Using supplements as insurance

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Healthy people who eat a nutritious diet still may want to use supplements to make sure they're getting adequate nutrition. Plenty of recent research supports their choice.

Protecting against disease

Taking supplements may reduce the likelihood of some types of cancer and other diseases. After analyzing data from a survey of 871 men and women, epidemiologists at Seattle's Fred Hutchinson Cancer Center found that people taking a daily multivitamin for more than ten years were 50 percent less likely to develop colon cancer. In addition, selenium supplements seem to reduce the risk of prostate cancer, and vitamin C seems to lower the risk of cataracts.

Supplementing aging appetites

As you grow older, your appetite may decline and your sense of taste and smell may falter. If food no longer tastes as good as it once did, if you have to eat alone all the time and don't enjoy cooking for one, or if dentures make chewing difficult, you may not be taking in all the foods that you need to get the nutrients you require. Dietary supplements to the rescue!

If you're so rushed that you literally never get to eat a full, balanced meal, you may benefit from supplements regardless of your age.

Meeting a woman's special needs

And what about women? At various stages of their reproductive lives, they, too, benefit from supplements-as-insurance:

tu i Before menopause: Women, who lose iron each month through menstrual bleeding, rarely get sufficient amounts of iron from a typical American diet providing fewer than 2,000 calories a day. For them, and for women who are often on a diet to lose weight, iron supplements may be the only practical answer.

Iron is a mineral element, so it may be called "iron" or "elemental iron" on the label. Iron pills contain a compound of elemental iron ("ferrous" or "ferric," from ferrum, the Latin word for iron), plus an ingredient such as a sulfur derivative or lactic acid to enable your body to use the iron. On the label, the combination reads "ferrous sulfate" or "ferrous lactate." Different iron compounds dissolve at different rates in your stomach, yielding different amounts of elemental iron, so supplement labels usually list the iron this way: Ferrous sulfate 325 mg/Elemental iron 65 mg. Translation? This pill has 325 milligrams of ferrous sulfate, yielding 65 milligrams plain old iron. Sometimes the label omits the first part and simply says: Iron 65 mg.

If your doctor says, "Take one 325-milligram pill a day," she means 325 milligrams iron compound, not plain elemental iron.

i During pregnancy and lactation: Women who are pregnant or nursing often need supplements to provide the nutrients they need to build new maternal and fetal tissue or to produce nutritious breast milk. In addition, supplements of the B vitamin folate now are known to decrease a woman's risk of giving birth to a child with a neural tube defect (a defect of the spinal cord and column).

Never self-prescribe supplements while you're pregnant. Large amounts of some nutrients may actually be hazardous for your baby. For example, taking megadoses of vitamin A while you're pregnant can increase the risk of birth defects.

i Through adulthood: True, women older than 19 can get the calcium they require (1,000 milligrams/day) from four 8-ounce glasses of nonfat skim milk a day, three 8-ounce containers of yogurt made with nonfat milk, 22 ounces of canned salmon (with the soft edible bones; no, you definitely should not eat the hard bones in fresh salmon!), or any combination of the above. However, expecting women to do this nutritional balancing act every single day may be unrealistic. The simple alternative is calcium supplements.

Supplement Safety: An Iffy Proposition

The Food and Drug Administration (FDA) regulates food and drugs (no surprise there). Before the agency allows a new food or a new drug on the market, the manufacturer must submit proof that the product is safe. Drug manufacturers must also meet a second test, showing that their new medicine is efficacious, a fancy way of saying that the drug and the dosage in which it's sold will cure or relieve the condition for which it's prescribed.

Nobody says the drug-regulation system's perfect. Reality dictates that manufacturers test a drug only on a limited number of people for a limited period of time. So you can bet that some new drugs will trigger unexpected, serious, maybe even life-threatening side effects when used by thousands of people or taken for longer than the testing period. For proof, look no further than Phen-Fen, a diet drug combination that appeared to control weight safely during premarket testing but turned lethal after it reached pharmacy shelves.

