Health professionals tend to have strong opinions when it comes to the role of supplements in the overall health and wellness of their patients and clients. Some see supplements as an ally to achieving health and fitness goals, while others feel that we should focus solely on diet and exercise before thinking of integrating supplements into our daily regimen.
This ongoing debate, in which the supplement and holistic health industries both have a strong influence, isn’t as straightforward as most make it out to be.
The extensive range of supplement types available, potential interactions, contradicting research, and effective and dangerous applications of supplements are all things you need to consider before recommending a supplement or taking one yourself.
Before we go into the details about what you should look out for before taking a supplement, we will give you an overview of the categories of supplements that exist, which is critical knowledge to have to avoid making blanket statements about supplements and their use.
What Are Supplements?
This might seem like a silly question. Most people who think of supplements will have an image of pills and powders in mind and the idea that supplements provide nutrients that we don’t get through our diet.
While that is true, supplements do not only provide vitamins and minerals. Different supplements also provide bioactive components that are neither macronutrients nor micronutrients but contain chemicals (both natural and man-made) that have an impact on the way your body’s cells and organs function.
The “official” FDA definition of a supplement is as follows:
The law defines dietary supplements in part as products taken by mouth that contain a “dietary ingredient.” Dietary ingredients include vitamins, minerals, amino acids, and herbs or botanicals, as well as other substances that can be used to supplement the diet.
We’ll go into details about the different types of supplements in the following section.
Types of Supplements
Supplements can be divided into four general types or categories based on the components they contain.
- Vitamin and mineral products: These include single or combinations of vitamins and minerals. Multivitamins fall into this category. They can provide anywhere between a fraction of your nutrient needs for a specific vitamin or mineral, to thousands of percent of the RDA (mega-doses).
- Herbs and botanicals: These include or come from plant materials, algae, or fungi. Sometimes, they are treated as two different categories of supplements. More specifically, botanicals are plants or plant parts that are consumed for medicinal or therapeutic properties. Herbs are a subset of botanicals and usually refer to the entire leaf or flowering parts of plants.
- Macronutrient and macronutrient building blocks: This category includes amino acids (protein building blocks), proteins, and fatty acids. Some examples are omega-3 fatty acids and taurine or branched-chain amino acids (BCAAS).
- Enzyme supplements: These are types of complex proteins that trigger biochemical reactions.
Within each category mentioned above, there are different “vehicles” of delivery; they may be available as tablets, gel caps, powders, or liquid suspensions. The stability and effectiveness of absorption may change depending on which vehicle is taken.
For example, your body will generally absorb a liquid supplement more effectively than it will absorb a tablet supplement since the body doesn’t need to break down the structure before freeing the active components for absorption into the bloodstream.
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Mega-doses – Good and Bad
Mega-doses are doses many times larger than the recommended daily amount (RDA) of a particular vitamin or mineral. Many supplements that are meant to provide only one or a few vitamins provide mega-doses.
Minerals, which are metals in microscopic quantities, are required in small amounts but toxic in large amounts, so mega-doses of these nutrients should generally be avoided unless for therapeutic purposes indicated by a doctor.
People commonly take some vitamins in mega-doses, like vitamins C and E, with the belief that they offer immune-boosting effects. In general, evidence has shown that supplement mega-doses of vitamin C do not reduce the duration of the common cold and supplement mega-doses of vitamin E do not provide benefits to heart health beyond recommended amounts.
It is crucial to keep in mind whether vitamins are water-soluble or fat-soluble. Water-soluble vitamins are easily removed from the body in your urine, so if you take more than you need, your kidneys can filter them out. Fat-soluble vitamins (A, D, E, and K) are stored in the liver and are not as easily removed from the body as water-soluble vitamins. This makes mega-doses of fat-soluble vitamins over long periods potentially dangerous to your health.
In summary, mega-doses of vitamins and minerals are generally not required and can be dangerous to your health. Mega-doses of vitamins and minerals should only be taken for therapeutic purposes as recommended and supervised by a doctor or licensed nutritionist.
Negative Interactions with Medications
Several supplements can have a negative interaction with medications, including reducing effectiveness, doubling efficiency, or causing negative interactions.
While this is the case for several categories of supplements, it is most common with herbal and botanical supplements.
Since many herbal and botanical supplements have similar effects as medicines, they can double the impact or block the effect, depending on the mechanism of action. For example, a study published in the Journal of Evidence-Based Complementary and Alternative Medicine identified 38 herbs that interact with warfarin, a common blood-thinning drug.
Additionally, St. John’s Wort, an herb used for improving sleep and mood, among other things, is the supplement with the most documented interactions with drugs.
With the growing body of evidence that points toward supplement-drug interactions, it is essential to remember that plants, even though they are “natural,” have chemical components that potentially have strong interactions with the body’s function.
You Might Not Need Them
Generally speaking, everyone should be able to get all of the nutrients they need through their diet. The purpose of a balanced diet is ensuring that you get the right nutrients in the right amounts, and deficiencies can be avoided with proper nutrition.
