Nutritional Supplements: Benefit or Risk?

Nutritional Supplements: Benefit or Risk?
Scott Resnick MD 2022

My mother is an elderly woman who uses some focused nutritional supplements. I received a distressed call from her recently after she listened to a geriatric specialist describe the “holistic” approach that his clinic was using with their patients. She agreed that a “holistic” clinic for aging adults made sense. The clinic supported strength, community, brain health and prevention. But she didn’t agree with everything the doctor said.

A question came up regarding supplements; his answer was brief and focused. He stated that there was “no place for supplements in the care of the elderly patient.” He said that it was unacceptable. And without mincing words, added the word dangerous.

When pressed as to why he said this, he offered a blanket response that there was “no science to support their use.” He was also concerned about the quality of the supplements and that a lack of regulation in the industry was putting people at risk.

Mainstream doctors frequently make claims like this. And to some degree which I’ll explore here, he may have a valid point.

Are Nutritional Supplements for Elderly Patients Really Dangerous?

His comments did not fully surprise my mother. What did surprise her was how cocky, dismissive, and angry the question made him. This doctor bristled with the suggestion that anyone would even consider the use of nutritional supplements in the elderly.

I was affronted by the fact that he wouldn’t consider their use.

Supplementation Synonyms: Are they All The Same?

To begin with, the blanket term “supplements” doesn’t lend itself to the fact that several different compounds fall under this heading. Could he have collectively meant the use of all vitamins, minerals, herbs, nutrients, phytochemicals, adaptogens, and enzymes? Are all of these dangerous?

Or was it the idea that a compound that didn’t fall under an FDA-regulated compound might show utility and benefit in his patient population? In this blog, I will examine all of these concerns.

Supplements and Science (Vitamins and Minerals)

There’s an old adage in medicine. If you don’t look for something, you surely won’t find it. This truism applies here.

I frequently go to PubMed to research topics. This is a government agency that storehouses all of the scientific papers published around the world. It is easily accessed at pubmed.com. Topics can be searched by a variety of means. I find that the easiest way to search is to put a few search words into the engine and see what comes up.

Input of the term vitamin D yields nearly 100,000 results. Clearly the study of this vitamin interests many researchers around the world. Vitamin D and aging yields 4000, Omega-3 fats and aging yields 1600– yet this doctor still holds that there’s no science supporting supplementation.

Typing B12 and aging into the search engine yields nearly 8000 citations. Magnesium and aging returns around 1500. So clearly the science is there for some of the more well-known minerals and vitamins.

When do molecules intended for human biochemistry to work become optional and or dangerous?

Supplements and Science (Herbs)

The blanket assumption that there is no place for plant-based substances in modern medicine is flatly absurd. Hippocrates knew that chewing the bark of the willow tree relieved pain. The active ingredient is salicylic acid. You probably have a bottle of this in your medicine cabinet. A more common name is aspirin.

Taxol, one of the most potent anti-cancer agents, comes from the Yew tree. Digitalis, a potent medicine that regulates and strengthens heart function is found in the Foxglove plant. And Resveratrol, found in grapes and central to the French red wine anti-aging paradox, has 16,000 references in PubMed.

Even a more esoteric herb, Bacopa Monnieri, when linked with the search term memory in PubMed elicits 200 citations. The science is emerging. Medicine needs to keep pace with the information made available to us.

Are Nutritional Supplements Dangerous?

This question is a reasonable one. Almost everything that we ingest has some degree of potential toxicity. Even water has a LD50, a dose at which 50% of the people who consume an excessive amount will die from the exposure.

For this reason, supplement manufacturers are not immune from producing potentially dangerous products. For this reason, there are several considerations to be made when choosing a supplement. The first comes from the herbal product itself.

Ephedrine, from the Ephedra plant, is a “natural” substance with 5000 years of use in traditional Chinese medicine. It works generally as a stimulant and boosts metabolism. Increased metabolism leads to weight loss. In the 1990’s the herb was marketed in the US for this purpose.

And it worked; it reduced weight. However, it also increased blood pressure, heart rate, and increased the risk of heart attack and stroke. Variations of concentration and potency differed by as much as 10-fold. Because of this, the herb was banned in the USA in 2006.

Would you open a bottle of Tylenol, and take up to 10 at once? Of course not. Epedra was pulled from the market when the consumer couldn’t be assured of a consistent product.

In this case, I believe that this regulatory intervention was a wise one.

How to Know If a Supplement is Safe?

Working with a physician or naturopath who is trained in the use of supplemental herbs, vitamins, and nutrients is the best way to supplement safely. He or she likely has the background to understand the biology of the product, its dosing and limitations, and the insight into appropriate testing to accompany such recommendations.

You can’t manage what you can’t measure. Know your levels of nutrients, define the supplement’s risks and benefits, and don’t just start any medication or supplement on a lark.

Supplements, defined more as “foods” and less as medicines, may in time require a greater degree of regulation. In 2015 the New York attorney general banned the sale of several supplements by some large-name retailers, notably Walmart and Target. This was based on detailed chemical analysis of several different products.

In some cases, the amount of the nutrient or supplement didn’t come close to matching what was listed on the products label. In others, there was zero DNA evidence of the presence of the listed herbs. And some capsules examined contained little but the common houseplant dracaena.

Nutritional Supplement Tips

The following recommendations can help to assure that a nutritional supplement will indeed benefit and supplement one’s dietary intake. In an ideal world, we would obtain all of our nutrients and vitamins through our diet. But any number of factors conspire against this. I’ll save that for another blog.

I have personally toured several of the supplement manufacturers. I’ll share a few of the recommendations I make to my patients below.

First, the company should source its raw materials from reputable sources. Prior to putting these into a capsule, they should have the products quality and purity confirmed by a third-party analysis. A quality supplement company will provide these certifications with a simple phone call.

Second, the company should be certified as GMP—Good Manufacturing Practices. This certification ensures consistency in sanitation, material testing, manufacturing control and even personnel.

Lastly, you can additionally choose companies that are reviewed by NSF International, another independent product tester. Thorne Labs, and Nordic Naturals are two American brands that sell products certified by both GMP and NFS.

The Benefits of Supplementation

Consequently, this physician’s blanket statement that “All supplements should be avoided in the elderly” could ironically harm, rather than help his patients. The use of minerals, vitamins, and herbs produced by reputable labs to replace a deficiency based on established testing and research may be prudent.

As with so many things, “the devil is in the details.” There is a place for focused and well-applied nutritional supplementation in medicine. This should be based in sound medical thought and judgement, directed testing, and the use of specific, safe products.

 

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