Dietary Supplements- Friend or Foe?

Over the last decade, there has been an increased awareness to the food we consume and the impacts that it has one our bodies. Nutrition is increasingly important, and people are looking to more alternative forms of therapy to maintain optimum health without the aid of prescription medications and remedies.

More and more people are turning to supplements, which can provide essential minerals vitamins to support optimal nutrition. In 2016, supplements accounted for 121.6 billion dollars globally with sports related, meal, homeopathic, and specialty supplements having the strongest growth (Morton, 2017)

It’s a fair assessment to say that every person reading this has either been recommended to take some form of vitamin, herb, or mineral or is currently consuming one of these now. Supplements are a great way to supplement nutritional/ dietary needs without having to consume the actual foods that contain them however, unlike pharmaceutical companies that have to endure rigorous testing and efficacy trials (as they should!), supplements are not regulated by the Food and Drug Administration (FDA) and do not go through this testing. In fact, the FDA merely regulates the labeling and marketing of supplements to ensure they are not misleading to consumers but consider supplements to be considered as food and therefore not subject to pre-market approval (McGinley, 2019). It is the responsibility of the manufacturing company to adhere to the rules and regulations established by the Dietary Supplement Health and Education Act (DSHEA) and the FDA (FDA, 2011) with only a small portion of these being tested by third parties to ensure efficacy.

With less than 25% of manufacturing companies actually being tested, only a fraction of those companies is actually delivering the active ingredient you believe you are consuming. Most of supplements do not have the active ingredient and/ or have added fillers to their product. In a study conducted by the University of Guelph in Canada in 2013, DNA tested 44 dietary supplements and found that only TWO companies were free from fillers and substitutions (PBS.org, n.d)

Long story short, if you’re consuming dietary supplements of any kind and you don’t know how to look for quality products, you could be throwing your money away.

How do I know what to look for?

 The FDA has recently released a statement acknowledging that the gap between testing and oversight of dietary supplements has grown exponentially and there is an increased need for more strict regulations and governance. Until then, there are ways to increase your odds of purchasing quality supplements.

1.     Third Party Testing/ Independent Lab- If your supplement is being tested in a third-party lab, they will be happy to display this label on their packaging! The United States Pharmacopeial Convention (USP) runs a voluntary program to certify and inspect the quality of a company’s facilities and product (less than 1% of products have this seal). There are also a couple companies that randomly evaluate dietary supplements and post their findings to the public. LabDoor and ConsumerLab.com will provide general results for free and more detailed findings for a fee. 

2.     Health Warnings/ Recalls- Consumers can verify supplements on the FDA website to understand if there are any health claims or sanctions for a particular supplement.  

Additionally, Consumer Reports has a list of supplements that are considered “The Dirty Dozen” because of know health implications, yet these products are still available to purchase. The Federal Trade Commission also has a list that can be found here.  

3.      Is the product too good to be true? If something sounds too good to be true, give yourself some space to pause. The LARGEST offender in the supplement game is supplements that are used for weight loss, body building, and sexual enhancement. Many of these products have been found to have substitutions like unapproved drugs, controlled substances, and possible cancer-causing agents (FDA, 2011)

4.     Is there evidence supporting the dietary supplements? The National Institute of Health composes fact sheets for commonly used dietary supplements. PubMed also has an easy to use website where consumers can research supplements to understand efficacy.

5.     Do you really need supplements? Could you already be consuming enough of the vitamin or mineral you are supplementing with? It’s always best to consult with your doctor/ dietician to ensure the best course of action.

It’s always best to consume the actual food versus taking a supplement, so here is a list of a few essential vitamins/ minerals and natural foods where you can find them:

Vitamin A:

Support eye health, growth development, teeth, and skin

Foods: Orange foods like carrots, cantaloupe, sweet potatoes, and melons

Vitamin K: Blood clotting

Foods: Greens! Kale, spinach, brussels sprouts, and broccoli.

B Vitamins: Energy Production, immunity function, and absorption of iron.

Foods: Whole grains, bananas, chili peppers, beans, and potatoes, and yeast

Folic Acid: Cell renewal and prevention of birth defects

Foods: Leafy greens, asparagus, broccoli, citrus fruits, beans, peas, seeds, buts, cauliflower, beets, and corn.

Vitamin C: Strengthens blood vessels, absorption of iron, anti-oxidants

Foods: Oranges, guava, green and red peppers, kiwi, grapefruit, Brussel sprouts

Vitamin D- Bone strength

Foods: You can get limited amounts of Vitamin D from eggs, fish, and mushrooms, though likely not all the vitamin D you require will come from food. The best way to stimulate Vitamin D production is to spend some time in the sun. If you would like more about Vitamin D, read my blog from April, 2018 here.  

This is one supplement that is highly recommended (especially in MN where we are further away from the equator and do not have as much sun exposure)

Vitamin E: Supports blood circulation, and protection from free radicals.

Foods: Almonds, sunflower seeds, and tomatoes

Calcium: Health teeth and strong bones

Foods: Dairy like yogurt, milk, and cheese. Additionally, tofu and black molasses.

