, epidemiological studies suggested that a diet rich in fruits and vegetables and abundant in antioxidants, nutrients, and other substances, reduced the risk of coronary heart disease and certain types of cancers. These initial promising results were not materialized by the more accurate and larger randomized controlled trials taking into account confounding factors.
Dietary supplements are products intended to supplement the diet. They are not drugs and, therefore, are not intended to treat, diagnose, prevent, or cure diseases. The FDA is the federal agency that oversees both dietary supplements and medicines.
In general, the FDA regulations for dietary supplements are different from those for prescription or over-the-counter drugs. Unlike drugs, which must be approved by the FDA before they can be marketed, dietary supplements do not require pre-market review or approval by the FDA. While the supplement company is responsible for having evidence that their products are safe and the label claims are truthful and not misleading, they do not have to provide that evidence to the FDA before the product is marketed.
Basically, escaping strict medicines regulations, accordingly, there would be patch to patch variations in quality (un-guaranteed reproductability) due to differences in climate conditions, storage, etc. Besides, the unrealistic/exaggerated claims of “curing diseases” and attempts of self-medication, especially for critical illnesses would delay the proper medication and could potentially cause more complications, the lack of documentation for herb-drug interactions (like Aspirin + Ginkgo Biloba) as well as side effects, as rarely does the patient report his/her side effects to a physician. There’s also the risk of getting a counterfeited/adulterated herbal products, for example:
1) addition of synthetic drugs, which is called “false labeling” (what you see is not always what you get), like,
a) adding corticosteroids for herbal products for arthritis and for skin inflammations.
b) Adding Phenyl Butazone and Indomethacine in products for Arthritis.
c) Valium in products for insomnia.
d) Ephedrine as a general tonic in Gensing preparation (gas me up).
2) Addition of heavy metals like Arsenic, Lead and, Mercury.
3) Addition of toxic elements like Aristolochic Acid (carcinogenic), Phorbol esters (tumor promoting) and Kava Kava (Kava pyrones which are hepatotoxic)…
It’s also worth-mentioning, the risk of contamination of the herbal raw material being used for the dietary preparation, contaminants as:
1) Unwanted Plant Material.
2) Toxic material as Pb due to car exhaust, Cd, Hg, and Arsenic.
5) Pesticides as DDT, Organophospherous cpds, Chlorinated HC, Triazines.
6) Fumigents as Methyl Bromide, Phosphine.
And last but not least, the nature of the Herbal raw material used in the preparation of those dietary supplements, they are complex in nature and contain up to 100 different components that wouldn’t be mentioned on the label of the supplement and the consumer might have an allergic reaction to any of the many unlisted components used.
With that being said, how does one ensure the quality of the dietary supplement that they’re purchasing?
Dietary supplements are complex products. The FDA has established good manufacturing practices (GMPs) for dietary supplements to help ensure their identity, purity, strength, and composition. These GMPs are designed to prevent the inclusion of the wrong ingredient, the addition of too much or too little of an ingredient, the possibility of contamination, and the improper packaging and labeling of a product. The FDA periodically inspects facilities that manufacture dietary supplements.
In addition, several independent organizations offer quality testing and allow products that pass these tests to display their seals of approval. These seals of approval provide assurance that the product was properly manufactured, contains the ingredients listed on the label, and does not contain harmful levels of contaminants. These seals of approval do not guarantee that a product is safe or effective. Organizations that offer this quality testing include:
- U.S. Pharmacopeia
- NSF International
What to keep in mind when taking dietary supplements?
- Some ingredients found in dietary supplements are added to a growing number of foods, including breakfast cereals and beverages. As a result, you may be getting more of these active ingredients than you think, and more doesn’t always mean better. Taking more than you need is always more expensive and can also raise your risk of experiencing side effects and symptoms and signs of toxicity will start to show. For example, getting too much vitamin A can cause headaches and liver damage, reduce bone strength, and cause birth defects. Excess iron causes nausea and vomiting and may damage the liver and other organs.
- Many multivitamin products also contain minerals such as calcium, iron, magnesium, potassium, and zinc. Minerals (especially taken in large doses) can cause side effects such as tooth staining, increased urination, stomach bleeding, uneven heart rate, confusion, and muscle weakness or limp feeling, so never take higher than the dose prescribed or written on the label.
- Be cautious about taking dietary supplements if you are pregnant or nursing. Also, be careful about giving them (beyond a basic multivitamin/mineral product) to a child. Most dietary supplements have not been well tested for safety in pregnant women, nursing mothers, or children.
- If you suspect that you have had a serious reaction from a dietary supplement, let your health care provider know. He or she may report your experience to the FDA.
- Never take supplements in place of, or in combination with, prescribed medications without the health care provider approval.
- Always tell your health care provider about all the supplements taken before any scheduled surgery.
- The term ”Natural” doesn’t always mean safe. A supplements safety depends on many things, such as its chemical makeup, how it works in the body, how it’s prepared, and the dose used. Certain herbs such as Kava can harm the liver.
Finally, Before taking a dietary supplement, ask yourself these questions:
- What are the potential health benefits of this dietary supplement product?
- What are its potential benefits for me?
- Does this product have any safety risks?
- What is the proper dose to take?
- How, when, and for how long should I take it?
- If you can’t find answers then communicate with your doctor or pharmacist for proper consultation about the best options for your case.