What Dietary Supplements Are You Taking?

Does Your Health Care Provider Know? It Matters, And Here's Why

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Partners in Health -- Working With Your Health Care Providers

With the abundance of conflicting information available about dietary supplements, it is more important than ever to talk with your doctor and other health care providers (dietitian, nurse, pharmacist, etc.) to help you sort the reliable information from the questionable.

Dietary Supplements -- More Than Vitamins...

Today's dietary supplements are not only vitamins and minerals. They also include other less familiar substances, such as herbals, botanicals, amino acids, and enzymes. Dietary supplements come in a variety of forms, such as tablets, capsules, powders, energy bars, or drinks.

If you do not consume a variety of foods, as recommended in the Food Guide Pyramid and Dietary Guidelines for Americans, some supplements may help ensure that you get adequate amounts of essential nutrients or help promote optimal health and performance. However, dietary supplements are not intended to treat, diagnose, mitigate, prevent, or cure diseases; therefore, manufacturers may not make such claims. In some cases, dietary supplements may have unwanted effects, especially if taken before surgery or with other dietary supplements or medicines, or if you have certain health conditions.

Unlike drugs, but like conventional foods, dietary supplements are not approved by the Food and Drug Administration (FDA) for safety and effectiveness. It is the responsibility of dietary supplement manufacturers/distributors to ensure that their products are safe and that their label claims are accurate and truthful. Once a product enters the marketplace, FDA has the authority to take action against any dietary supplement product that presents a significant or unreasonable risk of illness or injury.

Scientific evidence supporting the benefits of some dietary supplements (e.g., vitamins and minerals) is well established for certain health conditions, but others need further study. Whatever your choice, supplements should not replace prescribed medications or the variety of foods important to a healthful diet.

How To Recognize a Dietary Supplement

At times, it can be confusing to tell the difference between a dietary supplement, a food, or an over-the-counter (OTC) medicine. An easy way to recognize a dietary supplement is to look for the Supplement Facts Panel on the product.

Potential Risks of Using Dietary Supplements

Although certain products may be helpful to some people, there may be circumstances when these products can pose unexpected risks. Many supplements contain active ingredients that can have strong effects in the body. Taking a combination of supplements, using these products together with medicine, or substituting them in place of prescribed medicines could lead to harmful, even life-threatening results. Also, some supplements can have unwanted effects before, during, and after surgery. It is important to let your doctor and other health professionals know about the vitamins, minerals, botanicals, and other products you are taking, especially before surgery.

Here a few examples of dietary supplements believed to interact with specific drugs:

Calcium and heart medicine (e.g., Digoxin), thiazide diuretics (Thiazide), and aluminum and magnesium-containing antacids.
Magnesium and thiazide and loop diuretics (e.g., Lasix®, etc.), some cancer drugs (e.g., Cisplatin, etc.), and magnesium-containing antacids.
Vitamin K and a blood thinner (e.g., Coumadin).
St. John's Wort and selective serotonin reuptake inhibitor (SSRI) drugs (i.e., anti-depressant drugs and birth control pills).

What Should I Know Before Using Dietary Supplements?

Be savvy! Follow these tips before buying a dietary supplement:

Remember: Safety First. Some supplement ingredients, including nutrients and plant components, can be toxic based on their activity in your body. Do not substitute a dietary supplement for a prescription medicine or therapy.
Think twice about chasing the latest headline. Sound health advice is generally based on research over time, not a single study touted by the media. Be wary of results claiming a "quick fix" that depart from scientific research and established dietary guidance.
Learn to Spot False Claims. Remember: "If something sounds too good to be true, it probably is." Some examples of false claims on product labels:
- Quick and effective "cure-all."
- Can treat or cure disease.
- "Totally safe," "all natural," and has "definitely no side effects."
- Limited availability, "no-risk, money-back guarantees," or requires advance payment.
More may not be better. Some products can be harmful when consumed in high amounts, for a long time, or in combination with certain other substances.
The term "natural" doesn't always mean safe. Do not assume that this term ensures wholesomeness or safety. For some supplements, "natural" ingredients may interact with medicines, be dangerous for people with certain health conditions, or be harmful in high doses. For example, tea made from peppermint leaves is generally considered safe to drink, but peppermint oil (extracted from the leaves) is much more concentrated and can be toxic if used incorrectly.
Is the product worth the money? Resist the pressure to buy a product or treatment "on the spot." Some supplement products may be expensive or may not provide the benefit you expect. For example, excessive amounts of water-soluble vitamins, like vitamin C and B vitamins, are not used by the body and are eliminated in the urine.

Bottom Line

Do not self diagnose any health condition. Work with your health care providers to determine how best to achieve optimal health.
Check with your health care providers before taking a supplement, especially when combining or substituting them with other foods or medicine.
Some supplements can help you meet your daily requirements for certain nutrients, but others may cause health problems.
Dietary supplements are not intended to treat, diagnose, mitigate, prevent, or cure disease, or to replace the variety of foods important to a healthful diet.

Examples of Products Marketed as Dietary Supplements

Because many products are marketed as dietary supplements, it is important to remember that supplements include vitamins and minerals, as well as botanicals and other substances. The list below gives some examples of products you may see sold as dietary supplements. It is not possible to list them all here.

