1. Dietary Supplements Presented by Janice Hermann, PhD, RD/LD OCES Adult and Older Adult Nutrition Specialist

2. Vitamin and Mineral Supplements Almost half of the U.S. population takes vitamin and mineral supplements on a regular basis. One out of five people take multi-nutrient supplements daily and others take single nutrient supplements; most commonly vitamin C, vitamin E, iron and calcium. Many times, taking vitamin/mineral supplements is a costly but harmless practice; however sometimes, taking supplements can be costly and harmful.

3. Vitamin and Mineral Supplements Most people self-prescribe supplements, taking them on the advice of friends, media, the Internet or books that may or may not be reliable. Without a valid nutritional assessment the advice to take vitamin/mineral supplements may not be in appropriate, many times the preferred action is to improve food choices.

4. Vitamin and Mineral Supplements Healthful food choices can best provide the balance of vitamins, minerals and other nutrients needed for good health. Getting the recommended amount of food from each of the USDA Daily Food Plan food groups every day, can provide all the nutrients needed without taking a supplement.

5. Vitamin and Mineral Supplement Uses However, when circumstances make healthful eating a challenge a vitamin/mineral supplement may offers benefits that are both effective and safe.

6. Vitamin and Mineral Supplement Uses Correct nutrient deficiencies Improve nutritional status Reduce disease risk Support increased nutrient needs Improve the body’s defenses

7. A Supplement May Help People: With a nutrient deficiency; Who consistently do not eat the recommended amount of food from the USDA Daily Food Plan food groups; Consuming a low calorie intake, less than 1200 calories per day;

8. A Supplement May Help People: Who are strict vegetarians (vegans); Women who excessively bleed during menstruation, may need iron; With lactose intolerance or milk allergies who don’t consume enough dairy products, may need calcium;

9. A Supplement May Help People: In certain life cycle stages may have increased nutrient needs (infants may need iron and fluoride, women of childbearing age may need folate, pregnant women may need iron, and older adults may need calcium and vitamins D and B12); With low milk intake and exposure to sunlight, may need vitamin D;

10. A Supplement May Help People: With low milk intake and exposure to sunlight, may need vitamin D; Who have diseases, infections, or injuries or undergone surgery that interferes with the intake, absorption, metabolism, or excretion of nutrients; Taking medications that interfere with the body’s use of specific nutrients.

11. Check With Physician This doesn’t mean people who fit into one of the previous cases should automatically take a vitamin or mineral supplement. People should first consult with their health care provider, a simple dietary change may be all they need.

12. Cautions Dietary deficiencies are difficult to diagnose. Diseases have many causes. Symptoms aren’t a diagnosis. Correcting dietary deficiencies requires medical supervision.

13. Vitamin and Mineral Supplement Cautions Although under certain circumstances vitamin and mineral supplements may be beneficial, there can be problems with vitamin and mineral supplements.

14. Vitamin and Mineral Supplement Cautions Possible problems with supplements Toxicity Life-Threatening Misinformation Unknown Needs False Sense of Security Other Invalid Reasons Bioavailability and Antagonistic Actions

15. Vitamin and Mineral Supplement Cautions Toxicity Large vitamin and mineral doses can be toxic The DRI Tolerable Upper Intake Levels define the highest vitamin and mineral intake levels that appear to be safe for most healthy people. Of particular concern are toxicities in children

16. Vitamin and Mineral Supplement Cautions Life-Threatening Misinformation Large doses can be marketed with claims that large doses can be beneficial or cure serious diseases. Elderly and people with serious illnesses are most vulnerable People may take too much or may not seek proper medical treatment.

17. Vitamin and Mineral Supplement Cautions Unknown Needs People self-diagnose which vitamins and minerals they need to take Surveys have shown that there is little relationship between the types of vitamin and mineral supplements people take and the nutrients they actually need.

18. Vitamin and Mineral Supplement Cautions False Sense of Security Supplements can be harmful if they cause people to have a false sense of security. People may avoid making improvements in their diet because they believe their supplement will meet their needs.

