Transcription:
Should You be Taking Nutritional Supplements?

Melanie Cole (Host): Are you currently taking nutritional supplements, and how should you decide? That's the big question everybody says, "Which ones do I take? There are a million of them on the market. How do you sort through the confusion?" Well my guest today is going to help us, Maria McIntosh, she's a registered dietician and clinical nutrition manager at Henry Mayo Newhall Hospital. Maria, supplements as I said in the intro, boy there's a lot of them. It can be dizzying to stand in front of a shelf of all of these different ones. How do we know what ones we're looking at? Are they FDA regulated? What do we do to sort out some of the confusion?

Maria McIntosh, RD (Guest): Okay, an excellent question. You know, there are so many out there, and it really is very confusing for all of us. We hear so much hype about them. As a matter of fact, back in 2011, $30 billion were spent just in America alone on taking supplements. The concern really comes in when people have other chronic health conditions, because unfortunately what they may not realize is that some of these supplements may interfere with the other medications that they're taking.

So you brought up a very good point about the FDA, and are they regulated? Well the interesting thing about the FDA when you think about what they are, it's the Food and Drug Administration. Well supplements are not considered food, and they're not considered drugs. So interestingly, while the FDA does have some control over these, it's not nearly to the same extent that they would have over a food or a drug.

I'll give you an example. They can basically determine whether some of the ingredients in a supplement are what they claim to be, but they don't necessarily- they're not the ones that are making the claims about them, and there's very few claims that the FDA actually even support. Where the FDA comes in the most is really after the fact, if they're out on the market, and if someone claims that maybe they had an allergic reaction, or an otherwise adverse reaction to the supplement, then the FDA does have a website that keeps track of it. And when they do hear of some of these complaints, they can then go in and study these supplements further. So unfortunately before that happens, they don't have very much regulation to do with supplements at all.

Melanie: So do we look at the labels? I mean does looking at the labels matter?

Maria: Looking at the labels do matter for a few reasons. First of all, you can- looking to see if they have expiration dates, that's helpful because it does show you that it's probably made somewhere and produced somewhere that is looking at higher quality products that aren't bad for you, or that won't go bad for you in the particular product. It also helps to look at certain certifications. There's something called USP, and another one, NSF, and these are basically here in our country where it does indicate that they are of a higher quality product and what they say is in that supplement is probably actually in that supplement.

Unlike now that we can go on the Internet and get things from other countries and just about anywhere, it's really buyer beware because we don't know that what they say is in that supplement is actually there. So for those reasons, those are good reasons to look at the label, not to mention looking at how much of the certain supplement, the vitamin, the mineral, whatever it might be is actually in that product, because sometimes it may be more than we really should be taking. And so if the product does tell you how much of the RDA, the recommended daily allowance, or the DRI, which is just a daily reference intake, a dietary reference, then those that are more closely to 100% of those is much better than when we're taking mega doses, when we're taking like 1,000 times of what the recommendation might be.

Melanie: Well certainly you said buyer beware, and boy they can sure be expensive as well. If you were to tell- you're the clinical nutrition manager at Henry Mayo, if you were to tell somebody your top three or five, what would you recommend? Is it vitamin D? Is it a multi-vitamin? Women, folic acid to help reduce our risk of breast cancer. I mean some of these have been actually proven, folic acid one of them, Maria, right? Back in the sixties when they realized it could help with birth defects.

Maria: Well oh yes, oh absolutely folic acid is very important that we have adequate amounts of. As a matter of fact, back in 1998, and I don't know if this stands out to me because that's when I was having my daughter, but some laws were passed and we started fortifying some of our basic foods like flour, and bread, and crackers, and cereals, and those kinds of things with folic acid because the advantage was very great for women in their childbearing years. It reduced significantly the chance of neurotubule defects. Folic acid is necessary for when cells are growing very rapidly as we would expect to be happening when we're creating a child. So that was very important, so that was actually fortified in the foods.

And fortification means that they may not naturally be in that particular food, but it was felt that from a public health standpoint, it was important enough to put in a more wide range of foods. But folic acid is actually very easy to get in the diet, and we can get them from green leafy vegetables, from whole grains, and so it's not that it's impossible to get them only from a supplement.

Melanie: So what would be some of your favorites? I mean do you want people taking vitamin D, vitamin C? What do you like?

