Supplements: to take or not to take?

Many of us have considered or do take supplements. However, what evidence is there to support taking them?

We all want to do what is best for ourselves and look after our health, especially if something unexpected has happened such as a cancer diagnosis.

Firstly, what is a supplement:

Common groups of supplements

• Vitamins e.g. vitamins A, B and D
• Minerals e.g. magnesium and calcium
• Herbs or botanicals e.g. ginger
• Botanical compounds e.g. curcumin (turmeric)
• Amino acids e.g. glutamine
• Live microbial (probiotics)

At this point, it is important to note that supplements are regulated by the Food Standards Agency, which highlights how they are not medicinal products and cannot advertise themselves as such. This means they cannot claim to have a pharmacological, immunological or metabolic action. So, the use of food supplements is not intended for the treatment or prevention of illness or disease, and they can’t claim to transform physiological functions.

Reasons for taking supplements

Supplements provide nutrients into your diet that may be missing and seem like an easy way to improve or maintain your general health. They may do this by helping you meet your daily intake of essential nutrients.

However, the Association of British Dietitians recommends trying to make changes to your diet before choosing supplements.

What changes can I make?

• A minimum of five fruit and vegetable servings a day
• Choosing wholegrain options where possible
• 2-3 servings of milk and dairy for an adult a day (if you are using a dairy-free alternative you need to ensure it is fortified with calcium)
• Two servings of protein-rich food, such as fish, eggs, beans, meats and pulses (it is recommended to try and replace meat with pulses 1 – 2 times a week)
• Limiting foods which are high in fat, salt and sugar

The NHS recommends that people get the nutrients they need for maintaining healthy bodily function from their diet. To highlight this a study was conducted around vitamin C intake and it was found that vitamin C was already being excreted before taking the supplement. This means that just by having a regular healthy diet enough vitamin C is being ingested, as your body will get rid of or in some cases store what is not needed.

As with vitamin C, some supplements may be water soluble, meaning any extra will come out in urine, however an excess of fat-soluble supplements would be stored in your fatty tissues and liver, which in excess may cause issues. Even if you are not taking an excess of a supplement, it may still cause issues if you are having treatment for cancer as some supplements can interfere with how your body breaks down the treatment which in turn can make them less effective or even increase your side effects from treatment.

However, it may not always be possible, for a range of medical reasons, for a person to get the nutrients they need from their diet. If you are concerned you are unable to meet your nutritional needs or are considering taking supplements for any reason, talk to your doctor or dietitian before taking them.

The supplement business

 It is important to note that even though some people are advised to take supplements for varying reasons it is still an industry, an industry that was thought to be worth £122 billion in 2022 and is projected to reach £221 billion by 2030. Therefore, it is important to think about who is advising you to take the supplement and what their motives are; are they just trying to sell you a product?

As the industry is so profitable there are lots of people wanting a piece of the action which has led to a flood of counterfeit products being made. These are not regulated and therefore the product itself could be unsafe as at best they may not contain the active ingredient they are claiming to, at worst they can have actively toxic ingredients.

During 2016-2019 the government’s insolvency service launched an investigation into people being scammed by fake supplement companies, they found nine companies which were estimated to have scammed people out of £10.6 million. These findings were used by the government as part of a scam awareness campaign, advising people of the dangers of counterfeit supplements.

So now you think that is fine I will just use a reputable company, but Which magazine did research into well-known products and retailers and found that they have fewer products than advertised (legally supplements can contain up to 50% or 20% less of the active ingredient). They also found companies were making misleading claims about the benefits of their products, the claims have been found to be exaggerated and unauthorised. From their findings, they advised people to be careful with buying supplements and to be weary of believing the claims they make.

“If it sounds too good to be true, it probably is.”

This statement can also be extended to your family and friends. It can be tempting to try a supplement especially when recommended by someone that you know and trust, however, there isn’t a clear picture within the scientific community as to how effective supplements actually are. Keep in mind there is very little evidence that they can reverse a chronic condition and they are not able to claim that they can do so.

As most supplements are seen as natural the fact they can be dangerous and can be overlooked but it is important to think carefully about taking supplements and discuss them with your team or GP before starting any.

What to look out for if you choose to take supplements:

Firstly, before starting to take any supplements make sure you discuss with your doctor. As previously stated they may not be needed or might negatively affect your treatment. If after discussing with your doctor you still wish to take supplements keep the below points in mind:

• Don’t buy from the internet unless you are very confident in the supplier
• Buy from a reputable supplier such as a chemist, pharmacy or supermarket
• Be wary of products that are a lot cheaper than similar products
• Check the label, and make sure it has the dose and an expiry date

References

• https://academic.oup.com/eurpub/article/30/Supplement_5/ckaa165.1408/5915952 
• https://www.bbc.co.uk/news/magazine-24563590
• https://www.bbc.co.uk/programmes/articles/1VjFvRZvDv9XrMcdB5dt1Wh/should-i-take-vitamin-supplements
• https://www.bda.uk.com/resource/supplements.html
• https://www.cancer.org/cancer/managing-cancer/treatment-types/complementary-and-integrative-medicine/dietary-supplements/safety.html#:~:text=People%20getting%20chemotherapy%20(or%20other,effective%20or%20increase%20side%20effects.
• https://www.food.gov.uk/business-guidance/food-supplements
• https://www.gov.uk/government/news/dont-fall-victim-to-rogue-health-supplement-companies
• https://www.gq-magazine.co.uk/article/do-supplements-work
• https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/expert-answers/vitamin-d-toxicity/faq-20058108#:~:text=The%20main%20consequence%20of%20vitamin,the%20formation%20of%20calcium%20stones.
• https://newsinhealth.nih.gov/2013/08/should-you-take-dietary-supplements#:~:text=Supplements%20are%20available%20without%20a,maintain%20or%20improve%20their%20health.
• https://www.nhs.uk/conditions/vitamin-b12-or-folate-deficiency-anaemia/
• https://www.nhs.uk/conditions/vitamin-b12-or-folate-deficiency-anaemia/treatment/#:~:text=If%20you%20have%20had%20neurological,have%20injections%20every%202%20months.
• https://www.nhs.uk/conditions/vitamins-and-minerals/#:~:text=Vitamins%20and%20minerals%20are%20nutrients,need%20to%20take%20extra%20supplements.
• https://www.pennmedicine.org/updates/blogs/health-and-wellness/2020/february/the-truth-about-supplements
• https://www.which.co.uk/news/article/revealed-vitamin-supplements-that-dont-contain-what-they-say-anHzH4j22IQk