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| How
much do you really know about that multivitamin or herbal remedy
you religiously take every day? Did you ask for your doctor’s
approval prior to taking them? |
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| A
dietary supplement is a substance that is intended
to provide nutrients not available in adequate amounts
in a diet. The "dietary ingredients" in supplements
may include: vitamins, minerals, herbs or other botanicals,
amino acids, and substances such as enzymes, organ tissues,
glandulars, and metabolites. (Dietary Supplement Health
and Education Act (DSHEA) of 1994) |
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If you have an inadequate diet you may need to take supplements
to fill in the blanks, provided your physician has approved
them for you. For instance - |
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| • |
Inadequate
diet e.g., Vegetarians often have iron deficiency
due to lower availability of iron from vegetarian foods
they consume. |
| • |
Illness
& subsequent inability to take food orally,
e.g., in the case of post operative surgery, or cancer
therapy. |
| • |
Pregnancy
e.g., prenatal vitamin and mineral supplements may be
required during pregnancy to help in the growth of the
foetus. Women planning to conceive should take adequate
folate prior to becoming pregnant to ensure the good health
of the foetus. |
| • |
Children
may need certain vitamins/ minerals to prevent nutrient
deficiencies that may result in poor growth/ physical
disability. These are administered by paediatricians
at different stages of growth, when and only if deemed
necessary. |
| • |
Menstruation:
Heavy menstrual bleeding can cause anemia in women. During
the premenopausal stage in women there is a greater need
for iron. |
| • |
Mal-digestion
and absorption of nutrients from whole foods
e.g. in celiac sprue patients who may need water soluble
forms of vitamin A,D,E and K as their bodies may not be
able to absorb these vitamins in their natural form. |
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| Rule
# 1. Go with your gut feeling. For instance, if something
sounds too good to be true, it probably is. The following examples
of current supplement product labels are precisely that... Too
good to be true! |
| Do
some of these claims sound familiar... |
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“Totally
safe," "all natural," and "definitely
no side effects." |
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“Quick
and effective”, "cure-all." |
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Can
treat or cure disease. |
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Limited
availability, "no-risk, money-back guarantees," |
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“Fat
Grabber” and “Fat Buster” pills that
are 100% natural. |
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“Too
skinny! take these pills guaranteed to work, or just grab
those “Muscle Enhancer” orange pills, that
help you gain weight and bulk up your muscles. |
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“100%
of your days nutrient needs + herbal appetite suppressant.” |
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| Supplements
can never provide ALL the nutrients that one gets from fresh
fruits, vegetables, whole grains, proteins and dairy. |
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| Regulations
for supplements are now becoming stricter in the US, and globally
there are a few laws in the pipeline, but money spent on enforcement
is no match when compared to the marketing blitz that sells
these products. |
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| Some
common supplements and their examples are...
(These will be discussed at length in Part 2 & Part 3) |
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| Vitamins |
Minerals |
Herbs
& botanicals |
Ayurvedic
supplements |
Traditional
Chinese Medicine (TCM) |
http://
dietarysupplements
.nlm.nih.gov/dietary/
vitaminIngred.jsp |
http://
dietarysupplements
.nlm.nih.gov/dietary/
mineralIngred.jsp |
http://
dietarysupplements
.nlm.nih.gov/dietary/
betaHerb.jsp?list=all |
|
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| Beta-Carotene |
Calcium
(Shelcal, Macalvit) |
Glucosamine
and/or Chondroitin Sulfate |
Gymnema
sylvestre |
Ginkgo
biloba |
| Multiple
Vitamin/ Mineral A-Z (Revital) |
Iodine |
Acidophilus
Black Cohosh |
Ashwagandha
(Withania somnifera) |
Astragulus
root (huang qi) |
| Folic
Acid (folate) |
Iron
(Fefol) |
Ginger |
Aamalaki
(Emblic myrobalan) |
Panax
ginseng |
| Vitamin
A |
Magnesium |
Saw
Palmetto |
Amla |
Gecko |
| Vitamin
B Complex (Becosule) |
Potassium |
Evening
Primrose Oil |
Brahmi
(hydrocotyle asiatica) |
Ma
huang (active ingredient aka Ephedra) |
| Vitamin
C |
Selenium |
Echinacea |
Chandanam
(sandalwood, Santalum album) |
Dong
quai |
| Vitamin
D |
Sodium |
Fiber |
Haldi
(Turmeric, Curcuma longa/ domestica) |
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| Vitamin
E |
Zinc |
St.
John's Wort |
Guggulu |
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| Vitamin
K |
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Garlic |
Triphala |
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| Omega-3
Fatty Acids (Cadvion) |
|
Fish
Oil |
Boswellia |
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Neem |
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| Q.
