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The problems and controversy involving over-the-counter supplements & vitamins

Patients frequently ask me what I think about vitamins and nutritional supplements especially after this New York Times  article was printed: Vitamin Pills: A False Hope?

This article cited 3 studies:

1) The WHI (Women’s Health Initiative) one which was majorly flawed and this blurb points out why: Women’s Multivitamin Study Seriously Flawed, As Usual. It’s got a very anti-pharmaceutical slant but the flaws are so major the bias doesn’t take away from it I don’t think.

2) The 15, 000 male physician and vitamin E, C and multi-vitamin vs cancer study which used synthetic vitamin E and C and a multi in tablet form. The body responds much better to natural forms of vitamin E vs synthetics, and tablet forms of vitamins are potentially less likely to be absorbed properly vs capsule or liquid form especially if your digestion isn’t functioning optimally.

3) The 35,000 men and vitamin E and selenium vs prostate problems—again, the study used synthetic vitamin E, and the study itself acknowledged it chose to use a less active form of selenium.

Now the rest of the article does make some good points…

Yes vitamins and nutrients from whole foods are always better than singling out a single constituent and concentrating it into a supplement—fruits and veggies nowadays however are not as nutritious as they used to be since large scale non-organic farms rarely rotate crops anymore and the soil is depleted in nutrients. Plus the average diet is nutritionally defunct. Even if we think our diet is pretty good, how many of us are eating nutrient-dense dark leafy greens twice a day on a daily basis. Very few restaurants serve dark leafy greens like kale, collard, mustard greens with their entrees. Some people still count potatoes and ketchup as legitimate servings of vegetables.

And yes taking excessive amounts of antioxidants can be harmful because it’s always a balance game between antioxidants and free radicals. Too many antioxidants will turn into pro-oxidants which are also known as free radicals but considering how much toxicity there is from air/water pollution, plastic bottles, store receipts, gas pumps, soaps/detergents, shower curtains, perfumes/colognes, pesticides, air fresheners, paint, carpeting, charred meats, food additives/preservatives and a million other things you probably never think of—wouldn’t you gamble that you could use a little help with some antioxidants to help clear away some of the free radicals all that toxicity causes?

Lastly, huge studies like this are always lacking in value to me because they assume everyone in the study is the same. Vitamins and nutritional supplements can be very effective if the quality of the product is good, the vitamins are as close to natural as possible and the regimen is tailored to the individual but this is not conducive to massive studies. Tossing out a poor quality supplement at moderate doses to tens of thousands of people expecting great results is ridiculous.

For me, the issue with over-the-counter supplements is that they aren’t regulated so any sort of quality control is strictly voluntary and most companies never do it. It is important to find a company that does some sort of third party independent lab testing that shows that the vitamin they are selling is first of all a) actually in the product and b) at the correct amount. They should also be screening for contaminants.

There are a few ways to figure out what companies are good or not and some take effort.  You can call the company and ask if they do a slew of quality control via third party independent lab testing. Or you can subscribe to Consumer Lab, but they won’t have every product and some purists feel their standards aren’t nearly strict enough. Or you can get your supplements through a professional company that does the voluntary third party testing for quality control that every company with any sort of ethics should be doing. The one problem with professional companies is that they typically will only sell to professionals (MD’s, ND’s). So you might have to get those supplements through a doctor.

When looking for a multi-vitamin, capsule-form is probably more effective since most people don’t digest tablets very well. Unless you had your ferritin levels checked and are anemic, opt for one without iron. Minerals in citrate form are more highly absorbable than carbonate (i.e. calcium citrate vs. calcium carbonate from oyster shells).  Capsules hold less than tablets so if you get a multi-vitamin in capsule form you will mostly likely have to take more than one a day. For me, I would rather the inconvenience of taking multiple capsules of a more expensive supplement which I knew for a fact had what it is supposed to contain, than one tablet of artificial coloring and who knows what else (lead contamination in vitamins* is a lot more common than you would think).

*A vitamin a day may do more harm than good: ConsumerLab.com report finds unexpected nutrient levels, contamination

Another great article that shows the importance of third party testing for quality control when it comes to supplements:

Beyond Balco: The untold dietary-supplement scandal

To find quality supplements you can use Fullscript. Both buttons below provide 20% off everything and access to supplement companies that do good quality control.