Supplements Who Needs Them?: A Behind The Headlines Report June 2011
Supplements Who Needs Them?: A Behind The Headlines Report June 2011
Supplements Who Needs Them?: A Behind The Headlines Report June 2011
Foreword
Millions of us take vitamins and dietary supplements hoping to achieve good health, ease
our illnesses or defy ageing. Recent years have seen a massive boom in supplement use as
products that were once the preserve of specialist health food stores have become available
alongside our groceries in the supermarket and on the internet. As availability has grown,
so have sales. In 2009 the UK market for dietary supplements and vitamins was worth more
than 670 million.
However, the huge range of dietary supplements now available makes the area something
of a minefield for consumers. Take a browse through the stocks of the UKs leading
supplement suppliers and you will find hundreds of products ranging from acai capsules to
zinc, with everything from devils claw to royal jelly between. Even individual supplements
can come in a range of doses and a number of different formulations, making it hard to
know what is worth taking and what isnt.
The Behind the Headlines team has tackled numerous studies on supplements and during
our work it has become clear that the widely perceived benefits of certain supplements
simply do not have enough robust evidence to support them. At times, these misconceptions
appear to have been formed due to press coverage, at other times because of the way some
products are marketed or because of the sheer volume of misinformation floating around on
the internet.
So how do we know which dietary supplements we should take, whether they work and
whether theyre safe? Where should we be going for reliable information? In this report we
hope to make sense of some of these issues surrounding dietary supplements, and also to
look at a selection of evidence on some of the most popular supplements in use today.
Contents
Overview
What are dietary supplements?
Whats the industry worth?
Who takes supplements and why?
Supplements market share chart
Should we be taking supplements?
How are supplements regulated?
Herbal remedies
What claims can supplements make?
Vitamin supplements
Who needs vitamin supplements?
Vitamins as antioxidants
What can vitamin supplements really do?
Vitamins for fertility
Can supplements be harmful?
Key points on vitamins
Weight-loss supplements
So do they live up to their claims?
Are weight-loss pills safe?
Safe, proven ways to lose weight
Key points about weight-loss supplements
Fish oils
Fish oils for adults
Fish oils for children
The risks of fish oils
Key points about fish oils
Body building
Do the products work and are they safe?
The risks of protein supplements
Other products
Key points about body-building supplements
Conclusion
Why do we take supplements if they are unproven?
Are supplements worth the money?
Supplement your knowledge
References
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Overview
In this report, NHS Choices and Bazian have
attempted to examine both individual
supplements and the culture that surrounds
supplements as a whole. Given the breadth of the
topic it shouldnt be seen as a definitive review of
their merits, but we do hope that it will encourage
people to be more discriminating in the way they
choose supplements and, ultimately, look after
their health.
The Behind the Headlines service reviews two
health news stories each day, looking at whether
media claims match the research, as well as
the strengths and weaknesses of the scientific
Product
Does it have a
marketing
authorization?
N
Does it contain
herbal substances
and/or herbal
preparations?
Y
Are other
active
ingredients
present?
Is it presented for
treating or
preventing
disease?
Y
Product is a
medicinal
product.
Medicines
legislation
applies.
Food Safety
Act does not
N
Can it be
administered to
humans for
restoring, correcting,
or modifying
physiological
function?
Product is a
herbal medicinal
product
Product is food,
not medicine.
Food Safety Act
applies.
Is it concentrated
source of vitamins,
minerals or other
substances with a
nutritional or
physiological effect?
Y
Product is a food.
Food Safety Act
applies
Is it sold in
dose
form?
Y
Product is a Food Supplement.
Food Safety Act and
Food Supplement Regulations
apply
Herbal medicines
The way that some herbal products are regulated
has recently changed. As of April 30 2011 all
herbal medicines placed on the UK market must
have a Traditional Herbal Registration (THR)10 or
a marketing authorisation (previously known as a
product licence). The MHRA now defines individual
herbal medicines as either registered traditional
herbal medicines or licensed herbal medicines.
Vitamin supplements
RDA
800 g
5 g
12 mg -TE
75 g
1.1 mg
1.4 mg
16 mg
6 mg
1.4 mg
200 g
2.5 g
50 g
80 mg
Minerals
Calcium
Magnesium
Iron
Copper
Iodine
Zinc
Manganese
Potassium
Selenium
Chromium
Molybdenum
Fluoride
Chloride
Phosphorus
RDA
800mg
375 mg
14 mg
1 mg
150 g
10 mg
2 mg
2000 mg
55 g
40 g
50 g
3.5 mg
800 mg
700 mg
10
Weight-loss
supplements
Shedding Ibs or shedding s?
Obesity is one of the most serious health issues
in the UK. In England alone, more than one-third
of adults are overweight and nearly one-quarter
obese, with obesity rates predicted to rise by 60%
over the next 40 years20. Its widely recognised that
obesity is linked to major health problems such as
heart disease, type 2 diabetes and some cancers.
