Chronic illness sufferers understand the desperation that can occur when no relief is found through conventional treatment. It seems like doctors either can't figure out what's wrong, or when they prescribe medication, they're just guessing. So what happens when the patient starts medicating themselves with supplements? In my opinion, using supplements to treat chronic illness doesn't work.
Reasons behind my perspective
I want to explain my own background quickly, so you understand where I'm coming from with this article. I started working in healthcare as a teenager. I have a Bachelor's of Science degree in Alternative Medicine, but I have worked primarily in conventional medicine.
I had two jobs working in alternative/complementary medicine offices. The first was for a chiropractor who also recommended and sold supplements and other products as part of her practice. She was always studying and looking for new ways to help her patients; I felt she was a good person who truly believed in what she was doing and wanted to help people. Because of her (and later my degree), I was open to using alternative medicine for my own healthcare needs.
My second job "holistic medicine" job was at the office of a man who designated himself a homeopath. Despite this, I never saw him prescribe or administer any homeopathic remedies. He was, however, a big fan of using the same treatment on everyone, regardless of their diagnosis. People who came to him often felt they had no other options. I left after only a few months, disheartened by both his unscrupulous behavior and his lack of success.
Otherwise, I've worked in reasonably large, reputable clinics and hospitals that focused almost entirely on conventional care. Supplements were used when they had proven results, or as part of carefully controlled clinical trials.
Conventional medicine is not without its uncaring, dishonest swindlers either. Everyone must be their own advocate these days and carefully review both the recommendations and the doctors who provide them.
Five-plus years in clinical research taught me a lot about evaluating the safety and efficacy of drugs and supplements alike, and now I'd like to share that information with you.
Current regulations on supplements, natural products, and vitamins in the United States
The first thing you need to understand is that naturally-occurring substances cannot be patented in their natural form. For example, nobody can come along, claim turmeric, and control all use and distribution of it as a tool for health.
That means that anyone can manufacture and sell turmeric supplements. However, companies that do so have to be careful about what they say about turmeric, and not make any false, misleading, or unsubstantiated claims.
The Dietary Supplement Health and Education Act of 1994 (DSHEA)1 was created to define the meaning of "dietary supplement," which includes vitamins, minerals, herbs, extracts, and more. The law also provides regulations around the manufacture, sale, and marketing of supplements.
Before this, supplements were lumped with foods under the law, which meant that a jar of the spice turmeric and a pill labeled as turmeric were treated the same. The government recognized (after a lot of safety problems and complaints) that further regulation was needed. Now a jar of spice you buy on the baking aisle is food, and the pill is a dietary supplement.
A lot of supplement manufacturers will complain about the restrictions put upon them. But the fact is, the regulations of supplements are nowhere near as strict as those for prescription drugs.
The difference comes to this: prescription drugs must undergo rigorous testing and evaluation, and the results of those tests (clinical research) must be reviewed by the FDA before a drug can be approved to reach the market.
Because the FDA does not apply these constraints to supplements, their manufacturers are not allowed to make any statements that can be construed as medical in nature. Pick up just about any supplement bottle in the U.S., and you will find this disclaimer on the label:
"This statement has not been evaluated by the FDA. This product is not intended to diagnose, treat, cure, or prevent any disease."
This phrase is required by law because the FDA does not evaluate the safety of supplements, nor any claims that the manufacturer makes regarding their efficacy.
Read that again: the FDA does not evaluate the safety or efficacy of supplements before they reach the market. It will take consumer complaints for the government to find out that a supplement is dangerous, and then perform any action to have the product or its ingredients banned. Until then, the communication between a supplement company and the FDA is sparse in comparison to the FDA and drug companies.
Furthermore, supplement manufacturers are responsible for their own safety testing and can basically assert whatever they want regarding the ingredients in a supplement. Without independent testing or oversight, how are we to know what's really in those supplements?
How to find out what's in the supplement before you buy it
Even though it isn't required, some manufacturers want to assure their customers that they are providing something of quality. So they voluntarily submit to third-party testing, which allows them to have a label on their packaging verifying that testing was done.
In the States, we have a few reputable labs that test for purity and lack of contamination. Three of them are the U.S. Pharmacopeia,2 NSF International,3 and Consumer Lab.4
However, as I mentioned, this is voluntary. Not everyone goes through the testing because it's an extra expense. There are far more companies out there that don't submit to testing. When we use supplements from manufacturers that don't use third-party labs, we risk either wasting our money or exposing our bodies to contaminated products.
Will talking to your doctor about supplements help?
Unfortunately, most doctors know very little about supplements, and nutrition in general. The American Journal of Clinical Nutrition reported in 20065 that only 40 schools (out of 106 medical schools surveyed) provided 25 hours of nutrition education to medical school students. 25 hours is the minimum recommended by the National Academy of Sciences. The average was only 23.9 hours of instruction, and the majority of schools didn't even offer a separate course in nutrition as part of their curricula.
