Dietary supplements include your daily vitamin pill, calcium antacids favored by many American women, and the flavored liquid your grandma drinks before her afternoon power walk. 

What is a Supplement

According to the Food and Drug Administration, any tablet, capsule, powder, or liquid taken orally containing a dietary ingredient qualifies as a dietary supplement. 

This encompasses:

• Vitamins
• Minerals
• Herbs and spices like echinacea and ginger
• Amino acids
• Enzymes like lactase
• Organ tissue such as dried liver
• Hormones like melatonin, metabolites, and extracts. 

Dietary supplements can be single-ingredient, like vitamin E capsules, or combination products, such as multivitamins and mineral pills, or the widely debated “energy drinks” primarily fueled by caffeine.

When to Use Dietary Supplements

Many people view supplements as a quick and easy way to obtain nutrients without the hassle of extensive shopping and kitchen preparation, avoiding unwanted fats and sugars found in food. Some take supplements for nutritional insurance, while others use them as substitutes for medical drugs. 

Despite this, nutrition experts, including the American Dietetic Association, the National Academy of Sciences, and the National Research Council, generally recommend investing time and money in preparing balanced meals and snacks from real food.

Nevertheless, experts acknowledge that supplements can be valuable for individuals with specific nutritional needs and serve as an insurance policy in certain circumstances.

Where food alone is insufficient, supplements become essential

Certain metabolic disorders, diseases affecting digestive organs like the liver, gallbladder, pancreas, and intestines, and specific medications can disrupt normal food digestion and nutrient absorption. Consequently, supplements may be necessary to compensate for these challenges. Individuals dealing with chronic diseases, those recovering from significant injuries (such as severe burns), or those who have undergone surgery may also require additional nutrients beyond what can be obtained from regular food intake.

Note: For safety, consult your doctor before choosing a supplement with anticipated medical effects. Your doctor, being most acquainted with your health, is aware of your current medications and can provide guidance on potential side effects.

Supplementing aging appetites

As you age, your appetite may decrease, and your sense of taste and smell might diminish. If food loses its appeal, you frequently eat alone, find cooking for one unenjoyable, or face challenges with chewing due to dentures, you may not be consuming all the necessary foods to meet your nutritional needs. In such cases, dietary supplements can serve as a solution.

Meeting a woman’s special needs

At different stages of her reproductive life, a woman may find supplements beneficial. For instance:

Before Menopause: Women, who lose iron monthly through menstrual bleeding, often do not get enough iron from a typical American diet that provides fewer than 2,000 calories a day. For these women, as well as those on a weight-loss diet, iron supplements may be the most practical solution. 

During Pregnancy and Lactation: Before and during pregnancy, supplements of the B vitamin folate are known to reduce a woman’s risk of giving birth to a child with a neural tube defect (a defect of the spinal cord and column). Pregnant women often require supplements to provide the necessary nutrients for building new maternal and fetal tissue. After childbirth, supplements play a role in providing nutrients essential for producing healthy breast milk.

Note: Avoid self-prescribing during pregnancy. Even basic nutrients can be harmful to your baby. For instance, taking excessive amounts of vitamin A while pregnant may raise the risk of birth defects.

Throughout adulthood, women aged 19 and older can obtain the necessary calcium (1,000 milligrams per day) from sources like four 8-ounce glasses of nonfat skim milk, three 8-ounce or four 6-ounce containers of yogurt made with nonfat milk, 22 ounces of canned salmon (with the soft, edible bones, not the hard bones in fresh salmon!), or any proportional combination of these. Nevertheless, expecting women to perform this nutritional balancing act daily may be unrealistic. The straightforward alternative is calcium supplements.

Boosting a special diet

Vitamin B12 is found only in food from animals, such as meat, milk, and eggs. (Some seaweed does have B12, but the suspicion is that the vitamin comes from microorganisms living in the plant.) Once upon a time, vegans (people who eat only plant foods — no dairy foods or eggs allowed) would almost certainly have had to get their B12 from supplements. Today, fortified grains may do the trick, but some vegans still add B12 to be sure.

Using supplements as insurance

Some healthy individuals, even with a nutritious diet, choose supplements to ensure adequate nutrition. In 2002, the American Medical Association (AMA), which had long discouraged vitamin supplements, changed its stance after reviewing 26 years of scientific studies linking vitamin levels to chronic illness. The Harvard-based authors, Robert H. Fletcher and Kathleen M. Fairfield, published the study in the Journal of the American Medical Association (JAMA). They highlighted that while severe vitamin-deficiency diseases like scurvy and beriberi are rare in the West, having slightly less than needed vitamin levels is a genuine concern.

