Mini-Med 2019 #2
Supplements
Dr. Stephanie Taylor
Supplements are an addition that adds to or compliments something when added. For our purposes, we will discuss vitamins, minerals and herbal supplements.
Why would I take a supplement?
If our food supply was perfect, we would not need a supplement, but even in the best of fields, conditions are neither consistent nor ideal. Humans need to obtain many essential nutrients from food or supplements. A classic example is Vitamin C, which is essential for humans, but not other mammals because they generate their own vitamin C.
For us, essential nutrients are: essential micro-nutrients (vitamins), essential minerals, essential amino acids and essential fatty acids. Vitamin tablets became available in the 1950’s and were recommended to prevent vitamin deficiency diseases. A few examples are below:
| B1-thiamine | Beriberi |
| B3- niacin | Pellagra |
| B9-folates | Anemia, fetal neural tube defects |
| B12-cyanocobalamin | Pernicious Anemia |
| D-cholecalciferol | Rickets |
| C-ascorbic acid | Scurvy |
How are supplements regulated?
In the USA, supplements are regulated under the Dietary Supplement Health and Education Act of 1994. Adverse events are reported to the FDA under their voluntary reporting system. In 2007, Good Manufacturing Practices (GMP) were codified to regulate production and quality control standards. The current designation is cGMP (current GMP). Standards for vitamins are set by the United States Pharmacopeia (USP).
The manufacturer pays for the certification, and the cost varies by agency. The range is $3,000 to $8,000 per product. There may be an additional periodic audit fee of $4,000 to $15,000.
In addition to these certifying organizations, several producers have created their own internal quality management systems. Emerson Ecologics, a major distributor of supplements, certifies producers at the gold or silver levels. Silver requires demonstrated cGMP, regular audits, analysis certificates for raw materials and finished products. Raw product is tested for identity, microbiologicals, heavy metals, pesticides, aflatoxins, melamine and residual solvents. Potency testing is required for finished product. The Gold level includes all this in addition to analytic testing on each batch of raw material/finished product, a shelf life stability program, active ingredients present in sufficient quantity and Total Quality (R&D, sustainable environmental practices, clinical trials, good business practices).
Some supplements are sold with quality seals and here are four of the most common:
| Quality Seal | ConsumerLab.com | NSF International | USP US Pharmacopeia | UL |
| Source of test samples | Purchased | Provided by manufacturer | Provided by manufacturer | Provided by manufacturer |
| Testing frequency | Annually | Once per year both provided and purchased in stores | One to six times a year samples purchased in stores | Twice per year using samples purchased in stores |
| Products that are not tested | Products known to be unsafe | Products for weight loss or sexual enhancement | Products for weight loss, sports or sexual enhancement | Products containing ingredients known to be unsafe or not recognized as supplements by the FDA |
What supplements do I really need if I have a good diet?
Vitamin D- You can get Vitamin D from the sun, but we are too far north for this to be totally efficient. Wearing hats and sunscreen to prevent skin cancers decreases sun exposure Vitamin D production. Consequently, Vitamin D is the vitamin that you probably need to take. The RDA is 800 IU (20 mcg). The Institute of Medicine states the upper limit of safe use is 4,000 IU (100 mcg) daily. Remember you can overdose on the fat-soluble vitamins-Vit A, E and D.
Maybe “Activated” B Vitamins- The form of folate, B12 and pyridoxine in most multis need to be activated by MTHFR. Not every one does this well, so some will need the activated forms (methyl-folate, methy-B12, and pyridoxal 5’phosphate) in their multi.
Essential Fatty Acids- Commonly available in fish oil, and to a lesser degree in flax seed oil.
Essential amino acids-Vegetarians can get their essential aminos with food combining. Classically beans and corn, as deficiencies on one food are complimented by their presence in another.
Clearly, there is a host of other supplements to discuss. Resveratrol, turmeric, echinacea……….
Resources:
ConsumerLab.com-quality ratings of a wide range of supplements, and medicinal foods. The latter is the technical term for chocolate. Annual subscription is about $42.00.
American Botanical Council- reliable source of herbal information and the home of the Botanical Adulterants Monitor. http://cms.herbalgram.org/press/2014/Botanical_Adulterants_Monitor.html