What are supplements ?

This will be an overview of the official definitions by two main authorities, some examples of real life products and how they are being marketed, benefits of risks of supplements and a final conclusion. Supplements are concentrated sources of nutrients (or other substances) with a nutritional or physiological effect according to the EU. Overall you can take away that more vitamins and minerals do not necessarily mean better and that the benefits of supplements are small to non-existent except you have a special condition for which you would have to consult a doctor anyway and probably would get a prescription drug instead of a dietary supplement.

Official definitions

There are two main sources for official definitions for supplements. While these might vary in different countries based on local law and regulation we will stick to these for the purpose of this article to give you an overview of what supplements are to then dive deeper yourself.

The United States Food and Drug Administration defines supplements as followed:

A dietary supplement is a product intended for ingestion that contains a "dietary ingredient" intended to add further nutritional value to (supplement) the diet. A "dietary ingredient" may be one, or any combination, of the following substances:

a vitamin
a mineral
a herb or other botanical
an amino acid
a dietary substance for use by people to supplement the diet by increasing the total dietary intake
a concentrate, metabolite, constituent, or extract

Dietary supplements may be found in many forms such as tablets, capsules, soft gels, gelcaps, liquids, or powders. Some dietary supplements can help ensure that you get an adequate dietary intake of essential nutrients; others may help you reduce your risk of disease.

The European Commission defines the products in this category in this way:

As an addition to a normal diet, food business operators market food supplements, which are concentrated sources of nutrients (or other substances) with a nutritional or physiological effect. Such food supplements can be marketed in “dose” form, such as pills, tablets, capsules, liquids in measured doses, etc.

You already can see that the definitions are quite different. While the EU names "Concentrated sources of nutrients with a nutritional or psychological effect" the FDA names names it a "product intended for ingestion that contains a dietary ingredient" to then move on to define what a dietary ingredient is. So to me, it seems like the FDA is a bit more specific, while the EU intends to be broader. Both bodies seem to agree generally in which forms supplements are being produced and brought to the shelves.

Personally, I like the description which is given on Wikipedia, even though I will earn some criticism for citing the online encyclopedia as a source, which states:

A dietary supplement is intended to provide nutrients that may otherwise not be consumed in sufficient quantities.

is this is more accessible to me. Based on which country you are in dietary supplements might be classified as foods, drugs or other which determine whether they are freely available without a prescription for consumption. Consult your local doctor and authorities for specifics.

Forms and marketing of supplements

Supplements come in many forms like

Tablets,
Capsules,
Softgels
Gelcaps
Liquids
Powders
Energy bars

one of the newer trends is that the lines between food and supplement blur more and more. In Ireland, you will find Protein enriched milk on the shelves or omega 3 bread and the likes. As the consumers become more health conscious, products develop to address these needs. Depending on the target group, packaging, wording and presentation may vary greatly. Here are some examples:

Glucosamine for dogs

Here we have glucosamine for dogs. Yes, you are seeing right. What works for granny, grandad and marathon dad to keep their joints in check also should work for Wautzi. One of my personal favorites.

pharmacy supplements

Same thing, but probably being handed to you in a pharmacy when you ask for pain relief in your joints after strenuous exercise. Probably you would get more bang for your bug with the dog food if you wanted to maximise your glucosamine intake.

Whey Protein line up

Here you have a selection of sports supplements in the form of whey protein. Notice that these tubs mainly work with black and red, which are pretty aggressive colour combinations compared to the packaging of the aforementioned Glucosamine. That these containers are all also pretty big on the shelf is in my opinion also no coincidence as they promote muscle growth and their target group is 15 - 30-year-olds mainly.

In America, dietary supplements can not claim to

Diagnose
Cure
Treat
Prevent

diseases as they then would be classified as drugs and would fall under stricter regulation. This might also mean that depending on where you buy your supplements you might need a prescription or not. This might be one of the reasons will E-Commerce is rising in revenue streams for this kind of products as it opens an opportunity to get a supplement which you would need a prescription for your in your country without a prescription from somewhere else.