Beyond the important health implications, being
overweight can also be a source of unhappiness,
particularly if nothing seems to help shift that
extra weight.
Given the unfortunate fact that its generally much
easier to gain weight than it is to lose it, its not
surprising that growing numbers of people are
turning to over-the-counter slimming supplements
and internet wonder pills. There are dozens, if
not hundreds, of heavily marketed weight-loss
products that claim to contain herbs or natural
substances that work by mechanisms such as
speeding up the metabolism (the rate at which
the body burns calories), blocking the absorption
of dietary fat in the body (fat magnets) or
promoting feelings of fullness.
Even if you dont really believe the claims, its
easy to get drawn into the Wow! I feel great!
captions, the celebrity endorsements and the
before-and-after transformations showing how in
just 60 days some glum, pale, overweight person
has transformed into a trim, happy individual with
a cheesy grin and a pair of jeans that are now 10
sizes too big.
The slimming products industry is
vast: according to the British Nutrition
Foundation sales of over-the-counter
slimming products topped 900 million in
2009 in Western Europe alone.
And indeed, lots of us do end up taking the
plunge, reasoning that for a small outlay we might
transform our bodies and our lives, and that at
worst we will lose a bit of money if our pills dont
work. Well, unfortunately there is little evidence
for some of the products sold by reputable retailers
and, worse still, many of the guaranteed, clinically
Am I overweight?
Adults are defined as being overweight
or obese using a measure called the body
mass index (BMI). It is a way of assessing
whether your weight is appropriate for
your height by calculating the ratio of
your mass (your weight in kilograms)
to your height (in metres squared).
The following table categorises weight
according to BMI:
Classification
BMI (kg/m2)
Healthy weight
18.5-24.9
Overweight
25-29.9
Obese
30+
11
Table 1 Common ingredients in popular weight-loss supplements, categorised by purported mechanism of action
Purported mechanism of action
Enhance fat or carbohydrate metabolism
Insulin resistance
Drug interactions, potential liver damage for green tea extract
Licorice
Pyruvate
Pantothenic acid (vitamin B5)
L-carnitine
Chromium picolinate
Calcium
White kidney bean extract
Chitosan (polyglucosamine)
Ephedra (ma huang) or ephedrine
Bitter orange
Promotes satiety
Psyllium
Reduce stress- or depression-related eating St Johns Wort
Ginko biloba
Laxative
Cascara
Rhubarb root
Flaxseed
None reported
None reported
Gastrointestinal symptoms
Increased heart palpitation, psychiatric,
autonomic and gastrointestinal adverse effects
Increased blood pressure, possible drug interactions
Irritibility, heart palpitations, anxiety and other
central nervous system events
Blockage of the throat, oesophagus or intestine if taken without
~ 250ml of water or other fluid
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Orlistat
Its worth pointing out the difference between
slimming supplements and a licensed medicine
to help weight loss, called orlistat. This medicine
is available on prescription, with a lower dose
version called Alli available over the counter.
If a medicine is licensed, it has been through
a strict process of rigorous clinical testing to
show sufficient effectiveness and safety. Orlistat
has been shown to work by stopping the body
absorbing fat, so that it passes straight out in your
stools. Research shows it can help some people
lose weight, but even then it is not a wonder pill.
In clinical trials, between one-third and one-half
of participants achieved a 5% reduction in body
mass. Side effects include diarrhoea and bloating.
Read more about weight loss on the NHS Choices
website.
If you are still thinking of trying a weightloss supplement be aware of the risks,
particularly if you are shopping over the
internet. You could be wasting your
money or, more importantly, putting
your health at risk.
14
Vitamin C
Researchers have been interested in using vitamin
C to prevent and treat colds for more than 60
years. Some animal studies have found that
vitamin C strengthens resistance to infections. One
theory for this is that the vitamin protects cells
against oxidative stress. However, the results from
trials in people have so far had inconclusive results.
The latest position on vitamin C and colds comes
from a systematic review from the Cochrane
Library26, generally considered to be one of the
most respected sources of systematic review
evidence. The review concluded that there is little
evidence that vitamin C supplementation (0.2g
per day or more) is beneficial within the general
community in terms of preventing infection.
Even higher doses of 1g per day or more did not
prevent colds in the general population.
The same review did find that regular high doses
of vitamin C (1g per day or more) seem to reduce
the duration of colds a little, by 8% in adults and
13% in children. The researchers also found that
vitamin C supplements seemed to have a greater
effect for people who were undergoing extreme
physical stress, such as marathon runners. In
these groups, the supplements halved the risk
of getting a cold, and didnt necessarily need
to be taken in high doses.
Zinc
Zinc is a trace element that is essential for normal
growth. The mineral has been promoted for many
years as being able to boost the immune system.
Laboratory studies have found that it can inhibit
the replication of the rhinovirus, which is the most
frequent cause of cold symptoms (Cochrane).
Rest and plenty of fluids are the best treatment for colds
Echinacea
Echinacea, a group of plants with pinkish-purple
flowers, is a popular herbal remedy in the UK.
