The Path to a Happy, Healthy Hundred Years—Vitamins and Supplements: Beneficial or Harmful?

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By Mike DuBose with Blake DuBose and Surb Guram, MD

According to a 2013 Gallup poll, more than half of the US population takes some type of vitamin or supplement. As the June 2014 issue of Consumer Reports notes, “Supplements are almost as American as apple pie. Their use has grown significantly in the past 25 years, fueling what’s now a $28 billion-plus industry that stocks aisles of products in drugstores, supermarkets, and health food stores.”

Even with this widespread use, however, many misconceptions about supplements exist. In a 2013 Consumer Reports survey, 55% of respondents believed that the government monitors supplements to ensure that they contain no harmful ingredients and that their labels are accurate—but this is not the case. Strong lobbying forces have resisted any laws from Congress regulating supplements, such as Senator John McCain’s attempt to implement stricter controls. Bowing to pressure from the industry, Congress passed a law in 1994 that prohibited government agencies from monitoring supplement companies and deemed supplements a food, not a drug. Supplement manufacturers are not required to demonstrate the safety or effectiveness of a product before it reaches the marketplace, and the Food and Drug Administration (FDA) cannot intervene unless it can prove that a supplement or vitamin is unsafe. Many times, the agency must play a catch-up game to identify and stop violators.

Without any regulation or oversight by the government, supplement and vitamin manufacturers can say nearly anything they’d like in an attempt to sell their product. Full-page ads promote “miracle pills” and claim to report on “groundbreaking research.” One ad in the November 2014 Parade magazine claimed that its pills could reshape an entire body in 30 days—without a change in diet or exercise! (It also stated that the pill included a mood-elevating “feel good” energy component that would eliminate fatigue and put a smile on your face.) As USA Today’s editorial board wrote in December 2013, “[T]he supplement industry seems to lend itself to wild claims. The industry—by portraying its products as alternatives to medicine controlled by big pharmaceutical companies, self-interested doctors and large corporate interests—attempts to set itself apart from rigorous science and testing.” Consumer Reports and the FDA have both warned that if a supplement’s benefits sound too good to be true—near-immediate results with little to no effort, for example—then they probably are, and consumers should stay clear!

Even children are at risk. In a December 2013 Wall Street Journal article, infection control expert Paul Offit and Children’s Hospital pharmacy manager Sarah Erush described their alarm when parents brought their sick children to the hospital with supplements in tow. Often, the parents had not discussed their children’s supplement consumption with their doctors, nor had they checked for potential reactions between the supplements and the medications their children were taking. Offit and Brush were concerned, and they began researching the effectiveness and safety of supplements. (The Joint Commission, which oversees the accreditation of hospitals, treats patients’ supplements as drugs.)

Their research revealed some interesting findings:

  • Many supplements are mislabeled, either intentionally or unintentionally.
  • Some supplements in their study contained high levels of lead, mercury, and arsenic (something Consumer Reports also found in their research).
  • Herbal products like St. John’s wort and gingko biloba actually contained different herbs than those advertised on the label.

Some of the facilities where supplements are made were contaminated with rat feces and urine, according to the FDA. The agency estimates that there are 50,000 reports of adverse reactions to supplements annually, some of which result in hospitalization or death. In other words, taking a supplement could potentially cause more harm than people realize!

There are many questions you should ask yourself (and your doctor) before taking any kind of medicine, whether it’s a prescription, over-the-counter drug, vitamin, or supplement. We’ve researched some of the most common questions regarding supplements or vitamins and have come to some surprising conclusions.

Do supplements and multivitamins prevent disease?

