Over-the-counter: The Good, the Bad, And the Ugly

Submitted by Lisa L. Deal Pharm.D., BCPS

With the busy lifestyles that we all have, over the counter (OTC) dietary supplementation with vitamins and minerals is the way to go, right?  Seemingly harmless due to ease in availability, you or many people you know may take supplements on a daily basis.  While beneficial to some, supplements can also be harmful.  We are going to review the good, bad, and ugly of OTC supplementation.

First, let’s review the definition of dietary supplements.  Dietary supplements are any substance that provides vitamins, minerals, amino acids, and enzymes that are not provided by your diet.  Supplements are just that, supplements, and should not be used to treat or cure a disease, but only to supplement what you may have neglected in your diet.

THE GOOD
There are several groups that benefit from dietary supplementation.  Pregnant women, for example, taking a multivitamin and folic acid may decrease the risk of the development neural tube defects.  Vegans may not receive all the nutrients needed due to lack of animal products in their diet and supplementation will provide the necessary B12.  Vitamin D and calcium supplementation in the elderly is essential as this population may not receive enough vitamins through diet and/or have decreased sun exposure.  The elderly are also at increased risk of falls which can increase risk of fractures.  While important in the elderly, there is inconclusive information to recommend vitamin D and calcium supplementation in men and premenopausal women to prevent bone fractures.  The best way to get vitamin D and calcium is through diet and small daily exposures to sunlight.

THE BAD
Only about 10% of the U.S. population suffers from vitamin deficiencies. Yet, it is estimated that consumers will spend over $15 billion on vitamins and herbal supplements in 2015, with no guarantee that supplements are a healthy method of getting nutrients.  As life gets more hectic, many people may believe that supplements are helping them get the nutrients they are missing, especially when they or their children often eat fast food and fatty foods, while missing many fruits and vegetables. But supplements are not the solution. At best, they may do nothing at all, and at worst, they may cause some serious side effects.

THE UGLY
Dietary supplement manufacturers are not required to prove that their products improve health, and the FDA provides little oversight of their production, authenticity or quality.  For example, the New York Attorney General’s office recently found that six popular supplements, including those labeled “garlic,” “echinacea,” and “saw palmetto,” were either contaminated or lacked the labeled supplement in the ingredients of 80% of the products tested.  While this is only one study, it is eye opening to see that these seemingly benign products can contain ingredients such as allergens and even other prescription medications.

In many cases, supplements can be downright harmful. For example, St. John’s Wort, commonly used for anxiety, can interact with many prescriptions, including birth control pills and anti-rejection medications used in transplant patients.  Garlic, ginseng, ginger, and vitamin E can increase risk of bleeding, especially in people who take blood thinners.  Vitamin E, once thought to be something that promoted wellness, has now been shown to increase risk of death, and to cause lung cancer in male smokers. Bodybuilding supplements have been shown to increase risk for liver damage, and vitamin C in excess has been shown to lead to kidney disease.

THE FACTS
There is no quick fix to being healthy, and no single pill to make up for years of unhealthy habits, or to cure a complex or life-threatening medical condition. Generally, medications are used to treat or cure a disease or illness, and supplements are used to get additional nutrients into your diet.  But, all medications and supplements bring risk as well as benefit, whether they are prescribed or purchased over-the-counter.  Always speak to your primary care provider before taking any supplements, especially when you already take prescription medications. Make sure to let your healthcare provider know your medication and supplement regimen, and especially if you are experiencing any unusual or concerning symptoms. 

Lisa L. Deal is a pharmacotherapy specialist at Beebe Medical Center and speaks nationally regarding pharmacology.

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