Nutritional supplements: Do your research first
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* Natalie McGill

Vitamins are the nutrients in the food you eat every day. Every fruit or vegetable you bite into is filled with vitamins that strengthen your immunity and keep you healthier. But if you choose to skip the orange and get your vitamin C in pill form, known as a supplement, watch out. That supplement may contain more than just the vitamin you need.

Each day, between 150 million and 180 million Americans use supplements, such as multivitamins, says Daniel Fabricant, PhD, director of dietary supplement programs at the U.S. Food and Drug Administration’s Center for Food Safety and Applied Nutrition.

You may turn to a supplement in hopes it will help you ward off disease and stay healthy. Consumers are bombarded with ads for common supplements, such as glucosamine, echinacea or St. John's Wort, but their health promises are not always based on the best science.

Fabricant says supplements do not have to be proven safe or effective before ending up on your supermarket or drugstore shelf. FDA, which regulates food and prescription drugs, does not review supplements before they go on the market, he says.

“If consumers hear something or see something that sounds too good to be true, they should probably realize that it is and take appropriate precautions,” he says.

![Figure1](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/43/4/28/F1.medium.gif)

[Figure1](http://www.thenationshealth.org/content/43/4/28/F1)

Photo of label by Natalie McGill. Other art courtesy iStockphoto: woman shopping by Steve Debenport.

In some health situations, supplements do serve a purpose. Supplements are often recommended for older adults who need more vitamin D for immunity and bone health, vegetarians who need iron or pregnant women who need to consume more folic acid to protect against possible birth defects.

Unfortunately, many Americans are not getting necessary vitamins and minerals such as calcium, vitamin E and potassium, from the foods they eat. But a change in diet is recommended before turning to a supplement.

Rather than getting nutrients from a jar, FDA recommends eating a balanced, nutritious meal, limiting foods with high cholesterol and eating foods filled with a variety of vitamins and minerals.

## Talk to your health provider

But what rules should you follow if you do decide to take a supplement? Fabricant says the first thing to do is to tell your health care provider about the supplement and get her or his advice. Always make sure you tell your provider if you have any pre-existing medical conditions or if you are taking any medications. You don’t want to run the risk of supplements reacting badly with prescriptions you are taking.

The National Institutes of Health’s Office of Dietary Supplements says that before buying a supplement, you should ask yourself if the supplement provides any health benefits and how it would help you. You should also examine whether there are risks to taking the supplement, the dosage and how long and often you should be taking the supplement. If you don’t know the answer to any of these questions, you should ask your health provider.

Some supplements contain herbal ingredients that can be harmful. Herbs such as kava can be found in supplements and could damage your liver, according to NIH’s Office of Dietary Supplements.

“It could interact differently with other drugs,” Fabricant says. “Some supplements have a very profound physiological effect and some may have more of a pharmacological effect and you have to be cautious of that. I think those are the things people need to be aware of in the marketplace.”

If you have a bad reaction to a supplement, you should alert both your pharmacist and doctor. But don’t stop there. You should also report adverse reactions to the manufacturer and call FDA at 1-800-332-1088.

Finally, there is such a thing as too much of a good thing. It is possible to overdose on vitamins and harm your health, Fabricant says. An overdose of vitamin D, for example, could lead to kidney stones, he says.

## Always read supplement labels

Remember to carefully read supplement bottle labels and follow all safety instructions, Fabricant says.

Look out for words such as “no side effects” or claims that the supplement can cure or treat disease. These can be red flags that a product is unsafe, FDA says. Medical claims can only legitimately be made for drugs, not dietary supplements.

*   Copyright The Nation’s Health, American Public Health Association