Supplementing Your Dietary Supplement IQ

Chris D’Adamo, Ph.D. Assistant Professor

Department of Family & Community Medicine Department of Epidemiology & Public Health

Center for Integrative Medicine

Presentation Outline Overview of Dietary Supplements Definition Regulation

Supplements to Consider Multivitamin Vitamin D Omega-3 Fatty Acids Probiotics

Supplements to Avoid Potential for tainting with pharmaceuticals

Presentation Outline Supplement & Drug Interactions

Supplements for Special Situations People taking statins, beta-blockers, acid-blocking drugs Vegetarians Pregnant women

Other Popular Supplements by Health Concern Immune System Joint Health

Checklist: Informed Supplement Consumer

Digestion Depression

Liver Health Heart Health

Sleep

Dietary Supplements Defined What is a dietary supplement? 1994 Dietary Supplement Health and Education Act (DSHEA) A product (other than tobacco) intended to supplement diet Contains one or more dietary ingredients and taken orally Vitamins, minerals, herbs or other botanicals, amino acids

Vitamins Minerals Herbs Amino Acids

Immune System

Regulation of Dietary Supplements Federal Regulation of Dietary Supplements Food and Drug Administration (FDA) Supplements regulated as food

Pre-DSHEA assumed safe, post-DSHEA provide safety evidence Labeling and claims requirements

Ingredient names & amounts, directions for use, no health claims, etc. 2007 Good Manufacturing Practices (GMP)

Quality standards for manufacturing, preparation, storage, facility

Federal Trade Commission (FTC) Regulate marketing of supplements

Regulation of Dietary Supplements Federal Regulation of Dietary Supplements No universal regulation of supplement content “Don’t know what you’re getting”… in many cases, true!

Many dietary supplement companies hire 3rd party laboratories for product purity certification Contains specified ingredients No contaminants Dissolves properly GMP compliant NSF-certified gold standard!

Supplements to Consider

Multivitamin: Overview Most common dietary supplement 33% of Americans take multivitamin Usually contain at least 13 vitamins &

15 minerals most important to nutrition

How multivitamins are used Generally capsule or tablet orally once per day Powders, liquids, multiple daily doses less common

Best taken with meal Many of nutrients lipid-soluble, need fat for absorption

Why multivitamins are used Energy, promote health & wellness, insurance against poor diet

Multivitamin: Types RDI-centric RDI of most important vitamins/minerals Reference Daily Intake – replaced RDA in 1997 Prevent micronutrient deficiency in most people % Daily Value on food and supplement labels

Widely available & inexpensive

High potency Exceeds RDI for many vitamins/minerals Why? RDI prevent deficiency disease… not to promote optimal health!

Often higher in vitamin D, B-vitamins, vitamin C, etc. Pharmacies, health stores, Amazon & variable price Between $0.25/day - $2.00/day

Multivitamin: Favorable Research Improves nutritional status

2000 Journal of American College of Nutrition, 2009 European Journal Clinical Nutrition

Reduces risk of birth defects 2001 Epidemiology, 2002 Epidemiology, 2002 Pediatrics, 2003 Pediatrics

Associated with weight loss & decrease in body-fat % 2010 International Journal of Obesity Research

Reduced risk of macular degeneration & cataracts 2007 American Journal of Clinical Nutrition, 2008 Ophthalmology

Reduces risk of heart attack 2010 American Journal of Clinical Nutrition

Reduces risk of colon cancer 2002 Cancer Epidemiology, Biomarkers, & Prevention

Reduces risk of all-cause mortality and cancer mortality 2011 European Journal of Nutrition

Multivitamin: Unfavorable Research No benefit in some studies No reduction in risk of cancer or cardiovascular disease

2009 Archives of Internal Medicine

No reduction in risk of breast cancer 2010 Public Health Nutrition, 2010 American Journal of Clinical Nutrition

Slight increase in non-cancer, non-CVD mortality Lots of media coverage… but study flawed and over-interpreted

2011 Archives of Internal Medicine Direct conflict with 2011 European Journal of Nutrition Study!

Why discrepancy? Poor adjustment in observational studies

Other dietary factors, healthy lifestyles, “sick user effect”, etc. Clinical trials/many people use suboptimal products

Synthetic and poorly absorbed forms, inadequate potency

Multivitamin: Recommendations Does brand make a difference? YES! Cheap brands use cheap vitamin/mineral forms Affects absorption and effectiveness Natural vitamin forms better absorbed than synthetic

