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Top Three Ways Supplement Companies Fail You

Article at-a-glance:

  • Since the FDA isn’t authorized to review dietary supplements for safety and effectiveness before they’re marketed, consumers need to ask the right questions before buying. 
  • Many supplements use inferior, inexpensive nutrients that have low absorption.
  • Supplements should use the form of a nutrient cited in studies.
  • Supplements should provide the active forms of folate and Vitamin B12 that the body can actually use
Caution Sign
by Dr. John Neustadt

Walk into any supermarket, drugstore or health food store across America, and you’ll see shelves and overflowing aisles dedicated to supplements—vitamins, minerals, herbs, and blends for everything from healthy sleep to healthy weight, optimal mood, strong bones, balanced blood sugar levels, high energy, optimal digestion and more. The bottles seem to beckon with golden promise, but it’s difficult to determine how valid any of their claims are. 

The FDA regulates the manufacturing of supplements, but as they state on their own website: “The FDA is not authorized to review dietary supplement products for safety and effectiveness before they are marketed.1 This leaves consumers vulnerable to either outright fraud or to inferior grade nutrients. 

How can you determine whether the product you’re buying is made from the highest-quality, most absorbable, well-tolerated ingredients? How do you know the blends are properly balanced and reflect the latest scientific research? Are you sure the amounts claimed on the label accurately reflect what’s in the bottle? 

These questions are more important than ever today, as Americans focus on wellness and the dietary supplement industry continues to rapidly expand. A 2019 survey commissioned by the Council for Responsible Nutrition (CNR) reported that dietary supplement use had reached a new, all-time high, with over three-quarters (77%) of US adults taking dietary supplements.2 Dietary supplement manufacturers and ingredient suppliers operate in all 50 states. The dietary supplement industry provides jobs for more than 750,000 Americans and generates $5.75 billion in state and local taxes and $9.2 billion in federal taxes.3 In the US alone, Americans spend $122 billion each year, and that number continues to grow as consumers search for more ways to get and stay healthy.

Dietary supplements can be packaged as pills, capsules, powders, and liquids. They’re not intended to replace an optimal diet, but rather to “supplement” a healthy diet. This article provides a guide to the top three ways supplement companies fail consumers and will help you protect yourself against inferior quality supplements so that you can make informed purchases and reap all the profound health benefits that high-quality products provide.

They Use Nutrients You Can’t Absorb

Swallowing nutrients, either from food or dietary supplements, is only the first step. To benefit from nutrients, your body has to absorb them. And not all nutrients are easily absorbed. In particular, minerals, such as magnesium, calcium, selenium, boron, copper, and zinc, can be hard for the body to fully utilize. For instance, your gut may only absorb 0.4–2.5% of the important trace mineral chromium from your food.4

In supplement form, minerals are always combined with other substances, such as oxides, sulfates, carbonate, organic acids, or amino acid chelates. Not all forms are equally absorbed by the body and many dietary supplement manufactures save money by choosing inexpensive mineral complexes that the body cannot use. 

Calcium carbonate is the most common form of calcium in supplements, but this mineral salt is poorly absorbed and can cause constipation.5 Magnesium oxide is also inexpensive and commonly found in vitamin and mineral formulas. Although magnesium oxide offers a high percentage of elemental magnesium, its bioavailability is low.6 We absorb only about 4% of the magnesium as magnesium oxide.7 This means that 96% of what you put in your mouth is just passing right through you and being eliminated in your stool. In fact, magnesium oxide is so poorly absorbed that it’s used in higher amounts as a laxative.

The body’s first step to absorbing a mineral is to cleave the mineral from its carrier. This occurs in the stomach, and for both carbonates and oxides, ample stomach acid is required. But stomach acid production can be low if we take acid-blocking medications like Protonix, Prilosec, Nexium, and Aciphex; have an untreated Helicobacter pylori (H. pylori) infection; or if we’re chronically stressed. Stomach acid production also declines steadily with age: it has been estimated that 10–21% of people sixty to sixty-nine years old, 31% of those seventy to seventy-nine years old, and 37% of those above the age have low or no stomach acid (hypochlorhydria or achlorhydria), and this rate may be higher in people with autoimmune conditions.8 

Other, more efficient complexes include organic acids such as citrate and malate and amino acid chelates. Magnesium citrate and magnesium malate are better absorbed than magnesium oxide.9 Calcium citrate is better absorbed than calcium carbonate.10 The intestinal absorption of calcium citrate is approximately 24% better than that of calcium carbonate independent of intake with meals.11 And unlike carbonate forms of minerals, citrate and malate forms do not require stomach acid for absorption. 

