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How to Choose the Best Dietary Supplement?

Istanbul Kent University, Faculty of Health Sciences, Department of Nutrition and Dietetics
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"Today, it is becoming increasingly difficult to meet nutritional needs solely through diet."

Kişi İçin En İyi Besin Takviyesi Nasıl Seçilir?

What is the importance of a balanced diet?

Adequate and balanced nutrition involves providing the body with the necessary nutrients in appropriate amounts to support growth and development, maintain health, and enhance quality of life. A regular and balanced intake of essential macro and micronutrients plays a critical role in maintaining optimal health. However, in today’s world, meeting these nutritional needs solely through diet is becoming increasingly challenging.

What affects the nutritional content of foods?

The nutritional content of foods is adversely affected by various factors, such as changes in agricultural practices, soil mineral depletion, environmental pollution, and the widespread consumption of processed foods. The use of chemical fertilizers, pesticides, and herbicides disrupts the natural mineral balance of the soil, reducing the mineral content of plants. This decrease in the nutritional value of agricultural products prevents inpiduals from obtaining sufficient nutrients. For example, the reduction of vital minerals such as magnesium, zinc,and selenium in the soil leads to insufficient intake of these nutrients through food, thereby increasing the need for supplementation.

What are the current challenges in nutrition?

Today, many people struggle to access the variety of foods necessary for adequate and balanced nutrition. Factors such as time constraints and the fast-paced nature of modern life contribute to this difficulty. As a result, people often turn to convenient, quickly accessible processed foods, which are typically high in energy but low in vitamins and minerals. The consumption of these foods can lead to nutritional deficiencies and related health problems over time. To counteract this, the use of dietary supplements is often considered.

Herbal supplements

Herbal supplements offer various natural compounds that go beyond traditional medical treatments for the prevention and treatment of different diseases. The World Health Organization (WHO) estimates that approximately four billion people in developing countries use herbal supplements for therapeutic purposes. One of the most common uses of herbal medicine worldwide is disease prevention. Given the prevalence of these practices, it is crucial for dietitians to be knowledgeable and assess their clients accordingly. However, in cases of illness, herbal medicine practices are frequently used, posing a high risk of side effects and drug interactions.

Considerations with herbal supplements

In many countries, including ours, numerous herbal products that have not undergone quality control and lack evidence of containing necessary physiological effects are sold as "dietary supplements" at high prices, often without proper regulation. These products are readily available not only in pharmacies but also in herbal shops. Furthermore, social and visual media frequently advertise herbal products, with non-experts recommending their use in treatments. These products are marketed at high prices, creating significant profit margins.

There is a widespread belief that "herbal preparations are natural and therefore free from side effects or harmful effects," which leads to high demand for these products and contributes to the continuous growth of this market. However, the concurrent use of prescription medications with herbal or plant-based products can cause serious problems, exposing many patients to the risk of interactions between the herbal products they use and their medications. In the United States, it is estimated that over 100,000 deaths each year are due to side effects, with a portion of these potentially related to drug interactions, ranking these issues among the top causes of death. It is emphasized that some of these drug interactions may be linked to the use of herbal products. This situation particularly exposes patients undergoing multi-drug therapy, children, the elderly, and pregnant or breastfeeding women to undesirable and harmful effects due to interactions that are often overlooked because of a lack of knowledge.

Nutritional supplements

Nutritional supplements offer concentrated forms of vitamins, minerals, essential fatty acids, amino acids, and other nutrients to help address nutritional deficiencies. However, selecting the appropriate dietary supplement is a complex process because each inpidual's biological makeup, lifestyle, and health status differ.

How to choose the best dietary supplement?

To facilitate this process, consider the following key factors when selecting a dietary supplement:

Identify inpidual needs: The first and most crucial step in choosing a dietary supplement is identifying personal needs. Blood tests and dietary intake records play a significant role in determining which vitamins and minerals are deficient. A comprehensive evaluation by a doctor and dietitian is essential for interpreting blood tests and assessing nutritional status. For example, postmenopausal women may need calcium and vitamin D supplements to maintain bone health, while older adults may require protein supplements to preserve muscle mass. Pregnant women have increased needs for essential nutrients such as folic acid, iron, and omega-3 fatty acids.

