Dietary supplements are sold in grocery stores, and we often fall for their supposed health benefits. However, no one guarantees that we will actually reap those benefits. That’s why healthy food should be the primary source of all the nutrients our bodies need.
Compensating for Deficiencies
Dietary supplements serve as providers of substances to fill potential gaps in our nutrition. By incorporating supplements into our diets, we can support and restore various bodily functions. Studies have shown that regular use of dietary supplements can reduce the risk of deficiency by 80%. Examples of supplements include echinacea extract and omega-3 fatty acids. These bioactive substances and their combinations are intended to be consumed with food (they can be incorporated into food products). A dietary supplement is considered a food additive rather than a medication. However, the same substance can be registered as both a supplement and a drug. So, who can benefit from supplements, and who might find them harmful or a waste of money?
To improve our diets, we can use dietary fibers, amino acids, enzymes, bioflavonoids, vitamins, and minerals. Supplements can include multivitamins with minerals, immunomodulators, adaptogens, or chondroprotectors. Medical professionals often question the necessity of taking vitamin complexes. While an extra dose of vitamin D and calcium can be beneficial for osteoporosis, excessive beta-carotene increases the risk of lung cancer among smokers, and too much calcium and vitamin D raises the likelihood of kidney stones. Contrary to expectations, calcium, vitamins D and C, and multivitamins have not proven effective in preventing cardiovascular diseases, even though many people take them for that purpose.
Dietary supplements should be prescribed based on medical indications. For instance, a doctor may recommend supplements for adult patients diagnosed with celiac disease, where there are issues with nutrient absorption. In other cases, the optimal solution is to obtain vitamins and minerals from a balanced diet. Multi-component supplements packed with active ingredients should not be taken “just in case.” It’s essential to find a balance between the benefits and harms of supplements. Such prescriptions are not made “blindly.” It’s important to inform your new doctor about any supplements you are taking, as interactions between dietary supplements and medications can pose health risks.
Not Everything is Beneficial
With rare exceptions, essential organic compounds cannot be synthesized by the body: vitamins must come from food. A deficiency can disrupt vital processes necessary for life—they may slow down or even come to a complete halt. The need for vitamins is determined by the condition of the individual or environmental factors. For example, unlike most mammals, humans have lost the ability to synthesize vitamin C and must obtain it through their diet. Vegetarians need to supplement with vitamin B12, as plant-based foods do not contain it. Vitamin D is synthesized in the skin when exposed to sufficient sunlight, not through dietary supplements.
Under a doctor’s guidance, vitamin supplements may only be indicated in specific cases—such as for the elderly, newborns, pregnant women, and nursing mothers. Most people do not need vitamin supplements if they maintain a well-balanced diet. Consuming plant oils, dairy products, fish, fresh vegetables, and fruits will provide more benefits than taking a multivitamin pill. Authoritative researchers have concluded that long-term use of multivitamins does not improve life expectancy and, conversely, increases risks, potentially leading to heart attacks and cancers (including lung cancer). The necessity for mineral supplementation decreases in the following order: potassium, chlorine, sodium, calcium, phosphorus, magnesium, iron, zinc, manganese, copper, iodine, chromium, molybdenum, selenium, and cobalt. Boron and silicon are generally not included in supplements.
Protein synthesis involves 20 amino acids, 8 of which are essential (such as omega-3 and omega-6 fatty acids), meaning they cannot be synthesized by the body and must be obtained through diet. Non-essential amino acids are produced in the body from other amino acids, but the need for them can be influenced by age, health status, or lifestyle. Amino acids are a necessary component of sports nutrition. Probiotics, as dietary supplements, are used to normalize gut flora and modulate the immune system. Therapeutically, lactobacilli and bifidobacteria are prescribed, for example. Among natural dietary supplements with unproven effectiveness are echinacea, ginseng, ginkgo biloba, St. John’s wort, lecithin, collagen, and others. Despite their long history of use in herbal medicine and traditional practices, these powders, infusions, tinctures, and extracts lack standards and, consequently, quality guarantees.
