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Nutritional Supplements: Efficacy and Safety

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Courtesy photo: https://www.health.harvard.edu/alternative-and-complementary-medicine/the-arguments-against-dietary-supplements

By Brian Wallace, Ph.D., FACSM |

Lose fat, build muscle, improve memory, decrease heart disease, increase sex drive –  dietary supplements claim to do all this and so much more – a virtual panacea for what ails us. There are some 90,000 plus dietary supplements sold in the US with slightly more than half of Americans taking at least one supplement and 10 percent taking four or more and in so doing making the dietary supplement industry a multibillion dollar industry. But the overriding questions are: do they work and are they safe?

The reality is there is very little to no definitive scientific data for most supplements to suggest whether or not they are effective – even for multivitamins. What is not lacking though is the hype, scams, questionable science and putative experts permeating the industry and by extension giving a bad name to the entire industry; an industry which essentially functions with virtually no oversight and so opens up a pandora’s box for fraud.  For example, according to the Federal Trade Commission (FTC) rules ‘when ads represent, directly or by implication, that a commercial endorser is an expert, the endorser must have actual expertise in the relevant field’.  Someone with a Ph.D. in Political Science (especially a questionable one) does not qualify as an expert in nutrition. Ironically, according to the law (Dietary Supplement Health and Education Act of 1994), dietary supplement companies do not need FDA approval before they can go on the market. The FDA simply doesn’t have the capacity to test all the products and health claims of the 90,000 plus supplements available. However, when safety problems are suspected, the FDA is obligated to investigate and, when needed, take the appropriate actions. The FDA has in fact exposed more than 300 supplement frauds —the most egregious supplements, those that have been of the greatest concern for the FDA, due to added substances that are illegal and creating increased risk, are those used for sport performance, weight loss, muscle building and sexual function.

Recently, the Center for Science in the Public Interest (CSPI) sued a major drug store chain over misleading marketing of its DHA dietary supplement. The company’s ads and labels claimed that the product was ‘clinically’ shown to improve memory based on the results of a single study.  However, the FTC decided that the study did not in fact demonstrate that there was any improvement in memory, and ultimately, won the legal battle – though not the war. Moreover, in a recent issue of Nutrition Action (a CSPI publication), more than three dozen supplements sold online were identified that made unsubstantiated claims about their ability to enhance female fertility and were unable to provide any corroboration when asked for it.  With truth in advertising conspicuously deficient, what remains is an industry in critical need of more rigorous supervision and government oversight – rules and laws to protect consumers. Unfortunately, just the opposite is now in the works, see this article link below “FDA’s inspection hiatus provides opportunity for industry to prove self -regulation is real. With FDA receding into the inspection background, now is the time for the dietary supplement industry to step up and show if there are any real teeth in the notion of self-regulation.”1 

Furthermore, the confusion regarding the efficacy and safety of supplements is exacerbated by the outlier or occasional supplement that actually does seem to work such as creatine, one of the most studied supplements on the market. It’s success has elevated the aspirations of every other wannabe supplement under the sun and in the gym. But it’s a hit or (mostly) miss system and we are the guinea pigs and paying for it – literally and physically.  The reality is most people don’t need supplements to be healthy and reduce the risk of chronic disease particularly if they are eating a wide variety of nutrient dense food.  However, there are of course some who may benefit from supplementation such as when you are: 1) on a calorie restricted diet, 2) an older adult, 3) a vegetarian, 4) or pregnant. In sport and exercise there can also be an additional need for particular nutrients due to the added energy needs and anabolic processes – building a better you to keep up with the challenges of training and competition.  Still, they too can typically meet their nutrient and energy needs with a ‘healthy, athletic’ diet.  It is the best way to get the vitamins, minerals, phytochemicals (still being discovered), essential fatty acids and amino acids needed while avoiding illegal, potentially dangerous chemicals or exceeding the recommended upper limits of some nutrients which can be as much a concern as a deficiency.

Nonetheless, ‘don’t throw the baby out with the bath water’.  There are some good companies out there and there is a consensus belief for some of us that there is a real need and role for nutritional supplements though it will take some time to sort it all out.  For now, consumers must stay informed!  Check the ingredients on the label to make sure there is nothing harmful especially given any personal health issues; monitor your own personal responses to the supplement, and research the legitimate scientific articles, news and literature that comes out periodically. To help get started with that and determine where some supplementation may be advised, click on this link for a relatively brief guide to help navigate the labyrinthine realm of supplements:

https://jamanetwork.com/journals/jama/article-abstract/2672264

HTTPS://WWW.NUTRAINGREDIENTS-USA.COM/ARTICLE/2020/03/20/COVID-19-PROVIDES-OPPORTUNITY-AROUND-SELF-REGULATION 

Dr. Brian Wallace is the chair of sports exercise science at the United States Sports Academy.

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