Dietary supplements: How safe are they really?

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Walk into a health food store today and you can be overwhelmed by shelves piled with dietary supplements. What’s going on? For the past ten years the popularity of dietary supplements has increased steadily. Supplements are a big money industry. In 2012 global sales reached $20 billion, and according to the National Business Journal, are expected to reach $32 billion by 2021.

Are you one of the 56% of Americans who regularly use dietary supplements as part of their healthcare regimen? Warfighters often use dietary supplements because of the extreme demands of military performance. Many use them to promote health, prevent illness, enhance physical and cognitive performance, increase strength and stamina, build muscle mass, and lose weight. Making an informed decision about supplement use can be difficult, and a bad decision could cause a serious problem.

What is a dietary supplement? Is it a food, a drug, or a supplement? Yes. It could be all three. Intended to supplement a balanced diet, they contain one or more food ingredient: macronutrients, vitamins, minerals, amino acids, herbs or other botanicals. 

Anyone considering using dietary supplements should research before they begin their use. A well-intentioned friend from the gym, or the latest fad in the office are not necessarily your best resources for choosing a dietary supplement. Always consult your physician prior to introducing dietary supplements into your diet. The responsible and informed use of dietary supplements can aid in optimal health. 

Dietary supplements usually come in pill or powder form. They are NOT a food substitute. Remember, a proper diet and regular exercise regimens are the foundation of good health. Supplements should only be considered to enhance one’s overall nutritional health and not be considered a cure-all or treatment for a medical condition. 

Some food products have been modified to enhance health benefits. These are called functional foods, and are not considered dietary supplements. Unlike dietary supplements, functional foods are regulated by the Food and Drug Administration (FDA), which ensures scientific evidence exists and correlates to health claims. Some examples are orange juice with added calcium, milk with vitamin D, and vitamin-enhanced breakfast cereals. The military has many examples of functional foods: Meals Ready to East, First Strike Rations, Cold Weather/Food Packets, Long-Range Patrol, Light Weight Rations and Tailored Operational Training meals. 

Properly choosing a dietary supplement which is both beneficial and safe is difficult because they are so poorly regulated in the U.S. All medical drugs in the U.S. require extensive human studies prior to approval by the FDA. Even food additives are regulated, and strictly monitored, by the FDA and the Department of Agriculture. But, dietary supplements are not currently subject to this scrutiny; which, unfortunately, has led to the introduction of harmful products into the marketplace.

The 1994 Dietary Supplement Health and Education Act (DSHEA) requires dietary supplement manufacturers to adhere to “good manufacturing practices,” but does not regulate which chemicals go into the supplements. All reputable supplement manufacturers will notify the FDA prior to introducing a new supplement for sale. Under DSHEA requirements, dietary supplement packaging must list the product as a “supplement” and contain a complete list of ingredients. Manufacturers are also prohibited from making claims that their product can “prevent, treat or cure any disease.” There is no guarantee of quality, purity, composition, safety, or effectiveness of any dietary supplement. Users of dietary supplements must always be cautious that a supplement could contain banned or harmful substances not declared on the label.

Although there are no integrated, service-wide regulations on the use of dietary supplements, the general rule for the military is that if a supplement is not banned, or recalled, by the FDA, Federal Trade Commission, or Drug Enforcement Administration, it is not currently banned by the DOD. Individual services and installations are, however, permitted to establish guidelines limiting its use.

Tainted supplements

Beware of tainted dietary supplements! Some supplements contain hidden drugs and chemicals banned by the FDA not listed on their labels. Supplements that do not fully list their ingredients may contain ingredients which cause serious physical effects because they contain 3-4 times the recommended dose of an ingredient or may contain a chemical that negatively interacts with other medications. Some supplements contain steroids and other untested drugs or medications.

The highest-risk dietary supplements fall into four categories: body-building products, sexual-enhancement products, weight-loss products and diabetes products.

Be suspicious of products which have labels like, “Do not take if you have a medical condition,” or “May cause a positive result in a performance-enhancing drug test,” or “All natural alternative to” an FDA-approved drug. These claims often indicate that the supplement may contain substances not on the ingredients list, prescription drug components, or banned substances. Also avoid products with labels in a foreign language or that claim to cure a wide range of unrelated diseases (e.g. cancer, AIDS, diabetes) and promise “quick fixes” to cure or reduce disease within specific time frames.

Dietary supplement manufacturers and distributors with questionable products will often sell their products on off-markets, such as “available on the Internet only,” only through e-mails, or through out-of-country markets. (See Figure 1)

Use common sense

Common sense tells us that popping a pill alone does not build muscles.

In reality, individuals must use hard work, disciplined physical training,

and good nutrition to realize their full physical potential

Prior to taking a dietary supplement always ask the following questions:

1. What is in it?

2. Is it safe?

3. Is it the right supplement for the desired effect?

4. Does it make sense?

5. Does it work?

6. Does it reach its intended target?

7. Why take it?

Reputable sources to answer these questions are readily available on-line. Some examples of credible sources include: The Human Performance Resource Center, The Natural Medicines Comprehensive Database, The Office of Dietary Supplements, The FDA, and PubMed.

One resource is the Human Performance Resource Center (HPRC), an online, one-stop clearinghouse for evidence-based information. The HPRC holds a database of resources and information specific to the use of dietary supplements and is maintained by the Consortium for Health and Military Performance (CHAMP) at the Uniformed Services University of the Health Sciences (USUHS).

If you decide to take a dietary supplement, always follow the dosage recommendations from your physician and the HPRC.  Excessive nutritional intake of proteins, vitamins and nutrients beyond the normal recommended levels may put you at risk, (See Figure 2). Stacking, the practice of taking multiple supplements and ingredients together, will often increase the effect of selected ingredients beyond the desired level and should be avoided.

Always consult your healthcare provider prior to beginning the use of a dietary supplement. Your healthcare provider should consult with you on supplement use, educate you about supplement safety concerns and provide resources on where to find reliable additional information.

In summary, dietary supplements cannot offset the unfavorable effects of a poor diet and the lack of a regular and safe exercise program. Be an informed consumer. Use reliable, science-based resources to stay informed.