Risk of Complications
Adaptogens and immunomodulators in the form of natural products can be dangerous due to the presence of hundreds of active ingredients, contamination with heavy metals and other toxins, as well as adulteration with substituted components. Half of the tested products typically contain foreign substances. Analyses show that many dietary supplements exhibit hepatotoxicity. For instance, weight loss supplements have been found to contain not only diuretics and laxatives but even potent amphetamines and their derivatives. Scientific publications from 85 studies in the International Journal of Clinical Practice report side effects and reduced therapeutic effects when dietary supplements are taken simultaneously with medications.
This is particularly true for supplements containing magnesium, calcium, iron, yohimbe extract, ginkgo biloba, echinacea, St. John’s wort, and flaxseed. Cardiovascular, antiplatelet (for blood thinning), and antidiabetic medications, such as warfarin, digoxin, aspirin, clopidogrel, and insulin, are the most poorly combined with dietary supplements. Side effects in such cases can affect the gastrointestinal tract, nervous system, and urogenital system. According to the New England Journal of Medicine, approximately 23,000 emergency room visits in the U.S. each year are related to side effects from dietary supplements. This illustrates what can happen when the balance between the benefits and harms of supplements is lost.
Examples of incompatible combinations of vitamins and minerals with food include the following: iron and green tea, melatonin and other sedative herbs, red yeast rice and niacin, St. John’s wort and antidepressants, coenzyme Q10 and antidiabetic agents, vitamin K and blood-thinning medications, fish oil and ginkgo biloba. To avoid complications, these supplements should be taken with at least a 2-hour gap. Conversely, there are instances of pharmacological interactions where simultaneous intake of compatible elements is more desirable than separate consumption, as synergy enhances nutrient absorption. When compatible substances enter into a cross-reaction in the stomach during food consumption, they promote mutual absorption.
Good and Bad Combinations
Vitamins and minerals in dietary supplements can be good companions. For example, zinc enhances the absorption of vitamin A, while vitamins A and C, along with copper, boost iron absorption. Magnesium aids in the absorption of B vitamins (except B1). B2 vitamins stimulate zinc absorption, and B6 reduces its excretion from the body. Vitamin B3 is compatible with copper and iron. Calcium helps with the absorption of vitamin B12, while vitamins B6, C, and D assist in the absorption of calcium itself. Vitamin C and copper act as catalysts for iron absorption. Vitamin E pairs well with selenium (a mineral that enhances its antioxidant effect). Vitamin K is necessary for calcium to build bone tissue. In turn, calcium is compatible with vitamins B6, B12, and D. However, magnesium in a vitamin-mineral complex with these elements will create the opposite effect.
Vitamins and minerals with antagonistic actions should ideally be taken separately; otherwise, they will destroy or suppress each other’s properties. This applies to vitamin E and magnesium, copper, iron, and zinc. Vitamin B9 and zinc block each other, forming an insoluble complex that is difficult to absorb. Vitamin B12 is deactivated when combined with iron, copper, and manganese. Iron and copper complicate the absorption of vitamin B2. Copper reduces the activity of vitamins B5, B12, C, and E. Taking vitamins B1, B12, C, and copper in separate pills and at different times will allow for maximum concentration in the blood, reducing the likelihood of negative interactions. It’s better to take a break of 4-6 hours between incompatible components.
Taking vitamins B1 and B2 together may enhance allergic reactions. Vitamin B1 also does not “get along” with B3, B6, and B12: “siblings” from the same “family” block its biological activity. However, in vitamin complexes of dietary supplements, B vitamins are assembled with consideration for the release timing of each element, making this form of intake acceptable. “Enemies” include vitamins D and E—these antagonists should be taken separately. It’s also advisable to avoid combinations of vitamins E, B12, and K. Vitamins K, E, and A hinder each other’s absorption. To replenish vitamin K deficiency, the appropriate supplement should be taken separately from others, maintaining a time gap of 2 hours. Calcium is an antagonist of iron, zinc, sodium, and phosphorus. There are other cases that require caution. To avoid misjudging the benefits and harms of a dietary supplement, it’s best to steer clear of “a cat in a bag.”