A couple of years ago, I did an informal survey of my own among some of my coworkers the hospital I worked at. They were all taking a "gap year" after graduating pre-med to work on their medical school applications and garner letters of recommendation from the prestigious physicians we worked with. They were applying (and being accepted to) some of the best medical schools in the country--Stanford, Harvard, Berkeley, UCLA, Duke--all the top names you can think of.
I asked them two things:
- How many nutrition classes were required as part of your pre-med degree?
- How much nutrition education is listed as part of the medical degree you will obtain?
The answer to both questions was either "very little" or "none." So not much has changed since 2006.
This means physicians must learn about nutrition on their own, but when would they have the time? Most of them can't even keep up with current information about their specialty. I read one estimate from the New England Journal of Medicine that the amount of medical knowledge available will double every 73 days by the end of this decade.6
Sadly, your average dietitian or nutritionist is not going to be much help either. While they (in theory) should have the knowledge to explain how a vitamin, mineral, or herb will affect your body, there are so many companies out there that it's unlikely they will be able to attest to the quality of a particular brand. Also, many companies out there combine ingredients, supposedly to increase effectiveness or address a different nutritional need. If this combination doesn't have extensive, published information, it would be difficult for anyone to say whether it's something work taking. Many supplements out there have undergone limited research into their usefulness before coming to the market.
When dietary supplements are as potent as they say, there are more complications to worry about
Not only is regulation poor, but trouble can happen even when a company is delivering what it promises as far as ingredients and lack of contamination. Dietary supplements can interact with food and prescription drugs. There is no way a company can fit every possible effect of a supplement on its packaging.
Not only that, but the FDA only requires a company to state the amount of each ingredient. That doesn't mean that any vitamin, mineral or herb contained within a product is a safe amount.
Supplements commonly list vitamins that are included at 1000% or more of the Recommended Daily Allowance (RDA). Contrary to popular belief, more is not always better. And taking in excess doesn't always result in the extra amount being safely excreted from your system. For example, high doses of Vitamin C can cause a headache, flushing, and gastrointestinal upset, including cramps, nausea, vomiting, and diarrhea.
And for some rare ingredients or products that are new to the market, there might not be any data about how much is safe, or whether it’s effective at that dose.
There’s also the issue that some ingredients cancel each other out. For example, iron can block the absorption of calcium, so taking a multivitamin that has both (or the two vitamins separately, taken at the same time) makes you lose out on the calcium.
The parts aren't as effective as the whole
Food or nutritional synergy explains why it's better to eat whole foods in their natural form rather than taking a supplement.7 An unprocessed food has many nutrients, which work together to create a nutritionally valuable substance. When you choose one part of that food and consume it on its own, it does not always work as well because it needs those other nutrients.
So (for example), the effectiveness of eating a tomato is more significant than taking a lycopene supplement, because the sum of the tomato is greater than its parts.
The bottom line about supplementation
Dietary supplements such as vitamins, minerals, and herbs should be included in the diet only after careful consideration and research of any product. Here are some additional tips:
- Treat any supplement just as you would a prescription medication. Check with your doctor before starting it and report any changes to the dose. This is especially important if you will be having a medical procedure (surgery).
- Only use supplements that were manufactured in your own country or a country where you are familiar with their supplement laws and feel that the product is safe.
- Stick to products that have been tested by a reputable, independent lab for potency and purity.
- If you experience side effects from a supplement, stop taking it immediately and report your symptoms to the FDA's Office of Dietary Supplements.8 See your physician as needed.
- If you need to know more about uses, side effects, or drug interactions of herbs, choose a reliable database such as the one created by the Memorial Sloan Kettering Cancer Center.9
- Because most supplements Evaluate the cost of whatever supplement you are buying. Ask yourself, "If this doesn't help (or makes things worse), am I OK with throwing this money away?"
- Consider whether if there's a more direct way to get healthier. If you're worried that you lack enough of a particular nutrient, has this been verified by tests? Have you spoken to a nutrition expert about improving your diet? Instead of taking that magnesium pill, could you just eat magnesium-containing foods instead?
Your good health is essential, and as a chronic illness sufferer, there is no reason to throw away good money or risk further complications to your condition. Be smart about what you put in your body and do your homework, so you don't end up borrowing trouble.
1. https://ods.od.nih.gov/About/DSHEA_Wording.aspx
2. http://www.usp.org/
3. http://www.nsf.org/
4. https://www.consumerlab.com/
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2430660/
6. https://knowledgeplus.nejm.org/blog/staying-current-in-medicine-advice-for-new-doctors/
7. https://www.webmd.com/food-recipes/features/food-synergy-nutrients-that-work-better-together#1
8. https://ods.od.nih.gov/
9. https://www.mskcc.org/cancer-care/integrative-medicine/herbs/turmeric