Taking dietary supplements? Think safety first. Published March 16, 2016 By Prerana Korpe Air Force Surgeon General Public Affairs FALLS CHURCH, Va. -- While dietary supplements may provide health benefits, consumers should be aware of potential health risks associated with the use of supplements, and keep in mind practices for safe consumption. Supplement safety is a vital consideration for people of all ages, at all levels of health and physical fitness. The Food and Drug Administration (FDA) advises that dietary supplements are not approved as safe and effective. The FDA is not authorized to evaluate dietary supplements before they reach the market, therefore supplements are not FDA tested before they hit the shelves. Manufacturers are responsible for ensuring the safety of these products before they are sold and supplements may not include warnings about potential adverse effects. According to the National Institutes of Health (NIH), dietary supplements, including vitamins and minerals, may be toxic when consumed over an extended period, in high enough quantity or when taken in combination with certain other chemical substances. Adverse reactions to dietary supplements can happen. For example, it is important to take into consideration climate when using supplements. Research shows that certain supplements could exacerbate dehydration and lead to a serious health consequence such as kidney failure. According to the New England Journal of Medicine, adverse events associated with dietary supplement use result in approximately 23,000 emergency room visits in the United States each year. In 2015, the Department of Justice and its federal partners conducted a nationwide sweep to identify possible unsafe or contaminated dietary supplements. Through this effort, it was determined that tainted products were being marketed as dietary supplements, which resulted in criminal actions against 117 supplement manufacturers and distributors. In addition, NIH reports that combining supplements or taking supplements with medications (both prescription and over-the-counter) could create damaging and sometimes life-threatening effects. Certain supplements can increase the potential for internal bleeding, reduce the effectiveness of medications or cause physiological changes which could harm the body. Even before considering dietary supplements however, it is important to evaluate your diet. Capt. Denise Campbell, registered dietitian, 52nd Aerospace Medicine Squadron, Spangdahlem Air Base, Germany, explains, “It is important to have a good, well-rounded diet first, before turning to supplements.” Dietary supplements are just that –supplements. Intended to enhance certain diets to promote optimal health, dietary supplements should not be used to replace a balanced, nutritious diet. Supplements are not a substitute for healthy eating. “People need to be their own best advocate. Just because a product works for a co-worker, spouse, brother or friend, does not mean it is right for everyone. We all have different eating and sleeping habits and it is important to evaluate supplement use with our lifestyle in mind –not just by the word of a friend,” Campbell said. “To effectively evaluate the safety of dietary supplements, it is important to remain a smart consumer in general.” For help with good supplement safety habits, Capt. Campbell offers the following tips. When selecting a dietary supplement, ask yourself: Is this product effective? Does the supplement’s claim sound too good to be true? Will this supplement help me to meet my goals? Is this product safe; are there any recalls related to this product or the ingredients found in the product? Is the product adulterated? (Be extra careful with weight loss or body building products.) Has the product undergone third party verification? (Third party verification tests the identity, strength or disintegration --benefit/absorption-- factor. Supplement safety resource: Operation Supplement Safety (OPSS) provides information and FAQs about dietary supplement safety. If certain supplement information is not listed, individuals can submit questions to request additional information. OPSS is offered through the Human Performance Resource Center (HPRC), a Department of Defense initiative under the Force Health Protection and Readiness Program. Keep in mind: Evaluate what you are eating first to decide if you need a particular dietary supplement. Use of any dietary supplement should be discussed with a health care provider. Natural products can interact with prescription drugs and can enhance or inhibit effects of prescription drugs. Environment can play a role in the effect of supplements. (For example, in hot climates, take extra care to remain adequately hydrated.) Red flag: Proprietary blends or delivery systems include a “secret sauce” recipe, which is some combination of ingredients that a particular manufacturer will put together and label only the total amount (i.e. 1200 milligrams) but will not indicate how much of each ingredient is included in the product. This may increase risk for toxicity. Supplements which require being mixed with water should only be mixed with water –not sports drinks, sodas, etc. There can be too much of a good thing. Stacking supplements (taking multiple products) can be harmful or toxic to the body. High doses of vitamins or minerals may compete for absorption by the body Be aware when introducing new supplements to your routine, or a new combination of medications with existing supplement use. Look out for symptoms of adverse effects, such as: Dizziness, flushed skin, pins and needles in extremities, passing out, chest pain, rapid heartrate or heartburn Some new inexplicable change (if so, stop taking supplements) which could be an adverse reaction to the supplement If you experience any adverse effects, consult your health care provider. Supplements may contain undeclared ingredients. Keep an eye on the FDA recall list. Supplements do expire. Once expired, supplements should not be consumed, but disposed of. Name that supplement: Play the “Can I name all the ingredients?” game. See if you can pronounce ingredients in your supplement(s), identify what each ingredient is, as well as the effects of each ingredient. Use this as a test for supplements. Consideration for common supplements: A dose of daily vitamins should contain less than 200 percent of the recommended daily value. One hundred percent or less of the daily value is optimal. Caffeine intake should not exceed 600 milligrams (mg) per day. A dose of 200 mg (approximately a cup and a half or two cups of drip coffee) can be effective for enhancing performance without overdosing. An overabundance of caffeine can increase heart rate, cause tremors, nervousness or irregular heartbeat. Gummy vitamins are vitamins too. Keep in mind toxicity and do not consume more than is recommended on the container or by a health care professional. Adhere to labels recommending consumption of food with the supplement. To help “decode” the dietary supplement industry, check out the Human Performance Resource Center’s three-minute video “Decoding the Dietary Supplement Industry.” For more information on supplement safety, visit your local medical treatment facility. USAF. 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