To supplement or not to supplement?

Supplements are a huge industry in the United States. According to a survey completed by the CDC in 2007, over $15 billion is spent on supplements each year. Fish oil, Glucosamine, and Echinacea, are the top three consumed.

As a physician who commonly recommends supplements, I am often asked, “Are supplements really necessary or beneficial?”

Recent studies on Fish oil (see NEJM June 2012 and NEJM May 2013), Multivitamins (see Archives of Internal Medicine Oct 2011), Calcium (JAMA Internal Medicine Feb 2013) and Carnitine (Nature Med April 2013) bring into question not only their efficacy but also their safety.

However, there are also plenty of studies showing the benefits of Fish oil for ADHD, cardiovascular disease, and rheumatoid arthritis as well as multivitamins slowing down aging of cells, calcium improving osteoporosis, and carnitine helping with heart disease. With all of these conflicting reports, what are we to do?

First, it is important to understand that death and adverse effects from using nutritional supplements is extremely low compared to “prescribed medications”. Some estimates say only a few hundred deaths and less than 7,000 adverse events from supplements while there have been over 100,000 reported deaths from medications in over 2.2 million adverse events over the past 30 years.

Second, we must understand that not all supplements are created equal; there are over 60,000 dietary supplements currently on the market with variable levels of regulation, safety and evidence.

Although there is a process for supplement companies to have their supplements reviewed for quality and content the FDA has not always required standardization of production. The good news is that by the end of