Maria: Right, well it's not- it's not a case of what I like, but there are valid situations in which people can be benefitted from taking a supplement. The one thing that I think is interesting, we'll talk about some of the specifics in a moment, but the interesting thing is that half of those of us who do take supplements really take them without their physician knowing, and a quarter of them will begin taking them when they are diagnosed with a chronic condition. And the concern with this is that they do have interactions with blood pressure medications, with statins, which are important for lowering cholesterol and triglycerides and heart health. So there are things that unfortunately when our doctor asks us to write down the things that we're taking at home, the medications, we don't necessarily think to put down the supplements as well.

And I've talked to many oncologists who when their patients are going through chemo or radiation, they recommend that they do not take anything because they really are concerned about the way it may affect the treatment that they're receiving.

But having said that, let's take a look at some situations in which it may be very important to supplement. One would be for vegan. Vegan people don't eat any animal products at all, and B-12 which is one of the B vitamins and very important for myelin production and nerves, nerve cells and nerve function, may not get adequate amounts in their body because they're not eating any animal protein. Granted our liver has about a seven year supply, but depending on how long you've not been eating meat or any other kind of dairy products, you might be running low. So it might be important for people to take vitamin B-12.

Those of us, as we get older, vitamin D which we do know to be very helpful and may help contribute and promote bone health, vitamin D is not- while it's not truly a vitamin because we make it in our skin with the UV rays from the sun, converting it into active vitamin D, a lot of us don't get out in the sun much anymore. A lot of us are more aware of skin cancer, and we're putting more-

Melanie: Sunscreen on.

Maria: Sunblock, and that kind of thing, right? We're trying to stay out of the sun, and that's all very good, but a little bit of sun exposure can be helpful. But the older we get, the less able our body is to make that conversion with the UV rays and the skin production of vitamin D. So that might be a possibility for some of us older people. People with dark skin too may also be helped by vitamin D supplementation.

Let's see, some other situations, we already talked about the folic acid, and women generally when they become pregnant, the doctors will recommend supplemental folic acid, but it really- for women in childbearing age may want to consider folic acid supplement, particularly if they don't consume adequate foods with folic acid.

Some people are on restricted diets, or let's take a look at people with gastric bypass. Vitamin B-12 actually requires intrinsic factor, which is made in your stomach and the first part of your small intestine, and so if you've had any kind of gastric surgery, that may have removed a portion or lessened the portion of your GI tract, then they may require some supplementation as well.

I think the most important thing to consider here is that you do discuss with your health professional, and looking at your particular situation, the medications that you're currently on, and your health background, your health history; all of that is going to determine whether it's appropriate or not for you to take a supplement.

Melanie: So wrap it up for us, Maria, because you've really given us such great information and things to think about when people are looking at whether it's vitamin supplements, or herbal supplements, botanicals, amino acids, enzymes- digestive enzymes, any of these things and they're trying to decide between chewables, and liquids, and something you make into water. Whatever these things are, wrap it up for us with what you feel is the most important thing that we keep in mind when we're looking at all of these different products.

Maria: Well the most important thing to keep in mind is that there's really no long-term evidence that shows that multi-vitamin and mineral supplements really have an effect on our mortality. When we hear about specific nutrients that may be beneficial, most of the time it's coming from studies that have looked at food selections versus just simply taking a supplement. And so is there a substitute for a healthy diet? Unfortunately for many of us who would just like to take that magic pill, no there isn't. There's still so much that is being found in food, that we can't even begin to understand. I mean remember when beta carotene was the big thing? And now it's lycopenes, and some other foods, and now we know that food of any color, of any vibrant very colorful color has a host of very protective phytochemicals in them. And so a healthy diet and perhaps a multi-vitamin and mineral supplement that doesn't exceed 100% of the recommended daily allowance is probably the safest thing to consider if someone is feeling like they want to enhance their diet, or to increase their nutrient intake.

Other than that, and especially if we're talking about more of the mega doses that I discussed earlier, you really do want to look up your medications that you may be taking, and talk to your doctor or other healthcare professional. Dieticians are a very good source, pharmacists are a good source as well, but you really need to look at the whole picture. So you don't want to do it alone.

Melanie: Well that's great advice, and certainly looking to a clinical nutrition manager or registered dietician is a great way to get a lot of these questions answered and do it safely. Thank you so much, Maria, for sharing your expertise. What great information you've given us today. You're listening to It's Your Health Radio with Henry Mayo Newhall Hospital. For more information please visit www.HenryMayo.com. That's www.HenryMayo.com. This is Melanie Cole, thanks so much for listening.