Nutrition Supplements

What exactly is meant by the term "nutrition supplements?"

The word "supplement" means exactly that: a nutrient or group of nutrients (vitamins, minerals, protein, carbohydrates, fats and oils) that are meant to supplement, but not substitute for a healthy diet that you eat on a regular basis. Nutrition supplements come in a variety of forms: pills, capsules, powders, liquids, and even in gel form. The cost of nutrition supplements can range from almost "at cost" to being outrageously expensive.

Should I be taking supplements?

You probably don't need a general vitamin-mineral supplement if you are eating a reasonably varied diet most of the time, aren't restricting calories to lost weight, and generally don't skip meals. This doesn't mean you have to be a "perfect eater" - no one is! Taking extra supplements won't add extra energy. If you are fatigued because of a poor diet, only better nutrition can correct this problem. Being on a sleep-deprived schedule will require that you find a way to get more rest. Downing some B vitamins won't do the trick. Vitamins and minerals do not increase your appetite or cause weight gain.

Some students take a multiple vitamin-mineral supplement as sort of an "insurance policy" if they can't be sure they are eating well a lot of the time. But keep in mind that a supplement can never make up for eating poorly. And a multiple vitamin mineral supplement is just that; it can't provide your needed protein, energy, carbohydrates, nor fiber. Only food can give you these needed nutrients.

Don't some people need specific supplements?

Sure. Because of allergies, certain medical conditions, or simply the inability to obtain needed nutrients on a regular basis, you may know people who have to take specific supplements.

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Calcium

The recommendation for daily calcium intake for people from 19 to 50 years old is 1000 mg.  What does this mean in terms of food? You need to get the equivalent of slightly more than 3, 8-oz.servings of dairy products or calcium-fortified equivalent foods per day. That may be quite a challenge, so we encourage you to try for at least 3 servings, and then add a calcium supplement. Calcium supplements are better absorbed from the intestine in the presence of lactose (the sugar of milk) and protein. Taking the calcium supplement with a glass of milk is ideal. Once the calcium gets absorbed into your bloodstream, your bones will take up the calcium better in the presence of vitamin D. That's why almost all dairy products and many calcium supplements are fortified with vitamin D.

Other foods high in calcium that are absorbed well are calcium-fortified orange juice, tofu that is packaged in calcium brine, calcium-fortified cereals, and almonds. Easy ways to work in that extra calcium is to sprinkle cheese on your salad or baked potato, order lattes and cappuccinos if you drink coffee, or whip up a smoothie with low fat yogurt and fruit for a study break snack.

A great buy for calcium as well as multiple vitamin and mineral supplements can be found at the Health Services pharmacy. It should be noted that most multiple vitamin-mineral supplements do not contain enough calcium to be used as calcium supplements.

After your early 20's, your bones will have reached 90% of their "peak bone mass." ( Bone mass continues to develop until about age 30, however.) This means that if you are a woman, you will be carrying to menopause the density that your bones have accrued when you were much younger. Osteoporosis and bone fractures are becoming a very large problem for older women (and some men). The most important preventive measure you can do is to increase calcium intake now, along with regular "weight bearing exercise." Examples are walking, jogging, racket sports, Frisbee, and other activities in which your body weight is supported by your own bones. Working out with weight resistance exercise machines and free weights is also very helpful for increasing bone density, no matter what your age.

Iron

You may learn from having your blood tested by a medical provider that your iron levels are low. It is often recommended that you take iron supplements for awhile. Absorption of this iron will be increased if you take the iron along with an acidic food or juice (e.g., orange juice, tomato sauce, strawberries). Taking iron without food may upset the stomach. People may find that they are able to avoid the nausea sometimes associated with an iron supplement by taking it right before bed. Don't take a calcium supplement at the same time you take an iron supplement, since calcium can interfere with the body's ability to absorb iron.

It is never advised to take iron supplements without medical advice just because you "feel tired." Fatigue can be caused by many things, including lack of adequate rest, depression, an imbalanced diet, effects of some medications, and several medical conditions. By taking iron supplements when you are not deficient in iron, you could actually be doing more harm to your health. Hemochromatosis is a genetic disorder predisposing individuals to a toxic build-up of iron. Because supplementation may accelerate the effects of this condition, adult men should avoid taking supplements that include iron. You might be alerted to possible iron deficiency when you try to donate blood and are turned away because of a low iron level. Always consult with a medical provider if you think you may be iron-deficient.

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Vitamin C

If you are a heavy smoker, you may need as much as an extra 100 mg. of vitamin C per day (easily met by drinking an extra glass of orange juice, a large portion of broccoli, melon, or green pepper). Research has not convincingly shown whether or not extra vitamin C is helpful in warding off colds. It may help lessen the severity of a cold, however. Extra vitamin C is usually recommended around the time of surgery to aid in wound healing. Taking high amounts of vitamin C over a very long period of time can actually lead to "rebound scurvy," the deficiency disease of vitamin C. This is because the body can adapt to these extremely high levels. When one resumes a more normal intake, the body thinks it is then in a deficiency state (babies born to mothers who consume these very high levels during pregnancy sometimes develop this rebound scurvy after birth).

