Vitamins used to be simple: Gemini astronauts orbiting Earth drank Tang for vitamin C and paved the way to the moon. Old people with iron-poor blood took Geritol and danced on TV with Lawrence Welk. Lucy chugged Vitameatavegamin and created comic gold. Mom swallowed a little round multivitamin and arose at four every morning to squirt a pediatrician-recommended elixir into my orange juice that tasted like the black lagoon.
All of us — Lucy and the astronauts, Mom and I — were pretty healthy. So of course, it was the vitamins. Simple.
Vitamins become supplements
Then vitamins became dietary supplements. Options exploded. Self-proclaimed experts tripped over one another recommending this pill or that powder to achieve all kinds of benefits, providing consumers more than the recommended daily allowance of confusion.
Congress defined the term “dietary supplement” in 1994 as “a product taken by mouth that contains a dietary ingredient intended to supplement the diet.” (Dietary Supplement Health and Education Act)
Not exactly “Rose is a rose is a rose is a rose,” but close.
The Food and Drug Administration is clearer, if ickier. Dietary ingredients “may include: vitamins, minerals, herbs or other botanicals, amino acids, and substances such as enzymes, organ tissues, glandulars, and metabolites. Dietary supplements can also be extracts or concentrates, and may be found in many forms such as tablets, capsules, softgels, gelcaps, liquids, or powders.”
“Organ tissues” and “glandulars”?
Judging by shelf space, confusion isn’t deterring consumers from ingesting ever more supplements. By 2006, more than half of U.S. adults used at least one. By 2010, Americans spent $28 billion a year on dietary supplements.
Why people take supplements was the subject of a three-year study completed in 2010 of almost 12,000 adults. As reported by JAMA Internal Medicine in March 2013, the National Health and Nutrition Examination Survey found that 78 percent of the participants took vitamins to maintain or improve their health.
Most respondents were not motivated by doctors’ advice: More than three-quarters of supplements were consumed without a health provider’s recommendation. Those using supplements tended to describe themselves as being in very good or excellent health, non-smokers, moderate alcohol users, and regular exercisers. Is supplement use a cause or result of these admirable traits?
FDA: Supplements are foods, not drugs
Given that people take them to increase health and avoid illness, it would be easy — but wrong — to think of supplements as medicine. The FDA website says that, “unlike drugs, supplements are not intended to treat, diagnose, prevent, or cure diseases.” Exactly why people take them.
Though the industry is supervised by the FDA, supplements receive much less government oversight than pharmaceuticals. The FDA does not review or approve supplements prior to their being marketed, and it doesn’t authorize their production or sale. Manufacturers do not have to prove a supplement’s effectiveness to the FDA unless it contains a new ingredient or the agency initiates an investigation.
‘Safe’ does not mean ‘effective’
FDA investigations are only triggered by public health emergencies, reports of injury or illness, or if a supplement is suspected of being unsafe or fraudulent. And if it does investigate, the FDA’s objective is to ascertain safety, not effectiveness. Consumers who want information on supplements’ efficacy must turn to product manufacturers or independent laboratories.
Which leaves most of us in the pharmacy, gaping at shelves of unknown preparations for unimagined deficiencies. Where did vitamin K come from? What the heck is CoQ10? Visiting the supplement aisle can induce high school chemistry flashbacks — which don’t make for good decisions. Even consumers who know which supplement they want still have to decide on brand and dosage, and hope the pills are smaller than garden pebbles.
Even reliable sources conflict
For every study that says a supplement is worthwhile, two more disagree, and even reliable sources require close reading. For example, in December, the British medical journal The Lancet reported on a randomized, controlled study of vitamin D in fighting non-skeletal diseases. While the study found no proof that vitamin D levels affected cardiovascular disease or cancer, it did not explore the nutrient’s role in bone health. Yet that is a common reason physicians recommend vitamin D, one that has a stronger body of evidence than the non-skeletal hunch.
So what is the average person to do? Try to separate science from magical thinking, and valid concerns from fear mongering? People want to do the right thing. They worry about stopping something that seems to be doing good — or at least, not hurting. They read, listen, and stock up, then the common wisdom changes. Maybe they become so confused that they surrender and take nothing.
That’s just what the Annals of Internal Medicine would advise.
Annals of Internal Medicine: Fuhggedaboutit
In its December 17, 2013, editorial, “Enough is Enough: Stop Wasting Money on Vitamin and Mineral Supplements,” the medical journal does not mince words:
“Despite sobering evidence of no benefit or possible harm, use of multivitamin supplements increased among U.S. adults … sales of multivitamins and other supplements have not been affected by major studies with null results …The message is simple: Most supplements do not prevent chronic disease or death, their use is not justified, and they should be avoided. This message is especially true for the general population with no clear evidence of micronutrient deficiencies, who represent most supplement users in the United States and in other countries.”
Finally a clear answer, though not one supplement believers will likely swallow. Wherever we stand on dietary supplements, most of us would agree with the Academy of Nutrition and Dietetics that a balanced diet rich in nutrients is the surest way to maintain health and reduce the risk of disease. The longevity trinity — balanced diet, healthy lifestyle, and good genes — trumps everything else. Not easy, but simple.