Dietary supplements – including vitamins, minerals, herbs, energy drinks – are one of the world’s fastest-growing industries. According to Forbes magazine, the global market in 2012 was worth more than $32 billion. By 2021, that figure is expected to reach at least $60 billion.

What constitutes a “supplement”?

The definition according to the FDA is – any tablet, capsule, powder or liquid taken by mouth that contains a dietary ingredient.

Supplements include:

Vitamins
Minerals
Herbs
Spices (such as cayenne or turmeric)
Amino Acids
Organ tissue (such as dried liver)
Some hormones (such as melatonin)
Extracts
Protein powders
“Energy” or “sports” drinks

These products may comprise a single ingredient (such as Vitamin C), a complex (such as B vitamins), or combinations of ingredients (such as multi-vitamin and mineral capsules) or “synergistic” formulations, where nutrients are combined to increase absorbency within the body.

Why take supplements?

Few people consume the optimal amounts of all the vitamins and minerals by diet alone. Inadequate intakes have been linked to chronic diseases such as heart disease, some cancers, and osteoporosis. For this reason, some physicians recommend that all adults take vitamin-mineral supplements. Such regular supplementation would provide an optimum intake to enhance metabolic harmony and prevent disease at relatively little cost. Others recognize the lack of conclusive evidence and the potential harm of supplementation and advise against such a recommendation. The most recent statement from the National Institutes of Health acknowledges that evidence is insufficient to recommend either for or against the use of supplements to prevent chronic diseases.

Food Sources Have Become Less Nutritious – An Orange Ain’t What It Used To Be

Modern intensive agricultural methods have stripped increasing amounts of nutrients from the soil in which the food we eat grows.

A landmark study on the topic by Donald Davis and his team of researchers from the University of Texas (UT) at Austin’s Department of Chemistry and Biochemistry was published in December 2004 in the Journal of the American College of Nutrition. They studied U.S. Department of Agriculture nutritional data from both 1950 and 1999 for 43 different vegetables and fruits, finding “reliable declines” in the amount of protein, calcium, phosphorus, iron, riboflavin (vitamin B2) and vitamin C over the past half century.

The Organic Consumers Association cites several other studies with similar findings: A Kushi Institute analysis of nutrient data from 1975 to 1997 found that average calcium levels in 12 fresh vegetables dropped 27 percent; iron levels 37 percent; vitamin A levels 21 percent, and vitamin C levels 30 percent.

A similar study of British nutrient data from 1930 to 1980, published in the British Food Journal, found that in 20 vegetables the average calcium content had declined 19 percent; iron 22 percent; and potassium 14 percent. Yet another study concluded that we would need to eat eight oranges today to derive the same amount of Vitamin A as our grandparents would have derived from one.

Additionally, handling of foods can also lead to nutrient loss.

Although less ruthless than commercial processing methods which remove significant amounts of vitamins, minerals and fibre, home handling and cooking also means loss of nutrients in fruits and vegetables. For example, leafy vegetables will lose up to 87 % of their vitamin C content upon cooking, while carrots, potatoes, and other root vegetables will lose up to 33 % of vitamin B1, 45 % of B2, 61 % of B3, and 76 % of vitamin C.

An alternative to drugs – free from side-effects

While the jury is uncertain about prevention of chronic disease, there is much evidence to suggest that supplements can be used to successfully treat and heal certain conditions. Many independent studies have shown successful results. In my own practice, many of my clients have been healed of lifelong ailments, avoided surgery and been able to discontinue expensive and often less-than-effective drug treatments, with the use of a variety of supplements. These include vitamins, minerals, amino acids, herbs, etc – all without side-effects.

Many people take supplements to avoid the side effects of conventional drugs, with the aim of helping the body to heal, rather than just masking the symptoms. (Of course, it’s important to mention here that some natural substances can also cause serious side effects, and interactions with other drugs, if not carefully administered.) Especially where digestive disorders are concerned, many natural treatments succeed, where mainstream pharmaceuticals fail.

These people take supplements to treat a specific disorder, and many will discontinue the use of supplements when their condition has healed. Some will continue to take “maintenance” doses of various nutrients.

There are many other reasons for taking supplements.

