Healthy Living: March 6, 2018

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BANGOR, Maine (WABI) - Are you taking the right dietary supplements to optimize your health? This simple question does not have an easy answer due to the fact that proper medical research has never actually been done to answer it. Many non-medical folks are surprised to learn that in 1994 Congress passed legislation that allows the manufacturers of vitamins and other supplements to bring their products to market without having to undergo the rigorous testing that we require of all new prescription medicines. Under this law, the FDA cannot prevent a marketer from selling a product directly to the consumer that is 'generally accepted to be safe' as long as they do not make a claim to treat a specific condition like Coronary Artery Disease or Rheumatoid Arthritis. Instead they are allowed to use vague terms such as 'promotes over-all heart health' or 'good for your joints' and are not required to actually perform the basic placebo-controlled research necessary to determine how beneficial (or not!) these products might be.

Photo courtesy MGN Online Image Id: 353462 11/22/2016

As result, since the 1990's we have seen an explosion of products on the over-the-counter market which has become a $30 billion industry. In the US, surveys show that 52% of adults take at least one daily supplement and 10% report consumption of at least four such products every day! Is this a problem? According to an article in the Journal of the American Medical Association (JAMA) last month by the authors Manson and Bassuk, we may be taking a lot more vitamins and dietary supplements than we really need. Although this may not seem like a big deal, good research done in the mid 2000's has shown that some anti-oxidants such as beta-carotene, a vitamin A precursor, are actually associated with increased risks of some cancers. Other nutrients taken in high dose such as vitamin E, and some minerals such as selenium may increase your risk for neurotoxicity, liver disease, and hemorrhagic stroke. Making matters worse, a recent study on 'male-enhancement' products showed that the actual ingredients in some of the pills did not match was actually printed on the labels!

So what does the best data suggest regarding prudent usage of these supplements? To get the best understanding of the topic the authors in JAMA study referenced above have looked at the research based on life stages, as we have differing needs at different times in our lives:

1) Pregnancy: there is very good evidence that taking folic acid supplements and prenatal vitamins can prevent a host of severe problems including birth defects.
2) Infants and children: taking vitamin D until weaning is important for bone development, and iron supplements from age 4-6 months can prevent anemia.
3) Midlife and older adults: some may benefit from supplemental B12, vitamin D and/or calcium for metabolism and bone health.

Next, the researchers looked at high-risk conditions where there is good research that some supplements provide significant benefit. They outlined several areas:

1) Medical conditions that interfere with nutrient absorption, such as pernicious anemia, bariatric surgery patients, Crohn's and other inflammatory bowel disease: there is high-quality evidence that taking B vitamins - especially B12, fat soluble vitamins such as vitamin D, minerals such as iron, zinc and magnesium could be health protective.
2) Age-related macular degeneration: specific formulations of antioxidant vitamins with zinc and copper can slow progression of this disease.
3) Patients on certain long-term medications: this group benefits from a customized approach, depending on what medication you are on. For example, those on proton-pump inhibitors (e.g. Nexium, and many others for reflux or ulcers) should take B12, calcium and magnesium to prevent development of deficiencies. Diabetics and others using metformin can benefit from B12 as well. Other long-term medications such as the blood thinner warfarin work best if one avoids supplemental Vitamin K.

In summary, there is good research evidence for taking dietary supplements if someone is in the above groups. For the rest of us not in these special populations, we may have to wait for more definitive answers. However, the wait may not be too long: There is currently a large NIH supported study to define the benefit-risk balance for using supplements to prevent cancer and heart disease in healthy adults. Results of this trial are expected out in the next 3 years. Until then, the best practice is always to work with your board-certified primary care specialist for the optimal doses that would benefit your individual needs. Randomly taking a handful of supplements based on unsupported claims that have never been tested by good randomized controlled trials may not only leave your wallet feeling lighter than necessary, it could have opposite health effects from what you intend!