Two echinacea products ranked in the top three
supplements sold to support the immune system in
20092. There are many echinacea preparations on the
market, including tablets, drops, capsules, tincture
and loose tea. The herb also comes in a wide range
of doses from 400 to 4,000mg.
Taking zinc regularly may prevent you from catching a cold
17
Ginkgo
The leaves of the ginkgo biloba tree are used
in traditional Chinese medicine, in particular
for circulatory problems. Here in the West there
are claims that ginkgo extracts help a range
of conditions, including memory problems,
sexual performance problems and eye disorders.
Laboratory studies have suggested that some of
the active compounds in ginkgo may dilate blood
vessels, reduce blood viscosity (thickness), modify
neurotransmitter systems and reduce free radicals32.
Ginseng
There are several different species of ginseng. They
include Panax ginseng (also called Asian or Chinese
ginseng), and Panax quinquefolius (American)
ginseng. In alternative medicine, ginseng is often
referred to as an adaptogen, which implies a
substance that increases resistance to physical,
chemical and biological stress and builds up
general vitality. The major active components
(ginseng saponins, also called ginsenosides)
supposedly work in several ways, including having
possible antioxidant effects.
Glucosamine
Glucosamine and chondroitin sulphate are natural
substances found in and around the cells of
cartilage, the flexible connective tissue that protects
our bones at the joints. Both are produced by the
body. Glucosamine is one of the building blocks of
cartilage and chondroitin sulphate is a substance
that helps cartilage retain water.
In osteoarthritis, cartilage becomes thin and stiff,
and the theory is that glucosamine supplements
might help supply the materials needed to rebuild
it. In animal and laboratory studies, glucosamine
was found to normalise cartilage metabolism
and rebuild damaged cartilage. Glucosamine
supplements are often sold in combination with
chondroitin, the idea being that both substances
can slow down the progression of osteoarthritis.
The glucosamine found in dietary supplements is
usually harvested from the shells of shellfish.
There is a large and varied range of glucosamine
products available. Holland & Barrett, the UK and
Europes largest health supplement retailer, sells 43
glucosamine-containing supplements, in different
strengths and combined with other substances (such
as omega-3, cod liver oil and rosehip). They come in
different forms too, including gels, caplets and sprays.
Are the benefits of glucosamine worth the money
spent on it? The latest research suggests not. A
recent systematic review published in the British
Medical Journal (BMJ) pooled 10 studies published
up to 2009, involving 3,802 patients31. Neither
glucosamine, chondroitin or a combination of
the two were found to reduce joint pain or treat
the narrowing of the joint space associated with
osteoarthritis. The authors also say that the
differences in effect between the supplements
and placebo were less pronounced on average
in independent trials than in those funded by
industry. This review itself was well-conducted.
However, it should be pointed out that the trials in
this review were all small, potentially affecting the
reliability of the reviews findings.
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21
Fish oils
23
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Body building
Even athletes can get the protein they need from their diet
Other products
There are numerous other products on the
market that claim to build muscle. They contain
substances such as glutamine (an amino acid),
essential fatty acids, creatinine (a naturally
occurring organic acid that supplies energy
to muscle cells), thermogenic products (any
product that claims to increase body temperature,
metabolism and the rate at which the body burns
26
The public are warned against any bodybuilding supplements, which may be
more likely to do harm than good.
27
Conclusion
While this report should not be taken as a
definitive review of individual supplements, it is
clear that the perceived benefits of many popular
products have not been confirmed through robust
research. In some cases these supplements may
even be harmful. Overall, it is clear that we may
be placing our hope in products that still require
far more testing.
Of course, thats not to say that there arent any
supplements that work, or that all are harmful.
There are some products that have been found to
have clear benefits and many have been found to be
generally safe for use. The key point is that we cant
be certain that they are necessarily effective or safe
until they have been put through robust testing.
Why do we take supplements if they are
unproven?
There are lots of reasons why someone might
decide to start taking a supplement. They might
do so based on recommendations from friends and
family, opinions on the internet or having seen it
displayed in a shop.
There can also be media flurries surrounding many
supplements and, on occasions, newspapers have
proclaimed that a supplement works based on the
results of a single, flawed study, possibly alongside
a photo of a celebrity fan or glowing reports
from some new convert. Thats not to say that
the media is solely to blame, but its certainly
easier to fall into the trap of assuming a
supplement works if magazines, newspapers and
television keep telling us it does.
To their credit, newspapers do cover robust
research, including studies that contradict the
results of earlier trials. However, news articles
dont always stress the scientific merits of each
study, meaning that readers may not understand
that the results of a well-conducted systematic
review should be considered to be more reliable
than those from an earlier cohort study. Without
knowing that one set of results is more reliable
than another a reader may assume that two
studies are of equal weight, leading them to
believe that they simply cancel each other out,
that the results are unclear or that scientists just
cant make their minds up.
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VERSION 2.0: Amended and published July 1 2011
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