Fall 2009

Shopping for Supplements: What Do You Need to Know?

By Priscilla Abercrombie, RN, NP, PhD, Women's Health Specialist

Abercrombie Going down the aisle of the supplement section of the local health food store can be overwhelming. How do you read a supplement label? Are supplements tested for safety by the FDA? Can you be assured that you have purchased a quality product? In this column we will address these questions and hopefully help you feel more confident in what you are shopping for when you head down the supplement aisle.

Read the supplement label carefully.
All vitamin formulations are not the same. Look at the table on the back that lists the percentage of daily value (DV) for each nutrient in the supplement. The DV on food labels comes from the old recommended dietary allowances (RDA) developed by the Food and Nutrition Board. The RDA is the daily dietary intake level considered to be sufficient for 97%-98% of all healthy individuals. This includes both genders across the lifespan. If you want more recent information about your individual nutrient requirements based on age and gender see the Institute of Medicine’s 2005 References for Dietary Intake. They also have a table listing the upper limits of safe nutrient intakes.

Anatomy of the Supplement Label

"Serving size." Some vitamin labels show a nutrient list for a "serving size" of anywhere from one to eight tablets. Do not mistakenly think that the ingredients listed are for one tablet.

“Directions for use.” Sometimes the directions are to take your supplement three times a day. Will you really take it three times a day every day? If not, you may want to look for one that you take once a day. Be sure you can take them as directed if you want to get the health benefits of the supplement.

Ingredients. Be aware of proprietary blends added to supplements. They may use words like “Women’s Herbal Blend” on the label. Sometimes they only list the ingredients in their proprietary blend, not the doses or other important details about the herbs. It is unlikely that these herbs are added in adequate doses to have any therapeutic value. If you would benefit from a specific herb, your practitioner should prescribe for you the appropriate dose and formulation.

Expiration date. Verify freshness, and make sure you'll use the contents before you reach the expiration date.

Brand name. Buy reputable brands or those recommended by your practitioner. See Consumer Labs.com for supplements that have been tested.

Other Issues to Consider

Educate yourself. Consult evidence-based resources such as Natural Standard, The German E Commission Monographs or the American Botanical Council Web site for information about herbs and supplements. Nutraceuticals are big business, and they are being marketed heavily. Don’t believe everything you read. See below about how dietary supplements are regulated.

Store supplements in a cool, dry, safe place--not on the bathroom counter. As with all medication, keep supplements away from children, in a locked or secure location.

Be Cautious

Communicate with your practitioner. Talk to your health care practitioner before taking any medications or supplements when you are pregnant or breastfeeding, before surgery or when you have a chronic condition, such as heart disease. Make your practitioner aware of all the drugs and supplements you are taking at each visit. Check for interactions and contraindications* between any of the prescription drugs, over-the-counter drugs, herbs, and supplements you are taking. Know the side effects of all the medications and supplements you are taking.

How to know whether your vitamins and supplements are safe. Here is some information you might not know. The FDA regulates dietary supplements under a different set of regulations than those covering prescription and over-the-counter drugs. Under the Dietary Supplement Health and Education Act of 1994, the dietary supplement manufacturer is responsible for ensuring that a dietary supplement is safe before it is marketed. The FDA is responsible for taking action against any unsafe dietary supplement product after it reaches the market. Generally, manufacturers do not need to register their products with the FDA nor get FDA approval before producing or selling dietary supplements. Manufacturers must make sure that product label information is truthful and not misleading. The Federal Trade Commission regulates dietary supplement advertising.

Advice on Choosing a Quality Product:

Choose companies that follow good manufacturing practices (GMP); this will be on the label.
Look for the United States Pharmacopoeia Quality Verification Program seal (USP). Most Costco brand products have this.
Look for National Sanitation Foundation (NSF) certification; they certify water filtration systems around the world.
Search consumerlabs.com. They test supplements (very similar to USP criteria) and can be found online for an annual fee of about $25.

* You can check for interactions by talking with your pharmacist. In addition, there are some websites where you can do this.