Natural vitamin E twice absorption of synthetic Certain binding salts better absorbed than others

Magnesium sulfate much better absorption than magnesium oxide Certain vitamin forms more effective than others

Vitamin D3 superior to vitamin D2

Multivitamin: Recommendations How to choose a good brand? Comparative Guide to Nutritional Supplements

Lyle MacWilliam, biochemist, commissioned by Canadian Minister of Health Scientific analysis of 510 multivitamins available in US & Canada

14 quality comparison criteria

Multivitamin: Recommendations

Multivitamin: Recommendations Choose capsule if possible

Capsules absorbed better than tablets May need to take more capsules per day

Always consume with meal Important fat-soluble nutrients Poor absorption in absence of fat

Be an informed consumer! Choose/avoid the following… Vit E: d-alpha tocopherol (natural) NOT dl-alpha tocopherol (synthetic) Vitamin D3 NOT vitamin D2 Methylcobalamin form of B12 NOT cynacobalamin form of B12 Avoid oxide binding salts (magnesium citrate NOT magnesium oxide) Avoid iron for men and postmenopausal women

Vitamin D: Overview A uniquely important vitamin Hormone-like activity (secosteroid) Controls expression of over 200 genes

Vitamin D active in most biological systems Musculoskeletal system

Classically emphasized role Endocrine system Nervous system Cardiovascular system Digestive system Immune system

Vitamin D: Sources Sun exposure UVB light converted to vitamin D3 in skin D3 transported to liver, metabolized to 25(OH)D

Also called calcidiol… measured most vitamin D blood tests

25(OH)D converted to calcitriol in kidneys Calcium metabolism… remaining calcitriol & calcidiol → health benefits

20,000 international units (IU) from 30 minutes sun exposure Only spring and summer if north of Atlanta

Limited amount from foods D3 from oily fish, eggs, butter, cheese, fortified milk/cereals

Vitamin D is fat-soluble… needs fat for absorption 10-100 IU: depending upon source

Supplements deliver much higher doses… up to 5,000+ IU per pill

Vitamin D: Reference Daily Intake Current RDI varies Up to age 50: 200 IU Age 51-70: 400 IU 70 and older: 600 IU

Amount to prevent vitamin D deficiency Rickets

Softening of bones → deformities, fractures, etc. Most common in children… rare in United States Also occurs in adults… called osteomalacia

Amount to prevent chronic disease… much higher! Call to substantially increase RDI to at least 1,000 IU Explosion in vitamin D research

Vitamin D: Favorable Research Prevents bone disorders (osteoporosis, fractures, etc.)

2009 Cochrane Systematic Database Review

Reduced risk of cancers (breast, colon, prostate, etc.) 2004 American Journal of Clinical Nutrition, 2009 Cancer Epidemiology

Reduced risk and better control of diabetes 2010 Diabetes, Obesity, & Metabolism, 2010 Diabetes Care

Reduced risk of obesity 2010 Obesity, 2010 Diabetes, 2009 Journal of American Dietetic Association

Help weight loss & improve cardiovascular risk factors 2012 British Journal of Nutrition

Reduced risk of cardiovascular disease 2009 Archives of Internal Medicine, 2010 American Journal of Cardiology

Vitamin D: Favorable Research Improve depression & Seasonal Affective Disorder

2008 Journal of Internal Medicine, 1999 Journal of Nutrition, Health, & Aging

Reduced risk of Crohn’s disease, rheumatoid arthritis, multiple sclerosis and other auto-immune disorders 2010 Journal of Rheumatology, 2007 American Journal of Clinical Nutrition

Stimulate immune system to prevent infection 2010 American Journal of Clinical Nutrition

Decreased risk of all-cause mortality 2008 Archives of Internal Medicine

Vitamin D: Unfavorable Research No risks of high serum vitamin D in observational studies Unless extremely high concentrations over 100 ng/mL

Increased risk of atrial fibrillation “excess” 25(OH) D > 100 ng/mL Vitamin D increases calcium absorption… too much calcium in blood?

