The repeated publication of newspaper articles based on a study result published almost exactly one year ago have made a number of blanket statements about dietary supplements. The articles reference a US National Institute of Health study published on April 18, 2019, Dietary Supplements Aren't Associated with Lower Mortality.
Supplements should be taken as recommended – at the recommended dosage as advised on the label or as prescribed by a healthcare practitioner.
Clearly, there are many beneficial roles for supplements, particularly when used to address a specific deficiency or health requirement. However, supplements should be taken as recommended – including in the recommended dosage as advised on the label or as prescribed by a healthcare practitioner.
A healthy diet – the cornerstone to good health
The first-line of defence against disease is a healthy, balanced diet and lifestyle. But certain nutritional supplements are important for those of us who don’t consume the recommended daily nutrients from diet alone – and this is the vast majority of Australians.
Most Australians don't consume the recommended intake of fruits or vegetables. A nutritional short-fall can occur due to several reasons, including the sheer variety of foods and the large number of calories that must be consumed to meet the complex requirements, which also change with ages and stages. Nutrient requirements can vary according to ages, stages, lifestyle factors, cultural requirements (such as the covering of skin due to cultural reasons) and even the existence – and the treatment of – chronic conditions.
CMA reiterates that an integrative approach to taking medicines including complementary medicines, rather than one over the other, speaks to the fundamentals of Quality Use of Medicines principles.
The correct dosage
Just as with conventional medicines, the correct dosage and length of supplementation is essential. A concentration that is sub-clinical will not have the claimed effect.
Similarly, as with conventional medication, it is important not to consume concentrations that are higher than recommended – unless specifically prescribed by a healthcare practitioner. Following the recommendations as directed by the healthcare practitioner is vital, given many people – especially people who are older or unwell – may also be taking concurrent conventional medicines, sometimes more than one prescribed medication and may or may not have issues with absorption.
Numerous large random controlled trials have confirmed an essential role in the reduction of the occurrence of neural tube defects (NTDs). Whether women can get sufficient folate in their diets is debatable thus government experts recommend a folate supplement, ideally before conception and during the first three months of pregnancy when the neural tube and other organs are being developed. For women taking certain medicines (e.g. for epilepsy) this requirement is much higher.
In Australia, there is no question that certain supplements are recommended for groups of people, including:
- Pregnant women
- Breastfeeding mothers
- Those who drink alcohol more than the limit approved for reducing the risk of disease (i.e. one standard drink per day for non-pregnant women and two for men)
- Those who take illegal drugs
- Those who are consuming severely restricted diets and those crash dieters or low-calorie diets long-term
- The elderly (including those who are disabled or chronically ill)
- Vegetarians or vegans (some)
- Women with excessive bleeding during menstruation
- Those with allergies to certain food/food groups
- Those who have a health condition that means the body can’t absorb nutrients needs (for example, chronic kidney disease/ people on dialysis)
- Those with malabsorption problems such as diarrhoea, coeliac disease, pancreatitis and more.
Examining study results
The participants in the referred to study were U.S. adults who answered questions on their dietary supplement use in the previous 30 days, and about nutrient intake from foods and supplements. However, the reporting of dietary supplement use is subject to recall bias.
Plus, poor diet in those already diagnosed with cancer in the past was a major confounder in the study. Participants were more likely to be cancer survivors, smokers, physically inactive, diabetic, and in poor general health.
Even in a sample size of 30,000 people, the trend associating risk of death with number of supplements did not achieve statistical significance. The study itself concludes: “Use of dietary supplements is not associated with mortality benefits among U.S. adults,” – it does not state that that supplements are harmful.
Some of the study results were positive – such as the role of lycopene in reducing cancer risk. In the study, the use of vitamin E supplements in combination with multivitamins was associated with lower risk of death. These facts were not included in the article.
CMA CEO Carl Gibson ends by saying: “To conclude, there is no question that certain supplements are recommended for people according to their ages, stages, and lifestyle and medication intake. In Australia, it is recommended that people seek the advice of a healthcare practitioner to guide individuals about their personal needs.”