What You Need to Know About Supplements

By Carrie
Carter, M.D.

A Woman’s Guide to Good Health

Most physicians were trained
to dismiss all supplements- except those given solely for
mainstream medical conditions such as an obvious nutritional
deficiency, to support the needs of a pregnancy, or to
provide calcium to women for prevention of osteoporosis.
Before accepting or endorsing any supplement or treatment,
all physicians are trained to evaluate whether there is solid
research data that proves two things about the

1. That it is
2. That it is safe-or not harmful

Yet often that data does
not yet exist. The questions have come back around. Can we
get all the nutrients and nutrition we need just by taking a
special capsule? Can we outsmart Mother Nature and prevent
aging and disease with supplements? Some supplements

making headway in these
areas. However, others should be struck down by a lightning

What to
Look for in a Supplement-and a Husband

Figuring out what
supplement(s) to take is a lot like trying to find the right
husband. When deciding on a husband, once you get to the
point where you are seriously considering a guy, you may

● Will he actually do
what he says he will do after I marry him?
● Deep down, is he really who he seems to be?
● How will he get along with my family and

In the same way, when
considering nearly every nutritional supplement you should
ask yourself:

● Does this supplement
really do what the promoters say it does once it’s inside the
body? (Or does it only work in a test tube?)
● Is the stuff deep down inside the supplement the same as
what is listed on the label?
● How will this supplement interact with other supplements
and medications I am taking now?

Quality control is a big
problem with nutritional supplements. As a trade-off for the
privilege of buying whatever supplements whenever we want,
there are few-if any- uniform quality controls in place to
monitor nutritional supplements. Germany, by contrast,
requires that herbal remedies be registered with the
government and then standardized so you know what you are
getting. Their agency, called Commission E, evaluates the
safety and effectiveness of herbs. Because of the Dietary
Supplement Health Education Act (DSHEA) passed by Congress in
1994, the FDA does
have the same control
over nutritional supplements that they do with food and drug
items. In fact, their only control system is to prove that a
particular supplement that is already on the market is
dangerous (at the taxpayers’ expense rather than the
manufacturer’s expense). Many manufacturers are pushing the
limits of the law quite far with unsubstantiated claims and
false advertising. This is why the fine print on supplement
labels reads:
statements have not been evaluated by the Food and Drug
Administration. This product is not intended to diagnose,
treat, cure, or prevent any disease
. Now you know why!

There is a real
possibility that you may be accidentally overdosing on
certain supplements if you are taking supplements plus
fortified foods, bars, or supplement drinks. The saying that
you can’t have too much of a good thing doesn’t apply to
nutritional supplements. Too much of certain supplements
could prove toxic to your body.

Nutritional supplements
that have passed scientific scrutiny and quality control are
usually safe to take. But from your body’s viewpoint, adding
several supplements to your system is not quite the same as
eating extra servings of broccoli and blueberries. It’s
important to know what you are taking.

and Mineral Supplements

The word vitamin
in Latin means a
”chemical necessary for life.” Vitamins and minerals are
nutrients from our environment that we need for all the
essential reactions in our cells to occur. Our bodies can
make small amounts of certain vitamins, but we cannot
manufacture minerals. Every mineral in our body must first
come from outside our body. One way to look at our need for
vitamins and minerals is to think of each of our cells as an
intricate factory. Different vitamins and minerals must be
present to complete the particular task at hand at every
workstation. Without these necessary components, the whole
production line is held up, which can lead to a shut down in
the cell and subsequent health problems. The problems could
be minor or they could be major, but if the deficiency is
major, it could lead to serious diseases such as scurvy,
beriberi, or pellagra (these might sound like nice tropical
getaways, but believe me, they are trips you never want to

Because vitamins and
minerals are so essential, every five years the United States
Food and Nutrition Board of the Institute of Medicine revises
their recommendations for the minimum amounts of each vitamin
and mineral needed each day. These values used to be called
the Recommended Daily Allowances (RDA), but recently that
term was changed to the Dietary Reference Intakes

But several years ago, a
number of well-designed and well-respected studies all came
to the same disturbing conclusion:
of us (men, women, and
children) are
taking in even the
recommended DRI minimum daily requirements of certain
nutrients-especially calcium, magnesium, iron, and

3 4 5

In medical school most
doctors were taught that if you ate a good diet, you did not
need a vitamin and mineral supplement. But the medical
community as a whole reconsidered this stance after a medical
review of thirty years of research studies revealed strong
evidence that suboptimal vitamin and mineral intake is
associated with increased risk of chronic and degenerative
diseases like cancer, osteoporosis, and cardiovascular
disease. Then in 2002, the American Medical Association (AMA)
took a very big step and issued a formal endorsement
recommending the daily use of a basic multivitamin supplement
by all adults to decrease the risk of getting these

You’ve come a
long way, doc!