And finally, minerals can be chelated, or bound, to amino acids. To create an amino acid chelate, a mineral such as magnesium is molecularly bonded with one or more amino acids, which creates a readily absorbable organic compound. Chelated minerals are well absorbed, and thus lower doses are needed.12 Even in the presence of low stomach acid, the amino acid chelated form of minerals and those combined with organic acids are better absorbed than the oxide or carbonate forms. For example, chelated zinc (as zinc citrate and zinc gluconate) was absorbed around 11% more effectively in one study than non-chelated zinc (as zinc oxide).13 For all of these reasons, NBI does not use any oxide minerals. Instead, its products use only amino acid chelated or the organic acid (eg, citrate) forms of minerals. 

They Use Nutrients Your Body Can’t Use

Genetic variation is the spice of life. Some of us are, for instance, supertasters—we have more taste buds than most people and thus foods and flavors taste more strongly to us.14 Some of us are lactose intolerant—we have reduced levels of the enzyme that allows us to digest dairy products.15 And some of us have a variation of a gene called methyltetrahydrofolate reductase (MTHFR) that prevents or impairs our body from easily forming the active forms of vitamin B12 and folic acid. 

Vitamin B12 and folic acid help breakdown homocysteine. Although homocysteine is naturally produced by the body, it’s toxic. The active form of vitamin B12, methylcobalamin, donates a methyl group to homocysteine, which then turns into methionine, an essential amino acid. 

Once B12 donates its methyl group, it needs a new one. Methylfolate is the sole molecule than can donate a methyl group to vitamin B12, thereby recycling vitamin B12 into its active form, methylcobalamin. When your levels of methylcobalamin or methyl folate are too low, homocysteine builds. High homocysteine levels have been linked to an increased risk of cardiovascular disease, dementia, and osteoporosis.

While our bodies can convert inactive vitamin B12 and folic acid into their active, methylated forms, many of us have a common variant of the MTHFR gene that reduced the ability to activate these vitamins up to 70%.16 The frequency of this genetic mutation is high, especially in Europeans—as much as a third of the population—and particularly in Caucasians. This gene variant has been linked to Type 1 diabetes, cardiovascular disease, male infertility, cancer, depression, and bipolar disorder among other conditions.17

Numerous supplements contain inactive forms of B12 and folate, and those don’t provide much help to those who have trouble converting them to active forms. While people can get tested for this, it’s more economical just to take supplements that contain nutrients that the body can

use even if you have this genetic polymorphism18. Instead, look for products that contain methylcobalamin and methyltetrahydrofolate, like Supreme Multivitamin

They Use Sleight of Hand When Citing Clinical Trials

Many vitamin supplements cite impressive data from clinical trials on their websites or the landing pages of popular storefronts, but their own formulations don’t accurately reflect the study: they may use a different form of the nutrient or a lower dose than the dose shown effective in the clinical trial. 

Consider elderberry extract—a popular remedy to support immune function and help increase resistance to viral infections such as colds and flu. The dose shown to be effective in a randomized, double-blind clinical trial was 15 mL of liquid extract four times per day, but the common dose on one of the most popular brands found in health food stores recommends 10 mL twice a day—only one third the amount proven effective.19 

In a similar vein, literature for certain supplements will cite vitamin K2 for bone health and fracture reduction, but they will use a form of vitamin K2 that is different than that proven effective in clinical trials. There are two naturally occurring forms of vitamin K2 that are popular in supplements, MK4 and MK7. They are not chemically identical, and in biochemistry, changing even one atom can alter a nutrient’s function. 

MK4 has higher bioactivity than MK7 and the proven ability to reduce fractures.20  MK4 has a protective effect on bone loss and fracture risk in postmenopausal women—both those who are healthy and those who have osteoporosis.21 There are more than 25 clinical trials on MK4 showing that 45 mg/day stops and reverses bone loss and reduces fractures up to 80%.22,23, While MK-7 has a longer half-life than MK4,24 there are no clinical trials showing that it reduces fractures. 

Like MK4, MK7 has been shown to improve bone density, but bone density only predicts 44% of women and 21% of men who will break a bone.25 From a clinical perspective, nutrients that have been shown in clinical trials to reduce fractures have the best evidence for their use. Yet many supplements use MK7 even after citing literature that actually refers to MK4.26 To stay true to what the research supports, NBI only uses the clinically validated amount of MK4 (45 mg/day) in its Osteo-K and Osteo-K Minis products. 

