Nutritional & Dietary Supplements: A Word of Caution

For many, summer is a time to re-commit to health and fitness. Unfortunately, for some this will include the use of over-the-counter (OTC) dietary or nutritional supplements.

As the cliché says, ‘you are what you eat.’ Our bodies require vitamins, minerals, proteins, and other essential nutrients. Nutritional science has made enormous strides understanding how deficits (and excess) of these nutrients can impair the body and cause pathology. While an interest in nutrition and sports science should be encouraged, we must also exercise caution (and a healthy degree of scepticism) when it comes to the use of OTC supplements.

The trap that many fall prey to is thinking that because a beneficial effect occurs, it must be due to the supplement, instead of other changes. Let’s say you decide to improve your health-lose fat, get stronger, improve physical fitness etc. This usually entails a major change in health habits: you go to the gym more often, have more rigorous workouts, cut alcohol, improve diet… and buy supplements. After some positive changes are realised, you mistakenly attribute the gains (at least in part) to the supplements, instead of your fitness and lifestyle changes. It’s likely the supplements had little, if any, effect and may have even been harmful.

Caution Advised!
Supplements are a multi-billion dollar industry, and use is common. But there is little evidence regarding the biologic effects of many of these substances for use as health supplements. In most cases, what is required (in addition to a comprehensive fitness programme) is simply a well-rounded, nutritional diet.

Don’t necessarily accept that the use of words on supplement labels like ‘healthy and natural’ translate into ‘safe and effective.’ The fact is that some of these products can cause you harm. For example, most are familiar with ephedra alkaloids, marketed for weight loss or athletic performance enhancement. After many unfortunate outcomes, ephedra was implicated in cases of dangerously high blood pressure, disturbance in heart rhythm, heart attacks, strokes, seizures, and psychiatric symptoms. Other supplement constituents have been reported to cause liver toxicity, cirrhosis, kidney toxicity or genitourinary cancers (Aristolochia, for example). Some supplements have had major purity problems – contaminated with heavy metals, prescription and even illicit drugs.

Regulators warn about dangerous products marketed as supplements. In the US the Food and Drug Administration has found nearly 300 fraudulent products (promoted principally for weight loss, muscle building, and sexual enhancement), with many reports of harmful health effects. While in many cases ingestion of supplements simply gives the user expensive urine, these products can be dangerous. The harm may come from the substances themselves, from unscrupulous consumers taking ‘mega-doses’, or from drug interaction with prescribed medication.

Although many of these substances can have drug-like effects, they are regulated as foods, rather than drugs. The take home message is that these products are not subject to the same regulatory scrutiny as medications, and just because you see a supplement bottle on the shelf does not mean it is safe or effective.

Military Use
Military use is common. By one report, more than half of US Army Soldiers used supplements at least once per week. In the UK a recent paper in the RAMC Journal noted that almost half of those surveyed during an Op TELIC deployment admitted to a history of supplement use, and almost one-third were current users. The most common reasons for use cited included ‘increase muscle bulk,’ or to aid training and recovery. Alarmingly, a small subset admitted to current use of anabolic steroids. Afghanistan was worse: a similar study noted more than half (56.3%) admitted to a history of use with 40.2% actively using. Case reports include soldiers treated for conditions such as acute liver injury and psychotic reaction associated with supplement use in theatre.

Practical Guidance & the Smart Consumer
Exceptional or unrealistic claims are probably not true. While not every supplement is harmful, be sceptical of dubious claims such as ‘cure-all’ or ‘cures diseases.’ Beware of anecdotal information or personal testimonials suggesting the incredible benefits of using the product.

Also look out for:
• Products claiming to be alternatives to or have similar effects as prescription medication
• Products claiming to be legal alternatives to anabolic steroids
• Products providing warnings regarding testing positive on performance enhancement drug tests
• Products marketed through mass emails or primarily in foreign language
• Claims of a ‘radical new discovery’ or exclusively available product
• Product that it ‘does it all’ with claims to help with a wide-range of unrelated conditions
• Claims utilising meaningless medical jargon.

Embrace your commitment to improved health, but be smart. Don’t be taken in by product claims that seem too good to be true. Don’t mindlessly ingest substances with which you are unfamiliar or unknowledgeable. Talk to your doctor-and see you in the gym!

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