Dietary Supplements
I mentioned in a previous video that I am hesitant when it comes to dietary supplements, and I wanted to dig a little deeper on that today. I often find that patients are eager to address their health in natural ways, and I fully support this. You can look back at my blog posts thus far to see that my first approach is typically to review lifestyle, habits, behaviors, diet, and exercise when trying to make a diagnosis or create a treatment plan. My natural approach to health care however does not typically include dietary supplements.
Yes, some people will be deficient in vitamin B12, Vitamin D, Iron etc and need to take supplements of these. Yes, at times I recommend a probiotic for those with GI issues or when taking an antibiotic. Yes, there are likely health benefits associated with red yeast rice or saw palmetto or cranberry products etc.
But here is why I am not often suggesting these products for my patient. When the label of dietary supplement is used, as opposed to a medication, it means it escapes the regulations and monitoring offered by the FDA. A huge red flag for me is the disclaimer, ‘this product is not intended to diagnose, treat, prevent, or cure any illness.’ If a company is not intending their product for those reasons, then there is no need for them to provide customers with evidence that their product is effective, or safe, or that it even contains the ingredients it claims to contain.
Take for example Melatonin, which I discussed in my video as generally safe. Thank goodness it is, because a Canadian study tested about twenty different over the counter melatonin products to see how much melatonin, the active ingredient, each sample contained. They found that the miligrams of melatonin in the tablet or gummy varied from -80% to 400% of the miligram amount listed on the bottle - that’s a lot!! Further, they found that the miligrams of melatonin varied as much as 400% between lots from the same manufacturer. This is why someone might take melatonin and have no help with their sleep, while another person might try melatonin and have trouble waking up the next morning.
The same type of inconsistency is seen with red yeast rice. Sometimes I have patients requesting to try this rather than take a statin like Crestor or Lipitor to reduce their cholesterol. It’s true that red yeast rice will help lower your cholesterol - they actually work quite similar to statins! But I think marketing red yeast rice as a ‘natural’ way to lower your cholesterol is quite misleading. First, you are still taking a pill every day. Second, a similar study to that done with Melatonin was done with red yeast rice, and again found that the amount of the active ingredient varied from 0.3mg to 11mg per capsule. Many argue that taking a dietary supplement would be safer than taking a medication, but the same study that tested for the amount of active ingredient in the red yeast rice capsules found that 4 of the 12 preparations studied contained a nephrotoxic (kidney harming) agent.
So the bottom line for me is that dietary supplements do have a role for some people, but they should really be considered medication-adjacent. What I mean by this is don’t think of a dietary supplement as something separate than a medication. Most people are hesitant to take a medication without talking to a medical professional first. Think about supplements the same way, and discuss with your primary care! Another option is to look for dietary supplements that use a third party organization that does quality testing, such as US Parmacopeia, ConsumerLab, and NSF International. Just keep in mind these independent organizations are looking at quality, not weighing in on the supplements effectiveness or safety for all patients. I like the ConsumerLab website, linked above, to review various supplements, foods, and health products.
