Part I of a four-part series on dietary supplements
In the next four columns, we will look at the different nutritional and vitamin supplements that many people consume. Part 1 will deal with the most commonly used drugs: vitamins and multivitamins. Part 2 will deal with nutritional supplements and ‘health' drinks, which are a multi-crore business in India. Part 3 will examine the issue of how consumers and healthcare professionals are carried away with the feeling that costlier a supplement, the better it must be. The last column will deal with medical fraud associated with nutritional supplements, the false claims that many drug companies make and how to be a smart health consumer.
What are dietary supplements?
A dietary supplement is any product that contains a ‘dietary ingredient' intended to add to the diet. These ingredients may be any of the following substances
* Vitamins (like vitamin B, D and E)
* Minerals (like calcium, iron, zinc)
* Herbs or other botanicals (like ginseng, garlic)
* Amino acids
* Speciality substances such as glucosamine, probiotics and fish oils.
Dietary supplements may come in a variety of forms: tablets, capsules, and powders, as well as drinks and energy bars. Most people take dietary supplements under the impression that they will increase energy, maintain strength, enhance performance, maintain health and prevent nutritional deficiencies.
Do you require a dietary supplement?
If a woman is unable to get all the dietary requirements that she requires from her daily intake of food, dietary supplements may be required. However, pills and tablets cannot replace a healthy balanced diet. The stress, therefore, must be on maintaining a diet high in vegetables and fruits.
The following groups of people may require dietary supplements:
* People consuming fewer than 1600 calories per day
* Pregnant and breast-feeding women
* Postmenopausal women and those with heavy menstruation
* Chronic diarrhoea
* Food allergies and food intolerances
* Vegans (who do not include even dairy products in their diet), and anyone eliminating an entire food group from their diet
There is definite scientific evidence that some dietary supplements are beneficial for the maintenance of health and for managing some health conditions. For example, women planning a pregnancy should take folic acid since it decreases the risk of certain birth defects. Postmenopausal women need calcium and Vitamin D for keeping bones strong and reducing bone loss.
Multivitamin/ mineral dietary supplements
For a long time, Indians have been brainwashed into believing that vitamins and minerals are a panacea for a multitude of health issues and will insist on being prescribed ‘tonics'! Vitamins and minerals have developed the reputation of being ‘magic bullets' because they are very effective in treating deficiencies. However, this does not mean that in a well-nourished individual, these supplements will prevent diabetes, hypertension, heart disease, cancer, and other chronic diseases of the 21st Century that Indians are facing.
Multivitamin/mineral supplements contain a combination of vitamins and minerals, and sometimes other ingredients as well. They can be available as tablets, capsules or syrups. The vitamins and minerals in these formulations have unique roles in the body and are prescribed only in certain situations where the woman is unable to obtain these from her diet. The classic multivitamin/ mineral formulation is the B-complex and folic acid (vitamins) and iron (mineral), prescribed for pregnant women.
What kinds of multivitamin/ mineral supplements are available?
Among the most common multivitamin combinations are basic, once-daily products containing all or most vitamins and minerals. Most of the formulations will provide the recommended intake levels.
Manufacturers choose which vitamins, minerals, and other ingredients, as well as their amounts, to include in their products. This freedom they have allows them to add botanicals (like ginseng or garlic), trace minerals (like selenium and manganese) and this is where the problems arise. Adding an extra ingredient allows the manufacturer to price the medication at their whim. Most consumers aren't aware that the health claims on labels intended for marketing purposes may not be accurate. Since many of these formulations are sold as food and not as drugs, it is difficult to regulate their prices and consumers end up paying money which is out of proportion to the actual cost of the ingredients.
Check with your doctor if you really need a multivitamin. Effective multivitamins should not cost you more than Rs. 2-3 per tablet or capsule. If you are prescribed more expensive ones, request your doctor for a cheaper brand. Remember, when it comes to vitamins, more expensive is not necessarily better.
Next column: The myth of nutritional supplements and ‘health drinks'
The author is an obstetrician and gynaecologist practising in Chennai and has written the book 'Passport to a Healthy Pregnancy'.