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Excerpt from Dr. Janson's book
When I recommend supplements, I often hear questions about
where to get them and what brands to buy. How do you avoid
being misled by unscrupulous manufacturers or overzealous
sales pitches? Antagonists to dietary supplements sometimes
leave you with the false impression that all manufacturers
are disreputable. Nothing could be further from the truth.
In my experience, most supplement manufacturers are reliable
and honest, and they depend on good results from their
products to generate repeat sales.
Manufacturers and Retailers Manufacturers
and Retailers
Most manufacturers follow Good Manufacturing Practices (GMPs),
and you should make sure they do before purchasing their products.
The purpose of GMPs is to assure that what is on the label
is in the product; that the product disintegrates and is bioavailable
and unadulterated. Ask your retailer to find out from their
manufacturers or suppliers. You can usually find retail products
at health food stores, through mail-order channels and in
professional offices. I have a lot of experience with supplements
sold through professional offices. They are usually of high
quality and are designed by the practitioners for their own
method of practice. Practitioners sometimes have their own
brand label, but most of the products will be similar to those
of other practitioners and comparable to retail products.
It is true that practitioners sometimes will charge higher
prices for their products than retail store prices, assuming
that they are more convenient for their clients, but they
should not be markedly different from the products you can
buy through other channels. Sometimes professional products
are less expensive than those from other sources.
There are also good name brands available at health food
stores, and some of the larger stores have their own in-house
brand labels. Several mail-order sources supply brand names
similar to the ones in health food stores, and some of the
larger mail-order companies also have their own labels. Like
the manufacturers, they also are dependent on good results
to generate repeat business. What you need to know is that
virtually all of the raw materials for dietary supplements
are made in bulk by a few manufacturers. They are then
purchased by supplement “manufacturers” who only
tablet, encapsulate and affix their own label to the products
before sending them to distributors or retail outlets.
Be Wary of Claims Be Wary of Claims
What this means most of the time is that the hyperbolic claims
for particular brands are exaggerated, even though the ingredients
are what they claim to be and do what they are supposed to.
Some companies claim that their brand of “vitamin Z”
is superior because of the form, or because it is “all
natural,” or it is combined with “synergistic nutrients”
or herbs. Most of the time the additional dietary factors
that are present are there in such small quantities that they
have only a token presence - not enough to be therapeutic.
Some companies will say that their product is highly researched
and tested, but when you look at the research papers that
they provide, the studies refer to the basic nutrient ingredient
(such as folic acid or beta-carotene) not to their particular
brand. In these cases, I agree that their beta-carotene is
probably healthy and of great benefit, but so are many others
on the market that are just as good and usually much less
expensive.
What to Look for in Pricing
My advice is to seek a reliable mail-order, health food store,
or professional line of products, and check that the company
uses GMPs in manufacturing. You can ask the sellers, who should
be able to find out from the companies if they do not already
know. Also, make sure that they are hypoallergenic and that
there are no extraneous ingredients such as artificial flavor,
colors or preservatives in the products. Although some of
these may be safe, some of them are not, and their presence
is a sign that the manufacturers are not as concerned with
quality.
There have been in the past, and may still be, some very
cheap mail-order supplements that did not meet the potency
claims made on the label. This is much less likely now, but
it is still possible. If a price looks too good to be true,
it probably is. For example, if you price several reliable
brands at between $9 and $12 per hundred capsules, and you
find the same ingredients for $4 - $6 per hundred, you need
to be very suspicious. On the other hand, if you find the
same product for $19, you should also be aware that you may
be paying too much.
Most dietary supplement suppliers are very competitive (except
for multilevel marketing prices, which are high), and a below-cost
item may not meet label claim or on occasion may be made with
inferior raw ingredients. These may have contamination problems
or problems with solubility. Synthetic vitamin E, for example,
is much cheaper than the natural form, but the molecule is
slightly different, and contains only the alpha-tocopherol,
not the beta, gamma or delta forms found in “mixed, natural
tocopherols.” That information should be on the label.
The most likely supplements to be a problem are the most expensive
ones, such as coenzyme Q10 or proanthocyanidins, or non-standardized
herbs being sold for low prices compared to the standardized
products.
Timed Release?