Keeping that in mind, many people in the US do have some sort of nutrient deficiency. The most common deficiencies in adults are vitamin B6, iron, vitamin D, vitamin C, and vitamin B12. Some of these deficiencies have severe implications for public health. If needs cannot be met with diet, for some reason or another, then supplementation is appropriate.
Not all supplements are made equally. The quality of the nutritional supplement can make a significant impact on its effectiveness in the body and contribution to your health. Some of the elements to consider in identifying high-quality supplements include:
- Bioactive form. Iron supplements, for example, should be in the form of “heme” iron, which is more effectively absorbed. Vitamin D should be in the D3 form since this is the form that has a role in calcium absorption.
- Elimination of heavy metals. This is relevant for DHA omega-3 and other fish-derived supplements, as some sources of omega-3 are high in mercury, which is toxic in large amounts.
- Are certified by a third-party laboratory. These ensure that supplements follow the FDA’s Good Manufacturing Practices and contain the amount of the active ingredient that is stated on the label.
By looking at evidence-based effectiveness, you will be able to answer the question, “does X supplement really work?”
While it is true that there are many traditional supplements and medicines that have yet to have the research they deserve to demonstrate their effectiveness, it is essential to have scientific evidence that shows the effectiveness of each supplement you are recommending or considering taking. In addition to independent studies, look for meta-analyses and systematic reviews of the effects and safety of each supplement to have a better understanding of the truth in supplement claims.
Dosages May Make a Big Difference
After asking the question of “does it work,” it is important to look at how much a person needs to take to potentially see the effects and stay within safe parameters. One company that independently compiles evidence and reports on the effectiveness, in addition to comparing effective dosages, is Examine.
Who Should Take Supplements?
It is important to note that, in the general healthy population, most supplements are safe to take as long as you stick to the recommended doses. (Note: Safety is not the same as effectiveness. Safety refers to the lack of evidence to show that it does any harm, while effectiveness refers to the ability for a supplement to make a desired change in the body.)
However, there are some populations and individuals that may greatly benefit from supplements.
- People on a plant-based diet. Plant-based diets are very rich in vitamins and antioxidants, which are some of the components responsible for its fame as one of the eating patterns with the most health benefits, but there are a few nutrients that may be lacking and for which needs can easily be met with supplementation in reasonable amounts. Some examples include vitamin B12, vitamin D, omega-3 fatty acids, and zinc.
- People taking nutrient-blocking medicines. Antacids, for example, may deplete calcium, folate, iron, vitamin B12, and vitamin D.
- People with augmented risk for deficiencies. Pregnant women, for example, have an increased need for folic acid, and not meeting that need can have severe detrimental effects on the fetus’ development.
- People who follow traditional or alternative medicine. Research on several botanical and herbal supplements shows that they can be effective for treating symptoms of certain illnesses. Note, however, that people should not replace medication with supplementation without doctor supervision.
- People seeking augmented mental and physical function.This category of people might look to take supplements, not because of a health need, but rather out of a desire to have increased mental and physical function. Some examples that have been shown to improve cognitive function are a category of supplements called nootropics, and amino acids are commonly used to augment strength and endurance.
Why You Need to Be Careful
The US Food and Drug Administration (FDA) is the government entity responsible for protecting public health by ensuring the safety, efficacy, and security of drugs, medical devices, and cosmetics, and also ensuring the safety of the US food supply. Supplements are not under the jurisdiction of the FDA.
In other words, the FDA doesn’t oversee the safety or efficacy of dietary supplements. While supplement companies must be careful about the claims for which they are marketed (they cannot claim to cure or to treat conditions, for example), it is up to the consumer to choose whether to take a dietary supplement or not.
Additionally, note that all supplements in the US are available without a prescription and can be purchased over the counter, making the potential for supplements misuse a real possibility.
The Role of the Health, Fitness, and Wellness Coach in Recommending Supplements
Regardless of whether you choose to recommend supplements to your clients or not, you need to be informed about the advantages and risks of supplementation. Also remember that, as mentioned above, supplementing with a multivitamin is very different from supplementing with a macronutrient (like amino acids), a botanical, or an herb.
Before guiding each client toward or away from supplementation of different kinds, it is essential to examine his or her health history and current health and fitness goals holistically. Consider examining their diet in detail and any allergies or unusual eating patterns they may have, in addition to asking about any medication they are taking.
If you are unsure of potential person-supplement interactions, do not hesitate to refer your client to a doctor or specialized nutritionist.
The key to overall health is a balanced diet rich in foods that naturally contain immune-boosting nutrients, healthy lifestyle choices, and regular exercise. In many cases, it is possible to get all of your nutrients from what you eat. However, some supplements contain components that aren’t regularly found in the diet and may offer research-backed benefits for concentration, energy levels, stress modulation, and muscle building, among many others. Other available supplements may not be effective, may cause negative interactions with conditions or current medications, or may have side effects.
It is important to be aware that not all supplements are created equal, and many people regularly choose to integrate these into their health and wellness regimen. Staying up-to-date with current supplement trends and the research behind them will help you guide your patients better.