Inadequate Diet

Some people take dietary additives for non-medical reasons.

For example, they might consider their diet is at times inadequate – too much fast food or dieting, excessive exercising, insufficient fruits and veggies.

In this instance, taking supplements can be a replacement for nutritious eating. A balanced, nutrient-rich diet is always a better choice.

Today, 80% of women and children do not meet the daily RDI (recommended daily intake) for vitamin E and zinc.
And 80% of American women do not meet the RDI for magnesium.

A study of high school runners found that 45% of girls and 17% of boys were deficient in iron, while 31% of female college athletes were also found to be iron deficient.
A study of nutritional status in elderly Americans found that 25% were malnourished, and 50% of all hospitalised elderly suffer from malnutrition.

Disorders, Diseases, Deficiencies

In other cases, specific supplements can be beneficial for people with specific nutritional needs or deficiencies.
Certain metabolic disorders and diseases of the digestive organs (intestines, gallbladder, liver, pancreas) interfere with the normal digestion of food and absorption of nutrients. Certain medications can have the same effect.

People being treated for addictions to alcohol or other drugs may have nutrient deficiencies and other health issues which can benefit from supplementation.
People whose calorie intakes are particularly lower (fewer than 1600 calories per day) may need multi-vitamin/mineral support.

In all these cases, supplements can provide much-needed support to the body.

People who suffer from certain chronic diseases, or who are recovering from injury, illness or surgery, may also benefit from additional nutrients.

Inadequate Dairy Intake

People who have lactose intolerance or milk allergies or who otherwise do not consume enough milk products to forestall extensive bone loss may need calcium.

People who have inadequate intakes of milk or milk products, limited sun exposure, or heavily pigmented skin may need vitamin D.

Ageing

Older people may experience a decrease in appetite, and a declining sense of taste and smell. Cooking for one and eating alone is often not conducive to eating well. Dental problems might also affect enjoyment of eating. In these cases, supplements can often be beneficial for the elderly.

Supplements for Women

Supplements can be especially beneficial for women, at various stages of reproductive life.

Child-bearing years – Menstruating women rarely meet their daily iron requirements through diet alone (2000 calories per day). This is even more so if these women are on calorie-restricted weight-loss diets.

Pregnancy & Lactation – Before and during pregnancy, folic acid supplementation is known to decrease risks of giving birth to a baby with neural tube defects. During pregnancy, women often require supplements to supply sufficient nutrients for the growth of fetal and maternal tissue. After childbirth, supplements can assist in ensuring a healthy supply of breast milk.

Pregnant women may also find it difficult to consume sufficient calcium through food sources alone. Again, in this case, supplementation is a beneficial alternative.

(Note – Women should never self-prescribe supplements in these conditions. For example, excessive doses of Vitamin A while pregnant may increase the risk of birth defects. Always consult your doctor first.)

Supplements for Vegans

Vitamin B12 is found only in foods from animal sources – meat, eggs and dairy (milk, cheese, etc).
Some seaweed does contain B12, but research suggests it is derived from microorganisms living within the plant, rather than the plant itself.

Vegans consume no animal-derived products, and although many grain products have been fortified with B12, many vegans prefer to take supplements. Indeed, these are vital for the health of many people who are B12 deficient.

In addition, the stomach condition known as atrophic gastritis often creates a vitamin B12 dficiency.

Supplements as Insurance

Even people who consume a healthy, nutritious diet may choose to take supplements. Some people take supplements as an “insurance policy” – believing that certain nutrients might offer increased protection against ageing or certain illnesses.

There may be some evidence to support this concept.

In 2002, the American Medical Association (AMA), did an about-face on the subject of dietary vitamin supplementation, and recommended their use.

Two Harvard-based researchers, Robert H. Fletcher and Kathleen M. Fairfield, reviewed 26 years worth of scientific studies relating vitamin levels to the risk of chronic illness.

The study was published in the Journal of the American Medical Association. The findings noted that while the incidence of true vitamin-deficiency diseases (such as scurvy and beri-beri) is rare, sub-optimum vitamin levels are a genuine problem.

