A Smart Guide to Dietary Supplements

Deborah Kotz

Here's some disappointing news for those who suffer from chronic lower back pain: Glucosamine, a widely used nutritional supplement, is no better than a sugar pill at relieving pain and disability, according to a study published July 6 in the Journal of the American Medical Association. The substance, made from animal cartilage, is purported to relieve pain by helping to restore the bone-cushioning cartilage that often deteriorates with age, causing osteoarthritis.

About 1 in 4 patients with arthritis-induced back pain has tried glucosamine at one time or another for relief, yet the supplement, "probably offers little benefit," according to Andrew Avins, an internist and researcher at Kaiser Permanente Northern California, who wrote an editorial that accompanied the study. Previous glucosamine studies have also yielded disappointing results for the relief of arthritis-related knee pain.

The latest research, however, underscores a bigger problem: Not much is known about the dietary supplements we pop on a daily basis. Although most pose far fewer health risks than the prescription medications we take, says Adriane Fugh-Berman, a physician and associate professor in complementary and alternative medicine at Georgetown University Medical Center (Washington, D.C.), some herbal remedies can be downright dangerous.

Comfrey tea, for example, has been implicated in liver disease; bitter orange and other herbal stimulants for weight loss are known to dangerously rev up heart rate.

So how can you separate the hype from the reality? Fugh-Berman recommends the following rules of thumb:

1. Aim to get nutrients from food before turning to multivitamins.

One thing that's been shown repeatedly in studies: Those with higher levels of nutrients in their blood--like vitamin E, beta carotene, or calcium--tend to be healthier and more likely to avoid disease than others. That's probably because they're eating nutritiously, not popping pills to get nutrients.

Large clinical trials of beta carotene (a vitamin A precursor) and vitamin E supplements, for example, found that neither was effective at preventing cancer or heart disease and that they might actually slightly increase those risks. One possible reason for the difference? Nutritious foods actually contain many different varieties of individual nutrients; sweet potatoes and carrots, for example, contain dozens of different forms of vitamin A, says Fugh-Berman. And it could be that the various forms of the same nutrient work synergistically to prevent disease. Still, she concedes, if you don't eat a diet that covers the wide range of nutritional requirements, taking a daily multivitamin is a good insurance policy.

Two nutrients most of us are lacking: magnesium (found in spinach, almonds, and unrefined whole grains) and vitamin D (from fortified milk, fatty fish, and sun exposure).

2. Don't use supplements as cure-alls.

Be wary of any pill that promises to fix all your ills. Vitamin D supplements, for example, have been shown in studies to help protect the elderly from falls and fractures, but research hasn't proven other health claims, like cancer or heart disease prevention. And while it's perfectly reasonable to try immune-boosting echinacea at the first sign of a cold--studies suggest it may shorten the duration of symptoms by a day or two--echinacea shouldn't be taken continuously in the hopes of avoiding colds altogether. It doesn't work for this purpose, says Fugh-Berman, and certain risks may be associated with chronically boosting your immune system, especially if you're already prone to asthma and allergies, both triggered by an overactive immune system.

3. Consider the risks and the cost.

You have little to lose if you take a cheap supplement that's not associated with side effects beyond, say, an upset stomach. Vitamin D supplements, calcium, and multivitamins that cost 5 or 10 cents a day fall into this group. So too does fish oil, which acts like an anti-inflammatory, and may help with chronic pain conditions.

Expensive, unproven supplements may, however, be a big waste of money, says Fugh-Berman, and you should certainly avoid pills that confer far more risks than benefits, like the weight loss remedies mentioned above. Consumer Reports has identified some herbal products that are just too hazardous to try, including aristolochic acid, chaparral, kava, and yohimbe, to name a few.

4. Make sure you're using supplements wisely.

Vitamin D must be taken with a fatty food (like nuts, cheese, or a hard boiled egg) in order for your body to properly absorb it, says Fugh-Berman. And calcium supplements should be taken along with magnesium and vitamin D to get the mineral's bone-protecting benefits.

Always read the label instructions carefully and, if possible, check with your doctor before taking any new supplement to be sure it won't interact with any other medications you're taking.

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