Young Are Healthier with Folate

The statistics make it
clear that pregnant women who are deficient in the B vitamin
called folate (also known as folic acid) have a higher risk
of having a baby with the birth defect spina bifida, also
called neural tube defects. So a dose of at least 400 mcg per
day is highly recommended- not only for pregnant women but
for all women who could become pregnant, since critical baby
development often occurs during the weeks before a woman
knows she is pregnant. Also, women on birth control pills are
more often depleted of folate. There is also much new
evidence that low levels of folate can increase heart disease
(see chapter 9), so folate is important for all women as a
part of a balanced multivitamin/ multimineral

Older and
Now Wiser

Our older population
especially needs to be on a daily multivitamin/mineral
supplement. As we age, our bodies generally have more
difficulty pulling the nutrients out of our food and into the
bloodstream; plus, we have an increased need for certain
nutrients. Many recent studies confirm that the elderly are
healthier when they take a vitamin and mineral supplement
regularly. A recent study in the
of Nutrition
one hundred healthy adults over sixty-five years of age and
divided them into two groups, then compared one group that
was put on a daily multivitamin/multimineral supplement with
another group that was put on a placebo (sugar pill). After
one year the group that took the daily supplement scored much
better on tests of mental function (except long-term memory)
than they did before starting the supplement, while the group
that took the placebo showed no improvement.


Avoid the
a la Carte Method

A common practice is to pick and choose single nutrients to
supplement, like only taking vitamin C, niacin, or calcium. I
don’t recommend this. Vitamins and minerals work in concert
to maintain healthy function in your cells, and it’s
important to maintain the proper balance of nutrients. For
instance, certain nutrients-like calcium-need their
”buddies” huddled around them so they will be properly
absorbed. Otherwise they won’t do you much good. So take a
balanced vitamin and mineral supplement.

It is best to not only
select a balanced vitamin and mineral supplement but ideally
one that pays some attention to the plight of poor minerals
and their poor absorption history. In some of the higher
quality/higher priced combination supplements, this need is
addressed by including minerals that have been changed to a
state that is easier to absorb. One such product is the
Vitality Pak by Melaleuca: The Wellness Company, which uses a
patented process called ”fructose compounding” to attach
the minerals to fructose molecules, which helps the minerals
to be absorbed inside the body.

Another process
called ”chelation” is used by the USANA company to make the
minerals in their Essentials multivitamin, mineral, and
antioxidant supplement more absorbable.

This process
links an amino acid (protein part) to the minerals to help
absorption be more effective.

a Vitamin and Mineral Supplement

There are many factors to
consider when choosing the right vitamin and mineral
supplement for you.

1. Decide what you want
your supplement to do for you. Is your sole desire to make
sure you are receiving the DRIs of the vital vitamins and
minerals? Or are you seeking a supplement to prevent
degenerative diseases, which usually means taking more than
the DRI for most nutrients?

2. Take into account the
fact that many of us require higher amounts of nutrients than
the minimum in the DRI. This might be because of stress,
illness, age, or whether we smoke or are exposed to a toxic
environment- which probably covers most of us.

3. How much are you
willing to spend per month? Our options range from a few
dollars to as high as $70- 100 per month. Many outstanding
formulations are available for $35-40 per month.

4. What information is
available about the quality of the supplements you are
considering? This factor justifies why certain supplements
are worth spending a dollar a day. Look for information such


● Is the formula based on
the latest research in human nutrition?
● Are the nutrients of the highest quality and in forms that
are easy for the body to use?
● Is there evidence that GMPs (Good Manufacturing Practices)
are followed for quality assurance?
● Is the formula tested for potency and purity? Does it say
USP guidelines are used?
● Does the formula pass disintegration tests so nutrients are
available to be absorbed?

