Apply your heart to instruction and your ears to words of knowledge (Proverbs 23:12). As a scientist/dietitian in the dietary supplement industry, I formulate products, write structure/function claims, and substantiate claims with journal article research. Many physicians, pharmacists and therapists call me for advice on supplements. The dilemma for most health professionals is knowing what information on supplements is accurate, if there is research to support the claims, and whether the products are safe. It is a responsibility of the health professional to have a good understanding of basic information on supplements. God can work through counselors to be a great support to their clients by knowing some facts on vitamins, minerals, herbs and specialty nutrients. It is not their role to prescribe, but to educate, support and answer questions based on the scientific literature.
Top 10 things every counselor should know
• Are dietary supplements really necessary?
• Companies make outrageous claims on dietary supplements. How do you know if their products work?
• How do you know if the dietary supplement dosage is effective?
• Are dietary supplements safe?
• Do dietary supplements have interactions with drugs?
• Are there groups of people who should not take supplements?
• Are some products absorbed faster than others?
• How long does it take before I know a dietary supplement product works?
• Do dietary supplements have interactions with other nutrients?
• Who do you believe?
These questions and others were a “thorn in my flesh” during my college G years and while instructing college nutrition and other science courses. The concept of taking dietary supplement pills was a huge stumbling block for me, since I was taught that there wasn’t any research to substantiate claims on vitamins and minerals, let alone herbal extracts. I am thankful that God challenged, encouraged and helped me to open my mind to the scientific literature. There are peerreviewed, double-blind, placebocontrolled studies that demonstrate that many of these compounds are effective and safe. On the contrary, not all claims on supplements are accurate. This article will discuss the top 10 things every counselor needs to know about supplements. As I started my career in counseling, I was very close-minded toward dietary supplements. The turning point was when I was counseling a 40-year-old cancer patient and watched him, his wife and children plan his funeral. I turned to God for help and understanding. Most importantly, I pray for my clients and then help them to improve their eating habits and food selections. At that time, I prayed that God would give me wisdom and show me what I was missing in my counseling practice. For the Lord gives wisdom, and from His mouth come knowledge and understanding. He holds victory in store for the upright; he is a shield to those whose walk is blameless, for he guards the course of the just and protects the way of his faithful ones (Proverbs 2: 6-7). God answered my prayer as I began to read the scientific literature on dietary supplements. There are peer-reviewed human clinical studies, which demonstrate that many supplements are effective and safe. As I worked for large nutrition and dietary supplement corporations, I was exposed to journal articles that I had never seen before on supplements such as coenzyme Q-10, L carnitine and others. My office library continues to grow since there are so many great studies being performed and published. I thank the Lord for showing me this wonderful research on these compounds to help others —it was a dream come true. Now to Him who is able to do immeasurably more than all we ask or imagine, according to His power that is at work within us, to Him be glory in the church and in Christ Jesus throughout all generations, for ever and ever, amen (Ephesians 3:20).
Are dietary supplements really necessary?
We are what we eat and God holds us responsible for what we put into our bodies. The right food choices can help us perform at peak energy levels and be all that we can be to do the Lord’s work. We should be consuming a variety of vegetables and fruits to meet requirements for different vitamins and minerals. Although for most Americans, it is difficult to eat at least five fruits and vegetables a day. Therefore, a daily multiple vitamin/ mineral supplement may be necessary to fill in the vitamin or mineral gap that may be missing in our diets. Vitamins A, B complex, C, D, calcium, zinc, selenium, and chromium are just some that could be lacking. It has been shown that deficiencies do occur in the U.S. For example, it has been estimated that over 90 percent of women, 60 percent of men, and 66 percent of children are deficient in calcium.
Companies make outrageous claims. How do you know if their products work?