Scientists and health professionals are still conducting more research, but the evidence is growing that supplements and vitamins have only a slight effect on disease prevention. In a 2013 Wall Street Journal article, Jeanne Whalen reported on two large studies published in the Annals of Internal Medicine that showed that multivitamins are unlikely to benefit the health of typical Americans. The research “showed multivitamins had no effect on cognitive function or cardiovascular health,” according to Whalen, who cited an editorial accompanying the studies where four physicians and public health professionals said, “The message is simple: Most supplements do not prevent chronic disease or death, their use is not justified, and they should be avoided.” Although a study that was partially funded by Pfizer, maker of the Centrum Silver multivitamin, showed a slightly reduced risk of developing cancer in men 50+ who used Centrum Silver over 11 years, it did not have a significant effect on the risk of specific types of cancer (like colon or prostate) and did not statistically affect likelihood of dying from cancer. Additional university studies have had similar results.

Some supplements can actually cause harm, as a National Cancer Institute study showed. In their tests, they found that Vitamin E supplements increased the risk of prostate cancer in men, rather than preventing it as originally thought. The June 2014 Consumer Reports on Health reported that high doses of Vitamin A, which generates beta carotene, might reduce the incidence of lung cancer, but it actually increased the chances of lung cancer amongst smokers. It also failed to protect against several other cancers, including bladder, colon, kidney, and pancreatic cancer.

Will multivitamins and supplements improve my overall health?

A review of 26 studies found that vitamins do not offer significant health benefits to well-nourished populations (like most people in America). If you eat a balanced diet, exercise regularly, maintain a healthy weight, sleep well, and refrain from smoking, multivitamins will not help much. In fact, as the Mayo Clinic reported, many of the foods we eat and the liquids we consume, like fortified orange juice, have additional vitamins added to them already.

Certain vitamins, however, do have benefits for specific populations. According to a June 2014 article by Consumer Reports on Health, a good multivitamin may help prevent nutrient deficiencies in certain groups, such as pregnant women or those who are trying to get pregnant. Folic acid has also been shown to help prevent birth defects when taken by pregnant females. Melatonin is a proven sleep aid, and some Vitamin D is helpful in building strong bones for patients whose blood has a deficiency (as long as they ingest less than 4,000 IU). Some individuals with joint problems may take a combination glucosamine/chondroitin supplement with success, but it might not benefit others (those who do not see improvement after 60 days should assume it doesn’t work for them and discontinue the supplement). In addition, some individuals in atypical situations (such as vegetarians, individuals with medical conditions that prevent proper digestion and food absorption, or families too poor to eat a well-balanced, healthy diet) could benefit from a multivitamin.

If you’re concerned about a potential deficiency that might require you to take a supplement, contact your doctor for testing to make sure. For example, your physician can order a specific blood test to determine if you need to supplement your calcium consumption. (We’ve all been told that taking calcium is good for you, but there’s a good chance that you’ll reach the 1,000 mg you need each day through your natural food intake.) When my internist, Dr. Surb Guram, reviewed my blood tests, he determined that a calcium supplement I was taking was unnecessary. Many people take calcium in an attempt to prevent osteoporosis, but recent studies have not reinforced this theory. In addition, some research is now showing potential links between excessive calcium intake and increased risk of heart attacks. German and Swiss researchers who followed 24,000 adults over eleven years found that regular users of calcium supplements had a significantly higher risk of heart attack compared to those who used no supplements!

Do supplements impact medical tests?

Vitamins and supplements can skew the results of blood tests. If you are planning to have a blood test, discontinue taking any non-essential vitamins, supplements, or herbs at least three days (72 hours) before the test to prevent false readings. Provide a list of all supplements you are taking to your medical provider. Consult him or her to see if you are consuming the proper dosage or if you should cease or start taking any a supplement, vitamin, or multivitamin.

Are there potential side effects from supplements?

Supplements can generate serious side effects like hair loss, muscle cramps, diarrhea, joint pain, and fatigue, and some herbs can counteract life-saving drugs such as heart medicines. According to Harvard University researchers, even some of the most popular and seemingly harmless supplements can cause side effects. Garlic supplements can interfere with heart medications, some red yeast rice supplements contain a kidney toxin called citrinin, and 81 milligram baby aspirin can produce gastrointestinal problems (also, while this dose has been proven effective in preventing cardiovascular problems with men, there is less evidence that it may help women). St. John’s Wort can interfere with prescription drugs, and niacin, the natural supplement to lower bad cholesterol, can cause serious side effects. Fish oil may cause insomnia and it thins the blood, which can be dangerous to those who already take blood thinners. I also determined that a popular fiber I was taking caused my nausea, stomach cramps, and bloating!

