Last week I discussed why I believe nutritional supplements can be helpful in certain patients. Almost as important as the actual supplement taken is the quality and storage of supplements and is the topic of todays opinion piece.
I can’t recommend any specific brands, for a variety of reasons but none more important than the need to prescribe the best supplement or blend of supplements from all available ranges to meet patients individual needs. This also brings me to an important point, patient requirements will change with time and circumstances so should be reviewed regularly. A random scattergun or purchase of social medias latest and greatest supplement approach will lead to at best, a waste of money and at worst, side effects.
As a general rule of thumb there are two types of supplements: pharmaceutical and non-pharmaceutical grade. Interestingly, it is not mandatory for supplements to undergo clinical trials. Currently, NZ legislation states that “there is no pre-approval process for dietary supplements. It remains the responsibility of the sponsor (the person legally responsible for placing the product on the market) to ensure the product is made to an acceptable quality, is safe to use and complies with the law”.
Pharmaceutical grade supplements provide more reassurance in that they undergo Good Manufacturing Practice (GMP) certification and their grade, form, purity, bioavailability and third party verification means the product is likely to be more effective and safer.
A 2013 study by a research group in Canada demonstrates nicely the issues with non-pharmaceutical grade supplements. They looked at 44 supplements found commonly in USA supermarkets. The study showed that many were contaminated, including some with ingredients known to cause side effects; did not contain the listed active ingredient (in 50% of products); or contained different ingredients than those listed, including fillers (in 21% of the products). Only two out of 12 companies provided products with no substitution, contaminants or fillers.
Even more alarming was that two of the St. John’s Wort products, (indicated to help mild depression among other indications) which did not contain St John’s Wort. One instead contained rice only and the other a powerful laxative illustrating that not only can non-pharmaceutical grade supplements be useless but also dangerous.
Supplements can also be dangerous if they contain ingredients patients are allergic or intolerant to. Reassuringly pharmaceutical grade supplements are free of common allergens like gluten, dairy, soy, and nuts. Additionally, bioavailability of the active ingredients in these superior forms of supplements is increased by the often added synergistic ingredients.
Storage of supplements is just as important. Fish oils are a very common supplement and a great example of the potential problems of poor storage. Heat, including room temperature, will oxidise (damage) these fats, and considering these fats become an integral part of our cell membranes, this can lead to a host of problems. An easy solution is to only purchase fish oils that have been stored in a cold and ideally refrigerated environment.
Lastly, it is important that supplements contain the optimal, not the cheapest, form of ingredients. For example, zinc picolinate is more easily absorbed than zinc citrate found in most non-pharmaceutical grade supplements.
As with most things in life there is an element of you get what you pay for. Most of us generally aim for a car which has a good safety record to protect the outside of our bodies. What we put inside our bodies should be no different, and is achieved by aiming for good quality pharmaceutical grade supplements, if used. The common perception of supplements only benefiting us by creating expensive ‘wee’s’ is a factor with cheaper, non pharmaceutical brands only.
Lastly, it is important to reiterate that food is first and for training in the detection and management of nutritional deficiencies please contact The Australasian College of Nutritional and Environmental Medicine.