Most “timed-release” products are not worth the
extra money that you may spend on them. In fact, they may
even be less effective than the plain variety. For example,
in order to achieve the best effects with vitamin C, especially
in viral infections, you sometimes need a very high blood
level. These levels are more difficult to achieve with timed-release
pills, because of their slow dissolution and absorption.
Occasionally timed-release pills are not properly timed,
so that the tablet does not disintegrate and dissolve in time
or in the right place to be well absorbed from the intestinal
tract. Most plain supplements are fairly well absorbed and
utilized, so a slow-release form is unnecessary. There are
two exceptions to this that are worth mentioning. One is vitamin
B3, or niacin, which can cause a temporary flush of the skin,
but is less likely to do so in timed-release form. (Remember,
however, that the timed-release form is more likely to cause
liver problems in some people.) The other valuable timed-release
supplement is iron, which often causes some constipation and
indigestion in plain form. It is usually better tolerated
as timed-release iron fumarate. The common drug-store variety,
iron sulfate, seems to be the worst for causing constipation.
Combination Supplements
Except for a multivitamin and a few simple combinations,
it is better to take your individual nutrients in separate
pills. This makes it easier to change the dose of one nutrient
without having to alter many others at the same time. It is
almost invariably less expensive to take separate nutrients,
but you can expect to take from six to 10 pills twice per
day for a comprehensive, basic supplement program. This is
assuming you are healthy. If you have a health problem, you
might end up taking 10 - 15 pills twice a day. For vigorous
longevity programs, you may end up taking quite a few more.
Manufacturers make specific combinations to distinguish their
product from others - to establish a position, or “market
niche.” Such “exclusive” products can often
command a higher price. Do not be drawn in by their exaggerated
claims. A product may well have all of the claimed benefits,
but is it worth the price? Compare the ingredients (mg. to
mg., or IU to IU) and the price. Once you have an established
program with which you are satisfied, then you might find
a few combinations that meet your needs, and you can use them
to reduce the number of pills that you take.
If you find that a particular brand works for you and it
is reasonably priced, stay with it. You might want to ask
your health practitioner for advice. If you haven’t tried
comparable products, you would be wise to shop around for
price. Ask how long a brand has been on the market. Most of
the reliable companies have been around for a while. (Of course,
new reliable companies do appear in the marketplace.)
There was a time when there were more unscrupulous companies
selling dietary supplements, but as the industry has matured
they have formed trade groups to help monitor each other.
Also, the consumer is becoming more sophisticated at evaluating
supplements, because there are frequent articles in the newspapers
and magazines on the topic. Companies now have to keep on
their toes if they are to stay in business, and they have
to sell effective, competitive products.
When to Take Supplements
Most of the time, it is a good idea to take supplements with
food. Nutrients occur in nature as combinations with each
other and with other substances in foods. Generally, they
work together in digestion, absorption and other physiological
processes. Also, it is much easier on the digestion to take
supplements with food. Supplements are concentrated, and sometimes
they can cause digestive upset or abdominal discomfort when
taken in large doses on an empty stomach.
Single nutrients, such as vitamin C can usually be taken
at any time, in almost any dose, without upsetting your system.
Taking a drink of pure vitamin C powder mixed with dilute
fruit juice is actually refreshing, and it is an easy way
to take a large dose.
Sometimes, there is antagonism or competition for absorption
between different nutrients, such as copper and zinc, or in
utilization, for example, iron and vitamin E. However, these
are usually not sufficient to be a serious concern when taking
large doses of supplements.
There are some exceptions to this rule. For example, some
of the amino acids are better utilized for specific purposes
when taken separately from foods. (See Chapter 8.) My recommendation
is not to worry too much about such combinations; they are
minor, and worrying about them makes supplement programs confusing
and inconvenient. If you do not remember to take things, they
are not going to do you any good.
You may have concerns about swallowing so many pills if you
are on many different supplements. If you have difficulty,
it is easiest to take them with a thicker liquid, such as
tomato juice or a blended fruit and yogurt smoothee. This
usually makes it easy to open the throat for swallowing and
coats the pills, making it easier for them to go down. After
you are able to take them this way, it becomes easy to swallow
many pills at one time, even with plain water, but be careful.
(One of my patients uses this trick - just before taking the
liquid for the pills she says to herself, “I am really
thirsty.” She says it helps the pills go down.)
