DIETARY SUPPLEMENTS: WHAT YOU NEED TO KNOW

The majority of adults in the United States take one or more dietary supplements either every day or occasionally. Today's dietary supplements include vitamins, minerals, herbals and botanicals, amino acids, enzymes, and many other products. Dietary supplements come in a variety of forms: traditional tablets, capsules, and powders, as well as drinks and energy bars. Popular supplements include vitamins D and E; minerals like calcium and iron; herbs such as echinacea and garlic; and specialty products like glucosamine, probiotics, and fish oils.

The Dietary Supplement Label

All products labeled as a dietary supplement carry a Supplement Facts panel that lists the contents, amount of active ingredients per serving, and other added ingredients (like fillers, binders, and flavorings). The manufacturer suggests the serving size, but you or your health care provider might decide that a different amount is more appropriate for you.

Effectiveness

If you don't eat a nutritious variety of foods, some supplements might help you get adequate amounts of essential nutrients. However, supplements can't take the place of the variety of foods that are important to a healthy diet. Good sources of information on eating well include the Dietary Guidelines for Americansexternal link disclaimer and MyPlateexternal link disclaimer.

Scientific evidence shows that some dietary supplements are beneficial for overall health and for managing some health conditions. For example, calcium and vitamin D are important for keeping bones strong and reducing bone loss; folic acid decreases the risk of certain birth defects; and omega-3 fatty acids from fish oils might help some people with heart disease. Other supplements need more study to determine their value. The U.S. Food and Drug Administration (FDA) does not determine whether dietary supplements are effective before they are marketed.

Safety and Risk

Many supplements contain active ingredients that can have strong effects in the body. Always be alert to the possibility of unexpected side effects, especially when taking a new product.

Supplements are most likely to cause side effects or harm when people take them instead of prescribed medicines or when people take many supplements in combination. Some supplements can increase the risk of bleeding or, if a person takes them before or after surgery, they can affect the person's response to anesthesia. Dietary supplements can also interact with certain prescription drugs in ways that might cause problems. Here are just a few examples:

Vitamin K can reduce the ability of the blood thinner Coumadin® to prevent blood from clotting.

St. John's wort can speed the breakdown of many drugs (including antidepressants and birth control pills) and thereby reduce these drugs' effectiveness.

Antioxidant supplements, like vitamins C and E, might reduce the effectiveness of some types of cancer chemotherapy.

Keep in mind that some ingredients found in dietary supplements are added to a growing number of foods, including breakfast cereals and beverages. As a result, you may be getting more of these ingredients than you think, and more might not be better. Taking more than you need is always more expensive and can also raise your risk of experiencing side effects. For example, getting too much vitamin A can cause headaches and liver damage, reduce bone strength, and cause birth defects. Excess iron causes nausea and vomiting and may damage the liver and other organs.

Be cautious about taking dietary supplements if you are pregnant or nursing. Also, be careful about giving them (beyond a basic multivitamin/mineral product) to a child. Most dietary supplements have not been well tested for safety in pregnant women, nursing mothers, or children.

If you suspect that you have had a serious reaction from a dietary supplement, let your health care provider know. He or she may report your experience to the FDA. You may also submit a report to the FDA by calling 800-FDA-1088 or completing a form onlineexternal link disclaimer. In addition, report your reaction to the dietary supplement company by using the contact information on the product label.

Quality

Dietary supplements are complex products. The FDA has established quality standards for dietary supplements to help ensure their identity, purity, strength, and composition. These standards are designed to prevent the inclusion of the wrong ingredient, the addition of too much or too little of an ingredient, the possibility of contamination, and the improper packaging and labeling of a product. The FDA periodically inspects facilities that manufacture dietary supplements.

In addition, several independent organizations offer quality testing and allow products that pass these tests to display their seals of approval. These seals of approval provide assurance that the product was properly manufactured, contains the ingredients listed on the label, and does not contain harmful levels of contaminants. These seals of approval do not guarantee that a product is safe or effective. Organizations that offer this quality testing include:

U.S. Pharmacopeia

ConsumerLab.com

NSF International

Keep in Mind

Don't decide to take dietary supplements to treat a health condition that you have diagnosed yourself, without consulting a health care provider.

Don't take supplements in place of, or in combination with, prescribed medications without your health care provider's approval.

Check with your health care provider about the supplements you take if you are scheduled to have any type of surgical procedure.

The term "natural" doesn't always mean safe. A supplement's safety depends on many things, such as its chemical makeup, how it works in the body, how it is prepared, and the dose used. Certain herbs (for example, comfrey and kava) can harm the liver.

Before taking a dietary supplement, ask yourself these questions:

What are the potential health benefits of this dietary supplement product?

What are its potential benefits for me?

Does this product have any safety risks?

What is the proper dose to take?

How, when, and for how long should I take it?

If you don't know the answers to these questions, use the information sources listed in this brochure and talk to your health care providers.

Talk with Your Health Care Provider

Let your health care providers (including doctors, pharmacists, and dietitians) know which dietary supplements you're taking so that you can discuss what's best for your overall health. Your health care provider can help you determine which supplements, if any, might be valuable for you.

Keep a record of the supplements you take in one place, just as you should be doing for all of your medicines. Note the specific product name, the dose you take, how often you take it, and the reason why you use each one. You can also bring the products you use with you when you see your health care provider.

Federal Regulation of Dietary Supplements

Dietary supplements are products intended to supplement the diet. They are not drugs and, therefore, are not intended to treat, diagnose, mitigate, prevent, or cure diseases. The FDA is the federal agency that oversees both dietary supplements and medicines.