19. Vitamin and Mineral Supplement Cautions Other Invalid Reasons Belief the food supply or soil contains inadequate nutrients Belief supplements can provide energy Belief supplements can enhance athletic performance or build muscle Belief supplements will help with emotional stress Belief supplements can prevent, treat or cure illnesses ranging from colds to cancer.

20. Vitamin and Mineral Supplement Cautions Bioavailability and Antagonistic Actions Body absorbs vitamins and minerals the best from food Nutrients, particularly minerals taken in concentrated forms are likely to hinder the absorption of other nutrients Zinc can hinder copper and calcium Iron can hinder zinc Calcium can hinder magnesium and iron Magnesium can hinder calcium and iron

21. Balanced Diet, Not Supplements Supplement diet, don’t replace diet. Supplements can’t make up for a poor diet. You get more from food than supplements. The USDA Daily Food Plan is the best guide for getting the nutrients you need in the right amounts.

22. Supplement Tips Avoid taking isolated nutrients, unless prescribed by your physician. Use a combination, multi-vitamin multi- mineral supplement. Not more than Tolerable Upper Intake Level. Only take a single dose. Look for U.S.P. notation. Natural supplements are not better.

23. Dietary Supplement Labeling The Dietary Supplement Health and Education Act (DSHEA) set up the frame work for FDA regulation of dietary supplements. FDA’s pre-market review of dietary supplements is less than that for foods or drugs.

24. What Is A Dietary Supplement DSHEA broadened the definition of supplements to any product intended for ingestion as a supplement to the diet. Vitamins & Minerals Protein & Amino Acids Herbs & Botanicals Other Plant-Derived Substances Metabolites, constituents and extracts

25. Dietary Supplements Are Not Dietary supplements are not drugs. A drug is an article that is intended to diagnose, cure, mitigate, treat, or prevent diseases. Drugs must undergo clinical studies to determine their effectiveness, safety and possible interactions. FDA approve drugs before they are marketed.

26. Dietary Supplements Are Not Another thing dietary supplements are not are replacements for conventional diets. Supplements do not provide all the known-- and perhaps unknown--nutritional benefits of conventional food.

27. Dietary Supplement Label Identity Net quantity Structure-function claim and disclaimer Directions for use Supplements Fact panel Ingredient list Name and address of manufacture

28. Monitoring For Safety Food ingredients and drugs undergo strict pre-market safety testing and approval. Dietary supplements to not have to go through FDA pre-market approval. Once on the market FDA has to show a supplement is unsafe before it can take action to restrict it if a problem occurs.

29. Understanding Claims Under DSHEA dietary supplements are allowed to use three types of claims. Nutrient-content claims Disease claims Nutrition support claims Structure-function claims

30. Manufacturers can use structure-function claims without FDA approval. Structure-function claims must be accompanied with the disclaimer “This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.” Structure Function Claims

31. Some possible indicators of fraud are: Claims product “secret cure,” “magical.” Pseudomedical terms "detoxify," "purify" and "energize.” Cure a wide range of unrelated diseases. Has only benefits and no side effects. Accuses medical profession or government of suppressing treatment. Claims “natural” is better. Fraudulent Products

32. Consumers The majority of supplement manufactures are responsible and careful. But consumers must take responsibility too. Consumers need to evaluate claims and products with established medical sources. If a product is valid it will stand up to evaluation.

33. References Position of the American Dietetic Association: Fortification and Nutritional Supplements. JADA;2005;105,1300-1311. Tips for the Savvy Supplement User: Making Informed Decisions. U.S. Food and Drug Administration. FDA Consumer March-April 2002. www.fda.gov/fdac/features/2002/202_supp.html, Accessed January 2007. www.fda.gov/fdac/features/2002/202_supp.html Understanding Nutrition, 10th edition by Ellie Whitney & Sharon R Rolfes. Thomson Wadsworth, 2005. Thomson Wadsworth Publishers. Understanding Normal and Clinical Nutrition, 7 th edition by Sharon R Rolfes, Kathryn Pinna & Ellie Whitney, 2006. Thomson Wadsworth Publishers