No evidence of harm from typical vitamin D supplements Fat-soluble, but safe at even at very high intake

Acute D3 toxicity intake ≈ 176,000,000 IU… 440,000 400 IU capsules Only toxic cases manufacturing mistakes (extremely rare)

Vitamin D supplementation not beneficial in some trials Breast cancer – 2009 Breast Cancer Research and Treatment Heart attack – 2007 Circulation

Between 200 – 400 IU vitamin D used… very low dose

Vitamin D: Recommendations Convincing evidence: recommend 25(OH)D test to everyone! Vitamin D inadequacy extremely common Between 36-100% depending on group, 2006 Mayo Clinic Proceedings

Supplementation most important for people who… Live north of Atlanta in fall & winter

Cannot synthesize from sun

Have darker skin tone Less efficient synthesis in skin

Are aging Greater risk of osteoporosis & other chronic diseases

Avoid sun or wear sunscreen Most vitamin D from sun exposure

Have low serum 25(OH)D Everyone should have vitamin D tested… inexpensive and major risk-factor!

Vitamin D: Recommendations Not much difference by price or brand

Gel capsule preferable to tablet Vitamin D fat-soluble… better absorption

Take with food Vitamin D fat-soluble

Vitamin D3 preferable to D2 D3 (cholecalciferol) more effective than D2 (ergocalficerol)

2004 Clinical Endocrinology & Metabolism

Serum 25(OH)D target range ≈ 40 ng/mL (100 nmol/L) More research needed for optimal threshold… most people low!

Omega-3 Fats: Overview Class of polyunsaturated fatty acids (PUFA) Common structure (C=C in n-3 position)

Three nutritionally important omega-3 fats Alpha-linolenic acid (ALA)

One of two essential fatty acids “Short-chain”… converts to “long-chain”

Eicosapentaenoic acid (EPA) Long-chain omega-3

Docosahexaenoic acid (DHA) Long-chain omega-3

Health benefits of EPA and DHA most studied Precursor to eicosanoids… anti-inflammatory effects

Omega-3 Fats: Sources Vary by type of omega-3

ALA Nuts, seeds, vegetables

Flaxseeds, flaxseed oil, walnuts, leafy greens

EPA/DHA Oily fish

Salmon, sardines, mackerel, tuna, etc.

Other animal products Depends on animal's diet… grass-fed beef and pastured eggs

Seaweed Generally DHA only

Fortified foods Milk, yogurt, cereals, etc.

Omega-3 Fats: Rationale Reason 1: Convincing research evidence

1970’s… ecologic studies Low disease among populations consuming high omega-3

Nordic (fatty fish), Asians (seaweed), Eskimos (whale blubber)

1990’s… observational studies Omega-3 fat intake associated with less disease

Cancer, cardiovascular disease, depression, etc.

2000’s… clinical research RCT’s revealed improvement/decreased risk many diseases!

Omega-3 Fats: Rationale Reason 2: Standard American Diet low in Omega-3

Evolved on diet with ≈ even omega-6 : omega-3 (1:1) Fish, grass-fed meat, nuts, vegetables, fruits, etc. Both omega-6 & omega-3 necessary

Linoleic acid (omega-6) an EFA Imbalance affects inflammatory cascade… especially if too much omega-6

Standard American Diet… 20:1 omega-6:omega-3!

MUCH higher in many cases Recent changes… industrialization of food supply

Grain-fed beef, soybean oil, corn oil, etc. Thought to play role in auto-immune & inflammatory conditions

Omega-3 Fats: Favorable Research More clinical research than any vitamins

All studies below RCT’s or reviews of RCT’s

Improved many auto-immune conditions Rheumatoid arthritis, Irritable Bowel Syndrome, asthma, etc.

2009 Cochrane Systematic Review, 2005 Nutrition, 2000 American Journal of Clinical Nutrition, 2000 European Respiratory Journal

Reduced blood pressure 2002 Journal of Hypertension

Lowers triglycerides 2009 Nutrition and Health

Decreased cardiovascular disease events and mortality 2006 American Journal of Clinical Nutrition, 2008 British Medical Journal,

2009 Clinical Cardiology, 2009 Annals of Internal Medicine

Omega-3 Fats: Favorable Research Helps treat depression

2009 & 2010 Journal of American College of Nutrition

Helps manage bipolar disorder 2009 European Journal of Clinical Nutrition

Prevention of psychotic disorder among high-risk 2010 Archives of General Psychiatry

Reduction in ADHD symptoms 2009 Journal of Attention Disorders

Decreased cognitive decline in older adults 2011 Journal of Nutrition, Aging, and Health

