Practical Guidelines: Buying and Taking Supplements

When I recommend supplements, I often hear questions about where to get them and what brands to buy. How do you avoid being misled by unscrupulous manufacturers or overzealous sales pitches? Antagonists to dietary supplements sometimes leave you with the false impression that all manufacturers are disreputable. Nothing could be further from the truth. In my experience, most supplement manufacturers are reliable and honest, and they depend on good results from their products to generate repeat sales.

Manufacturers and Retailers

Most manufacturers follow Good Manufacturing Practices (GMPs), and you should make sure they do before purchasing their products. The purpose of GMPs is to assure that what is on the label is in the product; that the product disintegrates and is bioavailable and unadulterated. Ask your retailer to find out from their manufacturers or suppliers. You can usually find retail products at health food stores, through mail-order channels and in professional offices. I have a lot of experience with supplements sold through professional offices. They are usually of high quality and are designed by the practitoners for their own method of practice. Practitioners sometimes have their own brand label, but most of the products will be similar to those of other practitioners and comparable to retail products. It is true that practitioners sometimes will charge higher prices for their products than retail store prices, assuming that they are more convenient for their clients, but they should not be markedly different from the products you can buy through other channels. Sometimes professional products are less expensive than those from other sources.

There are also good name brands available at health food stores, and some of the larger stores have their own in-house brand labels. Several mail-order sources supply brand names similar to the ones in health food stores, and some of the larger mail-order companies also have their own labels. Like the manufacturers, they also are dependent on good results to generate repeat business. What you need to know is that virtually all of the raw materials for dietary supplements are made in bulk by a few manufacturers. They are then purchased by supplement “manufacturers” who only tablet, encapsulate and affix their own label to the products before sending them to distributors or retail outlets.

Be Wary of Claims

What this means most of the time is that the hyperbolic claims for particular brands are exaggerated, even though the ingredients are what they claim to be and do what they are supposed to. Some companies claim that their brand of “vitamin Z” is superior because of the form, or because it is “all natural,” or it is combined with “synergistic nutrients” or herbs. Most of the time the additional dietary factors that are present are there in such small quantities that they have only a token presenceÑnot enough to be therapeutic.

Some companies will say that their product is highly researched and tested, but when you look at the research papers that they provide, the studies refer to the basic nutrient ingredient (such as folic acid or beta-carotene) not to their particular brand. In these cases, I agree that their beta-carotene is probably healthy and of great benefit, but so are many others on the market that are just as good and usually much less expensive.

Multilevel Marketing

In my experience, most of the time the exaggerated claims are made by multilevel marketing companies. These are companies that market through a pyramid of distributors, each of whom takes a percentage of the sale. The distributors are usually just customers who want to take advantage of the “wholesale” prices that are offered to those who sign up. Some of these distributors then go on to take advantage of the business opportunity of selling retail and signing up distributors under them. They then get a percentage of the new distributorÕs sales, and so on down the line.

The companiesÕ home offices often leave the impression with distributors that their product is special in a way that is not justified by research. The distributors then go off into the market and, sometimes innocently, make these unjustified claims. Again, these claims are almost invariably exaggerated and used to mark up the price of the product beyond the value of the ingredients. Always be wary if a company claims that their supplement of 2 mg is equal to 30 mg from another source. There is no basis for this claim.

Multilevel marketing companies almost always admit that their retail price is high, but you can become a distributor and get the product “wholesale.” Unfortunately their wholesale price is usually still higher than comparable products sold through normal retail outlets. If you mark something up enough, a good discount still leaves you with a high price. Because of the multiple levels of distributors who take a cut from all sales, it is almost essential that the end-user price be elevated compared to other sources. To be fair, the companies claim that they save on marketing and advertising. They do less national advertising because of the zeal of distributors. This may be true, but it seems that they are not passing such savings on to the consumer.

What to Look for in Pricing

My advice is to seek a reliable mail-order, health food store or professional line of products, and check that the company uses GMPs in manufacturing. You can ask the sellers, who should be able to find out from the companies if they do not already know. Also, make sure that they are hypoallergenic and that there are no extraneous ingredients such as artificial flavor, colors or preservatives in the products. Although some of these may be safe, some of them are not, and their presence is a sign that the manufacturers are not as concerned with quality.

