Transcript Dietary Supplements

Dietary Supplements
Presented by
Janice Hermann, PhD, RD/LD
OCES Adult and Older Adult Nutrition Specialist
Vitamin and Mineral Supplements
 Almost half of the U.S. population takes
vitamin and mineral supplements on a
regular basis.
 One out of five people take multi-nutrient
supplements daily and others take single
nutrient supplements; most commonly
vitamin C, vitamin E, iron and calcium.
 Many times, taking vitamin/mineral
supplements is a costly but harmless
practice; however sometimes, taking
supplements can be costly and harmful.
Vitamin and Mineral Supplements
 Most people self-prescribe supplements,
taking them on the advice of friends, media,
the Internet or books that may or may not
be reliable.
 Without a valid nutritional assessment the
advice to take vitamin/mineral supplements
may not be in appropriate, many times the
preferred action is to improve food choices.
Vitamin and Mineral Supplements
 Healthful food choices can best provide the
balance of vitamins, minerals and other
nutrients needed for good health.
 Getting the recommended amount of food
from each of the USDA Daily Food Plan food
groups every day, can provide all the
nutrients needed without taking a
supplement.
Vitamin and Mineral Supplement Uses
 However, when circumstances make healthful
eating a challenge a vitamin/mineral
supplement may offers benefits that are both
effective and safe.
Vitamin and Mineral Supplement Uses
 Correct nutrient deficiencies
 Improve nutritional status
 Reduce disease risk
 Support increased nutrient needs
 Improve the body’s defenses
A Supplement May Help People:
 With a nutrient deficiency;
 Who consistently do not eat the
recommended amount of food from the
USDA Daily Food Plan food groups;
 Consuming a low calorie intake, less than
1200 calories per day;
A Supplement May Help People:
 Who are strict vegetarians (vegans);
 Women who excessively bleed during
menstruation, may need iron;
 With lactose intolerance or milk allergies who
don’t consume enough dairy products, may
need calcium;
A Supplement May Help People:
 In certain life cycle stages may have increased
nutrient needs (infants may need iron and
fluoride, women of childbearing age may need
folate, pregnant women may need iron, and
older adults may need calcium and vitamins D
and B12);
 With low milk intake and exposure to sunlight,
may need vitamin D;
A Supplement May Help People:
 With low milk intake and exposure to
sunlight, may need vitamin D;
 Who have diseases, infections, or injuries or
undergone surgery that interferes with the
intake, absorption, metabolism, or excretion
of nutrients;
 Taking medications that interfere with the
body’s use of specific nutrients.
Check With Physician
 This doesn’t mean people who fit into one of
the previous cases should automatically take
a vitamin or mineral supplement.
 People should first consult with their health
care provider, a simple dietary change may
be all they need.
Cautions
 Dietary deficiencies are difficult to diagnose.
 Diseases have many causes.
 Symptoms aren’t a diagnosis.
 Correcting dietary deficiencies requires
medical supervision.
Vitamin and Mineral Supplement Cautions
 Although under certain circumstances vitamin
and mineral supplements may be beneficial,
there can be problems with vitamin and
mineral supplements.
Vitamin and Mineral Supplement Cautions
 Possible problems with supplements
 Toxicity
 Life-Threatening Misinformation
 Unknown Needs
 False Sense of Security
 Other Invalid Reasons
 Bioavailability and Antagonistic Actions
Vitamin and Mineral Supplement Cautions
 Toxicity
 Large vitamin and mineral doses can be toxic
 The DRI Tolerable Upper Intake Levels define the
highest vitamin and mineral intake levels that
appear to be safe for most healthy people.
 Of particular concern are toxicities in children
Vitamin and Mineral Supplement Cautions
 Life-Threatening Misinformation
 Large doses can be marketed with claims that
large doses can be beneficial or cure serious
diseases.
 Elderly and people with serious illnesses are most
vulnerable
 People may take too much or may not seek proper
medical treatment.
Vitamin and Mineral Supplement Cautions
 Unknown Needs
 People self-diagnose which vitamins and minerals
they need to take
 Surveys have shown that there is little relationship
between the types of vitamin and mineral
supplements people take and the nutrients they
actually need.
Vitamin and Mineral Supplement Cautions
 False Sense of Security
 Supplements can be harmful if they cause people
to have a false sense of security.
 People may avoid making improvements in their
diet because they believe their supplement will
meet their needs.
