We’ve gotten to the point that if you don’t take supplements then you are in the minority. In 2017, Americans spent $43.2 billion on supplements, which was dramatically higher than 23 years prior, in 1994 when supplement sales were closer to $8 billion in the US. According to the 2018 Council for Responsible Nutrition survey, 75% of adults in the US take supplements.
Of those surveyed, 78% believe that the dietary supplement industry is trustworthy. And while supplements can be a very beneficial way to optimize your health, don’t be so quick to trust the industry. It should come as no surprise that supplements are not thoroughly regulated by the United States government. They are overseen by the Food and Drug Administration (FDA) and the Federal Trade Commission (FTC) under the Dietary Supplement Health and Education Act (DSHEA), passed in 1994. Within this framework, supplements are treated more like food than drugs. It’s always better to be cautious in order to help you choose a supplement that is highest in quality, safety and efficacy.
You also want to be sure that you are taking supplements that meet your personal needs. Your supplement needs are based on YOUR body, YOUR genetics, YOUR microbiome, and YOUR diet. Your need for supplements are unique to you and cannot be fully determined by an article on the internet and definitely not by your favorite celebrity.
Many of these concepts on choosing high quality supplements are discussed in great length in a research review paper that I co-authored with Dr. Stephanie Harris, PhD, RDN, LD, Kelly Morrow, MS, RDN, CD and Dana Goldberg, MS, RDN, LD.
1. Food First But Not Food Solo
Food First means that the foundation of anyone’s nutrient intake should be through food which is an amazing source of fiber, vitamins, minerals and phytonutrients. It’s estimated that just one serving of a fruit or vegetable (~12g) can have as many as 100 different phytochemicals, which means that food is a super source of a variety of concentrated nutrients that cannot be recreated in supplement form. Food also provides our cells with key messages that all for them to do their job and function at their best. Aim for getting as many nutrients from a well-balanced, varied diet and use supplements to fill in the gaps.
Not Food Solo means that most people wont want their solo source of nutrients to come from their food. Adding the right kind of high quality supplements is key for a lot of people. Not all practitioners will agree with that statement. There are some who are very closed minded to supplements, likely because they didn’t learn about them in school. Doctors receive virtually no training in supplements and dietitians receive some but arguably not enough.
There are a number of reasons for why most people need additional supplemental support:
- Digestive issues that impair nutrient digestion and absorption
- Lower quality soil that is depleted of nutrition
- Inadequate nutrient intake through diet
- Genetic variants that enhance your needs for certain nutrients
- Medications that can interfere with the absorption of nutrients ie: metformin, proton pump inhibitors, and statins. See previous article.
- Increased nutrient needs for different life cycles
Let’s also talk about the fact that people just aren’t getting enough nutrients through the foods that the are eating. According to research from NHANES data, a large percentage of Americans fall short on nutrients such as vitamin A, vitamin C, vitamin D, vitamin E, folate, calcium and magnesium. In my clinical experience of seeing thousands of people’s nutrient labs, some of the most common nutrient deficiencies include omega 3 fats, magnesium, and vitamin D. Nutrients like omega 3s, magnesium and vitamin D can be very difficult to get adequate levels through food and may be best to supplement.
2. Should Be Medical Grade Or Third Party Certified
The FDA is responsible for overseeing the manufacturing practices and labeling process but you should know that the FDA does not approve supplements for quality, safety or efficacy before being sold to consumers. The FDA requires supplements to have the good manufacturing practices (cGMPs) to ensure safety but they do not test or assess supplements before they go to market. There is random auditing done on the backend to ensure supplements contain what they say that they contain but the number of companies that are assessed is minimal.
In a recent report on B Vitamins that was conducted by ConsumerLab.com, 19% of B vitamins failed the review because they had far less or more of the ingredients than listed. In 2018, ConsumerLab.com reported that 46% of multivitamin and multimineral supplements did not meet the label claims. And another report from the Natural Products Insider conducted from 2010-2012 found that 444 of the 626 supplements inspected failed to comply with the cGMP.
Another issue with many companies is that they rely on ‘skip batch testing’ which means that they test every few batches to hope that the amount in a few supplement bottles are the same. They do not test every single bottle in every single batch.
The best way to ensure optimal quality is to purchase supplements that are medical grade and that have been third party tested. There are companies that conduct third-party testing and then award products their seal of approval to indicate that it meets the third-party standards. They assess the ingredient quality, consistency of product label, freshness, and more. The most common third party testing certifications that you want to watch out for include ConsumerLab.com, NSF International, Informed-Choice and US Pharmacopeial Convention (USP).
Other medical grade brands that I often use with clients include Pure Encapsulations, Designs for Health, Thorne, Metagenics and Integrative Therapeutics. Often times you need a practitioner code to order these supplements. You can access these brands through my supplement store where I sell them at a discounted rate by subscribing to my newsletter.
3. Don’t Take a Supplement Because your Friend Does
If you are like most people then you are taking supplements but you do not base your supplement routine off of advice given to you by a healthcare practitioner (doctor, nurse practitioner, dietitian, etc.). Data from NHANES indicates that 23% of supplement users take supplements based on recommendations from a healthcare practitioner.
In the 2014 Council for Responsible Nutrition survey, 52% of supplement users reported that they trusted their physician as a trusted source for reliable information, 28% trusted their nutritionist and 20% trusted their friends or family members. Just because your friend, family member or a Kardashian benefited from a supplement does not mean that it is the right supplement for you. You have different needs.
It is always best to work with a functional medicine dietitian, doctor or other practitioner to determine your supplement needs. This way you can also run tests to better understand your baseline labs prior to taking the supplements. We always have baseline labs run for the clients in our programs because it decreases the guesswork.
4. Look for Ingredients that Match your Food Philosophy
The Dietary Supplement Health and Education Act uses the term ‘ingredient’ to refer to the compounds used in the manufacture of a dietary supplement. This also refers to substances such as binders, colors, excipients, fillers, flavors and sweeteners. Excipients are inactive ingredients that are used to hold a tablet together, to fill space or to improve the flow of ingredients through machinery.
Pay attention to the excipients that are often added in the ‘other ingredients’ line of a supplement. For instance: if you are a vegetarian, avoid supplements with gelatin; if you are allergic to soy then avoid supplements with soybean oil; if you have a fructose intolerance then avoid supplements with fructose; if you avoid food dyes and artificial sweeteners like sucralose or aspartame in your diet then avoid them in supplements.
5. More is Not Always Better
We work with clients who think that the more nutrients that they get, the better they will be. This is not the case. It’s always best to first, not add too many supplements to the equation at once. If you are going to add a few new supplements to your routine, try one at a time and wait at least three days in between to see if you experience any symptoms. Also remember that fat soluble nutrients (vitamin A, D, E, and K) are fat soluble, meaning that excess levels are not excrete through your urine and pose more of a risk if you are taking too much.
Water soluble vitamins (B vitamins—B1, B2, B3, B5, B6, B7, B9, B12–and Vitamin C) can be excreted through the urine and are less likely to cause adverse reactions. Just because they are water soluble does not mean that it’s a good idea to take extremely large doses. For instance, people can’t absorb more than 500-1,000mg of vitamin C in one sitting so anything larger is not necessary and can cause abdominal cramping and diarrhea. This is also true for supplements like probiotics where the more strains does not always equate to the best results.