Supplements are a $ 30 billion racket: what the experts actually recommend.

Let's separate nutrients from illusions and deadly deceptions.

More than 90,000 vitamins and dietary supplements are sold in the United States. They are available in the form of tablets, powders, beverages and bars. All of them promise us improved versions of oneself - stronger bones, thinner waist, more healthy muscles, more joyful intestines, improved sexuality and brain work. They predict a departure from diseases and from aging.

And in general, we believe them. The volume of dietary supplements in the United States is estimated at $ 30 billion. Recent studies show that 52% of Americans take at least one dietary supplement - and 10% take four or more of them. But do we need this? Are we really getting healthier, smarter, stronger, better thanks to these daily doses?
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The answer is most likely not. Most of the dietary supplements have no or almost no data proving their effectiveness, not to mention safety. Often they are promoted on the basis of scanty research carried out on rodents and in Petri dishes or on small samples of people. The industry is filled with hype and wishful thinking — even the evidence for the multivitamins is not particularly convincing. And there are generally deadly deceptions. In addition, almost no one follows the industry.

The Food and Drug Administration (FDA) has no authority to investigate dietary supplements for safety and efficacy before they enter the market. This means that the contents of grocery stores, pharmacies and special shops of bottles and jars lining up on the shelves may not even correspond to the declared composition. They may differ drastically from batch to batch. They may contain hidden, forbidden ingredients, such as amphetamines. Or even harmful toxins like lead and cadmium.

And even after these potentially dangerous drugs enter the market, the FDA lacks the capacity to keep up with all the products and claims about their action, and to throw out unscrupulous market participants. And they are hard to blame. Doctors also do not have time for 90,000 products.

Two experts from Harvard decided to help this trouble and made a small guide to effective dietary supplements. Experts in preventive medicine Joann Manson and Shari Bassuk wrote out which supplements are effective and when. This list is rather short. This is what they and other experts recommend, along with a fast course on orienteering in the world of dietary supplements.

What to take

First, a couple emphasizes, the best way to get vitamins and minerals is to follow a healthy diet. Trace elements are often better absorbed by the body when taken with food, and there they are presented in optimal proportions compared to a bunch of concentrated substances in a tablet.

For the health of people of adult and elderly

Vitamin B ₁₂ - if you are over 50. At this age, the body can no longer cope with the processing of protein-related forms of vitamin B ₁₂ . Supplements can help fill the deficiency to the recommended daily dose of 2.4 mg per day.

Vitamin D - with age, our skin and kidneys produce less and less efficiently and process, respectively, vitamin D. For some people, supplemental vitamin D can help get to the recommended daily dose of 600 IU ( international units ) for adults under 70 and 800 IU for people older Some health organizations recommend larger doses, up to 2000 IU per day - but this is a moot point. If you exceed the content of vitamin D in the blood, it can become toxic, cause nausea, weakness and constipation.

Calcium is possible. Calcium absorption deteriorates with age. Today recommended daily doses of calcium are: 1000 mg for men from 51 to 70, 1200 mg for women from 51 to 70, and for all adults over 70 years of age. A recent analysis suggests that moderate doses (up to 1000 mg per day) may reduce the risk of bone fractures and bone loss in men and women after menopause from the age of 65. But an excess of calcium can also cause constipation. An excess of calcium derived from dietary supplements may increase the risk of kidney stones .

In general, multivitamins are not recommended for healthy people. There is no conclusive evidence of their usefulness. A 2013 analysis of 27 trials involving more than 400,000 people concluded that no clear evidence was obtained that multivitamins reduce the risks of cardiovascular diseases, cancer or mortality in general. A study that monitored the health of 6,000 men for 12 years found that they did not protect or improve cognitive abilities. One large, randomized, double-blind, placebo study in the United States found that some people taking vitamins showed a slight decrease in the risk of cancer (in particular, people diagnosed with vitamin deficiencies and previously diagnosed "cancer"). But this study must be repeated with the involvement of women and with an increase in the reference data on nutrition.

For people with diseases

Various medications, dietary restrictions and special conditions can affect the intake and absorption of nutrients. For example, people who do not treat celiac disease can receive less iron, magnesium, zinc, vitamins of group B, vitamin D. Long-term use of proton pump inhibitors , for example, omeprazole , which inhibits the secretion of gastric acid, can interfere with the absorption of vitamin B12, calcium and magnesium. People taking metformin for the treatment of type II diabetes may interfere with the absorption of vitamin B12, although the evidence for this is contradictory. Some patients with age - related macular degeneration can be helped by special supplements with vitamins C, E, beta-carotene, zinc with copper - according to one large-scale randomized study with a control group.

For pregnant

“Evidence is clear,” write Manson and Basuk, “that women who are preparing for pregnancy and become pregnant should receive an adequate amount of folic acid (from 0.4 to 0.8 mg per day). Judging from the epidemiological data, this substance helps to prevent defects in the neural tube , the germ of the brain and the spinal cord in embryos. But it is not yet clear how folic acid affects this. Researchers have noted that it is involved in a complex network of metabolic reactions associated with neural tube growth.

And although folic acid is found in many foods, it is one of several nutrients that is better absorbed in synthetic form, in dietary supplements and food with an increase in its quantity.

Several small studies have shown that calcium supplementation during pregnancy can reduce the risk of hypertension and preeclampsia . But in order to support this information it is necessary to conduct larger studies.

About the benefits of taking omega-3 polyunsaturated fatty acids, vitamin D and multivitamins during pregnancy for the health of mother and child received so far too little data.