Vitamins, Minerals, Nutrients	Botanicals and Other Substances
Multiple Vitamin/Mineral	Acidophilus
Vitamin B Complex	Black Cohosh
Vitamin C	Ginger
Vitamin D	Evening Primrose Oil
Vitamin E	Echinacea
Beta-Carotene	Fiber
Calcium	Garlic
Omega-3 Fatty Acids	Ginkgo Biloba
Folic Acid	Fish Oil
Zinc	Glucosamine and/or Chrondroitin Sulfate
Iron	St. John's Wort
	Saw Palmetto

Adapted from A Healthcare Professional's Guide to Evaluating Dietary Supplements, the American Dietetic Association & American Pharmaceutical Association Special Report (2000).

Note: the examples provided do not represent an endorsement or approval by any agency or organization that contributed to this material.

FDA MedWatch
If you suspect that you have had a serious reaction to a dietary supplement, you and your doctor should report it to FDA Medwatch:

Phone: 1-800-FDA-1088

Fax: 1-800-FDA-0178

Internet: www.fda.gov/medwatch/how.htm

This brochure includes three tools to help you and your health care team manage your dietary supplement and medicine intake:

Nutrition Assessment
Dietary Supplement Diary
Medication Diary

First Tool: Nutrition Assessment

Think about the following statements and use this checklist to talk to your health care provider about your nutritional status and whether taking a dietary supplement(s) is right for you.

Nutrition Assessment	Yes/No
I currently take a dietary supplement(s).
I eat fewer than 2 meals a day.
My diet is restricted (e.g., don't eat dairy, meat, and/or fewer than 5 servings of fruits and vegetables).
I eat alone most of the time.
Without wanting to, I have lost or gained more than 10 pounds in the last 6 months.
I take 3 or more prescription or OTC medicines a day.
I have 3 or more drinks of alcohol a day.
Source: adapted from the Nutrition Screening Initiative.
General Questions About Dietary Supplement Use	Yes/No
Is taking a dietary supplement important to my total diet?
Are there any precautions or warnings I should know about (e.g., is there an amount or "upper limit" that I should not go above)?
Are there any known side effects (e.g., loss of appetite, nausea, headaches, etc.)?
Are there any dietary supplements I should avoid while taking certain medicines (prescription or OTC) or other supplements?
If I'm scheduled for elective surgery, should I discontinue use of dietary supplements? If so, when?

Second Tool: Dietary Supplement Diary

To have an accurate record for your health care provider, list all the supplements you take (e.g., multiple, single, or combination vitamins, minerals, or any botanical supplements) and how often. If you are unsure if a product is a dietary supplement, check to see if there is a Supplement Facts Label on the package.

Complete, print out, and share this chart with your health care provider so you can discuss what's best for your overall health.

It is very important that you consider your combined intake from all supplements (including multivitamins, single supplements, and combination products) plus fortified foods, like some cereals and drinks. Excess intakes of some supplements may cause health problems.

Refer to "Examples of Products Marketed as Dietary Supplements" for help completing this chart.

Third Tool: Medication Diary

Please complete information about all of the prescription and over-the-counter (OTC) medications that you frequently take or are currently taking (e.g., aspirin, pain reliever, cold medicine, stool softener, etc.). Provide this information to your health care provider so he or she can update your records and better respond to your questions.

Health Professionals' Contact List

Dietary Supplement Resources

Federal Government Agencies:

Administration on Aging, DHHS: http://www.aoa.gov
Food and Drug Administration, DHHS, Center for Food Safety and Applied Nutrition:
http://www.cfsan.fda.gov/~dms/supplmnt.html
http://www.cfsan.fda.gov/~dms/ds-savvy.html
http://www.cfsan.fda.gov/label.html
National Institutes of Health, DHHS:
- Office of Dietary Supplements: http://dietary-supplements.info.nih.gov
- National Center for Complementary and Alternative Medicine (http://nccam.nih.gov) and Clearinghouse (1-888-624-6226)
Office on Women's Health, DHHS: http://www.4woman.gov/OWH or 1-800-994-WOMAN
Federal Trade Commission: http://www.ftc.gov
U.S. Department of Agriculture, Food and Nutrition Information Center: http://www.nal.usda.gov/fnic

Others:

American Association of Retired Persons (AARP): http://www.aarp.org
American Dietetic Association: http://www.eatright.org
American Pharmacists Association: http://www.pharmacist.com
Food Marketing Institute: http://www.fmi.org
National Council on Patient Information and Education (NCPIE): http://www.talkaboutrx.org

Links to non-Federal government organizations do not represent endorsement of these organizations or their materials.

Organizations that contributed to this educational material are the Administration on Aging (Department of Health and Human Services [DHHS]), American Academy of Family Physicians, American Association of Retired Persons, American Dietetic Association, American Medical Association, American Pharmacists Association, Federal Trade Commission, Food and Drug Administration (DHHS), Food Marketing Institute, International Food Information Council Foundation, National Council on Patient Information and Education, Office of Dietary Supplements (National Institutes of Health, DHHS), and the Office on Women's Health (DHHS).