The past few days have not been good for dietary supplements and quality control (understatement of the year, Moyad). The New York State attorney general accused four national retailers (GNC, Target, Walgreens, and Walmart) of selling store-brand dietary supplements that were fraudulent and, in numerous cases, "contaminated with unlisted ingredients" (including wheat, rice, and asparagus). A total of four out of the five products tested contained none of the herbs advertised on the label.
This is a wake-up call, folks, but I'm not ready to walk away from my life's work of supplement research. I wrote The Supplement Handbook because I know that this can be a messy field filled with more marketing and hearsay than medical fact, but that doesn't diminish the health benefits of supplements, such as preventing Alzheimer's or helping you sleep.
To that end, it's time to treat dietary supplements as a full-time discipline or specialty that needs constant objective review and surveillance. Until we start seeing real, systemic changes in how supplements are regulated, here are 7 ways to be an educated, safe consumer when it comes to buying and taking supplements.
#1: Revaluate your medicine cabinet. Only take the supplements that you think you and your doctor you trust and a pharmacist thinks you need. Revisit your list every single year. I meet people daily who don't know why they are taking many of their supplements, and they have no idea if they are experiencing any benefit.
Would you follow this same approach with a drug? No way! Unless you really need it, then why take more pills? Drugs and supplements are very similar. Deciding whether one works or not comes down to looking at a preponderance of the evidence, just like in a courtroom. It also always depends on a benefit-versus-risk scenario for the individual.
For example, patients often remark that they do not know if fish oil or ginseng supplements are doing anything for them. I tell them to stop the product for four to six weeks and see if they feel any different or if anything on their blood tests got better or worse (or stayed the same). Always be safe and consult your own doctor before doing so.
#2: Look for a seal of approval. There are several seals on supplement bottles that increase the chance that what is reported on the label is what is in the bottle. For example, the NSF-certified label is one of the best. Many professional athletes and teams look for this label to ensure quality. Other certifiers that are good to look for are USP verified or NPA certified.
#3: Buy name brand. Before you get down on me for liking "Big Pharma," consider the fact that pharmaceutical brand supplements have a lot to lose if they are wrong. Pharmaceutical companies like Pfizer (Centrum), Bayer (One-A-Day), or Abbott Labs generally have very good quality control, and overall their prices are competitive (aka low-cost). Bad products on the supplement side could be a disaster in terms of public relations and profit on the drug side. So in general I find that these companies fly straight because they cannot afford to fly any other way.
#4: Know that herbal supplements are different than regular supplements. I usually have little to worry about when it comes to basic vitamins and minerals in supplements like vitamin D or A or magnesium: The amount listed on the label is usually accurate.
The real concern over quality control lately has been herbal products, so demand some level of quality-control testing. Look for a seal of approval, and research the brand for other types of quality-control testing.
Also, understand that every herbal product that has ever demonstrated real, measurable health benefits has an active ingredient that should be standardized. Look for the active ingredient on the website and label. For example, in many of the fatigue-reducing studies of American ginseng the active ingredients were standardized to 3 to 5 percent ginsenosides (the active ingredients). Knowing the active ingredient will help you identify what to look for in your herbal supplement (and how much of it should be there).
#5: Avoid multivitamins with herbal additives. The Physicians Health Study II (PHSII), the longest and best clinical study ever to look at supplements, never used any herbal products in the multivitamins it used, and it still showed a benefit of multivitamin use (slight reduction in risk of cancer and cataracts). I see no reason to purchase a multivitamin with any herbal ingredients on the label: If you're aiming to get the same benefits, you might as well mimic what worked best in the largest clinical trial of a multivitamin (they used Centrum Silver).
#6: Stick with single-ingredient supplements. Most well-done clinical studies of supplements to help almost any condition used a single standardized ingredient. Where consumers get in trouble is when they start to buy products that have multiple ingredients that include ones that were never used in clinical studies.
This process not only dilutes the active ingredient, rendering it less effective, but also pollutes the product and can make it tougher on your liver to metabolize.
#7: Take the next step—demand better. Write your congressperson and ask for more strict penalties for companies that do not comply with quality-control standards. I think Congress currently is under pressure to come up with some kind of solution to this mess, so turn up the volume with your own voice. Until all supplement companies subscribe to some kind of transparency service, we're essentially dealing with an honor code, and that's just a recipe for disaster, as we've seen.
And, also do your research on the amount and diversity on ingredients in your supplements. Things to look out for are heavy metals, pollutants or, silicon dioxide (aka "sand") in the product(s). If I see silicon dioxide as one of the principal ingredients or the company will not release its report of heavy metals or pollutants in its pills, then I get nervous.
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