Over-the-counter dietary supplements, nutraceuticals and herbal products are now all the rage. Dr. Pieter Cohen mentioned in an article published in the New England Journal of Medicine in 2012 that there are 55,000 products labelled and marketed as ‘dietary supplements’. And according to the Global Industry Analysts, the global nutraceutical market is projected to exceed US$243 billion by 2015.
Although these products are neither recommended nor prescribed by conventional physicians, consumers use them indiscriminately believing that they provide health benefits, preventing against disease. According to the US Center for Disease Control, “more than half of US adults take dietary supplements with 40% of men and women reporting they take a daily multivitamin.”
The aggressive advertising and inadequate labeling of these products put patients and health care providers into a dilemma.
WHAT ARE THE DIETARY SUPPLEMENTS?
This term includes a wide spectrum of products ranging from vitamins, minerals, trace elements, herbal products to sports nutrition products, functional foods, nutraceuticals and other related nutritional products that boost the nutritional value of food. This confusing definition may be due to the challenges in classifying these products due to the absence of a clear regulatory basis. Unlike prescribed drugs, the US Dietary Supplement Health and Education Act (DSHEA) of 1994 do not require testing of these products to prove safety and efficacy.
The term ‘Nutraceutical’ was coined by Stephen De Felice in 1989; it came from the words ‘nutrition’ and ‘pharmaceutical’ indicating its nutritive value and its pharmacological function.
- MICRONUTRIENTS (vitamins and minerals) needed in small amounts throughout life to carry out different physiological functions such as physical and mental development and supporting various metabolic processes.
- HERBAL PRODUCTS that apparently augment vitality and treat diseases. According to the World Health Organisation about 80% of people worldwide depend partly on herbs for their primary health care. Plants had been used long before recorded history for their curative value. Significantly, one fourth of drugs are derived from plants. But according to DSHEA herbs are not considered drugs and are included under the term ‘nutrient supplements’. Again, no regulation is available to assure safety and efficacy.
THE NUTRACEUTICAL DEBATE
One side of the argument is that the food we consume falls short of the essential nutrients our cells need to function normally. Karen Ansel, spokeswoman for the American Dietetic Association advises “taking a once daily multivitamin pill because diets are missing nutrients”. Whilst, the Linus Pauling Institute’s Micronutrient Information Center, suggests taking a multivitamin/mineral supplement with 100% of the Daily Value to maintain wellbeing. Also, The Harvard School of Public Health suggests a once daily multivitamin as a nutritional back-up.
On the other side; scientists, researchers and clinicians do not advise the regular use of nutritional supplements unless there is a documented deficiency or a definite clinical condition. They argue that the indistinctive use of supplements may be dangerous because these products contain bioactive substances that may lead to toxicity and side effects.
Even though there is no sufficient evidence to support a recommendation for or against the regular use of supplements in maintaining vitality or in the primary prevention of diseases, supplements should not be considered unnecessary or overrated as important adjuncts to vitality.
TO POP OR NOT TO POP?
Supplements are not a substitute for balanced food. The dietary advice makes it clear that nutritional demands should be met primarily through a balanced diet. In an ideal situation, balanced whole food offers greater nutritive value over supplements because it contains the whole spectrum of vitamins, micronutrients, minerals, trace elements and fibres needed for proper metabolism. It also contains other protective substances such as phytochemicals and anti-oxidants that protect against cancer, heart disease, hypertension and diabetes as well as oxidative damage.
The rationale behind the ‘food first’ approach is due to our cells processing nutrients in food differently than nutrients supplied separately because food contains other factors which have synergistic effects. Robert C. Peale, an agronomist, emphasises that ‘the best and most efficient pharmacy is within your own system.’
MEDICAL INDICATION FOR THE USE OF SUPPLEMENTS
Athletes, children, elderly people, vegetarians, men and women need nutrients differently. Supplements in optimal dosage may be required to target specific clinical condition and certain nutritive needs to support the innate capacity to heal. So, dosages should be adjusted accordingly.
Even though there is increasing scientific evidence supporting its role in treating or preventing disease by restoring, correcting or modifying physiological functions, supplements should not be consumed without paying attention to its level in the body and the specific clinical indication. Additionally, they should be consumed within the context of a balanced diet, healthy lifestyle and exercise and under the supervision of a healthcare provider.
When indicated, supplements can save lives. For example, a pregnant woman needs to get iron and folic acid from fortified foods or supplements; patients complaining from clinical conditions that influence absorption of nutrients need also to receive supplements.
Because these products are unregulated, it is always advisable to take herbal or nutrient supplements under the supervision of a healthcare provider to avoid the possibility of developing side effects or the possibility of masking the symptoms of a serious disease. According to Catherine Ulbricht, pharmacist at Massachusetts General Hospital, “’Natural’ does not equal ‘safe’, while herbal, dietary, and nutritional supplements may offer specific health benefits they can also have harmful and even life-threatening effects when combined with commonly used medications.”
The potential risk increases when mixing these products. Common example is the mixing of garlic with gingko and ginger leading to increased risk of significant bleeding; and mixing chromium, cinnamon and whey protein leading to decreased blood sugar.
HOW MUCH IS GOOD?
The holistic personalised medical model advocated by anti-ageing physicians does not advocate the “One dose fits all” rule and supplements are not an exception to this rule.
OUR DIET IS FAR FROM IDEAL
Despite the availability of food in sufficient amounts, our food is deficient in its nutritive value. Nutritional deficiencies remain undetected for years. The minor damage caused by its deficiency accumulates until it reaches a threshold leading finally to clinically overt disease.
Even though our food is deficient in many nutritive substances; this is not an excuse for taking supplements randomly. Laboratory assessment of nutrients has shown that individuals having similar lifestyle and similar food choices may have different insufficiencies or deficiencies.
Nowadays we have the tools to respect the biochemical identity that guides metabolism thanks to the advanced bio-technology that can show precisely whether we have deficiencies or not. The only solution is to measure the level of micronutrients in the body. The technology of assessing the level of micronutrients goes one step further by not only providing the actual levels of the different micronutrients but also by determining the functionality of these nutrients at the cellular level.
THEN THE DEBATE IS SOLVED…
There is a place for the use of dietary supplements or herbal products, but its use is not justified unless you are targeting a specific deficiency or clinical condition under the supervision of health care provider experienced in prescribing these products. Indications must be individualised and backed-up by clinical need and the dose must also be bespoke, tailored according to the need as demonstrated by the measurement.
So, the scientific approach emphasises that supplements should be administered under the supervision of health care providers and after thorough clinical evaluation that includes the determination of the level of the different nutrients in blood.
Dr. Fadi Alshaban: Board certified in Anti-Ageing Medicine and also in General Surgery, he worked as general surgeon in Jordan and Saudi Arabia and is now based at Dermalase Clinic in Dubai.