What does it mean to have “sub-optimum” vitamin levels? Sub-optimal intake of folate and vitamins B6 and B12 may increase your risk of heart disease, colon cancer, breast cancer and birth defects.

Sub-optimal intake of Vitamin D can increase the risk of osteoporosis and rickets.

But, before you reach for your vitamin pills …

There are is little evidence to prove that consuming large doses of certain vitamins will reduce your risk of cancer.

A report published in The Archives of Internal Medicine in 2009 failed to find benefits.
The results of a study of more than 150,000 women reported that taking multi-vitamins everyday had no effect on the risk for breast cancer, colorectal cancer, lung cancer, ovarian cancer, endometrial cancer, heart attack, stroke, blood clots or mortality.

Of course, evidence is not always as reliable as we might like – in fact, quite the opposite. So, unfortunately, none of these findings can be considered absolutely conclusive.

Who should not take supplements?

The following list recognizes that in certain circumstances, these people may need to avoid specific supplements:
• Men and postmenopausal women should not take iron supplements given that excess iron may be harmful and generally more likely so than inadequacies.
• Smokers should not take beta-carotene supplements given that high doses have been associated with increased lung cancer and mortality.
• Postmenopausal women should not take vitamin A supplements given that excess retinol has been associated with increased risk of hip fractures and reduced bone density.
• Surgery patients should seek advice from their surgeon – vitamin E supplements, some herbs and a variety of other supplements can act as blood thinners, and should not be taken during the week before surgery.

Safety – Who Regulates Dietary Supplements?

In the US, the FDA regulates food and drugs. Before a new food or drug is permitted to enter the market, the manufacturer is required to submit proof of its safety.

Drug manufacturers are required to meet a second test – they must prove their product meets its claims – that is, that the drug will cure or relieve the condition for which it is prescribed.

This system is not perfect. There are countless accusations of self-interest, lobbying and false test results within the pharmaceutical industry.

Drug tests are usually carried out on relatively small groups of people over short periods of time.

It is to be expected that, in some circumstances, new drugs will trigger unexpected, potentially dangerous side effects when they are released on the market and consumed by thousands of different people, with different health issues and different body chemistry.

Proof of this can be seen in the number of recalls issued by the FDA over the past decades.

The positive aspect to this situation is that at least the FDA has the ability to require that safety and effectiveness information and warnings be displayed on foods and drugs.

The FDA has no such regulatory power when it comes to dietary supplements.

In 1994, the Congress and Bill Clinton passed the Dietary Supplement Health and Education Act into law.

This limited the FDA’s control over dietary supplements.
Under this law, the FDA does not have the power to:

1. Require premarket tests to prove or guarantee that supplements are safe and effective – that they work “as advertised”.

2. Limit the dosage in any dietary supplement. Supplements can contain above or below the recommended amount.

3. Halt or restrict sales of a dietary supplement – unless evidence shows it has caused injury or illness when used according to the directions on the package.

As a result of these regulations, the FDA has found it virtually impossible to remove products from shelves, even after reports of serious side-effects.

One well-publicised example is that of supplements containing the herb ephedra, once marketed for its reputed ability to increase weight loss and enhance sports performance.

More than 600 reports of illness and at least 100 deaths were linked to the use of supplements containing ephedra.
The controversial herb was banned by professional football and college athletics in the US, and by the Olympics Committee.
However, the FDA was late to take action. It was not until the February 2003 death of Baltimore Orioles pitcher Steve Belcher, who reportedly used ephedra supplements to help control his weight, that the FDA became involved.

The FDA ruled that henceforth every ephedra product must carry strong warnings that the herb can cause potentially lethal heart attacks or strokes.

Soon after, the FDA banned all ephedra products – despite an unsuccessful challenge from an ephedra supplement manufacturer.

More recently, in 2015, a number of health food stores elected to voluntarily remove products containing a herb known as acacia rigidula. Studies indicated that the supplement contained an amphetamine-like stimulant called BMPEA, which has never been well studied in humans.

The FDA, however, claimed the product “does not identify a specific concern at this time”. This was strongly disputed by various experts, including the Council for Responsible Nutrition.

So, when it comes to supplements, it’s important to consult your healthcare professional and conduct your own research.