Smart about SupplementsCristin Stokes, RDN, LNMUS Wellness Program

October 6th, 2016

Webinar DescriptionThe dietary supplement industry is a big, multi-billion dollar industry offering thousands of products. Many questions arise when it comes to dietary supplementation:

• Should I use supplements? • If so, what do I need? • What is safe? • What is effective? • Am I throwing my money away?

Dietary Supplement Defined

Dietary Supplement: Product intended for ingestion that contains a dietary ingredient intended to add further nutritional value to the diet. Usually in pill, powder, or liquid form.*

*definition from the US Food & Drug Administration

Dietary Ingredient Examples

Vitamins Vitamin D, Vitamin C, Folic Acid

Minerals Iron, Calcium, Magnesium

Herbs/Botanicals Garlic, Ginseng, Echinacea

Amino Acid BCAA, L-Glutamine

Other Fish Oil, Probiotics, Glucosamine

Supplement Industry Stats• Nearly $37 billion in revenue in 2014

• 1/6 of all purchases: Multivitamins

• Estimated 68% of Americans take some form of a supplement• Increases with age

• Over 65,000 dietary supplements on the market

• Reasons cited for taking supplements: • Maintain and improve health• Prevent chronic disease• Increase energy• Athletic performance• Weight loss

Disclaimers• Consult with your health care provider. Make sure your physician

and pharmacist are aware of all supplements you are taking.

• Age, gender, personal health history, race, dietary habits, health goals all affect need & dose of supplementation.

Do you need a supplement?

• Food first!

• Best way to get nutrients:

• Real, whole foods

• Synergy

• Tomato example

• Buffer theory

Do you need a supplement?

• Typical American diet low in:• Calcium• Potassium• Fiber• Magnesium• Vitamin A• Vitamin C• Vitamin E

• Most of us have some nutrient gaps.

• Nutrient deficiency disorders are rare.

Do you need a supplement?• Special populations

• Older adults

• Pregnant/nursing women

• Eating less than 1200 calories per day (women); 1500 calories per day (men)

• Drug/alcohol use

• Conditions that cause malabsorption

• Vegan/vegetarian

• Food allergies that limit entire food groups

• Diagnosed nutrient deficiency

Do supplements work?

• Supplements work…• If you’re deficient

• Example: Vitamin C

• More is not necessarily better• U-shape response curve• Zinc• SELECT study

Multivitamins (MVIs)• “Based on current research, it's not possible to recommend for or against

the use of multivitamins to stay healthier longer.” – National Institutes of Health (NIH)• Mixed research evidence• Difficult to control for other factors

• Nutrition insurance for a few cents per day• Basic, inexpensive brand is fine

• Avoid high-potency, mega-dose MVIs• ≤100% DV

• Take with a meal• Part time supplementation

Others to consider? • Vitamin D

• Fish Oil• High TG or heart disease

• Depression

• 1000 mg EPA + DHA combined

• Probiotics• Antibiotics

• Calcium• Osteoporosis or significant risk factors

• Bottom line: Consider individual needs, specific circumstances, and prioritize whole food sources

Supplements for Athletic Performance

• Amount, composition, and timing of food intake more critical for optimal performance than supplements

• US Olympic Team RDN

• Protein powder

• For muscle building & recovery

• Use for convenience, when whole food protein sources unavailable

• Whey protein for digestibility, cost

Supplements for Athletic Performance

• Branched Chain Amino Acids (BCAAs)

• Leucine, Isoleucine, Valine

• Supplementation unnecessary if sufficiently high protein intake

• Anti-fatigue effects seen in untrained/lightly trained athletes, or those with low protein intake

• Fasted state

• Recovery Carbohydrate + Protein Drink

• Cost vs Convenience

Supplements for Weight Loss

• Suppress appetite, increase metabolism, and/or reduce absorption of nutrients

• Most popular: Garcinia Cambogia, Hydroxycut, Orlistat, green tea extract, conjugated linoleic acid (CLA), or whatever Dr. Oz is getting paid to promote right now

• Unpleasant or dangerous potential side effects

• Very little to no research evidence

• Animal only, poorly designed, industry sponsored

• May modestly assist with weight loss short term

• Benefit not worth the risks!

Are supplements safe?• Supplement manufacturers do not have to prove safety and

effectiveness prior to marketing• Different than drugs

• FDA & Federal Trade Commission:

• Label and package insert must be truthful and not misleading

• "This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.“

• Legal action can be taken

• FDA Class I drug recalls (2004-2012): More than half were for dietary supplements

• i.e. Ephedra

Are supplements safe?

• Third party certifications• US Pharmacopeia

• ConsumerLab.com

• NSF International

• Ensures the product was properly manufactured, contains the ingredients listed, free of harmful contaminants• Does not ensure that the product is safe and/or effective!

General supplement safety rules• Avoid mega-doses

• Especially true for Vitamin A and Iron (unless directed by your physician)• ≤100% DV

• Do not substitute supplements for medicine in management of chronic disease

• Supplements most likely to be contaminated with pharmaceutical ingredients:

• Herbal remedies for weight loss and for sexual or athletic performance enhancement

• Fewer extra ingredients, the better

General supplement safety rules

• Natural does not necessarily mean safe• Example: Kava

•Drug-nutrient interactions can be serious• Vitamin K + Coumadin• St. John’s wort + antidepressants, birth control

•Inform your doctor about all supplements you are taking

Questions to ask before taking a supplement• What are the potential health benefits of this

dietary supplement product?• What are its potential benefits for me?• Does this product have any safety risks?• What is the proper dose to take?• How, when, and for how long should I take it?

Best Consumer Resources• Dietary Supplements Fact Sheets from the Office of Dietary

Supplements, National Institutes of Health• https://ods.od.nih.gov/factsheets/list-all/

• Dietary Supplement Label Database (NIH)

• Examine.com

• Pubmed.com

In Conclusion

• Food first!

• Supplements second…maybe

• If it sounds too good to be true, it probably is.

• More is not necessarily better.

Next Up…

• Next Webinar: November 15th

• Gym Bloopers. Common gym mistakes and how to correct them.

• Back on the Road!

• Live workshops in Billings, Miles City, Glendive, Dillon & Missoula.

• Check out registration links on montanamovesandmeals.com or MUS Wellness Facebook page. facebook.com/MUSwellness