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References

1U.S. Food & Drug Administration. What You Need to Know About Dietary Supplements. 11-29-2017. [Report]

2Council for Responsible Nutrition. Dietary Supplement Use Reaches All Time High. September 2019. [Report]

3Nutraceuticals World. Supplement Industry Contributes $122 Billion To U.S. Economy. 2016. [Report]

4National Institutes of Health. Chromium Dietary Supplement Fact Sheet. Updated February 2020. [Report]

5Nicar MJ, Pak CY. Calcium bioavailability from calcium carbonate and calcium citrate. J Clin Endocrinol Metab. 1985;61(2):391‐393. [Article]

6Lindberg JS, Zobitz MM, Poindexter JR et al. Magnesium bioavailability from magnesium citrate and magnesium oxide. J Am Coll Nutr. 1990;9(1):48‐55. [Article]

7Firoz M, Graber M. Bioavailability of US commercial magnesium preparations. Magnes Res. 2001;14(4):257‐262. [Article]

8Hurwitz A, Ruhl C. Gastric Hypochlorhydria and Achlorhydria in Older Adults-Reply. JAMA. 1997;278(20):1659–1660. [Article]

9Uysal N, Kizildag S, Yuce Z, et al. Timeline (Bioavailability) of Magnesium Compounds in Hours: Which Magnesium Compound Works Best?. Biol Trace Elem Res. 2019;187(1):128‐136. [Article]

10Sakhaee K, Bhuket T, Adams-Huet B et al. Meta-analysis of calcium bioavailability: a comparison of calcium citrate with calcium carbonate. Am J Ther. 1999;6(6):313‐321. [Article]

11van der Velde RY, Brouwers JR, Geusens PP, Lems WF, van den Bergh JP. Calcium and vitamin D supplementation: state of the art for daily practice. Food Nutr Res. 2014;58:10.3402/fnr.v58.21796. [Article]

12Milman N, Jonsson L, Dyre P, et al. Ferrous bisglycinate 25 mg iron is as effective as ferrous sulfate 50 mg iron in the prophylaxis of iron deficiency and anemia during pregnancy in a randomized trial. J Perinat Med 2014;42(2):197-206. [Article]

13Wegmüller R, Tay F, Zeder Cet al. Zinc absorption by young adults from supplemental zinc citrate is comparable with that from zinc gluconate and higher than from zinc oxide. J Nutr. 2014;144(2):132‐136. [Article]

14Scientific American. Super-Tasting Science: Find Out If You’re a “Supertaster”! December 2012. [Report]

15NIH. Lactose Intolerance. June 2020 [Report]

16Liu J, Jia X, Li H, et al. Association between MTHFR C677T polymorphism and abdominal aortic aneurysm risk: A comprehensive meta-analysis with 10,123 participants involved. Medicine (Baltimore). 2016;95(36):e4793. [Article]

17Yadav U, Kumar P, Gupta S et al. Distribution of MTHFR C677T Gene Polymorphism in Healthy North Indian Population and an Updated Meta-analysis. Indian J Clin Biochem. 2017;32(4):399‐410 [Article]

18Neustadt J, Pieczenik S. Biochemical Individuality. Integrative Medicine 2007 6(3):30-32. [Article]

19 Zakay-Rones Z, Thom E, Wollan T, Wadstein J. Randomized study of the efficacy and safety of oral elderberry extract in the treatment of influenza A and B virus infections. J Int Med Res. 2004;32(2):132‐140. [Article]

20Akbari S, Rasouli-Ghahroudi AA. Vitamin K and Bone Metabolism: A Review of the Latest Evidence in Preclinical Studies. Biomed Res Int. 2018;2018:4629383. [Article]

21Orimo H, Nakamura T, Hosoi T et al. Japanese 2011 guidelines for prevention and treatment of osteoporosis—executive summary. Archives of Osteoporosis. 2012; 7:3–20. [Article]

22Cockayne S, Adamson J, Lanham-New S, Shearer MJ, Gilbody S, Torgerson DJ. Vitamin K and the Prevention of Fractures: Systematic Review and Meta-analysis of Randomized Controlled Trials. Arch Intern Med. 2006;166(12):1256-1261. [Article] 

23Shiraki M, Shiraki Y, Aoki C, Miura M. Vitamin K2 (Menatetrenone) Effectively Prevents Fractures and Sustains Lumbar Bone Mineral Density in Osteoporosis. Journal of Bone and Mineral Research. 2000;15(3):515-522 [Article]

24Myneni D, Mezey E. Regulation of bone remodeling by vitamin K2, Oral Diseases, 2017. 23, no. 8, pp. 1021–1028. [Article]

25 Marshall D, Johnell O, Wedel H. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ. 1996;312(7041):1254-1259. [Article]

26Akbari S, Rasouli-Ghahroudi AA. Vitamin K and Bone Metabolism: A Review of the Latest Evidence in Preclinical Studies. Biomed Res Int. 2018;2018:4629383. [Article]

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