In general, the FDA regulations for dietary supplements are different from those for prescription or over-the-counter drugs. Unlike drugs, which must be approved by the FDA before they can be marketed, dietary supplements do not require premarket review or approval by the FDA. While the supplement company is responsible for having evidence that their products are safe and the label claims are truthful and not misleading, they do not have to provide that evidence to the FDA before the product is marketed.

Dietary supplement labels may carry certain types of health-related claims. Manufacturers are permitted to say, for example, that a dietary supplement addresses a nutrient deficiency, supports health, or is linked to a particular body function (like immunity or heart health). Such a claim must be followed by the words, "This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease."

Manufacturers must follow certain good manufacturing practices to ensure the identity, purity, strength, and composition of their products. If the FDA finds a product to be unsafe or otherwise unfit for human consumption, it may take enforcement action to remove the product from the marketplace or work with the manufacturer to voluntarily recall the product.

Also, once a dietary supplement is on the market, the FDA monitors information on the product's label and package insert to make sure that information about the supplement's content is accurate and that any claims made for the product are truthful and not misleading. The Federal Trade Commission, which polices product advertising, also requires all information about a dietary supplement product to be truthful and not misleading.

The federal government can take legal action against companies and Web sites that sell dietary supplements when the companies make false or deceptive statements about their products, if they promote them as treatments or cures for diseases, or if their products are unsafe.

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The Truth About Belly Fat

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Surprise: Everyone has some belly fat, even people who have flat abs.

That's normal. But too much belly fat can affect your health in a way that other fat doesn't.

Some of your fat is right under your skin. Other fat is deeper inside, around your heart, lungs, liver, and other organs.

It's that deeper fat -- called "visceral" fat -- that may be the bigger problem, even for thin people.

 measuring waist

Even thin people can have too much belly fat. It's more about how active you are than your pants size.

Deep Belly Fat

You need some visceral fat. It provides cushioning around your organs.

But if you have too much of it, you may be more likely to get high blood pressure, type 2 diabetes, heart disease, dementia, and certain cancers, including breast cancer and colon cancer.

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The fat doesn't just sit there. It's an active part of your body, making "lots of nasty substances," says Kristen Hairston, MD, assistant professor of endocrinology and metabolism at Wake Forest School of Medicine.

If you gain too much weight, your body starts to store your fat in unusual places.

With increasing obesity, you have people whose regular areas to store fat are so full that the fat is deposited into the organs and around the heart, says Carol Shively, PhD, professor of pathology-comparative medicine at Wake Forest School of Medicine.

How Much Belly Fat Do You Have?

The most precise way to determine how much visceral fat you have is to get a CT scan or MRI. But there's a much simpler, low-cost way to check.

Get a measuring tape, wrap it around your waist at your belly button, and check your girth. Do it while you're standing up, and make sure the tape measure is level.

For your health's sake, you want your waist size to be less than 35 inches if you're a woman and less than 40 inches if you're a man.

Having a "pear shape" -- bigger hips and thighs -- is considered safer than an "apple shape," which describes a wider waistline.

“What we’re really pointing to with the apple versus pear,” Hairston says, "is that, if you have more abdominal fat, it’s probably an indicator that you have more visceral fat."

Thin People Have It, Too

Even if you're thin, you can still have too much visceral fat.

How much you have is partly about your genes, and partly about your lifestyle, especially how active you are.

Visceral fat likes inactivity. In one study, thin people who watched their diets but didn't exercise were more likely to have too much visceral fat.

The key is to be active, no matter what size you are.

4 Steps for Beating Belly Fat

There are four keys to controlling belly fat: exercise, diet, sleep, and stress management.

1. Exercise: Vigorous exercise trims all your fat, including visceral fat.

Get at least 30 minutes of moderate exercise at least 5 days a week. Walking counts, as long as it's brisk enough that you work up a sweat and breathe harder, with your heart rate faster than usual.

To get the same results in half the time, step up your pace and get vigorous exercise -- like jogging or walking. You'd need to do that for 20 minutes a day, 4 days a week.

Jog, if you're already fit, or walk briskly at an incline on a treadmill if you're not ready for jogging. Vigorous workouts on stationary bikes and elliptical or rowing machines are also effective, says Duke researcher Cris Slentz, PhD.

Moderate activity -- raising your heart rate for 30 minutes at least three times per week -- also helps. It slows down how much visceral fat you gain. But to torch visceral fat, your workouts may need to be stepped up.

“Rake leaves, walk, garden, go to Zumba, play soccer with your kids. It doesn’t have to be in the gym,” Hairston says.

If you are not active now, it's a good idea to check with your health care provider before starting a new fitness program.

2. Diet: There is no magic diet for belly fat. But when you lose weight on any diet, belly fat usually goes first.

Getting enough fiber can help. Hairston’s research shows that people who eat 10 grams of soluble fiber per day -- without any other diet changes -- build up less visceral fat over time than others. That’s as simple as eating two small apples, a cup of green peas, or a half-cup of pinto beans.

4 Steps for Beating Belly Fat continued...

“Even if you kept everything else the same but switched to a higher-fiber bread, you might be able to better maintain your weight over time,” Hairston says.

3. Sleep: Getting the right amount of shut-eye helps. In one study, people who got 6 to 7 hours of sleep per night gained less visceral fat over 5 years compared to those who slept 5 or fewer hours per night or 8 or more hours per night. Sleep may not have been the only thing that mattered -- but it was part of the picture.

4. Stress: Everyone has stress. How you handle it matters. The best things you can do include relaxing with friends and family, meditating, exercising to blow off steam, and getting counseling. That leaves you healthier and better prepared to make good choices for yourself.

“If you could only afford the time to do one of these things," Shively says, "exercise probably has the most immediate benefits, because it gets at both obesity and stress.”

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