There have been in the past, and may still be, some
very cheap mail-order supplements that did not meet the potency claims made on the label. This is much less likely now, but it is still possible. If a price looks too good to be true, it probably is. For example, if you price several reliable brands at between $9 and $12 per hundred capsules, and you find the same ingredients for $4-$6 per hundred, you need to be very suspicious. On the other hand, if you find the same product for $19, you should also be aware that you may be paying too much.

Most dietary supplement suppliers are very competitive (except for multilevel marketing prices, which are high), and a below-cost item may not meet label claim or on occasion may be made with inferior raw ingredients. These may have contamination problems or problems with solubility. Synthetic vitamin E, for example, is much cheaper than the natural form, but the molecule is slightly different, and contains only the alpha-tocopherol, not the beta, gamma or delta forms found in “mixed, natural tocopherols.” That information should be on the label. The most likely supplements to be a problem are the most expensive ones, such as coenzyme Q10 or proanthocyanidins, or non-standardized herbs being sold for low prices compared to the standardized products.

Timed Release?

Most “timed-release” products are not worth the extra money that you may spend on them. In fact, they may even be less effective than the plain variety. For example, in order to achieve the best effects with vitamin C, especially in viral infections, you sometimes need a very high blood level. These levels are more difficult to achieve with timed-release pills, because of their slow dissolution and absorption.

Occasionally timed-release pills are not properly timed, so that the tablet does not disintegrate and dissolve in time or in the right place to be well absorbed from the intestinal tract. Most plain supplements are fairly well absorbed and utilized, so a slow-release form is unnecessary. There are two exceptions to this that are worth mentioning. One is vitamin B3, or niacin, which can cause a temporary flush of the skin, but is less likely to do so in timed-release form. (Remember, however, that the timed-release form is more likely to cause liver problems in some people.) The other valuable timed-release supplement is iron, which often causes some constipation and indigestion in plain form. It is usually better tolerated as timed-release iron fumarate. The common drug-store variety, iron sulfate, seems to be the worst for causing constipation.

Combination Supplements

Except for a multivitamin and a few simple combinations, it is better to take your individual nutrients in separate pills. This makes it easier to change the dose of one nutrient without having to alter many others at the same time. It is almost invariably less expensive to take separate nutrients, but you can expect to take from six to 10 pills twice per day for a comprehensive, basic supplement program. This is assuming you are healthy. If you have a health problem, you might end up taking 10-15 pills twice a day. For vigorous longevity programs, you may end up taking quite a few more.

Manufacturers make specific combinations to distinguish their product from othersÑto establish a position, or “market niche.” Such “exclusive” products can often command a higher price. Do not be drawn in by their exaggerated claims. A product may well have all of the claimed benefits, but is it worth the price? Compare the ingredients (mg to mg, or IU to IU) and the price. Once you have an established program with which you are satisfied, then you might find a few combinations that meet your needs, and you can use them to reduce the number of pills that you take.

If you find that a particular brand works for you and it is reasonably priced, stay with it. You might want to ask your health practitioner for advice. If you haven’t tried comparable products, you would be wise to shop around for price. Ask how long a brand has been on the market. Most of the reliable companies have been around for a while. (Of course, new reliable companies do appear in the marketplace.)

There was a time when there were more unscrupulous companies selling dietary supplements, but as the industry has matured they have formed trade groups to help monitor each other. Also, the consumer is becoming more sophisticated at evaluating supplements, because there are frequent articles in the newspapers and magazines on the topic. Companies now have to keep on their toes if they are to stay in business, and they have to sell effective, competitive products.

When to Take Supplements

Most of the time, it is a good idea to take supplements with food. Nutrients occur in nature as combinations with each other and with other substances in foods. Generally, they work together in digestion, absorption and other physiological processes. Also, it is much easier on the digestion to take supplements with food. Supplements are concentrated, and sometimes they can cause digestive upset or abdominal discomfort when taken in large doses on an empty stomach.

Single nutrients, such as vitamin C can usually be taken at any time, in almost any dose, without upsetting your system. Taking a drink of pure vitamin C powder mixed with dilute fruit juice is actually refreshing, and it is an easy way to take a large dose.

Sometimes, there is antagonism or competition for absorption between different nutrients, such as copper and zinc, or in utilization, for example, iron and vitamin E. However, these are usually not sufficient to be a serious concern when taking large doses of supplements.

There are some exceptions to this rule. For example, some of the amino acids are better utilized for specific purposes when taken separately from foods. (See Chapter 8.) My recommendation is not to worry too much about such combinations; they are minor, and worrying about them makes supplement programs confusing and inconvenient. If you do not remember to take things, they are not going to do you any good.

