Supplements: Use a Dose of Caution

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By Caralee Adams

You’ve seen the bottles lining the grocery store shelves. Bright red hearts burst off the labels to catch your attention. CoQ10: Promotes energy production in the heart. Garlic: Helps maintain cholesterol levels. Fish oil: May reduce coronary heart disease. 

Americans are buying the claims—literally. Sales of dietary supplements now top $20 billion annually according to the Nutrition Business Journal, as about half of all Americans take some vitamin or dietary supplement daily.

Hype or Help?
Consumers will probably be disheartened by the answer. Clinical trials in the past couple of years have been more “disappointing than promising,” says Rebecca Costello, a nutrition scientist with the National Institutes of Health (NIH) Office of Dietary Supplements in Bethesda, Maryland. “There is no magic bullet,” Costello says. “It all comes back to one of the hardest prescriptions that we can give anybody: Diet and exercise play such a huge role.”

The American Medical Association (AHA) echoes her words, stressing that it’s best to get proper nutrition from whole foods and that dietary supplements are no substitute for a healthy diet. “It really makes no sense to go fishing for a cure on the shelf of one’s local health food store instead of improving one’s lifestyle in ways that are shown to work,” says Ron David, M.D., a physician and AMA spokesperson.

Even vitamins, once considered a slam dunk for health, are now on the “maybe” list. The NIH State-of-the-Science Conference in May 2006 concluded that there is insufficient evidence to recommend for or against taking multivitamin/multimineral supplements to prevent chronic disease. Still, some nutritionists say vitamins are a safe, inexpensive, and reasonable way to ensure meeting daily nutritional requirements.

Likewise, when it comes to herbal supplements, botanical enthusiasts suggest that negative studies often overshadow the encouraging ones. Consumers should be aware, however, that because dietary supplements are regulated as foods rather than drugs or over-the-counter medications, they are not tested for safety and effectiveness by the U.S. Food and Drug Administration (FDA) before they reach the market. It is the manufacturer’s responsibility to ensure the product is safe and the claims truthful. Each supplement’s label contains a statement that the product has not been evaluated by the FDA and is not intended to be a cure. The FDA does investigate reports of adverse effects and issues warning letters to manufacturers when such reports are received. The U.S. Federal Trade Commission also monitors claims.

To help cut through the confusion, last year the American College of Cardiology Foundation (ACCF) issued a report on integrating complementary medicine into cardiovascular medicine. Omega-3 was the only dietary supplement recommended. Several other supplements were considered “possibly useful.” Let’s take a closer look.

What Works
Omega-3 fatty acid (fish oil) supplements get the thumbs-up sign. For people with cardiovascular disease or those with high triglycerides, the (AHA) recommends consideration of fish oil supplements: 1 gram a day for individuals with pre-existing cardiovascular disease and 2–4 grams in individuals with hypertriglyceridemia.

Alice Lichtenstein, nutrition scientist at Tufts University and the chairwoman of the AHA Nutrition Committee, says that fish oil is the only dietary supplement proven to help heart health in a specific group of individuals. Recent research shows that fish oil reduces the risk of heart attack and some types of stroke.

However, Lichtenstein adds a word of caution. “People should not take dietary supplements unless they are recommended by their health-care provider,” she says. “Not only have we found that most of them to date are not efficacious, there is some concern that at high intakes supplements can have adverse health consequences.”