Vitamin and Mineral Supplement Cautions
 Other Invalid Reasons
 Belief the food supply or soil contains inadequate nutrients
 Belief supplements can provide energy
 Belief supplements can enhance athletic performance or
build muscle
 Belief supplements will help with emotional stress
 Belief supplements can prevent, treat or cure illnesses
ranging from colds to cancer.
Vitamin and Mineral Supplement Cautions
 Bioavailability and Antagonistic Actions
 Body absorbs vitamins and minerals the best
from food
 Nutrients, particularly minerals taken in
concentrated forms are likely to hinder the
absorption of other nutrients
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Zinc can hinder copper and calcium
Iron can hinder zinc
Calcium can hinder magnesium and iron
Magnesium can hinder calcium and iron
Balanced Diet, Not Supplements
 Supplement diet, don’t replace diet.
 Supplements can’t make up for a poor diet.
 You get more from food than supplements.
 The USDA Daily Food Plan is the best guide
for getting the nutrients you need in the
right amounts.
Supplement Tips
 Avoid taking isolated nutrients, unless
prescribed by your physician.
 Use a combination, multi-vitamin multimineral supplement.
 Not more than Tolerable Upper Intake Level.
 Only take a single dose.
 Look for U.S.P. notation.
 Natural supplements are not better.
Dietary Supplement Labeling
 The Dietary Supplement Health and
Education Act (DSHEA) set up the frame work
for FDA regulation of dietary supplements.
 FDA’s pre-market review of dietary
supplements is less than that for foods or
drugs.
What Is A Dietary Supplement
 DSHEA broadened the definition of
supplements to any product intended for
ingestion as a supplement to the diet.
 Vitamins & Minerals
 Protein & Amino Acids
 Herbs & Botanicals
 Other Plant-Derived Substances
 Metabolites, constituents and extracts
Dietary Supplements Are Not
 Dietary supplements are not drugs.
 A drug is an article that is intended to diagnose,
cure, mitigate, treat, or prevent diseases.
 Drugs must undergo clinical studies to
determine their effectiveness, safety and
possible interactions.
 FDA approve drugs before they are marketed.
Dietary Supplements Are Not
 Another thing dietary supplements are not
are replacements for conventional diets.
 Supplements do not provide all the known-and perhaps unknown--nutritional benefits
of conventional food.
Dietary Supplement Label
 Identity
 Net quantity
 Structure-function claim and disclaimer
 Directions for use
 Supplements Fact panel
 Ingredient list
 Name and address of manufacture
Monitoring For Safety
 Food ingredients and drugs undergo strict
pre-market safety testing and approval.
 Dietary supplements to not have to go
through FDA pre-market approval.
 Once on the market FDA has to show a
supplement is unsafe before it can take
action to restrict it if a problem occurs.
Understanding Claims
 Under DSHEA dietary supplements are
allowed to use three types of claims.
 Nutrient-content claims
 Disease claims
 Nutrition support claims
 Structure-function claims
Structure Function Claims
 Manufacturers can use structure-function
claims without FDA approval.
 Structure-function claims must be
accompanied with the disclaimer “This
statement has not been evaluated by the
Food and Drug Administration. This product
is not intended to diagnose, treat, cure, or
prevent any disease.”
Fraudulent Products
 Some possible indicators of fraud are:
 Claims product “secret cure,” “magical.”
 Pseudomedical terms "detoxify," "purify" and
"energize.”
 Cure a wide range of unrelated diseases.
 Has only benefits and no side effects.
 Accuses medical profession or government of
suppressing treatment.
 Claims “natural” is better.
Consumers
 The majority of supplement manufactures
are responsible and careful. But consumers
must take responsibility too.
 Consumers need to evaluate claims and
products with established medical sources.
 If a product is valid it will stand up to
evaluation.
References
 Position of the American Dietetic Association: Fortification and
Nutritional Supplements. JADA;2005;105,1300-1311.
 Tips for the Savvy Supplement User: Making Informed Decisions. U.S.
Food and Drug Administration. FDA Consumer March-April 2002.
www.fda.gov/fdac/features/2002/202_supp.html, Accessed January
2007.
 Understanding Nutrition, 10th edition by Ellie Whitney & Sharon R Rolfes.
Thomson Wadsworth, 2005. Thomson Wadsworth Publishers.
 Understanding Normal and Clinical Nutrition, 7th edition by Sharon R
Rolfes, Kathryn Pinna & Ellie Whitney, 2006. Thomson Wadsworth
Publishers