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Supplements & Nutritionals

Ensuring Their Safety … and Yours

Have you ever heard of melamine?

This is a food adulterant associated with kidney and renal disease. One study in 2015 found this substance in up to 48% of the tested items. It has been found in foods and supplements originating from various countries such as China and South Africa.[1]

How about lead?

Another study showed up to 25% of calcium supplements contained elevated levels of lead with less than 20% containing acceptable ‘safe’ levels of lead.[2]

68% of Americans use some form of supplement for either their general health and wellness or to enhance their performance, and 84% express confidence in the quality of the supplements they use. Supplements and nutritionals are used by persons from all walks of life and even recommended by doctors and nutritionist. Yet there are serious concerns about their safety. Whatever your position on supplements, I think we can all agree they should be safe. At a bare minimum, they should cause no harm.

In previous articles, I have written about the use and efficacy of supplements. In this article, I want to focus on the safety of supplements.

68% of Americans use some form of supplement…
Yet there are serious concerns about their safety.

The line between “drugs” and naturally-occurring substances is a recent historical development, with advantages and disadvantages for our personal and communal health and wellness.

According to the Federal Food, Drug, and Cosmetic Act, as amended, Section 201(g)(1), the term drug is defined as an “article intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease.” Technically, vitamins, minerals, trace elements, amino acids, herbs, or homeopathic remedies are not classified as drugs. However, these substances can have significant effects on physiology and must be used rationally.

Prior to the creation of morphine from opium in 1803, plants, fungi, and their derivatives were the only medicines available. In the years following the creation of morphine, quinine, and strychnine, the production of pharmaceutical grade drugs escalated. After the Food and Drug Act of 1906, there was a transition from natural or non-synthetic forms of medication to pharmaceutical grade ones. By the late 20th century, the world of natural medicines had become almost lost to physicians in the West. During my training in medical school from 1996–2000, the only plant-based chemicals that were discussed in school were toxicants and poisons. Yet in the last fifteen years there has been a seismic shift in the American public towards supplements and nutriceuticals to the extent that now most Americans reported using some type of a supplement.

Unfortunately, we have a deep history of food, drug, and supplement adulteration in the United States. Whether it is the ‘blue milk’ of Upton Sinclair’s The Jungle that led to the Food and Drug act of 1906, the adulteration of 5HTP that led to the discovery of eosinophilia-myalgia syndrome (EMS) in 1989, or the initial references above, due diligence is therefore necessary when choosing any supplements or food-based products.

Unfortunately, we have a deep history of food, drug, and supplement adulteration in the United States … due diligence is therefore necessary when choosing any supplements or food-based products.

Our Due Dilligence

Veterinary supplements are those made specifically for animal use.

Nutritional grade supplements are those made purely to deliver a specific dose of a vitamin or mineral. These are the most common supplements sold in stores. Nutritional grade supplements typically rely on synthetic components, which are least expensive to produce and fit into a single pill or capsule.

Medicinal grade supplements contain particular nutrients, which at higher levels have pharmaceutical effects (e.g. high dose niacin raises HDL and lowers LDL cholesterol).

Pharmaceutical grade supplements have the highest grade of purity, use only bioactive and bioavailable components, and are third-party tested for both content and purity.

So what is that proper diligence? To begin with, we need to understand that not all supplements are created equal. In general, there are four supplement grades:

  • Veterinary
  • Nutritional
  • Medicinal
  • Pharmaceutical

These four supplement grades vary widely in their bioactivity and bioavailability. They also vary in accountability of third-party testing. Let’s look at these in turn.

Bioactivity & Bioavailablity

Bioactive substances are biologically active and have an effect upon a living organism, tissue, or cell.

Bioavailable substances are those that are able to be digested and absorbed.

Bioactive and bioavailable substances are more expensive to harvest and harder to fit into a single pill or capsule, which is why nutritional grade supplements typically rely on synthetic components which are not bioactive or bioavailable—meaning they are not readily digested and absorbed. They, therefore, have less impact on your health than their higher grade equivalents. Examples of this would be the white zinc oxide coating of lower-end multivitamins or the use of cyanocobalamin (cyanide molecule attached to cobalamin) as a source for the vitamin B12 (e.g. Centrum). These multivitamins were known during my residency training as ‘bedpan pills.’ Older individuals in the hospital and nursing homes often passed them in their stool into their bedpans—undigested and unabsorbed. In other words, useless.

Third-Party Testing

Nutritional and veterinary grade supplements are not third-party tested for purity. This means that if they either use contaminated source materials or become contaminated in the manufacturing process, this will not be discovered and may be passed on to the consumer. Medical grade supplements use higher quality sourcing and only bioavailable ingredients. Medical-grade supplements are also third party tested for purity, but they still have added fillers, colors, dyes and other non-essential additives that aid the manufacturing process. Only pharmaceutical grade
supplements are both pre and post production tested as well as exclude any fillers, colors, dyes and additives (as well as using pharmaceutical grade ingredients). Consequently, only pharmaceutical grade supplements are guaranteed to be free from adulterants.

While pharmaceutical grade supplements may come at a higher cost than those found on the shelves of pharmacies or health food stores, the value must also include assurance of their purity, quality, bioavailability, and effectiveness.

For these reasons, Richmond Integrative & Functional Medicine uses four cardinal rules for supplement recommendation:

  1. The quality of the science behind the product
  2. The quality of the ingredients themselves
  3. The quality of the manufacturing process
  4. The synergism among product components

Richmond Integrative & Functional Medicine only recommends supplement brands that meet our high standards and tend to produce predictable results. Our recommendations in no way reflect the entirety of what is available on the market, which is an impossible feat. But we have spent the last several years scouring the available products and have made our choices based on researching the available suppliers.

For your convenience, we have partnered with Fullscript, an online store that reflects our own stringent requirements for dealing with supplement vendors.

Accessing Fullscript

Fullscript login screen

Fullscript home screen

You may use the button below, or use the link in the main menu of our website, to register an account with Fullscript (using an email and login of your choice).

You will then have full access to RIFM specific recommendations. You can search for products or select from options under the ‘Dispensary Categories’ menu located at the upper left of the screen. Supplements are organized by therapeutic use. All supplements on Fullscript are offered at a considerable discount but feel free to price shop. We recommend sticking with our recommended (and therefore vetted) manufactures. Due to the overall high quality of Full Scripts suppliers, you can feel free to search their entire inventory, but we always recommend making a thorough investigation into an unknown manufacturer and their practices prior to making a purchase.

Questions to consider include:

  • Are their products third-party tested?
  • Are their sources evaluated and tested prior to entry into the manufacturing process?
  • Can you get a copy of a product’s certificate of manufacture to see the results of their third-party testing?
  • Does their overall philosophy of producing their product align with yours?

Registered users receive a 25% discount off retail prices.

Other Resources

For those wanting to research supplements themselves, the best single resource currently available is ConsumerLab.com While it is not 100% complete and accurate, ConsumerLab.com is the best single resource on supplements, supplement claims, and individual product testing.

References

  1. Gabriels, Gary et al. “Melamine contamination in nutritional supplements—Is it an alarm bell for the general consumer, athletes, and ‘Weekend Warriors’?” Nutrition journal vol. 14 69. 17 Jul. 2015, doi:10.1186/s12937-015-0055-7
  2. Bourgoin, B P et al. “Lead content in 70 brands of dietary calcium supplements” American journal of public health vol. 83,8 (1993): 1155-60.

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