Sweet trouble

Nobody wants to choke down a yucky supplement, but pills that look or taste like candy may be hazardous to a child's health. Some nutrients are troublesome — or even deadly — in high doses (see Chapters 10 and 11), especially for kids. For example, the Food and Drug Administration warns the lethal dose for young children may be as low as 3 grams (3,000 milligrams)

elemental iron, the amount in 49 tablets with 65 milligrams iron apiece. If you have youngsters in your house, protect them by buying neutral-tasting supplements and keeping all pills, nutrient and otherwise, in a safe cabinet, preferably high off the floor and locked tight to resist tiny prying fingers.

But at least the FDA can require that premarket safety and/or effectiveness info be displayed on foods and drugs. Unfortunately, the agency has no such power when it comes to dietary supplements.

In 1994, Congress passed and President Clinton signed into law the Dietary Supplement Health and Education Act, which limits the FDA's control over dietary supplements. Under this law, The FDA can't i Require premarket tests to prove that supplements are safe and effective i Limit the dosage in any dietary supplement i Halt or restrict sales of a dietary supplement unless evidence shows that the product has caused illness or injury when used according to the directions on the package; in other words, if you experience a problem after taking slightly more or less of a supplement than directed on the label, the FDA can't help you

As a result, the FDA has found it virtually impossible to take products off drugstore shelves even after reports of illness and injury. For example, supplements containing the herb ephedra are reputed to enhance weight loss and sports performance. More than 600 reports of illness and at least 100 deaths have been linked to the use of ephedra supplements. The herb is banned by professional football and college athletics in the U.S. and by the Olympics. However, the FDA didn't act until February 2003, following the death of Baltimore Orioles pitcher Steve Bechler, who reportedly had been using ephedra products to control his weight.

Bechler's untimely death rang warning bells across the country, including in Washington, D.C., where the FDA ruled that henceforth every bottle of ephedra must carry strong warnings that the popular herb can cause potentially lethal heart attacks or strokes. In the sports world, ephedra was immediately forbidden in minor league but not major league baseball. The FDA banned all ephedra products, but the ban was partially reversed in April 2005, when a federal judge ruled that products containing low doses of ephedra were safe and could remain on the market. Some in Congress are pressing for a law that would enable FDA to ban any supplements considered even potentially hazardous to your precious health. Stay tuned.

By the way, ephedra isn't the only herbal supplement that can make you really uncomfortable. Table 5-1 lists some equally problematic herbal products that you need to approach with caution — or avoid altogether. In many cases, even small amounts are hazardous.

Table 5-1 Some Potentially Hazardous Herbals

Herb

Known Side Effects and Reactions

Blue cohosh

Nausea, vomiting, dizziness, smooth

muscle (such as the uterus) contractions

Chaparral

Liver damage, liver failure

Comfrey

Possible liver damage

Kombuchu tea

Potentially fatal liver damage, intestinal

upset

Lobelia (Indian tobacco)

Potentially fatal convulsions, coma

Pennyroyal

Potentially fatal liver damage, convulsions,

coma

Senna

Severe gastric irritation, diarrhea

Stephania (also known as magnolia)

Kidney damage (sometimes severe enough

to require dialysis or transplant)

Valerian

Severe withdrawal symptoms

"Vitamin and nutritional supplements," Mayo Clinic Health Letter (supplement), June 1997; Nancy Beth Jackson, "Doctors' warning: Beware of herbs' side effects," The New York Times, November 18, 1998; Jane Brody, "Taking a gamble on herbs as medicine," The New York Times, February 9, 1999; Carol Ann Rinzler, The Complete Book of Herbs, Spices, and Condiments (New York: Facts on File, 1990)

"Vitamin and nutritional supplements," Mayo Clinic Health Letter (supplement), June 1997; Nancy Beth Jackson, "Doctors' warning: Beware of herbs' side effects," The New York Times, November 18, 1998; Jane Brody, "Taking a gamble on herbs as medicine," The New York Times, February 9, 1999; Carol Ann Rinzler, The Complete Book of Herbs, Spices, and Condiments (New York: Facts on File, 1990)

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