medical information

Nutritional Supplements | Definition | Description

Definition

Nutritional supplements, also called dietary supplements , include vitamins , minerals, herbals, botanicals, amino acids, enzymes, and animal extracts. The U.S. Food and Drug Administration (FDA) defines them as food rather than drugs, and regulates their labeling as such—to be used as supplements and not as drugs. Nutritional supplements come in the form of pills, capsules, powders, gel tabs, extracts, or liquids, and are sometimes added to products like energy drinks or energy bars. Supplements are distinguished from nutritional support, the means through which people are nourished when they cannot get sufficient nourishment through eating or drinking. This type of support is generally defined as artificial feeding, among other terms.

Description

Nutritional supplements include an extensive list of vitamins, minerals, nutrients, botanicals, herbs, and other substances that are intended to enhance human health. Since ancient times, certain herbs and botanicals have promised everything from longer life to beautiful skin. Some of those natural products have become, or have been incorporated into, commonly used medicines. Many of these products, which are not determined to be drugs, list thousands of claims as benefits.

The FDA has established regulations for the drug industry, and in 2007 it established new regulations in order to improve the safety and consistency of all supplements. These new regulations are in full effect as of 2010. Once the regulations are in effect, individuals should still investigate any nutritional supplement and determine how it might affect health and well-being, and possible side effects, especially when taking it with prescribed medications. Seriously harmful effects of these supplements are to be reported under the FDA regulations, but reading through the information can be daunting for individuals.

As of 2005, the list of nutritional supplements on the market was estimated to be near 29,000. That was up from 1993 when the total supplements available were near 25,000. An estimated 150 million Americans take nutritional supplements on an annual basis. Products that were once available only in health food stores are now available online, at the local drug store, or even in the supermarket. These products are not intended to be taken alone for nourishment in place of food, but as a complement to a healthy diet . Nutritional supplements have been promoted for use in sports performance; weight management, either loss or gain; and health issues including memory loss , arthritis, heart attack risks, overall health enhancement, and promoting a longer life. Not all claims have been proven scientifically to perform the way they are advertised.

Vitamins, minerals, and nutrients commonly taken in the form of nutritional supplements include multivitamins and minerals, vitamin B complex, vitamin C , vitamin D , vitamin E , calcium , fiber,folic acid , zinc , iron, beta-carotene, and the Omega-3 fatty acids.

Popular herbal or botanical supplements are acidophilus, black cohosh, ginger, evening primrose oil, Echinacea, garlic , ginkgo biloba , fish oil, glucosamine and/or chondroitin, sulphate, St. John's wort, and saw palmetto .

Healthy diets of nutritional food usually contain an adequate daily supply of necessary nutrients, vitamins, and minerals. Some individuals, especially senior adults, have dietary restrictions, health problems, mental health issues, and other factors that might prevent the ingestion of enough food to supply those necessary nutrients. Even with proper diets, nutritional supplements are sometimes necessary for people over the age of 50 due to the needs brought on by aging bodies or an inability to absorb necessary nutrients. Supplements that are often necessary in older adults include vitamin B₁₂ , calcium, vitamin D, iron, and vitamin B6. Seniors should always consult with their physicians to determine if these are necessary.

Recommended dosage

Each individual supplement label indicates a recommended dosage or daily usage limit. The manufacturers of these supplements may make suggestions, but it is the responsibility of the individual or caregiver to determine what is appropriate. Dosage or usage of supplements that include vitamins and minerals can be matched against the daily value (DV) recommended by the FDA. For other dietary supplements, it is best to research and consult with a physician if the supplement is necessary and determine proper dosage.

In February 2008, a medical study reported in the Archives of Internal Medicine examined nearly 14,000 adults. The study found that higher blood levels of selenium—a mineral found in grains, certain nuts, and some meats and seafood, such as beef and tuna—were linked to a lower risk of death over a 12-year period. At that point, the risk seemed to rise. This mineral is touted as a factor in longevity, but could ultimately increase the risk of death from any cause, or from cancer specifically, when the levels of the mineral go beyond a certain mark. This study provided just one example that consuming too much selenium could prove harmful over a long period of time. This and other such studies serve as a reminder that it is necessary to exercise precaution when self-prescribing supplements.

Precautions

Age, health status, prescription medicines, and the supplement itself can affect what is safe, what is effective, and what is harmful. According to the American Cancer Society (ACS) nearly 24,000 calls were made to poison control centers in the United States in 2005 related to ingestion of nutritional supplements. More than 212 of these incidents were determined to have moderate to severe outcomes, with 13 deaths.

Over 350 of the cases produced what were considered adverse reactions. These statistics indicated only the number of people who called a poison control center, and not cases that might have gone unreported with equally, or more severe consequences.

QUESTIONS TO ASK YOUR PHARMACIST

· Is it necessary for me to take this supplement?

· What foods should I avoid when taking this product?

· I am scheduled for surgery. Is there any reason to stop taking a certain supplement?

· What is the recommended dosage, or what level might be dangerous for me to exceed?

When an individual consults appropriate medical professionals such as medical doctors or dieticians before taking any supplements, or does responsible research the chances of harmful side effects is likely to be reduced. False claims in advertising can be confusing, even to the most seasoned medical professional. To a senior adult who hears claims on television, or reads promotional literature—often presented as valid medical research when it might not be—the claims can lead to life-threatening behavior if untested supplements become part of a daily routine, or even as a one-time dosage.