Supplements and vitamins also sometimes include additives that are not listed on the label, such as metals (like nickel), yeast, wheat, gluten, milk derivatives, lactose, preservatives, soy, artificial colors, and artificial flavors. Individuals may experience allergic reactions or sensitivity to these unlisted ingredients. According to a 2013 USA Today editorial, “The Food and Drug Administration has found no fewer than 123 companies that have sold products spiked with drugs and harmful additives.”

Overdosing is another serious threat. According to WebMD and a 2012 Huffington Post article by Meredith Melnick, it’s easy to get too much of a vitamin, which can have serious—and even deadly—results. The body knows how much of certain vitamins it needs and usually excretes the excess through the digestive and urinary systems. However, certain vitamins like A, D, E, and K are fat-soluble and, along with certain minerals like iron, can build up in the body. They can eventually reach toxic levels, damaging one’s health.

Scientists and medical providers have documented their concerns about how supplements and herbs can change the chemistry of prescription drugs. According to Consumer Reports, while it’s possible that many supplements, herbs, and vitamins could interact negatively with prescription drugs or cause side effects, only 13% of those they studied warned of potential problems on the label. (Visit ConsumerReports.org/health for more information about possible interactions between supplements and prescription drugs.)

Which brands of supplements are safe to use? How can I protect myself from those that aren’t?

It can be difficult to know who to trust when it comes to vitamins and supplements. Many vitamin and supplement companies have similar names, so it can be difficult to tell them apart in the store. For example, Nature Made, Nature’s Way, NatureWorks, Nature’s Blend, and Natural Balance are just some of the similar-sounding brands that are available.

Although there is little legitimate regulation governing supplements and how they are made, some supplement businesses use misleading labels declaring their drugs “scientifically-proven,” “all natural,” “certified,” “organic,” “lab tested,” “pharmacy-grade” or “accredited.” They may even go so far as to pay a medical doctor to lend legitimacy to their products. Many people mistakenly think that if a medical physician endorses a product, then the results must be safe, reliable, and accurate!

Researchers Offit and Erush reported that there are hundreds of less-than-reliable supplement companies in existence. They tried to contact many supplement producers as a part of their research, but “around 90 percent of the companies we reached out to for verification never responded. They didn’t call us back, or their e-mail or manufacturing address changed overnight,” they said. Others claimed that they met standards for good manufacturing practices but were not listed on the FDA website. The Federal Trade Commission, which monitors diet and supplement advertising, has brought more than 100 legal actions against companies that have misrepresented their products.

In a June 2014 report by Consumer Reports on Health, the organization wrote, “Since 2008, the Food and Drug Administration has warned about more than 330 products that turned out to be adulterated with active drugs not listed on the labels.” Indeed, it was revealed in 2013 that a popular workout supplement called Craze contained methamphetamine. Other supplements have been found to harbor toxic plant materials, heavy metals, arsenic, or bacteria. In a DNA analysis published in 2013, fewer than half of the 44 herbal products tested could be verified as containing the ingredients advertised or listed on the label.