If you choose to use a
supplement limited to the DRI range of different
offers information on
which products meet their criteria. A few products that made
the grade are several Centrum formulations (Advanced Formula_
Centrum_ High Potency, Centrum_ Performance_ Complete, and
Centrum_ Silver _), as well as thirty-three other brands and
formulations. You can view all the latest results and
supplement evaluations on

In general, major name
brands and major store brands are recommended because they
are more likely to have inside the bottle what is written on
the label, and many of these companies utilize the same

I find that a large
percentage of supplement takers wrestle with ”breaking the
DRI laws,” as if there is a cop hiding around the corner
ready to give them a ticket for ”driving under the
influence” of too many vitamins! Yes, it is wise to be
cautious about overloading your body with these nutrients.
But most vitamins and minerals are
harmful in amounts that
far exceed the DRI, and many studies show that many nutrients
at higher than DRI levels may decrease the development of
degenerative diseases.

Vitamin A: Tricky Business
Some nutrients can be harmful
in very high amounts. Vitamin A, for example, is a tricky
one. There are two different substances listed together on
supplement labels as ”vitamin A,” but only one of them,
retinol-or true vitamin A-is thought to be harmful in high
amounts. The other substance, beta-carotene, is considered
nontoxic, according to many research studies. Why the
confusion? Beta-carotene is pre-vitamin A, or vitamin A’s
parent, and though the ”parent” is harmless, the ”child”
can be toxic!

The toxicity issue for
true vitamin A is a big deal for women in pregnancy, for
daily doses of 10,000 I.U. or more have been associated with
the birth defect spina bifida, and in adults overdoses can
cause permanent liver disease. There is also concern for
women who are postmenopausal. In a recent eighteen-year study
of more than seventy-two thousand post-menopausal women,
researchers found that those who took over 3,000 mcg/day of
retinol were nearly twice as likely to suffer a hip injury or
fracture in a fall. However, those who took high quantities
of beta-carotene did
have an increase in hip


Upper Limits for Common Vitamins and Minerals

The Food and Nutrition
Board of the Institute of Medicine establishes and updates
the recommended amounts of vitamins and minerals, which are
now called the DRIs (Dietary Reference Intakes) rather than
the RDAs, for adults to consume daily. The board also
establishes and updates the Upper Intake Levels (ULs) of
vitamins and minerals that are considered ”safe” for most
adults. These levels are conservative on purpose to leave a
margin of safety.


Reference Intake

Intake Levels

Vitamin A

3,000 IU (900

10,000 IU
(3000 mcg)

Niacin (Vit.












Folate (Folic


1,000 mcg or 1





600 IU (15

2,000 IU (50


22 IU natural

none currently


33 IU

none currently































(Source: Food and Nutrition Board of the Institute of
Medicine and the Council for Reponsible Nutrition,


So what vitamin and
mineral supplements make the grade in the “over the DRI”
category? There are many excellent choices available, and
again, I recommend you select a well-known, established brand
or a major store brand. Compare the label to the Upper Intake
Levels in the table to see how it measures up. I have
positive personal experience with both Melaleuca’s Vitality

and USANA’s

A reminder: Do
not be surprised that you do not see any of your ”over the
DRI” supplements listed on the Consumer Lab approved list.
It does
mean these supplements
are inferior. The Consumer Lab only included supplements with
DRI levels, so they are not even considered for

Countless consumers of
these higher quality, ”over the DRI” products nearly all
respond the same way when asked why they take these
supplements over lower-priced versions: ”Because I feel
better on these, and I never felt different on other vitamins
that I have tried. Now I have more energy, and I am sick less

A ”DRI level”
supplement or an ”over the DRI” vitamin and mineral
supplement? I hope this helps you choose the one that best
suits your unique needs.


Many of the antioxidants
are vitamins and minerals such as vitamin C, E, beta-carotene
(often listed as vitamin A), selenium, zinc, copper, and
manganese. Many studies confirm that supplements of this
dream team functioning as antioxidants can make a significant
difference in our health, but we still need more studies. One
reason is the disturbing findings of a study done to test the
effect of beta-carotene and the incidence of lung cancer.
Those in this study who were longtime smokers and took
beta-carotene had a higher incidence of lung cancer than
those who did not take the supplement. No one is sure why the
results came out this way, and in fact, it may not have
anything to do with beta-carotene. Perhaps this group of
smokers already had precancerous cells in their lungs that
naturally progressed during the study and beta-carotene could
not undo the damage already in place. We need more studies to
know for sure.