Individuals considering certain supplements should be aware that product claims could be false, especially claims that the product is a “cure-all” responsible for treating everything from arthritis to prostate problems, to cancer. Any claim that the product is a treatment or cure for a disease, such as shrinking tumors or curing impotency, for instance, is not in the realm of a supplement, only an approved drug. Other claims requiring caution are those that indicate no side effects, miraculous cures, or personal testimonials. Often, paid professional actors are used to praise a product's benefits without validity.

Individuals must act with caution when pursuing supplements that are given publicity even from reliable sources. Single studies, even when scientifically and reliably conducted, might not provide a complete picture regarding the safety or effectiveness of any given supplement or vitamin. The term “natural” is often used to present a supplement as safe. That is not always the case. Several dangerous substances are found in nature; substances that can cause a harmful interaction with prescribed medication or produce allergic reactions. Manufacturers should provide a consumer with enough information of their own testing to support the claims made for the product. Even still, there may not be sufficient evidence to ensure the safety of a particular case, or individual.

Side effects

The potential for side effects exists with nearly all types of supplements. Allergic reactions may occur in one person, and not in another. Supplements such as glucosamine may be harmless and effective in reducing the joint pain of arthritis in some individuals, but because it contains a compound of glucose, it can be harmful for individuals with diabetes. Research and label reading, as well as consulting with physicians, dieticians, or a pharmacist are crucial when taking any supplements. When in doubt, individuals should exercise caution and not take the supplement in question.

Interactions

A pharmacist may be able to confirm potential interactions a particular drug may have when taken with a nutritional supplement if the supplement label itself does not. A senior adult who takes several prescription medicines, or even just one, should always consult the primary care physician or pharmacist to determine if there is a harmful interaction between the prescribed medication and any supplements, even certain vitamins. The ACS has reported that some dietary supplements can cause skin sensitivity and severe reactions during radiation treatments for cancer patients. Recommendations often include avoiding supplements when being treated for cancer either with radiation or chemotherapy .

Any individual who experiences adverse effects related to a dietary supplement should report them immediately to the primary care physician and to the MedWatch Program sponsored by the FDA.

Caregiver concerns

Maintaining a well-balanced diet for a senior adult can be a challenge. With decreased appetite due to medications, depression , or other health concerns, an adequate diet that supplies necessary nutrients for optimum health may not be easy to provide. For full-time caregivers, especially family members who are residential, control over the situation can be maintained through efficient grocery shopping, preparation of appealing meals, and companionship that encourages the appetite of individuals who may not otherwise find eating healthy meals desirable. Supplemental energy drinks and liquid dietary supplements are often recommended by the primary care physician or dietician if eating regular meals is difficult due to food allergies , dietary restrictions, or physical challenges presented by medical conditions or prescribed medications.

KEY TERMS

Botanical —Any supplement that is derived from a plant. This term is often used interchangeably with herb.

Nutritional supplement —Any capsule, pill, powder, gel tab, extract, or liquid that is orally ingested and not classified as a drug.

The caregiver for the senior adult must pay attention to the value and potential side effects of any dietary supplement, whether it is a simple vitamin pill or a nutritional supplement. Working with the patient's health care team is essential when making any determinations to include nutritional supplements to their daily diet regime. If supplements are included, a caregiver should observe any and all side effects such as allergic reactions or drug interactions . Such side effects can present in various ways, including skin rashes, a change in mood, physical energy, nausea, heightened glucose levels in diabetics, shortness of breath, and increased blood pressure . Individuals who are allergic to shellfish may have an allergic reaction to chondroitin, which is produced from shark cartilage.

When caregivers or family members do not reside with a senior adult and do not always have control over the dietary habits of that individual, extra caution and observation is necessary. Conversation can be an important tool in order to learn what the individual has eaten, or taken as a supplement. Asking questions and observing moods and physical appearance can provide important clues to possible adverse reactions of any nutritional supplements.

Abundant resources are available to determine the safety of a nutritional supplement, along with the advisability of taking it, the origin, and any information that could provide crucial guidance for an individual's safety. National offices and organizations that provide information through brochures or websites include the Office of Dietary Supplements of the National Institutes of Health; Center for Food Safety and Applied Nutrition , an agency within the FDA; National Agricultural Library of the U.S. Department of Agriculture; and The Council for Responsible Nutrition (CRN), which is a trade association that represents the dietary supplement industry, ingredient suppliers, and manufacturers.

Resources

BOOKS

PDR for Nonprescription Drugs, Dietary Supplements, and Herbs, 2008. Edited by Physician's Desk Reference Guide staff. London: Thomson Healthcare. 2007.

Talbott, Shawn, and Kerry Hughes. The Health Professional's Guide to Dietary Supplements. Philadelphia: Lippincott Williams & Wilkins, 2006.

OTHER

“Dietary Supplements: How to Know What is Safe.” Making Treatment Decisions. December 6, 2007 [cited April 14, 2008]. American Cancer Society.http://www.cancer.org/docroot/ETO/content/ETO_5_3x_How_to_Know_What_Is_Safe_Choosing_and_Using_Dietary_Supplements .asp.

Dietary Supplements Labels Database. United States National Library of Medicine. October 24, 2007 [cited April 14, 2008]. http://dietarysupplements.nlm.nih.gov.

Drugs, Supplements & Herbal Information. MedlinePlus. [Cited April 13, 2008].http://www.nlm.nih.gov/medlineplus/druginformation.html.

Health Information. Office of Dietary Supplements. [Cited April 14, 2005].http://dietary-supplements.info.nih.gov.

“Tips for Older Dietary Supplement Users.” Dietary Supplements. December 2003 [cited April 14, 2008]. U.S. Food and Drug Administration, Office of Nutritional Products, Labeling, and DietarySupplements. http://www.cfsan.fda.gov/-dms/ds-savv2.html.