House call: Navigating the supplements road
Long gone are the days when your nutritional supplement choices were limited to Flintstones for the kids and One-a-Day for yourself. There are multivitamins formulated for men, for women, and for seniors. There are individual supplements like vitamin C, niacin, lysine and fish oil. In addition to good old tablets, there are chewable supplements, gelcaps, gummy supplements, and liquid supplements. Some are reasonably priced and some are downright exorbitant.
There have been many studies to see if vitamin and mineral supplementation improves general health where nutritious food is not in short supply. To date, the evidence points toward supplements not making much, if any, difference, or the benefits being inconclusive. If you eat a reasonably healthy diet, with adequate fruits and vegetables and a variety of foods you probably do not need to take supplements. For the most part if you are taking a supplement that you don’t need I’d say that you are making expensive urine, as most vitamins are cleared through the kidneys. Fat-soluble vitamins like A and D can build up and become toxic if taken in excess.
Because they are available without a prescription, supplements are largely a matter of personal choice. I take a daily multivitamin, a vitamin D soft gel, and glucosamine, none of which is particularly expensive.
I have many patients who swear up and down that their joint pain is less so long as they take daily glucosamine. Studies to date have not demonstrated a benefit. Since it is not harmful, it is not breaking the bank and I feel that most studies have not been long enough to prove or rule out benefit, I take it myself. I also have patients who find digestive relief from bloating by taking probiotic supplements.
Circumstances where a supplement is often recommended or needed include pregnancy and when you have a specific deficiency. I always recommend a prenatal supplement to patients who are pregnant or trying to get pregnant. The folic acid in them lowers the risk of the baby developing neurological problems. Examples of specific illnesses caused by a vitamin or mineral deficiency include anemia (iron deficiency), osteoporosis (calcium and vitamin D) and scurvy (vitamin C).
I don’t recommend using supplements to treat an illness that is not a vitamin or mineral deficiency. Never self-diagnose a vitamin deficiency. There may be an underlying cause that needs to be treated and self-diagnosis and treatment can mask a more serious problem that needs to be dealt with. I have seen many patients who choose to spend an enormous amount on supplements that I seriously doubt are doing them any good.
It is often OK to take supplements with medications to treat an illness, but check with your doctor or pharmacist because some supplements and medications do not play nice with each other. For example, taking an iron supplement at the same time as levothyroxine (a thyroid hormone used to treat underactive thyroid) reduces how well the levothyroxine is absorbed and may result in under treatment of the condition.
Do not take supplements with a “more is always better” attitude. Everything can be consumed in great enough quantities to make you quite ill, even water. For example, an overdose of niacin (a B vitamin) can cause skin flushing, dizziness, rapid heartbeat, itching, nausea, vomiting, abdominal pain, diarrhea and gout. Taken persistently it can cause liver inflammation.
If you decide to take any supplements, read up on them. The daily value information on the label tells you approximately how much of a nutrient a serving of the supplement provides. The National Institute of Health’s Office of Dietary Supplements website (https://ods.od.nih.gov/) has fact sheets available on many, many supplements.
Dr. Bob Riggs is a family medicine physician practicing at Group Health’s Riverfront Medical Center.