Omega-3 Fats: Unfavorable Research No clinical studies showing harm But be aware of potential interaction with anticoagulants

Some clinical trials found no benefit ADHD

2001 Journal of Pediatrics Cognitive performance 2008 Neurology

Schizophrenia 2001 American Journal of Psychiatry

Omega-3 Fats: Recommendations Convincing evidence: recommend to most people Not recommended for people on anticoagulant drugs

Coumadin, etc. Omega-3 supplements can thin blood

Most important for people who… Don’t eat fatty, cold-water fish

Vegetarians/vegans… ALA poorly converted to DPA/EHA Flounder, catfish, etc. no omega-3

Have autoimmune or chronic inflammatory conditions Have or are at high risk for heart disease Have high triglycerides Eat Standard American Diet

Omega-3 Fats: Recommendations Supplement with ALA or DHA/EPA? Flaxseed oil (ALA) vs. fish oil (EPA/DHA)

Fish oil superior to flaxseed oil ALA conversion to EPA/DHA very poor! Only 8 to 20% ALA converted to EPA/DHA

2008 Nutrition Reviews Most omega-3 benefits from EPA/DHA

Krill oil another good source of EPA/DHA If vegetarian/vegan Consider algae-based EPA/DHA supplement

Flax seed has other benefits Fiber, improve lipids, etc.

Omega-3 Fats: Recommendations All omega-3 fats prone to oxidation PUFA’s health-promoting, but unstable → easily rancid

What to look for in fish oil Dark bottles Light can cause oxidation

Added vitamin E/antioxidants (ex. rosemary) Antioxidants slow oxidation

What to look for in flaxseed oil Dark bottles Refrigeration ALA even more unstable than DHA/EPA!

Probiotics: Overview Probiotics defined: World Health Organization “Live micro-organisms… administered in adequate

amounts, confer beneficial health effect on the host”

Probiotics can be bacteria or yeasts Bacteria much more abundant… play bigger role in health Primarily colonize gastrointestinal tract

Why are gut bacteria important? Over 100 trillion bacteria in gut Ten times the amount of cells in human body!

500 different species of bacteria in gut Play critical role in metabolism and immune system

Probiotics: Important Varieties Three classifications of probiotics Genus – broadest Species – more specific Strain – most specific Probiotic supplements usually classified by genus & species only

Lactobacillus One of most common bacterial genera in gut Convert lactose & other sugars to lactic acid Can help some with lactose intolerance Acidic environment inhibits harmful bacteria

Over 100 species Indicated by L. _______ Some of most important: L. acidophilus, L. casei, L. reuteri, L. brevis

Probiotics: Important Varieties Bifidobacterium Another common bacterial genera in gut Inhibit pathogenic bacteria Competes for resources & produces lactic acid

29 species identified Indicated by B. _______ Some of most important: B. longum, B. breve, B. animalis

Saccharomyces Common fungal genus in gut Most yeast damage gut, e.g. Candida Albicans

Some species compete with pathogens Indicated by S. _______ S. Boulardii prevents/treats GI disorders

Probiotics: Dietary Sources Fermented Foods Component of most traditional diets

Asian Miso and Natto

Fermented beans/grains… often soy L. acidophilus (miso) & B. natto (natto)

Kimchi Fermented cabbage, radishes, etc. L. kimchii

Kombucha

Fermented tea S. cerevisiae

Probiotics: Dietary Sources European Yogurt

Fermented dairy Cow, goat, sheep milk

L. bulgaricus & Streptococcus thermophilus

Kefir

Also fermented dairy More probiotic species than yogurt L. rhamnosus, B. longum, S. florentinus, etc.

Sauerkraut

Fermented cabbage L. plantarum, L. mesenteroides, etc.

Probiotics: Dietary Sources African Ogi

Fermented grains… often corn L. brevis, L. acidophilus, etc.

Currently in United States… Primarily yogurt Traditional products available health food stores

Kefir, Kimchi, Kombucha, etc.

Probiotics: Supplement Rationale Americans consume few fermented foods!