Evaluate the contents: Proper evaluation of the contents of dietary supplements is critical for their effectiveness and safety. The labels of dietary supplements should be carefully examined, and the information about the vitamins, minerals, and other active ingredients they contain should be understood. Additionally, check for any substances that may cause allergies.

Assess quality and reliability: Quality and reliability are significant factors when choosing a dietary supplement. Products that are certified and approved by regulatory agencies enhance their reliability. In the United States, the USP (United States Pharmacopeia) certification indicates that products have been tested for quality, purity, and dosage. In Europe, the safety of dietary supplements is ensured by criteria set by the EFSA (European Food Safety Authority). In Turkey, the reliability and regulation of dietary supplements are overseen by the Ministry of Agriculture and Forestry. It is important to ensure that the product is certified and has undergone necessary inspections.

Follow dosage instructions: The effectiveness of dietary supplements varies depending on the recommended dosage and usage instructions. Inadequate or excessive intake of supplements can lead to side effects. For instance, taking more than the recommended amount of vitamin A can cause toxicity and liver damage. Therefore, it is essential to follow the dosage instructions specified on the product packaging.

Regular health check-ups: Finally, regular health check-ups should be conducted to assess the health outcomes of the supplement being used. Based on these assessments, adjustments to the dosage or the product itself may be necessary.

Akyol AD and Oz B, The use of complementary and alternative medicine by patients with cancer: in Turkey. (2011).

Bauer J, et al., Evidence-based recommendations for optimal dietary protein intake in older people: a position paper from the PROT-AGE Study Group. (2013).

Baysal, A. (2011). Beslenme (13. Baskı). Ankara: Hatiboğlu Yayınları.

Baytop, T. (2021). Türkiye’de Bitkiler ile Tedavi (3rd ed.). Ankara: Ankara Nobel Tıp Kitapevleri.

Ceylan, A. (1995). Tıbbi Bitkiler I (3rd ed.). İzmir: Ege Üniversitesi Ziraat Fakültesi Ofset Atelyesi.

Ceylan S, et al., Complementary and alternative medicine use among Turkish diabetes patients. (2009).

Coates PM, et al., Encyclopedia of dietary supplements. (2010).

De Smet PA, Herbal medicine in Europe—relaxing regulatory standards. (2005).

Ersöz T, Bitkisel İlaçlar ve gıda Takviyeleri ile İlgili Genel Yaklaşım ve Sorunlar. (2012).

Féart C, Dietary Supplements: Which Place between Food and Drugs? (2020).

Fortmann SP, et al., Vitamin and mineral supplements in the primary prevention of cardiovascular disease and cancer: An updated systematic evidence review for the U.S. Preventive Services Task Force. (2013).

Jones DL, et al., Nutrient stripping: The global disparity between food security and soil nutrient stocks. (2013).

Penniston KL and Tanumihardjo SA, The acute and chronic toxic effects of vitamin A. (2006). Petroczi, A, et al., Mission impossible? Regulatory and enforcement issues to ensure safety of dietary supplements. (2011).

Reid IR and Bolland MJ, Calcium and/or Vitamin D Supplementation for the Prevention of Fragility Fractures: Who Needs It? (2020).

T.C. Sağlık Bakanlığı. (2022). Türkiye Beslenme Rehberi (TÜBER) (Yayın No:1031; A. G. Pekcan, N. Şanlıer, M. Baş, N. Acar Tek, & H. Gökmen Özel, Ed.). Ankara.

Wierzejska RE, Dietary Supplements-For Whom? The Current State of Knowledge about the Health Effects of Selected Supplement Use. (2021). 

Wilson RD and O'Connor DL, Maternal folic acid and multivitamin supplementation: International clinical evidence with considerations for the prevention of folate-sensitive birth defects. (2021).

Yetley EA, Multivitamin and multimineral dietary supplements: definitions, characterization, bioavailability, and drug interactions. (2007). https://www.efsa.europa.eu/en/topics/topic/food-supplements

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