Are supplements a waste of our money?

Physician turned television celebrity Dr. Oz faced a critical Senate subcommittee last week for his endorsement of dietary supplements. The hearing has supplements back in the news, and prompted us to answer some questions we often hear from our customers.

How are supplements regulated?

Before 1994, dietary supplements were subject to the same regulatory oversight as foods. That year the Dietary Supplement Health and Education Act (DSHEA) was signed into law and it created a new regulatory framework for the safety and labeling of dietary supplements. Under DSHEA, supplement companies are responsible for determining that their products are safe. They are also responsible for substantiating any health claims with adequate evidence.

The bottom line is that dietary supplements do not need approval from the FDA before they are marketed, and the manufacturer does not have to provide the FDA with evidence of safety or effectiveness.[i] The supplement industry is essentially self-regulated. (And some would say not really regulated at all.)

Do supplements work?

The Annals of Internal Medicine recently rocked the supplement world by publishing three long-term scientific studies which concluded that dietary supplements are ineffective in preventing heart attacks or other chronic diseases.

An accompanying editorial went further in discrediting a broad range of supplements in preventing or treating disease. The writers concluded that the trial data should be turned into action and, in the absence of a micronutrient deficiency, physicians should actively advise their patients against taking any supplements at all.[ii]

This news may have come as a shock to the more than 100 million Americans who spend $30 billion each year on supplements. But are we really surprised? Ask yourself a simple question: Americans have been taking vitamin supplements for years but are we actually any healthier?

There is no question that someone with iron deficiency anemia would benefit from iron supplements. Or that a pregnant woman may want to take a folate supplement to help prevent birth defects because she has no appetite for leafy greens. But the widespread use of supplements goes far beyond such specific situations and the verdict appears to be in: overall, supplements do not make us any healthier.

If not supplements, then what?

The data is overwhelming that chronic diseases like heart disease and diabetes — increasingly being lumped together as “cardiometabolic disorders” — are lifestyle diseases intimately linked to the food we eat. It’s not far-fetched to call heart disease a food borne illness. And there is also abundant evidence that optimizing food intake has a significant impact on helping prevent and treat cardiovascular disease. This only makes sense: if food is the cause, food must also be part of the solution. [iii-viii] Although supplements have held the promise of making up for poor eating habits, we now know that, in the absence of a documented nutrient deficiency, they add little value to health care or prevention efforts.

To decrease the rates of heart attack, stroke, and diabetes, we simply cannot continue to eat poorly and hope that a few pills will right all wrongs. To truly improve our health, we must pay attention not only to calories but also to the quality of our food. We have to recognize the role food plays in causing disease. We might be a lot better off if we spent that $30 billion a year on healthful foods.

 

References:
[i] Food and Drug Administration. Q&A on Dietary Supplements. Retrieved from http://www.fda.gov/Food/DietarySupplements/QADietarySupplements/default.htm#what_is [ii] Appel L, Guallar E, Mulrow C, Stranges S. Enough is Enough; Stop Wasting Money on Vitamins and Mineral Supplements. Ann Intern Med. 2013;159:850-851 [iii]Jenkins DJ, Kendall CW, Marchie A, et al. The Garden of Eden–plant based diets, the genetic drive to conserve cholesterol and its implications for heart disease in the 21st century. Comp Biochem Physiol A Mol Integr Physiol. 2003;136(1):141-151. [iv] Van Horn L, McCoin M, Kris-Etherton PM, et al. The evidence for dietary prevention and treatment of cardiovascular disease. J Am Diet Assoc. 2008;108(2):287-331. [v] Masley S, Kenney JJ, Novick JS. Optimal diets to prevent heart disease. AMA. 2003 Mar 26;289(12):1510; author reply 1510-1. [vi] Wasling C. Role of the cardioprotective diet in preventing coronary heart disease. Source. Br J Nurs. 1999 Oct 14-27;8(18):1239-48. [vii] Berenson GS, et al. 1998. Atherosclerosis: a nutritional disease of childhood. Am J of Cardiol. 82:22T-29T. [viii] de Lorgeril M, et al. 1999. Mediterranean alpha linoleic acid rich diet in secondary prevention of heart disease; The Lyon Diet Heart Study. Circulation; 99:779-85.

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