Commercial yogurt not optimal source Often high in sugar… feeds yeast & pathogens Relatively low bacterial count 100 million lactic acid bacteria per serving… 100 trillion bacteria in gut

Probiotics: Favorable Research Most clinical research of all dietary supplements All clinical trials or reviews of clinical trials Major species listed for each outcome

Regulates bowel function Effective against diarrhea… especially antibiotic-associated

L. rhamnosus GG, S. Boulardii, L. Bulgaricus and many others 2006 Lancet Infectious Diseases

Effective against constipation B. lactis, L. casei 2010 World Journal of Gastroenterology

Probiotics: Favorable Research Effective treatment for some Inflammatory Bowel Disease Ulcerative Colitis

B. Animalis, B. Breve, L. Acidophilus and combinations 2010 Proceedings of the Nutrition Society, 2010 Annals of Pharmacotherapy

Crohn’s Disease Evidence not as convincing… some success with L. Rhamnosus 2009 Current Pharmaceutical Design

Effective treatment for Irritable Bowel Syndrome L. Acidophilus, B. Breve, B. Bifidum, S. Boulardii and combinations 2010 Journal of Nutrition

Probiotics: Favorable Research Effective treatment for other autoimmune conditions Eczema and allergic rhinitis

L. Acidophilus, B. Lactis, L. Sakei 2010 American Journal of Clinical Dermatology, 2010 Pediatric Pulmonology

Improve immunity in healthy individuals Reduces risk of common cold L. paracasei, L. plantarum, L. Bulgaricus Younger adults

2010 European Journal of Nutrition Older adults

2010 British Journal of Nutrition

Probiotics: Unfavorable Research No evidence of harm Not necessarily harmless… more research needed

Ineffective in some trials for certain conditions Crohn’s Disease 2008 Digestive Disease and Sciences

Pancreatitis 2008 Lancet

Probiotics: Recommendations Recommend to people eating Standard American Diet Usually not necessary if consume variety of fermented foods Don’t usually need to take on an ongoing basis

Cycle on and off occasionally... few times a year or specific situations

Most important for people who… HAVE BEEN ON ANTIBIOTICS! Critical to replenish flora & prevent side-effects

Have digestive problems and/or food intolerances Will be travelling out of the country Prevent diarrheal disorders

Have an autoimmune condition Are at risk for infections Especially useful during flu season

Probiotics: Recommendations Core product: contains variety of genus & species Especially Lactobacillus & Bifidobacterium Occasionally rotate products for increased variety

Specific conditions: single-species okay S. boulardii, L. GG, etc. for diarrhea

Choose high potency products At least 5 billion colony forming units (CFU) ≥ 10 billion preferable… especially after antibiotics Many products contain over 100 billion CFU Remember… 100 trillion bacteria in gut!

Probiotics: Recommendations Choose refrigerated product during summer Probiotics die if exposed to high temperatures Refrigerating extends life

Generally choose enteric-coated capsules Many species die in acidic stomach conditions

Choose products that specify strain Most specify genus and species Best products also specify strain!

Supplements to Avoid

Supplements to Avoid Most supplements safe… but some may pose risk Especially products tainted with pharmaceuticals Three classes of supplements most likely to be tainted

Weight-loss supplements Not likely to be effective long-term Cannot replace healthy diet & exercise habits

Often stimulant-based… contraindications? Especially among overweight

Some products tainted with sibutramine Active ingredient in Reductil (withdrawn by FDA) Increases blood pressure, pulse, potential risk for CVD events http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsin

gMedicineSafely/MedicationHealthFraud/ucm234592.htm

Supplements to Avoid Sexual-enhancement supplements Some products tainted with tadalafil or sildenafil Active ingredients in Cialis and Viagra Can interact with nitrates to cause low blood pressure http://www.fda.gov/Drugs/ResourcesForYou/Consumers/Buying

UsingMedicineSafely/MedicationHealthFraud/ucm234539.htm

Bodybuilding supplements Some products tainted with anabolic steroids Often marketed as containing “steroid-like” components Have caused liver or kidney problems http://www.fda.gov/Drugs/ResourcesForYou/Consumers/Buying

UsingMedicineSafely/MedicationHealthFraud/ucm234539.htm

Tainted products rare… but can pose health risk!

