Taking Care with Supplements
healthwindows.com, spring 2001

Since they are not regulated by the FDA, the way prescription drugs are, nutritional supplements often seem like magical and harmless answers to our most basic health problems. In our fantasies, we grab a bottle of St. John's wort in the grocery store, take a couple of pills and suddenly that clinical depression is gone. No embarrassing doctor's visit, no trip to the pharmacist, no therapy, nothing. Unfortunately, there's no such thing as a free lunch. If a substance is strong enough to have a positive effect on your mental or physical health, it's probably powerful enough to cause health risks too. Like anything you put into your body, you have to be careful with herbs and other nutritional supplements.

Dr. Jason Theodosakis and Dr. David Feinberg, authors of Don't Let Your HMO Kill You, have the following advice when it comes to nutritional supplements: Be careful. Though nutritional supplements can be extremely helpful in areas such as heart disease, anemia, osteoporosis, toxemia of pregnancy, arthritis and birth defects, they can also be completely useless or extremely dangerous.

Drs. Theodosakis and Feinberg identify three main problems with current nutritional supplements: variable quality, unsubstantiated claims and a lack of standardization in nutrient level testing. Let's take them one by one.

When it comes to nutritional supplements, the first problem is a lack of consistency in potency. How can you evaluate whether something works if you don't know how much you're taking? Many of the substances you buy in your local drugstore are about as potent as a sugar tablet, and it's all completely legal. The FDA cannot remove a subpotent product from the shelf unless it is harmful, so buyers must fend for themselves in an increasingly crowded and complicated supplement marketplace.

Some supplement manufacturers, however, have taken steps to ensure that their products are safe and potent. They follow what are known as "good manufacturing practices" (GMPs), guidelines from the FDA intended to help manufacturers provide safe and properly labeled products. They may also submit their products for testing by the Supplement Testing Institute (STI), an independent organization whose mission is to allow consumers to easily identify dietary supplements that have passed postmanufacture quality assurance tests. Do some research on the products you take, and find out if their manufacturers have taken these steps. You can find more information at www.supplementtesting.org.

The second problem in choosing supplements is the vast number of unsubstantiated claims that pervade the supplement industry. Unfortunately, the fact that nutritional supplements tend to be derived from natural substances only perpetuates these claims. Since a manufacturer can't patent minerals and plants, they have no incentive to submit their products to rigorous study. Again, the key is research. Talk to your doctor and find out what really works. By no means should you take the word of the manufacturers on faith.

Finally, there is the problem of a lack of standardization in nutrient level testing, which means tests to find out the existing levels of nutrients in your body. People take supplements blindly, without finding out first whether they really need them. And sometimes, they already have too much of the nutrient in their body already.

Unfortunately, current nutrient-screening methods are extremely limited in scope. Doctors will test routinely for sodium, potassium, chloride, calcium and phosphorous in every standard "chemistry panel," and they sporadically test for substances such as vitamins B6, B12 and folate; iron; magnesium and vitamin D. But rarely will a mainstream doctor test for all the known nutrients important for human health. Drs. Feinberg and Theodosakis believe that the real progress in nutritional medicine will come when physicians have reliable information about their patients' nutritional profile. Dr. Theodosakis is working on a standard panel of 15 to 20 nutrients that should be tested routinely.

Essentially, the question of nutritional supplements comes down to a lack of information. Patients and doctors lack concrete information on the efficacy of nutritional supplements and don't even have a clear picture of the patient's health in the first place. Manufacturers vary wildly in their attention to good manufacturing processes, and have no incentive to submit their products for intensive testing to find out if they work at all. Until patients decide to stop accepting manufacturers claims at face value, and begin to take responsibility for their own health by demanding more evidence and seeking out better information, this state of confusion will only continue. that you consult a nutrition-savvy doctor before making any changes to these recommendations. You can find more information on Drs. Feinberg and Theodosakis' recommendations at www.drtheo.com.