Although the field is unregulated and supplements’ benefits are largely unproven, some reputable organizations do at least certify that supplements actually contain the substances they claim to and that they are manufactured in sanitary conditions. When considering a brand of supplement, look for these certifications:

  • United States Pharmacopeia (USP) certification is carried by less than 1% of the 55,000 supplements offered in the public marketplace. For supplement reviews, visit www.usp.org/usp-verification-services/usp-verified-dietary-supplements.
  • NSF International is recognized by regulatory agencies, and the NSF certification mark means that the product complies with certain standards. Visit www.NSF.org for details.
  • Good Manufacturing Practice (GMP) is administered by the FDA. GMP regulations for drugs contain minimum requirements for the methods, facilities, and controls used in manufacturing, processing, and packing of a drug product. The regulations ensure that a product is safe for use and that it has the ingredients and strength it claims to have. Visit www.fda.gov/food/guidanceregulation/cgmp/default.htm for more information.
  • Certificate of Analysis (COA) gives the exact details about a supplement’s quality and compliance to specifications. Visit www.sigmaaldrich.com/united-kingdom/technical-services/c-of-a.html for more details.

Keep in mind that some of these certifications do not assess the quality or effectiveness of a supplement or vitamin; they just verify that the label’s contents are accurately stated. To our surprise, after carefully reviewing hundreds of supplements and vitamins for sale at our local pharmacies, grocery stores, and major retail outlets, we only found one USP-certified brand (Nature Made) amongst them! While many of the others used terms like “lab-tested,” and other official-sounding marketing jargon, none other than Nature Made carried any of the certifications we were seeking (add that to the fact that their manufacturing facilities are based in the US, and Nature Made is now our brand of choice!).

In addition to checking for certifications, you can also go to www.fda.gov to determine if the vitamin or supplement you are considering has been subject to recalls, warnings, or alerts. If you experience a problem with one, you can report the issue to the FDA by calling 1-800-332-1088 or visiting www.fda.gov/medwatch.

The bottom line: Many of us are consuming supplements and vitamins we don’t truly need—or that could even harm us. If you’re a person who exercises regularly; sleeps eight hours a night; eats a balanced diet rich in fruits, vegetables, fish, olive oil, and nuts; maintains a healthy weight; doesn’t smoke; and practices generally healthy habits, you probably don’t require any additional vitamins. However, everyone is different, so work closely with your medical provider to determine if supplements, herbs, and vitamins are needed for your best health. If you do take them, use the proper dosage, and ensure that they are manufactured by a reputable company carrying USP or another reliable type of certification. It doesn’t mean they will work, but at least you’ll know what you’re buying is what’s advertised on the label!

Human beings’ natural state doesn’t include drugs or supplements, so we recommend taking as few as possible, collaborating with your doctor, and simply practicing good health habits. Although it can be tempting to believe, you can’t just swallow a pill to experience a disease-free, long, and healthy life!

About the Authors: Our corporate and personal purpose is to “create opportunities to improve lives” by sharing our knowledge, research, experiences, successes, and mistakes. You can e-mail us at [email protected]

Mike DuBose received his graduate degree from the University of South Carolina and is the author of The Art of Building a Great Business. He has been in business since 1981 and is the owner of Research Associates, The Evaluation Group, Columbia Conference Center, and DuBose Fitness Center. Visit his nonprofit website www.mikedubose.com for a free copy of his book and additional business, travel, and personal articles, as well as health articles written with Dr. Surb Guram, MD.

Blake DuBose graduated from Newberry College’s Schools of Business and Psychology and is president of DuBose Web Group (www.duboseweb.com).

Katie Beck serves as Director of Communications for the DuBose family of companies. She graduated from the USC School of Journalism and Honors College.

Dr. Surb Guram, MD is a board-certified internist and a graduate of the University of South Carolina School of Medicine. He is a partner with the SC Internal Medicine Associates in Irmo, SC and has practiced internal medicine in the Midlands for the past 30 years. See www.scinternalmedicine.com for more information on Dr. Guram and his practice.

© Copyright 2016 by Mike DuBose—All Rights Reserved. You have permission and we encourage you to forward the full article to friends or colleagues and/or distribute it as part of personal or professional use, providing that the authors are credited. However, no part of this article may be altered or published in any other manner without the written consent of the authors. If you would like written approval to post this information on an appropriate website or to publish this information, please contact Katie Beck at [email protected] and briefly explain how the article will be used; we will respond promptly. Thank you for honoring our hard work!