The dietary supplement industry is dynamic and scientific research is available on many supplements to show that they have great benefits to the body. Every company that makes a dietary supplement claim on labels is required to have a full file of published scientific research to support their claims. The Federal Trade Commission (FTC) and the Food and Drug Administration (FDA) have a responsibility to regulate the claims made on product packaging, inserts and other promotional materials. Marketing on the Internet is also subject to their regulation. In 1994, the Dietary Supplements Health and Education Act (DSHEA) was established. It brought about the requirement on labels and marketing copy to be truthful, not misleading, and substantiated with scientific research. DSHEA brought about the term “structure/function claims.” These are statements used on product labels to promote their benefits. Dietary supplement claims need to be truthful based on the research, but also should not imply drug effects. For example, a dietary supplement can’t imply it is going to reduce colds or the flu. It can state that it may support well-being, but that is a difficult statement for the average consumer to understand. It is difficult to write structure/ function claims that are truthful and honest and do not imply that the product has drug-like effects.
How do I know if the dosage of the ingredient is effective?
If a product makes a claim, the dosage should match the effective dose in the supporting research. For example, a product may claim, “Ginkgo biloba supports blood circulation to the brain.” Ginkgo biloba, as a standardized extract, is effective at 120 to 240 mg per day according to the scientific literature. People may have beneficial effects at a lower dosage, but the daily dosage of a dietary supplement should match the effective dose used in the published research data. The delivery system should also be the same one used in the studies. The delivery system is the form the supplement is delivered in, such as tablets, capsules, tinctures, liquids and sprays.
Are dietary supplements safe?
Many compounds have been traditionally used for centuries, demonstrating that they are safe. Although, dietary supplements should have good safety/toxicity research to demonstrate that they are safe for consumption. New ingredients, which are not grandfathered in by DSHEA (sold in U.S. prior to 1994), need to be submitted to the FDA as a new dietary supplement with safety research to support their use.T I provide assistance to companies by performing exhaustive literature searches and evaluating ingredient efficacy and safety. I review all the ingredients in vitro (laboratory), animal, and human clinical studies. It is the responsibility of the company to determine if ingredients in their products are safe before they are sold to the public. Companies should be aggressive and diligent to confirm the safety of their products
Do dietary supplements have interactions with drugs?
Yes, some supplements have been shown to enhance or suppress drugs or have side effects when taken in combination with them. Some dietary supplements, like huperzine A and vinpocetine, are drugs in other countries and have drug-like effects. Therefore, if individuals are on prescription drugs, they need to be aware that certain dietary supplements may be contraindicated. Huperzine A, acetyl-L-carnitine, DMAE and phosphatidlylserine appear to inhibit acetylcholinesterase, which may elevate acetylcholine levels in the brain. Low acetylcholine levels have been observed in Alzheimer’s patients. These dietary supplements have been shown to be effective, and taken together, could have an accumulative effect. These ingredients taken alone at effective levels may have a cholinergic effect, which may improve memory, cognitive function, and alertness. It is uncertain what kind of short or long-term effects could occur when brain neurotransmitters are promoted. It is important to keep in mind that these ingredients may enhance prescription drugs that have a cholinergic effect, such as Donepezil or Tacrine. They also could reduce the efficacy of anticholinergic drugs, such as Atropine or Cogentin. If a person is taking prescription drugs, they should consult with their physician prior to taking dietary supplements.
Are there groups of people who should not take dietary supplements? Pregnant or lactating women and children should not take supplements without guidance from a nutritionally aware health care professional. This person can help determine whether a multiple vitamin/mineral prepared for them is appropriate. There are many people who have allergies to certain supplements. For example, those with allergies to shellfish should not consume chitosan or glucosamine sulfate products.
Are some dietary supplement products absorbed faster than others?
It is important to investigate statements on labels that claim the product is “more bioavailable or absorbed faster or better” than other forms. It is a pretty bold statement and would need to be supported by good science, which demonstrates that this product is superior in absorption to others. Granted, there are some calcium products such as calcium citrate and calcium citratemalate, which have human clinical studies to demonstrate that they are more bioavailable. (Bioavailability describes how much of a mineral is being absorbed and used by the body). Calcium citrate malate (CCM) is made up of calcium, citric acid and malic acid. It has been shown to be highly bioavailable versus calcium carbonate. There was a study performed that evaluated CCM versus calcium carbonate absorption in 12 healthy adolescents. After the calcium supplements were ingested, they were traced with a calcium tracer intravenously. The results were evaluated by mass spectrometry and showed that calcium from CCM had a 36.2 percent greater absorption than from carbonate at an increase of 26.4 percent. The goal of these different forms of calcium is to find a form that is more bioavailable than others. Remember, that the FTC requires companies to be truthful and honest with the consumer. Bottom line: Claims need to have published research to support strong statements. The consumer may ask the company for research citations to support the product.
