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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 2010 all supplement companies were required to demonstrate “Good Manufacture Processes”. Although, not as strict as drug GMP requirements it is a step in the right direction. However, checking to make sure you have a good product is import. reports on brands that have failed their strict evaluations. In one recent review they found defects in nearly 40% of multivitamins chosen

Third, our food is depleted in minerals and vitamins. When I first started in medical school and even early in my practice, I held firmly to the belief that as long as we focused on eating a variety of plant foods and minimized our intake of “artificial or processed” foods that we would essentially get all of the nutrients and vitamins that we need from our diet. That view has now changed as I have learned about the changes in our current food status.

Now, our food is genetically modified, sprayed with larger quantities of pesticides and herbicides than ever before, exposed to heavy metals (arsenic in rice), and lacking in nutrients that have been depleted from the soil (there are 30 essential elements needed for healthy plants and animals and most fertilizers contain only 3, nitrogen, phosphorus, and potassium and only 7% of farmland is considered prime). All the processed and artificial ingredients in our foods are wreaking havoc on our bodies. If all of us could eat a nutrient-rich, organic, toxin free, all-natural, plant based diet, we probably wouldn’t need much supplementation. But I know for me that is not possible, despite having my own garden and eating locally grown produce.

Supplements are only SUPPLEMENTS! In other words, if we don’t improve our foundation then we are unlikely to get much benefit from our supplements. They do not replace a nutrient-rich, plant-based diet and physical activity. They only enhance it.

When we do buy supplements we need to keep in mind that not all supplements are created equal and some can be dangerous (see consumer reports article on supplement safety:

Making sure that you are getting a quality supplement is the key. I recommend that you talk with your physician or a nutritionist who is knowledgeable about supplements who can advise you which supplements that you should take in order to optimize your health. We have high quality supplements available through my online store which is a safe and reliable place to purchase some of my favorite products.

The bottom line is that you have to change your lifestyle if you want to become healthy. Supplements are only there to help you along the way.

Erik Lundquist, M.D.

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