Insufficient intake of folate and two other B vitamins (B6 and B12) may increase the risk of heart disease, colon cancer, breast cancer, and birth defects. Inadequate vitamin D intake is associated with a higher risk of rickets and osteoporosis. However, there is no evidence that consuming large amounts of some vitamins reduces the risk of cancer. 

Choosing the Most Effective Supplements

 The following guidelines can help you choose the safest, most effective products:

Choose a reputable brand

While the FDA can’t make manufacturers provide safety and effectiveness data, a well-known name on the label provides some assurance of a quality product. It also ensures a fresh product, as popular brands typically sell out faster. The initials USP (U.S. Pharmacopoeia, a respected testing organization) are another indicator of quality, as are phrases like “release assured” or “proven release,” indicating that the supplement is easily absorbed by your body.

Check for the expiration date

Over time, the potency of all dietary supplements diminishes. Opt for the product with the longest shelf life to ensure maximum effectiveness. Avoid those that will expire before you can use all the pills, like a 100-pill bottle with an expiration date only 30 days from now.

Read the storage instructions

Even if you purchase a product with the correct expiration date, its effectiveness may be compromised if not stored properly. Some supplements require refrigeration, while others should be kept in a cool, dry place, similar to any food product. Refrain from storing dietary supplements in a cabinet above the stove or refrigerator. Although the inside of the fridge is cold, the motor outside generates heat.

Stick to a safe dose

If your doctor doesn’t prescribe a dietary supplement as medicine, avoid products labeled “therapeutic,” “extra-strength,” or similar variations. Choose one that provides no more than the Recommended Dietary Allowance (RDA) for each ingredient.

Steer clear of hype

If the label makes promises that sound too good to be true, they likely are. The FDA doesn’t allow supplement marketers to claim their products cure or prevent disease (as that would classify them as medicines, requiring premarket testing). However, the agency does permit claims related to function, like “maintains your cholesterol” (as opposed to the medical claim of “lowers your cholesterol”).

Examine the ingredient list

In the early 1990s, the FDA introduced the consumer-friendly nutrition food label, featuring a mini-nutrition guide, comprehensive ingredient listings, and reliable information on how certain foods may impact your risk of chronic illnesses like heart disease and cancer. Take the time to read it.

Getting Nutrients from Food Rather Than Supplements

Finally, after presenting the benefits of supplements and guidance on selecting effective ones, here’s why individuals without underlying chronic or temporary medical conditions (such as pregnancy) might be better served by obtaining most or all of their nutrients from food:

Cost

If you’re willing to plan and prepare nutritious meals, you can usually obtain your nutrients more affordably from fresh fruits, vegetables, whole grains, dairy products, meat, fish, and poultry. Moreover, food tends to taste better than supplements.

Unexpected bonuses

Food comes as a package deal, including vitamins, minerals, protein, fat, carbohydrates, and dietary fiber, along with a variety of phytochemicals (phyto = plant) that could be essential for your ongoing good health.

Safety

Some common nutrients can be toxic in megadose servings, which are amounts several times larger than the Recommended Dietary Allowances (RDAs). Large doses of vitamin A, for instance, are associated with birth defects and symptoms similar to a brain tumor. Niacin megadoses may lead to liver damage, and megadoses of vitamin B6 could cause temporary nerve damage in the arms, legs, fingers, and toes. These adverse effects are more likely to occur with supplements. While pills are easy to swallow, it’s unlikely that you would consume enough food, regardless of your hunger, to reach toxic levels of nutrients.

Summary

It’s advisable for healthy individuals to primarily fulfill their nutritional needs through a balanced diet. However, there are situations where supplements may be necessary, such as nutrient deficiencies, conditions causing malabsorption, limited access to food, and specific life stages like pregnancy.

Because supplements face limited regulation by the FDA, it can be challenging to identify safe and effective options. When purchasing vitamins and supplements, opt for products that have undergone third-party testing and contain appropriate levels of vitamins and minerals.

Due to potential interactions and safety concerns, it’s crucial to consult with your doctor before taking any vitamin or supplement product—especially if you’re pregnant, breastfeeding, taking medications, or have or suspect a medical condition.

Reference: Rinzler, C. A. (2021). Nutrition for dummies. For Dummies.