Jan. 26, 2022 -- Are you thinking of adding supplements to your diet? While supplements can be helpful in some cases, they can be a very slippery slope, and users must proceed with caution, one registered dietitian nutritionist says. 

Jamie Lee McIntyre, a dietitian and nutrition consultant at JamieLeeRDN.com, says she sees more interest in supplementation every January with people’s New Year’s resolutions. But there is also a year-round curiosity, she says, especially since the pandemic began, making it even more important to understand the risks and rewards associated with them.

First off, it’s important to note that the FDA does not regulate supplements.

“Though they are sold over the counter, they can be as dangerous as medicine. The least dangerous worst-case scenario is a waste of money,” says McIntyre. “For example, megadoses of water-soluble vitamins are literally flushed down the toilet through urine when there is no medical need or true nutrition deficit in the person taking it.”

“The most dangerous worst-case scenarios can be a food and drug interaction, such as vitamin K interfering with blood thinning medications, or toxicity, which can happen with fat-soluble vitamins and others,” she continues.

Reading labels for certification can help but is another place where education is essential. Many supplement makers will opt for testing by a third-party operator to show a high quality and demonstrate that what’s on the label is indeed what’s in the bottle.

McIntyre recommends looking for certification from Informed Sport, NSF Certified for Sport, or USP if you’re checking.

Beyond reading labels, it’s essential to understand your actual needs before popping pills or adding powders to your drinks. Liberal use of supplements can cause several issues, says McIntyre.

“One of my very first patients I met as a new dietitian was an individual hospitalized for a gastrointestinal bleed because of his regular use of a laundry list of vitamin supplements,” she says. “Many labels even warn of this. While toxicity and food and drug interactions are the most dangerous complications, less dangerous but undesirable issues can arise, such as masking a different deficiency or undiagnosed health condition, or creating a new issue or symptom from taking an unnecessary supplement.”

For those looking to boost fitness gains via supplements specifically for that purpose, the slope can be just as slippery.

“I often see clients taking pre-workout or ‘energy-boosting’ supplements, with high amounts of caffeine,” says McIntyre. “This can lead to diarrhea, rapid and irregular heartbeat, high blood pressure, and dizziness, among other issues. Another common side effect is gastrointestinal distress and upset stomach.”

How to Get It Right

If you are wondering if you need a supplement of any sort and want to add it to your diet in a safe way, there are steps to take to accomplish that. The first and best way to go about supplementation is to start with your doctor or a registered dietitian.

“I first perform a full nutrition assessment, complete with review of past medical history, allergies, current and past medication use, current supplement use, lab work (most often chem, heme and lipid panels), and, of course, a diet review using food logs or food questionnaires to understand where they stand in terms of current nutrient intake,” says McIntyre. “Labs that I would order separate from the panels I’ve mentioned would be iron and total binding capacity, ferritin, B12 and folic acids, as well as vitamin D.”

Depending on your lifestyle, this approach may vary.

“For certain populations, like athletes considering low-risk supplementation, lab work may not be necessary for implementing a product like creatine monohydrate. Or if I know a client is having a tough time meeting protein needs on a vegan diet, a minimal-ingredient plant-based protein powder could be low-risk,” McIntyre says. “As with all things nutrition-related, it comes down to the individual and what is required to determine the best approach truly specific to them.”

What about taking a simple multivitamin? Should you check in with a doctor or registered dietitian for that?

“A single multivitamin, in the absence of other nutrients and serious health conditions, can be a good insurance plan,” says McIntyre. “If a person has decided to take a multivitamin, I recommend looking for one that is third-party tested, contains nutrient dosing specific to the person’s needs based on sex and age, has good bioavailability of key nutrients, is convenient, and sold at a reasonable cost.”

Some multivitamins are targeted to specific populations, like post-menopausal women, for example. While these might seem like the right idea, you should again tread carefully before you take one. For instance, be wary of supplements that promise hormone balance or are otherwise not standard practice without first getting a full nutrition assessment and proven medical need for such a supplement.

This holds true in this current moment of the pandemic, too. Misinformation about what supplements can and can’t do to prevent or cure COVID is widespread.

“You cannot, nor would you want to, ‘boost’ your immune system with supplements,” warns McIntyre. “Yes, it is true certain nutrients support immune health. Vitamins A, C, and E, and minerals like zinc, all play a role in immune system function.”

That said, “there is no need to take supplements if you eat a balanced diet, so the recommendation should be to include these foods in your daily diet for essential nutrients that support your immune system.”

And in an ideal world, you will do just that -- get the nutrients you need, without supplements.

“If there is a perceived, specific need for supplementation, it is always best to review your interest with your physician, dietitian, and pharmacist so that they can best help you navigate and choose what is right for you,” says McIntyre.