How long does it take before I know a dietary supplement product works?
Do not be anxious about anything, but in everything, by prayer and petition, with thanksgiving, present your requests to God. And the peace of God, which transcends all understanding, will guard your hearts and your minds in Christ Jesus (Phil 4:6). Today everyone wants results immediately. Dietary supplements nutritionally support the body. Therefore, they usually take time before you will witness results. People give up too quickly, and consequently will not reap the benefits. There are numerous supplements that show benefits after 30 days, 60 days or even 90 days, when studied in doubleblind human trials. Chondroitin sulfate is a compound, which has been shown to support joint health. The human double- blind clinical studies have shown that it takes up to 90 days to see positive results. One study saw significant benefits over a three-year period. Another study extended over a three-year period. The research is good, but patience is key.
Do dietary supplements have interactions with other nutrients?
Yes, dietary supplements may interact with each other or too much of one can cause a negative effect on another. For example, studies have shown that consuming 45 mg of zinc daily can cause a copper deficiency. There are many multiple vitamin/ mineral products that provide an appropriate balance of vitamins and minerals. Many manufacturers that produce multiple vitamin and mineral products usually include a balance between the proper levels of vitamins and minerals to prevent problems. Fat soluble vitamins need to be consumed with a meal high in fat, and should not be taken with products such as chitosan, which binds fat and fat soluble vitamins.
Who do you believe? There is so much hype out there in print.
Remember the phrase; don’t judge a book by its cover? Well that certainly applies to printed material on diets andI dietary supplements. Don’t believe all the hype on the book cover or magazine article on dietary supplements before you review the research and make your own judgment. Look at the author’s credentials and the science behind the dietary supplement or diet. It is important to investigate authors of articles and books to determine if they have qualified credentials in their field. The second thing is to look for the author’s references and then retrieve the abstracts (summaries of studies) for review. You can retrieve abstracts on the Internet free of charge. Many times, personal opinions float into the text as a fact, which is misleading to the reader. Supplements are not food and should be taken very seriously because they could cause harm if not used properly. Testimonies are great, but it is best to have good research on efficacy and safety in place first. On the other hand, I personally did not believe that there was any research on high protein/high fat diets until I reviewed the literature. I challenge you to do a literature review on any supplements that are a “thorn in your flesh.” God will help you as you invest the time. In conclusion, dietary supplements have become popular in the U.S. as an alternative to traditional medicine. It is important for health professionals to know if information on supplements is accurate by investigating. Is there research to support claims and are they safe? Counselors have an opportunity to support their clients by staying current on the new trends in the dietary supplement industry. God wants us to use wisdom in all that we do.
Judi Quilici-Timmcke, M.S., is a Scientist/ Dietitian, President of Q-Tech Services, Inc., and product formulator in the dietary supplement industry. She was previously, Vice- President of Product Development and Research for Weider Nutrition-Specialty Market and has a Master’s degree in Dietetics/Exercise Physiology. Visit her at www.judiq.net or www.judiq.com.
References
1 The Indiana Calcium Initiative Consensus Statement, July 1, 2001.
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3 Krieglstein J. Neuroprotective properties of Ginkgo biloba—constituents. Zeitschrift Phytother. 1994; 15:92–6.
4 Miller J, et al. Calcium absorption from calcium carbonate and a new form of calcium (CCM) in healthy male and female adolescents. Amer J Clin Nutr. 1988; 48:1291-4.
5 Crolle G, D’Este. Glucosamine sulphate for the management of arthrosis: a controlled clinical investigation. Curr Med Res and Opin. 1980; 7(2):104-109.
6 Pavelka K, Gatterova J, Olejarova M, et al. Glucosamine sulfate use and delay of progression of knee osteoarthritis: a 3-year, randomized, placebo-controlled, double-blind study. Arch Intern Med. 2002; 162(18):2113-2123.
7 Abdulla M, Suck C. Blood levels of copper, iron, zinc, and led in adults in India and Pakistan and the effect of oral zinc supplementation for six weeks. Bio Trace Elem Res. 1998; 61:323-331.