Supplement and Drug Interactions

Supplements and Drug Interactions St. John’s Wort and Antidepressants

Synergy: increased risk of serotonin syndrome

Red Yeast Rice and Statins Synergy: increased risk of muscle & liver problems

Calcium/magnesium/zinc and Antibiotics Reduced absorption: antibiotic may not work as well

Ginkgo Biloba and Anticoagulants Increased bleeding risk

Fish Oil and Anticoagulants Increased bleeding risk

Supplements for Special Situations

Supplements for Special Situations Coenzyme Q10 for people on statins or beta-blockers aka “CoQ10”

These medications deplete CoQ10 Coenzyme Q10 supplementation recommended

2006 Annals of Pharmacotherapy Also good idea to take with Red Yeast Rice

Why is supplementing with CoQ10 important? Critical in making ATP & strong antioxidant Reduces cardiovascular disease risk and blood pressure

2007 Nutrition Review & 2006 Journal of Cardiac Failure Reduces statin-induced muscle myopathy

2007 American Journal of Cardiology

Supplements for Special Situations Vitamin B12 for people on stomach acid-blockers Prilosec, Zantac, antacids, etc.

These medications deplete vitamin B12 Reduced stomach acid to absorb B12

Why is vitamin B12 important? Help metabolize protein, fat, and carbohydrates Low levels → fatigue, depression, neurological damage Low concentrations associated with Alzheimer’s disease

2010 Neurology Supplementation lowers homocysteine

2008 Proceedings of Nutrition Society Supplementation reduces cognitive decline

2012 American Journal of Clinical Nutrition

Supplements for Special Situations B-vitamins, iron and zinc for vegetarians Especially B12 for vegans Vegetarian diets low in these nutrients 2002 American Journal of Clinical Nutrition

Iron not recommended for men Or most post-menopausal women… not lost through menstruation Accumulates and can cause oxidative stress

Folic acid for pregnant women Deficiency can cause neural tube defects Supplementation prevents neural tube defects 2009 Annals of Internal Medicine

Can often be obtained in quality multivitamin

Popular Supplements by Health Condition

Popular Supplements: Immune System Echinacea

2006 Cochrane Database Systematic Review

Vitamin C 2010 Journal of International Medical Research

Vitamin D 2010 Nutrition

Zinc 2011 Cochrane Database Systematic Review

Probiotics 2006 Journal of Clinical Gastroenterology

Popular Supplements: Joint Health Glucosamine & Chondroitin

2006 New England Journal of Medicine

Methylsulfuromethane (MSM) 2006 Osteoarthritis and Cartilage

Hyaluronic Acid 2008 Nutrition Journal

Turmeric 2006 Arthritis and Rheumatism

Ginger 2001 Arthritis and Rheumatism

Popular Supplements: Liver Health Milk Thistle

2008 Annals of Hepatology

N-Acetyl Cysteine (NAC)

2005 Clinical Therapeutics

S-Adenosyl Methionine (SAM-e)

2007 Hepatology

Turmeric

2009 Liver International

Popular Supplements: Heart Health Red Yeast Rice

2010 American Journal of Cardiology

Fish Oil

2009 Annals of Internal Medicine

Coenzyme Q10

2007 European Heart Journal

Vitamin D

2009 Archives of Internal Medicine

Popular Supplements: Digestion Digestive Enzymes

Plant-based Bromelain Papain Broad-spectrum

Animal-based Pancreatin

2009 Alimentary Pharmacology & Therapeutics

Betaine HCL/Pepsin/Conjugated Bile Acids 2007 Gastroenterology

Deglycyrrhizinated Licorice (DGL) 2001 Hospital Practice

Popular Supplements: Depression St. John’s Wort

2008 Cochrane Database Systematic Review

Fish Oil

2010 Journal of Clinical Psychiatry

S-Adenosyl methionine (SAM-e)

2002 International Journal of Psychopharmacology

Popular Supplements: Sleep Melatonin

2004 Journal of Clinical Endocrinology & Metabolism

Valerian Root 2006 American Journal of Medicine

5-Hydroxytryptophan (5-HTP)

2000 Alternative Medicine Review

Checklist: Informed Supplement Consumer No interactions with other drugs/supplement

- Talk to healthcare professional and consult literature

No outrageous label claims

- Especially weight loss, sexual, bodybuilding products

Only buy from reputable sources

- Vitamin Shoppe, health food stores, Amazon, etc. - Avoid “too good to be true” websites, unlabeled products, products not labeled in English, multi-level marketing

Checklist: Informed Supplement Consumer Carefully consider all ingredients on label

- Consider potential for interactions - Also content and quality of ingredients - Some forms of vitamins, minerals, etc. better than others

Seek 3rd party verification certificate

- Sign of commitment to product quality - NSF “Gold Standard” of product quality

Thank You! Questions?

Contact information: cdadamo@compmed.umm.edu