Cristin Stokes, RDN, LN, discusses how to navigate the multi-billion dollar nutritional supplement industry. Learn how to discern what are the best and safest supplement options for you.

1. Smart about Supplements
Cristin Stokes, RDN, LN
MUS Wellness Program
October 6th, 2016

2. Webinar Description
The dietary supplement industry is a big, multi-billion dollar industry offering thousands of
products. Many questions arise when it comes to dietary supplementation:
• Should I use supplements?
• If so, what do I need?
• What is safe?
• What is effective?
• Am I throwing my money away?

3. Dietary Supplement Defined
Dietary Supplement: Product intended for ingestion that contains a
dietary ingredient intended to add further nutritional value to the
diet. Usually in pill, powder, or liquid form.*
*definition from the US Food & DrugAdministration
Dietary Ingredient Examples
Vitamins Vitamin D, Vitamin C, Folic Acid
Minerals Iron, Calcium, Magnesium
Herbs/Botanicals Garlic, Ginseng, Echinacea
Amino Acid BCAA, L-Glutamine
Other Fish Oil, Probiotics, Glucosamine

4. Supplement Industry Stats
• Nearly $37 billion in revenue in 2014
• 1/6 of all purchases: Multivitamins
• Estimated 68% of Americans take some form of a supplement
• Increases with age
• Over 65,000 dietary supplements on the market
• Reasons cited for taking supplements:
• Maintain and improve health
• Prevent chronic disease
• Increase energy
• Athletic performance
• Weight loss

5. Disclaimers
• Consult with your health care provider. Make sure your physician
and pharmacist are aware of all supplements you are taking.
• Age, gender, personal health history, race, dietary habits, health
goals all affect need & dose of supplementation.

6. Do you need a supplement?
• Food first!
• Best way to get nutrients:
• Real, whole foods
•Synergy
• Tomato example
• Buffer theory

7. Do you need a supplement?
• Typical American diet low in:
• Calcium
• Potassium
• Fiber
• Magnesium
• Vitamin A
• Vitamin C
• Vitamin E
• Most of us have some nutrient gaps.
• Nutrient deficiency disorders are rare.

8. Do you need a supplement?
• Special populations
• Older adults
• Pregnant/nursing women
• Eating less than 1200 calories per day (women); 1500 calories per day
(men)
• Drug/alcohol use
• Conditions that cause malabsorption
• Vegan/vegetarian
• Food allergies that limit entire food groups
• Diagnosed nutrient deficiency

9. Do supplements work?
• Supplements work…
• If you’re deficient
• Example: Vitamin C
• More is not necessarily better
• U-shape response curve
• Zinc
• SELECT study

10. Multivitamins (MVIs)
• “Based on current research, it's not possible to recommend for or against
the use of multivitamins to stay healthier longer.” – National Institutes of
Health (NIH)
• Mixed research evidence
• Difficult to control for other factors
• Nutrition insurance for a few cents per day
• Basic, inexpensive brand is fine
• Avoid high-potency, mega-dose MVIs
• ≤100% DV
• Take with a meal
• Part time supplementation

11. Others to consider?
• Vitamin D
• Fish Oil
• HighTG or heart disease
• Depression
• 1000 mg EPA + DHA combined
• Probiotics
• Antibiotics
• Calcium
• Osteoporosis or significant risk factors
• Bottom line: Consider individual needs, specific circumstances, and prioritize
whole food sources

12. Supplements for Athletic Performance
• Amount, composition, and timing of food intake more
critical for optimal performance than supplements
• US Olympic Team RDN
• Protein powder
• For muscle building & recovery
• Use for convenience, when whole food protein sources
unavailable
• Whey protein for digestibility, cost

13. Supplements for Athletic Performance
• Branched Chain Amino Acids (BCAAs)
• Leucine, Isoleucine,Valine
• Supplementation unnecessary if sufficiently high protein intake
• Anti-fatigue effects seen in untrained/lightly trained athletes, or those with low protein
intake
• Fasted state
• Recovery Carbohydrate + Protein Drink
• Cost vs Convenience

14. Supplements forWeight Loss
• Suppress appetite, increase metabolism, and/or reduce absorption of nutrients
• Most popular: Garcinia Cambogia, Hydroxycut, Orlistat, green tea extract,
conjugated linoleic acid (CLA), or whatever Dr. Oz is getting paid to promote right
now
• Unpleasant or dangerous potential side effects
• Very little to no research evidence
• Animal only, poorly designed, industry sponsored
• May modestly assist with weight loss short term
• Benefit not worth the risks!

15. Are supplements safe?
• Supplement manufacturers do not have to prove safety and
effectiveness prior to marketing
• Different than drugs
• FDA & Federal Trade Commission:
• Label and package insert must be truthful and not misleading
• "This statement has not been evaluated by the Food and Drug Administration.
This product is not intended to diagnose, treat, cure, or prevent any disease.“
• Legal action can be taken
• FDA Class I drug recalls (2004-2012): More than half were for dietary
supplements
• i.e. Ephedra

16. Are supplements safe?
• Third party certifications
• US Pharmacopeia
• ConsumerLab.com
• NSF International
• Ensures the product was properly manufactured, contains the
ingredients listed, free of harmful contaminants
• Does not ensure that the product is safe and/or effective!

17. General supplement safety rules
• Avoid mega-doses
• Especially true for Vitamin A and Iron (unless directed by your physician)
• ≤100% DV
• Do not substitute supplements for medicine in management of chronic
disease
• Supplements most likely to be contaminated with pharmaceutical
ingredients:
• Herbal remedies for weight loss and for sexual or athletic performance
enhancement
• Fewer extra ingredients, the better

18. General supplement safety rules
• Natural does not necessarily mean safe
• Example: Kava
•Drug-nutrient interactions can be serious
• Vitamin K + Coumadin
• St. John’s wort + antidepressants, birth control
•Inform your doctor about all supplements you are taking

19. Questions to ask before taking a supplement
• What are the potential health benefits of this
dietary supplement product?
• What are its potential benefits for me?
• Does this product have any safety risks?
• What is the proper dose to take?
• How, when, and for how long should I take it?

20. Best Consumer Resources
• Dietary Supplements Fact Sheets from the Office of Dietary
Supplements, National Institutes of Health
• https://ods.od.nih.gov/factsheets/list-all/
• Dietary Supplement Label Database (NIH)
• Examine.com
• Pubmed.com

21. In Conclusion
• Food first!
• Supplements second…maybe
• If it sounds too good to be true, it probably is.
• More is not necessarily better.

22. Next Up…
• Next Webinar: November 15th
• Gym Bloopers. Common gym mistakes and how to correct them.
• Back on the Road!
• Live workshops in Billings, Miles City, Glendive, Dillon & Missoula.
• Check out registration links on montanamovesandmeals.com or MUS
Wellness Facebook page. facebook.com/MUSwellness