You may have concerns about swallowing so many pills if you are on many different supplements. If you have difficulty, it is easiest to take them with a thicker liquid, such as tomato juice or a blended fruit and yogurt smoothee. This usually makes it easy to open the throat for swallowing and coats the pills, making it easier for them to go down. After you are able to take them this way, it becomes easy to swallow many pills at one time, even with plain water, but be careful. (One of my patients uses this trickÑjust before taking the liquid for the pills she says to herself, “I am really thirsty.” She says it helps the pills go down.)

What About Pregnancy?

Most pregnant women need extra nutrition, and most physicians will recommend at least some dietary supplements. As stated before, folic acid is essential for the prevention of some birth defects, and other nutrients are helpful in preventing toxemia of pregnancy (see B6 and magnesium). Some supplements are helpful in reducing morning sickness of pregnancy, especially pyridoxine (vitamin B6).

Most of the nutrients on basic supplement programs are helpful during pregnancy and are often recommended by obstetricians. Extra iron and calcium are useful additions to a routine supplement program. The only caution is taking too much vitamin A during the first 3 months. Anything above 10,000 IU may be too much, but this only applies to preformed vitamin A, not to beta-carotene.

How to Store Supplements

You do not need to take special precautions when storing most dietary supplements. It is usually sufficient to keep them on a shelf in a pantry or on the kitchen counter. Most of the products are quite stable if kept in dry, room-
temperature conditions. As with any food, do not leave them for prolonged periods in a hot car or in a closed carrier out in the sun, where they will easily get overheated.

Sometimes people are tempted to put their supplements in the refrigerator, but this is not a good idea. Every time you open a bottle of cold supplement pills in a warm external environment, there will be some condensation on the surface of the pills that remain in the bottle. Eventually, they will become wet and sticky, or they will actually begin to dissolve, depending on how much they attract moisture. An exception is some supplements of intestinal flora (lactobacilli or bifidobacteria), which sometimes keep better in the cold.

For the same reason, do not keep your supplements in the bathroom (not that you were really tempted to do so). It gets too humid with all the showering to keep them dry and fresh. The best place for storage is probably the kitchen, since it is usually dry, and it is convenient, since you will mostly take your supplements with meals.

How Long Do They Keep?

It is not a good idea to keep supplements for a long time after they have been opened. Although some are quite stable in a dry environment, there is inevitably some oxidation and loss of potency. The amount of loss depends on the particular nutrient. Many of the supplements are quite stable, and last for years if kept cool and dry. Minerals do not deteriorate with time.

With some products, the surface of the pill will change color when some components oxidize. When this happens, the surface of the tablets usually becomes darker and mottled. You should discard these tablets. You can also see this kind of discoloration inside of some two-part capsules, and you should discard these also. (Some products normally have a mixed-color surface, and you should get to know what they look like when you first buy them so you will know when they change.)

The best course of action is to buy what you need for a
1- to 3-month period or up to 6 or 8 months if it is more convenient, and store unopened bottles in a cool (but not necessarily refrigerated), dark room. If you buy a large amount, you may keep the unopened bottles in the refrigerator, but be sure to bring them to room temperature before opening them, and don’t store them in the fridge once they have been opened.

Multi-compartment Storage Boxes

One last note that will make it easier for you to take supplements if you are taking more than a few: There are multi-compartment storage containers, similar to fishing tackle or sewing boxes, but with a rubber gasket seal to keep out air. They come with six to 16 chambers, to hold a number of different supplements. Label each chamber unless you clearly recognize the different supplements. If you have too many for the box, you can mix two in one chamber as long as you recognize the difference.

The advantage of having one of these multi-compartment boxes is that you only have to open one lid each time you want to take your supplements. Since you might be taking many different products at one time, this is an enormous time saver. And if you have arthritis, it will help reduce the stress on your hands from opening so many bottles so frequently.

Another way to accomplish this is to purchase some empty pharmacy vials and set aside some time to fill up a
1-week supply of morning and evening doses all at once. It is a good idea to have different size vials for your morning and evening for recognition, in case the doses are different.

Both of these methods have one further advantage, in that the original storage bottle for each supplement is opened less frequently, reducing exposure of the main supply to air and humidity. You should not have great difficulty keeping supplements safely.

Avatar Written by Michael Janson MD

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