What About Pregnancy?
Most pregnant women need extra nutrition, and most physicians
will recommend at least some dietary supplements. As stated
before, folic acid is essential for the prevention of some
birth defects, and other nutrients are helpful in preventing
toxemia of pregnancy (see B6 and magnesium). Some supplements
are helpful in reducing morning sickness of pregnancy, especially
pyridoxine (vitamin B6).
Most of the nutrients on basic supplement programs are helpful
during pregnancy and are often recommended by obstetricians.
Extra iron and calcium are useful additions to a routine supplement
program. The only caution is taking too much vitamin A during
the first 3 months. Anything above 10,000 IU may be too much,
but this only applies to preformed vitamin A, not to beta-carotene.
With herbal products, it is wise to be more careful during
pregnancy as we often have little scientific evidence. However,
many of them have been used extensively in traditional medicine,
and a doctor with experience using herbs should be able to
advise you.
How to Store Supplements
You do not need to take special precautions when storing
most dietary supplements. It is usually sufficient to keep
them on a shelf in a pantry or on the kitchen counter. Most
of the products are quite stable if kept in dry, room-temperature
conditions. As with any food, do not leave them for prolonged
periods in a hot car or in a closed carrier out in the sun,
where they will easily get overheated.
Sometimes people are tempted to put their supplements in
the refrigerator, but this is not a good idea. Every time
you open a bottle of cold supplement pills in a warm external
environment, there will be some condensation on the surface
of the pills that remain in the bottle. Eventually, they will
become wet and sticky, or they will actually begin to dissolve,
depending on how much they attract moisture. An exception
is some supplements of intestinal flora (lactobacilli or bifidobacteria),
which sometimes keep better in the cold.
For the same reason, do not keep your supplements in the
bathroom (not that you were really tempted to do so). It gets
too humid with all the showering to keep them dry and fresh.
The best place for storage is probably the kitchen, since
it is usually dry, and it is convenient, since you will mostly
take your supplements with meals.
How Long Do They Keep?
It is not a good idea to keep supplements for a long time
after they have been opened. Although some are quite stable
in a dry environment, there is inevitably some oxidation and
loss of potency. The amount of loss depends on the particular
nutrient. Many of the supplements are quite stable, and last
for years if kept cool and dry. Minerals do not deteriorate
with time.
With some products, the surface of the pill will change color
when some components oxidize. When this happens, the surface
of the tablets usually becomes darker and mottled. You should
discard these tablets. You can also see this kind of discoloration
inside of some two-part capsules, and you should discard these
also. (Some products normally have a mixed-color surface,
and you should get to know what they look like when you first
buy them so you will know when they change.)
The best course of action is to buy what you need for a 1-
to 3-month period or up to 6 or 8 months if it is more convenient,
and store unopened bottles in a cool (but not necessarily
refrigerated), dark room. If you buy a large amount, you may
keep the unopened bottles in the refrigerator, but be sure
to bring them to room temperature before opening them, and
don’t store them in the fridge once they have been opened.
Multi-compartment Storage Boxes
One last note that will make it easier for you to take supplements
if you are taking more than a few: There are multi-compartment
storage containers, similar to fishing tackle or sewing boxes,
but with a rubber gasket seal to keep out air. They come with
six to 16 chambers, to hold a number of different supplements.
Label each chamber unless you clearly recognize the different
supplements. If you have too many for the box, you can mix
two in one chamber as long as you recognize the difference.
The advantage of having one of these multi-compartment boxes
is that you only have to open one lid each time you want to
take your supplements. Since you might be taking many different
products at one time, this is an enormous time saver. And
if you have arthritis, it will help reduce the stress on your
hands from opening so many bottles so frequently.
Another way to accomplish this is to purchase some empty
pharmacy vials and set aside some time to fill up a 1-week
supply of morning and evening doses all at once. It is a good
idea to have different size vials for your morning and evening
for recognition, in case the doses are different.
Both of these methods have one further advantage, in that
the original storage bottle for each supplement is opened
less frequently, reducing exposure of the main supply to air
and humidity. You should not have great difficulty keeping
supplements safely.
drjanson@drjanson.com
November
through May: 386-409-7747
June
through October: 603-878-2256
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