1.     Morton, C. Top Takeaways on the 2017 global supplements market. New Hope Network. (November, 2017) Retrieved from https://www.newhope.com/market-data-and-analysis/top-takeaways-2017-global-supplements-market

2.     McGinley, L. The FDA launches tougher oversight on supplements.  Washington Post. (February 11, 2019) Retrieved from https://www.washingtonpost.com/health/2019/02/11/fda-launches-tougher-oversight-supplements/?noredirect=on&utm_term=.cbe9f574500c

3.     Beware of Fraudulent Dietary Supplements. Food and Drug Administration.  https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm246744.htm. March 2011

4.     National Institute of Health. Dietary Supplements: What you Need to Know. https://ods.od.nih.gov/HealthInformation/DS_WhatYouNeedToKnow.aspx

5.     FDA Statement. Feb 11, 2019. Statement from FDA Commissioner Scott Gottlieb, M.D., on the agency’s new efforts to strengthen regulation of dietary supplements by modernizing and reforming FDA’s oversight. Retrieved from https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm631065.htm

6.     Five Questions to Ask before When Considering Health Supplements. https://www.pbs.org/wgbh/frontline/article/five-questions-to-ask-when-considering-health-supplements/

7.      October, 2013. 11 Essential Vitamins and Minerals Your Body Needs. GoodNet. Retrieved from https://www.goodnet.org/articles/11-essential-vitamins-minerals-your-body-needs

Can I Lose Weight With Fat?

What is the Ketogenic Diet?

A ketogenic diet consists of a diet that is composed of primarily of fat and protein, with very little carbohydrates. There are varying levels of ketogenic dieting with a typical diet consisting of daily carbohydrate intake around 5%, protein intake around 20%, and the remaining 75% intake consisting of fat.

Glucose vs. Fat as Energy

Your body primarily is fueled by glucose and inhibiting carbohydrates means that your body cannot rely on glucose as an effective energy source.

So, your body will rely on dietary ketosis instead of glucose metabolism as a resource for fuel. Ketone production increases and glucose production slows.

When the body is lacking carbohydrates, the mobilization of fatty acids from adipose tissue speeds up and the liver converts acetyl CoA into ketone bodies acetoacetate and 3-hydroxybutyrate. Since the liver lacks the mitochondrial enzymes to utilize the ketone bodies, they transfer to the extra hepatic tissues like the brain,1 thus replacing the need for glucose (carbs) as energy and allowing for ketone bodies to burn fat as energy instead.

Inducing starvation or a diet in low carbohydrates encourages ketone production. When an otherwise healthy individual consumes a diet consisting of mostly fat and protein and limited carbohydrates, they will tend to lose more body fat quickly and maintain lean body mass.1

Short Term Effects of Ketogenic Diet and Weight Loss

According to a meta-analysis of controlled random studies by Nordmann, Nordmann, Briel, et.al, the short-term effect of a ketogenic diet in an otherwise healthy individual supports the idea that the individual will lose more body fat and increase their lean body mass in a six-month period, however, when this length was extended to one year, there was no longer a noticeable effect,2 meaning that weight loss with this diet was not sustainable.

Long Term Effects Questionable

In another study published by the American Physiological Society published in 2014, mice that sustain a ketogenic diet long-term (over one year) have a higher likelihood of dyslipidemia and increased inflammation as well as glucose intolerance and insulin dependency, 3 further suggesting that a long-term ketogenic diet is not healthy and should be further evaluated with your physician.  

Resistance Training and Building Muscle Mass

As suggested in the control trial conducted by Vargas, S., Romance R., Pedro J., et. al, there is an increased impact on weight loss when resistance training is incorporated into a ketogenic diet however would not be suggested for an individual looking to build more muscle mass.4

Summary

Several studies support1,2,3,4 a short term benefit for a faster weight loss prediction with the ketogenic diet, however, there is zero evidence that supports this method long-term and many suggestions that long term use of ketogenic diet could be detrimental to an individual’s overall health with potential negative impacts on LDL-C, glucose dependence, and insulin resistance, regardless of potential favorable outcome to HDL-C and triglyceride levels2

Other Considerations

A ketogenic diet has been proven to be very beneficial to specific groups of people with underlying conditions including epilepsy and diabetes. As with any change to your diet or lifestyle, be sure to speak with your health care practitioner regarding your all of your options and what is best for you, individually.

1.     Manninen, A. Metabolic Effects of the Very-Low-Carbohydrate Diets: Misunderstood “Villians” if Human Metabolism. J. Int Soc Sports Nutr. 2004. Doi: 10.1186/1550-2783-1-2-7

2.     Nordmann AJ, Nordmann A, Briel M, et al. Effects of Low-Carbohydrate vs Low-Fat Diets on Weight Loss and Cardiovascular Risk Factors- a Meta-analysis of Randomized Controlled Trials. Arch Intern Med.2006;166(3):285–293. doi:10.1001/archinte.166.3.285 

3.     Vargas, S., Romance, R., Pedro, J. et. al. Efficacy of ketogenic diet on body composition during resistance training in trained men: a randomized controlled trial. J Inc. Soc Sports Nutrition. 2018. Doi: 10.1186/s12970-018-0236-9

4.     Dashti, H., Thazhumpal, M., Husseinm ,T, et. al, Long-term effects of a ketogenic diet in obese patients .Exp Clin Cariodol. 2004. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2716748/ . Accessed October 6, 2018.

5.     Ellenbroek, J., Djick, L, Tons, H., et. al. Long-term ketogenic diet causes glucose intolerance and reduced β- and α-cell mass but no weight loss in mice. American Physiological Society. 01 March 2014. Doi: https://doi.org/10.1152/ajpendo.00453.2013