Be cautious, read the labels before you buy them, skip some of them

This issue I’m writing a little about the 10 top selling nutrition and health supplements. It’s a big industry in the U.S., grossing $23 billion dollars a year.

Remember that items marketed as supplements are regulated differently than medicines. While some supplements are assembled in laboratories, others are not much more than bagged up lawn clippings packaged in someone’s garage and labeled with misleading claims. Look at least for supplements that are labeled USP grade, which means that the U.S. Pharmacopoeia randomly tests some batches. Or look for the GMP—good manufacturing practice—label. Supplements made in Europe are generally subjected to higher quality controls, while those imported from Asia are notorious for the possibility of contamination and mislabeling.

1 – Multivitamins—These are the good old workhorses of the vitamin world, and they are not unreasonable for most people. In the ideal world, of course, we’d all eat a variety of healthy foods and get all the vitamins and minerals that we need from our diets. While most Americans get plenty of calories, we’re not so good at getting a healthy variety of nutrient- rich foods.

2 – Meal Replacements—These are items designed to replace home- prepared meals and include souped-up granola bars such as Zone bars, breakfast drinks, and more elaborate plans like Nutrisystems. They shouldn’t completely replace a regular diet, but they do have a place. For people who have been over-eating for years, they serve as a reminder of what healthy portion sizes should look like, and can jump-start efforts at weight loss. They can provide a healthy alternative to fast food when you’re in a hurry and don’t have time to cook a meal. But many are high in sodium so check the label. And they won’t replace the rich variety of nutrients you’ll get from a diet including a variety of fruits, vegetables, and whole grains.

3 – Sports Nutrition—This covers a gamut, from electrolyte replacement solutions to assorted supplements claiming to increase muscle mass. For most people, replacing fluid is the key requirement when exercising. And that can be done with plain old bargain priced tap water. The extra sodium and potassium found in electrolyte replacements probably isn’t needed unless you are in an endurance sport or exercising in the extreme heat. And energy drinks? Read the label; that’s usually a code word meaning caffeine, which is best avoided when you exercise.

As for supplements designed to increase muscles or boost your performance? There’s no evidence they work, so save your money to use on healthy foods or to join a gym.

4 – Calcium—This is a nutrient that is hard to consume in sufficient amounts in the diet. Dietary sources include dairy products, green leafy vegetables, and whole grains. But spinach and wheat bran contain substances that prevent the absorption of calcium, and cottage cheese’s high salt content also makes that a poor source for calcium. If you’re over 50, you need 1,200 mg. of calcium per day. The National Institute of Health (www.niams.nih.gov/Health_Info/Bone/Bone_Health/Nutrition/calcium_intake.asp) has information online to help determine your calcium requirements and to calculate your dietary intake.

5 – B Vitamins—These include B12, folate, and B6, and they are included in most multivitamins. In order to absorb B12 you need to have acid in your stomach. So people taking medicines for GERD (gastroesophageal reflux disease) may need extra B12, to make up for decreased absorption. The good news is that most people don’t need injections, because large oral doses of B12 overcome the decreased absorption. B12 shots are useful short- term to quickly boost levels in patients who have severe deficiencies.

6 – Glucosamine/chondroitin—The jury is still out on whether glucosamine with chondroitin is effective in osteoarthritis, because study results have been conflicting. You can read more from the National Institute of Health—nccam.nih.gov/research/results/gait/qa.htm. But it seems safe, so it’s reasonable to try. Remember that if it does help, it may take weeks to months before you see a reduction in osteoarthritis pain.

7 – Vitamin C—If you have a cold, gobbling down big doses of Vitamin C won’t help. This is one vitamin where megadoses can harm you. Your body excretes excess vitamin C in the urine, where large quantities can from crystals that damage the kidneys.

8 – Homeopathy—Many people mistakenly believe that homeopathy is another word for natural. It’s not; instead it refers to a specific belief system whose practitioners believe that tiny doses of various substances can produce powerful cures. But homeopathic remedies are so diluted that they are nothing more than expensive water containing few if any molecules of the supposedly therapeutic molecules. Don’t waste your money.

9 – Vitamin D—It’s tough to get sufficient Vitamin D from diet and sunlight alone in this climate. And the RDA (recommended daily allowance) found in multivitamins is probably too low. The RDA of 200 IU (international units) will prevent the bone disease rickets, but it’s not enough to prevent osteoporosis and to optimize cardiovascular health. Aim for at least 1,000 IU per day.

10 – Fish Oil—These provide healthy omega-3 fatty acids that benefit the cardiovascular system. But be careful with high doses over 2 grams per day, which can increase the risk of bleeding, especially if you are taking a blood thinner such as warfarin (Coumadin). Quality can vary widely, even within different lots of the same brand, because it easily becomes rancid. You can test your bottle of fish oil by taking out a capsule, poking it with a pin, and squeezing a drop onto a tissue. Smell it. If it smells OK, then taste a drop. And if that doesn’t taste bad, your fish oil is not spoiled.