Popular dietary supplements include

Calcium
Echinacea
Fish Oil
Ginseng
Glucosamine and/or
Chondroitin Sulphate
Garlic
Vitamin D
St. John’s Wort
Saw Palmetto
Ginkgo
Green Tea
Vitamin E
Calcium
Ironherbs
Probiotics

This is just a little insight into the world of supplement marketing. Always be aware that these supplements usually live in the realm of making you believe that they provide the benefits of prescription drugs while being risk-free, even though they have been regulated less strict and therefore not tested as professionally (and expensively). This also results in several cases in which dietary supplements have been found to be mislabeled overstating or understating the true ingredients. Here one statement from a study done by labdoor on probiotics:

"Total viable bacteria ranged from -99% to +2400% vs. the products' stated label claims (-24.975 billion CFUs to +120 billion CFUs)."

One of the biggest scandals of mislabeling which I have personally witnessed was the 2013 Horse Meat scandal in the UK and Ireland in which low quality minced beef was found out to have up to 29% equine meat in it. Another example would be the huge Durham trial that was done in the UK with claims that fish oil would enhance the intelligence of children... which turned out it doesn't.

Benefits of supplements

While supplements are no substitute for a healthy diet the can help you to get the nutrients which you might not get otherwise. There is some evidence that creatine and protein supplementation is beneficial for vegetarians, as they miss out on meat, one of the prime deliverers of protein. With age, you also might want to supplement to counterbalance that your body will not produce as much of a certain nutrient anymore. For probiotics, there was some beneficial impact recorded to help to keep a healthy gut flora when being on antibiotics, as the antibiotics kill the bacteria you replenish by taking probiotics. Iron is supposed to help prevent anaemia while and fish oils are said to have benefits for heart diseases.

If you have a deficiency for a certain nutrient based on your medical record, due to medication or lifestyle choices speak to your GP to get clarity whether dietary supplements make sense for you.

The harvard medical school states in one of their articles that most of the benefits of dietary supplements are observational and could not be reconstructed in randomised trials against placebo.

Risks of supplements

One of the worst combinations in the internet age are self-diagnoses followed by self-treatment with dietary supplements. Please consult your doctor and get proper medication if you are ill. Here are some of the risks of supplements I have found. This is just an overview, not an all encompassing list

Vitamin K can reduce the effect of the blood thinner Coumadin
St. John's root can speed up the breakdown of drugs like antidepressants and birth control pills and therefore reduce their effectiveness
Vitamins C and E might reduce the effectiveness of some types of cancer chemotherapy.
Very high levels of vitamin A can cause headaches and liver damage, reduce strength and cause birth defects
Excess iron can have similar effects like an excess of vitamin A
Glucosamine has bad interactions with warfarin
Vitamin E, which was initially thought to protect the heart, was later discovered to increase the risk for bleeding strokes

To prevent yourself getting something that might harm you here are some guidelines when choosing a supplement:

It is too good to be true, it usually isn't
Natural does not mean safe (think of a cobra bite, natural...but you are still dead)
If something which is sold over the counter states that it is better than a prescription drug, it probably should not be sold over the counter
Safety is more important than your gains, pain relief, etc. the wrong tablet at the wrong time will only make you worse
Get your information for your final decision from a doctor or at least from a local government website like
- NIH
- FDA
- USDA
- Website of the European Commission.

And here a final quote from the FDA on why you should be careful:

While the supplement company is responsible for having evidence that their products are safe and the label claims are truthful and not misleading, they do not have to provide that evidence to the FDA before the product is marketed.

Conclusion

Supplements are products which usually come in tablet, powder or capsule form and are still classified as foods and therefore do not have to forego the scrutiny of testing which prescription drugs have to undergo. In most cases, they provide nutrients in concentrated form to bring up the daily uptake. For most of the products brought to market, there are no long-term controlled studies available. For the supplements where there are long-term studies they more often than not do not show any better result than placebo. As long as you do not have a factor which already inhibits the intake or processing of a specific nutrient, it is very likely that the benefit you gain from a supplement is marginal to non-existent. This excludes the placebo effect, which is a beast on its own and sometimes shows real world benefits, which are caused not by the supplement, but the ritual of taking a pill.