Who is responsible for ensuring the safety and efficacy of dietary
supplements? |
Answer:
The Manufacturer of the product and not a Federal regulatory
body.
A lot of supplements specially “Herbal”
are used extensively in Complementary and Alternative Medicine
(CAM) practices such as Ayurveda, Naturopathy and Traditional
Chinese medicine.
Because there is little regulation of these supplements, Health
shops abound in them. In the USA, the Food and Drug Administration
(FDA) has a say in the claims made by dietary supplement manufacturers
only after they enter the market. The onus of making sure that
a supplement is safe and that the claims made by the manufacturer
are true lies with the manufacturer. This is because supplements
are not considered to be a drug, even though they act like a
drug.
Organizations such as the Health Foods and Dietary Supplement
Association of India (HADSA) which was established in 2002 are
trying to promote awareness and laws to bring some kind of order
in this area. The Indian Food Safety and Standards Bill was
also signed into law in 2005 to deal with this issue, but enforcement
is inadequate.
Below are a few examples of how some supplement ingredients,
including nutrients and plant components, can be toxic and have
severe reactions: |
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Calcium
and heart medicine (e.g., Digoxin used to treat
irregular heart beat) individuals taking Digoxin should
be careful with calcium supplement intake as high levels
of calcium can cause a toxic reaction, while low calcium
levels make the drug ineffective. |
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Taking
Calcium supplements while on the antibiotic gentamycin
can potentially increase risk of damage to the kidneys
from the antibiotic |
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Magnesium
and thiazide and loop diuretics (e.g., Lasix®,
etc.), some cancer drugs (e.g., Cisplatin, etc.), and
magnesium-containing antacids. |
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Coumadin
a blood thinner & supplements - Vitamin K
supplements interfere and can impede effectiveness of
blood thinners. On the other hand Ginkgo biloba (an herbal
supplement), aspirin (an OTC drug) and vitamin E (a vitamin
supplement) can each thin the blood, and taking any of
these products together with Coumadin can increase the
potential for internal bleeding. |
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St.
John's Wort and cyclosporine: St John’s
Wort should not be taken with cyclosporine, an immunosuppressant
drug taken by transplant patients, as it can reduce effectiveness
of the drug and cause rejection of the transplanted organ. |
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St
John’s Wort and Antidepressants: People
on antidepressants must consult their physician prior
to taking St John’s Wort as it amplifies the antidepressant
activity of the medication. |
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The
herbal remedy Arnica has a toxic effect
on the heart and causes very high blood pressure. |
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| 8
Safety tips for Supplements - |
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| 1. |
Do
not self-diagnose any health condition or
substitute a dietary supplement for a prescription
medicine or therapy, or for the variety of
foods important to a healthful diet. |
| 2. |
Just
because they say 100% Natural on the bottle,
Are they? The words ”Natural”
“herbal” are used very loosely
in the land of supplements! |
| 3. |
Don’t
fall for the latest celebrity endorsed advertisement
for a supplement. Remember they are paid handsomely
to endorse the product. |
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| 4. |
Supplements
when taken in large doses or when taken incorrectly,
can cause reactions similar to drugs. |
| 5. |
Always
consult your primary doctor before using any supplement,
especially if you are taking any medications (whether
prescription or over-the-counter). |
| 6. |
Supplements
are intended to fill in the gaps in a diet - not
be an excuse for one. You cannot live off the myth
of a miraculous supplement, period! And remember
- more is NOT better! Large doses can occasionally
be lethal. |
| 7. |
Herbal
supplements/remedies are still not understood very
well, even though they have been around for a long
time. Many people consider these substances to be
natural herbs and therefore harmless. However, they
are untested, unregulated and the effects from consuming
them can be unpredictable, and in certain circumstances
potentially toxic. |
| 8. |
Bottom
line! Given the potential pitfalls and in many cases
lack of factual scientific data, shouldn't we pause
and seek the advice of our physician prior to starting
a supplement regimen. |
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| Upcoming
Issues: |
Part
2: Categories and properties of Nutritional supplements.
Part 3: Herbal remedies: Claims, Myths, Facts
Part 4: Supplements: The good, the bad and the ugly. How to
be an educated consumer. |
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Note:
The examples provided do not represent an endorsement or
approval by NutritionVista. The information provided is based
on careful consideration by a team of dieticians to benefit
and make the consumer aware of available products and their
side effects. We recommend that if you are currently on any
supplement not prescribed by your physician, or want to start
taking one, please do consult with your primary care physician
before doing so.
By Ms. Meenakshi Hejmadi MS, RD, Dietitian, NutritionVista.com |
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