Friday, May 20, 2011

Supplements: What works?

St. Luke’s Health Watch

Dr. Dan Fairman

Americans have a fascination with pills, and with medicines overall. Isn't there a pill for my belly fat? How about a pill to make me smarter? How about one to improve my sexual ability? Is there something that will make me stronger? How about living longer?

Pharmaceutical companies have a tremendous fi-nancial impact on the economy, and the same can be said for vitamin and supplement manufacturers. In 2007, vitamins and supplements were a $25 billion business. That's a lot of money, but I think the biggest question with any medicine should always be: "But does it work?"

Part of the answer to that question is in how you define efficacy. There are some studies for various supplements, but for many supplements on the market, there are very few well-controlled studies that are helpful. For many manufacturers, there is really no need for a study. In 1994, Congress (with much prod-ding from Sen. Orrin Hatch of Utah) passed the Dietary Supplements Health and Education Act. The act allows the sale of supplements so long as they do not claim to treat a specific condition. It is because of this act that you can see claims such as "may improve prostate health" or "may improve digestion" or "may improve sexual function." No proof is required, but the supple-ment may work. (Eating dirt may work also, but I wouldn't recommend it.) Scientific studies cost money, and if you can just hint at efficacy, why not use that?

So, what does work? And how can we as consumers know? Is there a pill that will help my hair loss, make me more attractive, stop my snoring or help me win the lottery? Here is a partial list of supplements that I see in my clinic, in no particular order.

Calcium: Calcium is very necessary and beneficial for women to prevent or treat osteopenia/osteoporosis. Calcium is available in pills, liquids and drops, and as calcium carbonate, calcium citrate or calcium phos-phate. It can be obtained from dairy products, fortified juices like orange juice and vegetable sources. These different forms vary only slightly in absorption and side effects; spending extra money on Coral Calcium or other expensive brands doesn't really make much dif-ference. Beware of claims (from any supplement) of "improved absorption," "superior results," "improved bioavailability" or "improved cellular health." (The last claim is from ASEA, a very expensive brand of saltwater.)

Co-Q 10: In 1980, one of my medical school profes-sors believed that co-enzyme q-10, or ubuquinone, was a compound in search of a disease. To this date, the only disease that this chemical treats is co-q 10 defi-ciency, which is exceedingly rare. This drug has been considered for a number of heart diseases, but again has no efficacy for any heart disease. It may have some benefit for lowering blood pressure (though there are better and cheaper alternatives), but both the Mayo Clinic and Natural Standards give it a "C" grade, as there is little or unclear scientific evidence for its use.

Vitamin E: The recommendation for the use of vi-tamin E came from observational studies of the Medi-terranean diet. This diet is high in antioxidant fruits and vegetables, in addition to favoring "healthy" fats such as olive oil and smaller amounts of proteins. The diet lowers risk of heart disease and cancer, possibly due to the antioxidant effects of vitamins E and C. Well, the diet does work; the pills don't. In fact, sup-plementation with vitamin E has actually been linked to higher rates of lung cancer and heart disease. The Mayo Clinic and Natural Standards give vitamin E a "C" grade and in some situations a "D" grade. Eating healthy is still the best source of antioxidants.

Glucosamine sulfate, with or without chondro-itin sulfate: This compound may be of some benefit for knee osteoarthritis. There have been a number of well-done studies; some showing no benefit but some showing mild benefit in pain relief. The most recent trial, which looked at radiographic (X-ray) progres-sion, found that glucosamine seemed to minimize car-tilage loss over time. There is little downside to gluco-samine supplements. I tell my patients it's OK to try over a two- to three-month period. If there is improve-ment in symptoms, it seems reasonable to continue. If not, then stop taking it.

Are supplements safe? Do supplements interact with my prescription medicines? Can I combine this sup-plement with this other supplement? Does this sup-plement have any long-term benefit? How about long-term risks? And what about colon cleanses or other alternative medicine practices? These questions have the same answer as the efficacy question above: There is often no answer, as no one has done the studies to tell for sure.

So what do I tell my patients? I try to stick with proven recommendations. For cancer prevention, eat healthy, and avoid tobacco and excess alcohol. For heart disease prevention, eat healthy, exercise and avoid tobacco, but have a drink a day. If you can't eat healthy, for whatever reason, a multiple vitamin is reasonable, but don't spend a lot of money on one. To lose belly fat, eat less and exercise more.

If it sounds too good to be true, look closely at the evidence from a reputable source. And no, I can't help you win the lottery.

Dr. Dan Fairman is board certified in internal medi-cine. He practices at St. Luke's Clinic—Internal Medicine and Urology in Ketchum

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