For healthy children and babies

Like healthy people, healthy children do not need multivitamins, and they need to avoid high doses of certain nutrients. Some studies suggest that omega-3 fatty acids may be beneficial in treating hyperactivity and autism syndrome , but there is not enough data for definitive conclusions.

The American Academy of Pediatrics and the Centers for Disease Prevention and Control recommend giving vitamin D supplements to infants during breastfeeding during the breastfeeding period. The Academy also recommends iron supplements for them. In breast milk, these nutrients are not enough. Children who eat special foods usually get enough of these substances.

What not to take

The three categories of supplements that cause the most dissatisfaction on the part of experts and the FDA are supplements that help lose weight, restore sexual function and increase results in sports and muscles. Among them there are the most problems with dangerous, unmarked or simply illegal ingredients.

For example, in 2014, the FDA checked 21 “natural” dietary supplements, some of which claimed to help in weight loss, and found nine dietary supplements containing artificial compounds similar to amphetamines. Also last year, the FDA announced the recall of dietary supplements, declared as a means to improve muscle function, after the discovery of anabolic steroids in their composition.

The FDA even has a general warning about the risks of bodybuilding products. “Many of these products are not dietary supplements at all; these are illicitly sold and not approved drugs, ”said Kara Welch, chief advisor to the dietary supplements department at the FDA.

In a 2015 study , scientists from the Centers for Disease Control and Prevention (CDC) estimated that dietary supplements cause 23,000 visits to the emergency room in the United States annually. Excluding cases of the use of dietary supplements by children without parental supervision, the scientists deduced that the most dangerous supplements were supplements for weight loss and toning.

But less suspicious supplements can also carry risks. Due to the lack of approval from the FDA before entering the market and the content of herbal ingredients and imported ingredients in many additives, quality control can be a problem. In particular, dietary supplements have encountered a problem with contamination with heavy metals - for example, additives with a high lead content are constantly encountered.

Rest

Thousands of other formulations, tablets, extracts, elixirs, and blends supposedly beneficial to health are in the interval between proven vitamins and muddy weight loss pills. For most of them, there is very little data proving their safety or confirming benefit. Many companies give evidence of inconclusive experiments on mice, rats, cell cultures, and experiments on a small number of people.

It may take decades for the data to confirm health claims. But what if these statements prove true? Dietary supplements for billions of dollars are sold by hope - and an unjustified attitude like "oh well, it will not be worse."

No, but, in fact, what if the statements prove true?

A perfect example is turmeric, and curry seasoning ingredients. For years, dietary supplements manufacturers and some researchers have stated that turmeric helps from everything from inflammation and arthritis to cancer and Alzheimer's disease.

Her potential neurocognitive benefit has been the subject of several studies. Epidemiological data suggested that Indians who consume curry are less likely to have Alzheimer's disease , and the cognitive abilities of their elderly are, on average, better . Recently, a small randomized, double-blind study and control group found that the bioavailable form of one substance contained in curcumin , curcumin , may slightly improve verbal memory and attention in two of seven tests. The test was carried out for 18 months, and 40 elderly people who did not suffer from dementia participated in it. The results were published in The American Journal of Geriatric Psychiatry.

As Dr. Yuko Haar told us, these statistics are “minimally significant”. Hara is the current director of the team for preventing aging and Alzheimer's disease in the Alzheimer's Drug Search Fund. The team seeks to critically evaluate the latest Alzheimer's treatment data in order to provide patients with the fastest and safest treatment possible.

In general, Hara said that this study found the same thing that other small studies found - curcumin can slightly improve memory. But, as she notes, this is another small study, and "the statistics are not so reliable." It must be repeated with a large number of subjects to check whether the effect will continue. There was not enough data for the fund to raise the rating of curcumin among potentially useful substances.

Dr. John Ringman, a clinical neurologist at the University of Southern California, generally agrees with Hara. “The study inspires hope,” he told us via e-mail, but also noted the small size and small effects. "The real clinical impact of this improvement is unclear."

In 2012, Ringman was the lead author of a similar small study that studied the cognitive effects of curcumin. Unlike the new study, they found no advantage. But, he says that “despite this, I take curcumin every day, because we found that, depending on the size of the dose, we recorded a decrease in the number of complaints of pain in the joints. Therefore, I accept it. ”

Other preliminary data and small studies suggest that curcumin may help with knee pain associated with osteoarthritis . But the results are not final, and besides, there are certain doubts about his safety, Hara said. Curcumin may interfere with medications, such as aspirin, other painkillers, and diabetes medications.

How to choose?

Check with your doctor about health and diet. If you decide to take dietary supplements, backed up by dubious or insufficient data, make sure that your doctor knows about it and talk with you about safety. Many dietary supplements, like curcumin, can interfere with the work of other drugs and even affect the results of laboratory tests. For example, large doses of biotin (vitamin B7), which some take to improve the health of their skin, hair and nails, can distort the results of tests associated with heart attacks.

To make sure that the selected vitamins and dietary supplements are not contaminated with toxins and do not contain substances in excess of those listed, choose a dietary supplement that has been tested by independent companies (ConsumerLab.com, US Pharmacopeia, NSF International or UL). This is not a panacea, but experts say it is better than nothing. There are also companies, for example, LabDoor, verifying dietary supplements for label compliance with content.

For information on common dietary supplements, you can use the useful list from the Department of biological additives of the National Institute of Health.