Folate

There has been recent concern that all women of childbearing age get adequate folate (a B vitamin) in their diets, in order to prevent some types of birth defects. Folate is also linked to heart disease prevention and may help prevent depression. Folate is easily found in foods such as fortified cereals, dried beans and legumes, dark green leafy vegetables (spinach, kale, broccoli), and orange juice.

Are protein powder supplements necessary if I'm working out?

Unfortunately, a lot of money is spent on protein supplements (usually in a powdered form), in the hopes that the protein consumed will go straight to the protein of your muscle. If it were only that easy, we could all save a lot of time in the gym!

The body likes to take a more indirect route, however. Much of this high level of protein is actually converted to carbohydrates and fats in the body. Too much extra protein can put a burden on the kidneys, be dehydrating, and can cause calcium loss from the body. Your protein needs are usually met quite easily by a slight increase of protein in the diet. Most Brown students, unless they are restricting calories, get about 1-1/2 to 2 times the protein they need just with a regular diet. This is true for both vegetarians and meat-eaters.

More details about eating for working out and various sports supplements can be found in the Nutrition Resources section.

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How do I know if herbal supplements are safe?

This is a difficult question to answer, because there are no federal regulations that standardize quality of ingredients contained in these products. Additionally, no testing is done on the actual products that you see on the shelves in stores. You therefore lack assurance that what is stated to be true on a supplement label even resembles what you are getting. The lobbying influence of the nutrition supplement industry in Washington is very strong, and past efforts to get any type of labeling legislation passed has failed. Additionally, few long-term, reliable studies have been done on most herbal and "natural" products. There is often very little information on food-herbal, drug-herbal, and multiple herbal-herbal interactions. Of particular importance for women is that if you are pregnant or breast-feeding, you should not use any dietary supplement without the advice of your physician.

Where does all this leave you, as the consumer? Perhaps the most important thing you can do is to try to stay informed about which products are potentially harmful (the most important factor when deciding to use supplements), which might be fairly neutral, and which might actually do some good, if taken in sensible amounts.

Two excellent and reliable books that you might want to explore in this area:

  • Sarubin, Allison, MS, RD, The Health Professional's Guide to Popular Dietary Supplements. The American Dietetic Assn., Chicago. 2006. (The 2000 edition may be checked out from the Health Education Library)
  • Foster, Steven, and Varro E. Tyler, Ph.D., Tyler's Honest Herbal. A Sensible Guide to the Use of Herbs and Related Remedies. 4th Ed. Haworth Herbal Press, New York. 1999. (May be accessed in the Health Education Office; not for loan)

You can also use the links below for more information.

Links you can use

Consumerlab.com
This web site provides independent test results and information to help consumers and health care professionals evaluate health, wellness, and nutrition products (by brand name). You can sign up for newsletters. Health and nutrition products tested include: herbal products, vitamins, minerals, other supplements, sports and energy products, functional foods, foods and beverages, and personal care products.

Food and Drug Administration
The FDA has a user-friendly web site that contains "Frequently Asked Questions" about food supplements.

Office of Dietary Supplements
The National Institutes of Health Office of Dietary Supplements has a web site that offers a comprehensive overview of nutrition supplements as well as a listing of new studies and safety issues.

Gatorade Sports Science Institute
This site has articles by experts in exercise science, sports nutrition, supplements and "ergogenic aids" for athletes. Other topics include hydration and sports psychology.

American Botanical Council  
This organization works to educate the public about beneficial herbs and plants and to promote the safe and effective use of medicinal plants.

National Center on Complementary and Alternative Medicine
NCCAM is part of the National Institutes of Health and is dedicated to exploring complementary and alternative health practices in the context of rigorous science. The A-Z index allows you to search for a particular treatment or therapy. Topic areas include acupuncture, vitamin supplements and ayurvedic medicine.

Discovery Health
The alternative medicine center of Discovery Health has information on supplements, a Drug Interaction Center and articles on certain herbal medicines.

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Disclaimer: BWell Health Promiotion is part of Health Services at Brown University. Health Promotion maintains this site as a resource for Brown students. This site is not intended to replace consultation with your medical providers. No site can replace real conversation. Health Promotion offers no endorsement of and assumes no liability for the currency, accuracy, or availability of the information on the sites we link to or the care provided by the resources listed. Health Services staff are available to treat and give medical advice to Brown University students only. If you are not a Brown student, but are in need of medical assistance please call your own health care provider or in case of an emergency, dial 911. Please contact us if you have comments, questions or suggestions.