The other broad class of
antioxidants is plant-based phytochemicals. Again, doctors
wrestle with the same issue here: for many of these
substances we do not have a lot of research in humans to be
able to confidently say what these substances as supplements
can and cannot do. I know it is a cautious answer, but for
this class of supplements as a whole, that is the current
bottom line. There are, however, impressive research studies
with grape seed extract-based supplements in test tubes,
animals, and humans that point to grape seed as a very safe
supplement and very effective antioxidant. We will look at
grape seed extract in more detail in the next

Although there are
excellent nutritional supplements that can be very helpful,
there is no substitute for a balanced, healthy diet. We know
a lot about nutrition, but we still have limited knowledge of
all the minute substances in food and the intricate
interactions that take place when all these substances come
together into our bodies to nourish us. We know that
antioxidants in foods protect our cells from harm. However,
we must be cautious about jumping to conclusions regarding
isolated substances. We may think we can feed them alone to
the masses and save them from cancer, but we still know so
little about what makes food tick. We may not yet have
uncovered the crucial substances that make all of food’s
magic happen. In other words, it would be like analyzing
discovering it was made with paint and then thinking an
artist should be able to recreate it based on that knowledge.
We, likewise, do not have the full knowledge necessary to
determine whether certain supplements will work as well
inside the human body as the same substance in a food source.
We still need more clinical research studies to confirm that
they work reliably before we can announce that every one of
us should take these on a daily basis.

I personally choose to
take a variety of antioxidant supplements daily (both grape
seed extract-based and a vitamin-mineral combination),
because there is a very good likelihood that they help and a
low likelihood that they will harm me. You need to make your
own choice. But choose nutritious foods first and then think
about additional supplements. A supplement should be exactly
to a healthy

Taken from
A Woman’s Guide to Good
Carrie Carter, M.D

Carrie Carter, M.D.,
has been a primary-care
physician for over fifteen years. She is an award-winning
author of two books, a magazine columnist, and a national
speaker, and she has appeared as a medical expert on over one
hundred national and regional radio and TV


3. K. Alaimo et al.,
“Dietary Intake of Vitamins, Minerals, and Fiber of Persons
Ages Two Months and Over in the United States,”
National Health and Nutrition Examination Survey, phase
, 1988-91,
(258) (1994
Nov 14): 1-28.

4. J.A. Pennington,
“Intakes of Minerals from Diets and Foods: Is There a Need
for Concern? (Results of the Total Diet Studies),”
of Nutrition
(9 suppl) (1996):2304S-2308S.

5. J. Hallfrish and D.C.
Muller, “Does Diet Provide Adequate Amounts of Calcium, Iron,
Magnesium, and Zinc in a Well-Educated Adult
Population?” Experimental
(4-5) (1993): 473-83.

6. R.H. Fletcher and K.M.
Fairfield, “Vitamins for Chronic Disease Prevention in
Adults: Clinical Applications,” Journal
of the American Medical Association
287 [2002]: 3127-29.

7. “Taking a Multi May
Improve Cognitive Function,” Environmental
December 2001, 8.

8. The Vitality Pak ($23
a month), availabe from Melaleuca: The Wellness Company,
online (www.melaleuca.com) or by phone

9. Essentials ($35 a
month), available from USANA, online
(www.usana-nutritionals.com) or by phone

10. Interview with Tim
Wood, Ph.D.: Vice President for Research and Development of
USANA, Inc., January 28, 2002.

11. Used by permission.
If you log on to www.ConsumerLab.com, you can purchase a
single product category subscription ($5.25), which gives you
access to all their information on the multivitamins and
multimineral products, or any other single product category
of your choice for thirty days. Or you can subscribe for
twelve months ($15.95) and have access to all product
category reviews for one year.

12.Diane Feskanich et
al., “Vitamin A Intake and Hip Fractures Among Postmenopausal
Women,” JAMA
287 (2002):

13. See endnote 7,
chapter 8.

14. See endnote 8,
chapter 8.

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