Experts urge caution with vitamins and supplements | Health

We’ve all seen online ads about vitamins and herbal supplements that make grand promises to boost health and wellness. But, say two local experts, a doctor or pharmacist should always be consulted before starting any new regimen.

“Anyone who wants to take anything for any reason really should consult their doctor or pharmacist before starting it, to reconcile it against other medications or medical conditions, because there is always a possibility of an interaction,” said Micaela Mitchell, a pharmacy manager at Geisinger.

“The pharmacist is a great local resource and an appointment is not needed. (Anyone) can walk into any local drugstore and ask to speak to the pharmacist for a recommendation,” Mitchell said.

The pharmacist will ask about their symptoms, but will also other questions about their health history, including heart health and blood thinners. 

According to Mitchell, consumers should be especially cautious about vitamins and supplements because they are not vetted by the U.S. Food and Drug Administration (FDA). She suggests looking for a USP (U.S. Pharmacopeia) verification and to use a reputable local source when purchasing vitamins and supplements, not from online websites.

“USP verification signals that the company is standing by what is in the product and how it is labeled, and there are no additional additives or ingredients,” Mitchell explained.

Taking a new vitamin or supplement should be rooted in medical science, such as lab bloodwork showing a deficiency. For example, in those cases, a doctor will advise the correct dosage and frequency. If taking a daily vitamin or mineral to supplement one’s diet, follow the recommended daily allowance (RDA). Those values are established by the Food and Nutrition Board.

“While some dietary supplements have their role in wellness, they remain quite controversial,” said Dr. Di Tran, UPMC Williamsport Family Medicine Residency.

“There is very little regulation over herbals and vitamin supplements by the FDA as they do not undergo the same rigorous oversight, research, and randomized clinical trials that would otherwise be required for the prescription medication approval process. They are not necessarily approved for safety and efficacy before they hit the market. The onus of verifying product safety falls on the supplement company and they do not have the same regulatory standards as the FDA, said Tran.

Tran and Mitchell both said that too many vitamins can be harmful — and they are not always easily expelled from the body.

According to Tran, vitamins are either water soluble or fat soluble.

“Water soluble vitamins such as Vitamin C and B (which are complex vitamins) have less risk of overdose since whatever is unabsorbed is eliminated through the urine,” said Tran. 

“However, the fat-soluble vitamins, Vitamin A, D, E, and K, are stored in fatty tissue and the liver rather than expelled. As such, they have the potential to accumulate and lead to toxicity. Dietary supplements, in particular, can interact with many different prescription medications either by altering a medication’s absorption and excretion or directly affecting the mechanism of the drug itself,” said Tran. 

“As a result, taking supplements with prescription medications can make medications less effective or more potent,” said Tran. “For example, Vitamin K has been shown to reduce the effects of the blood thinner, Warfarin.”

“Even supplements that are labeled natural, like herbals, have the risk of harmful drug interaction,” said Tran. “For instance, St. John’s Wort has been noted to reduce the efficacy of several medications including oral contraceptives, cardiac medications, and antidepressants.”

Tran gave another example, “Goldenseal, a drug that is marketed for upper respiratory infections and GI upset, has been shown to block specific enzymes that are involved in the metabolism of more than 50% of prescription medications on the market and thus is strongly recommended against using alongside both OTC and prescription medications.”

“While supplements can help individuals meet daily requirements, ultimately, the best source of vitamins and minerals are through a balanced and varied diet rich in whole grains, vegetables, and fruits,” said Tran. She recommended making lifestyle changes to one’s diet and physical activity. Equally important are addressing mental health concerns, making meaningful social connections, and reducing the use of harmful substances.  

According to Mitchell, another good practice is to use one pharmacy location or one pharmacy chain for all of your medication, vitamin and supplement needs.

Mitchell said that getting your prescriptions filled at two or three different pharmacies can be harmful because pharmaceutical records are not centralized. As a result, the pharmacist doesn’t have the necessary information to make a recommendation about drug interactions or the appropriateness for the individual who is asking for assistance.