April 2023

To Supplement...or Not?

The supplement aisle at the drugstore (grocery store, vitamin store) has begun to resemble a candy shop, bursting with rainbow-colored gummies, powders, pills and tinctures that claim to increase energy, improve focus, boost skin radiance, help you fall asleep and more. But can a gummy or capsule really do all that?  It’s complicated.

Traditional multivitamins and supplements are typically taken to “supplement” food intake, serving as backup for days when our diets are deficient. The new look-better-feel-better formulas are designed to work similarly, bridging nutritional gaps and acting as support for our bodies as they work overtime to manage stress, fatigue and anxiety.  Stress can deplete our nutrient stores, so when needed it’s important to replenish through healthy eating and supplementation. Low levels of certain nutrients can affect mood, stress and energy. For example, insufficient vitamin B6 can result in fatigue, concentration issues and poor mood. And women taking oral contraceptives are susceptible to having low levels of vitamin B6. In addition to B6, the new crop of supplements may also contain other clinically researched ingredients, including minerals, herbs, amino acids and enzymes. Most experts say the concern is not so much the efficacy of the ingredients but how much of those ingredients are actually contained in the supplements you purchase. There is very little regulation over the claims made or the ingredients in these supplements. While brands are required by the FDA to declare ingredients and their amounts on product labels, many supplements with multiple active ingredients contained one or more of them in amounts that exceeded what was on the labels. And if a brand won’t share its ingredients or has a proprietary complex and won’t reveal what’s in it that is a red flag.

To get a better sense of what you’re ingesting, experts point to third-party testing. The USP (U.S. Pharmacopeia) Verified mark indicates that the product does contain all of the ingredients on the label, in stated amounts. And ConsumerLab.com, which has been called the Consumer Reports of supplements, conducts independent testing to certify the quality of dietary-supplement products, including their purity and potency. The latter is especially important because some supplements may contain more of an active ingredient than they claim. And taking too much of a good thing is a bad thing. For example, St John’s Wort, used in some mood-boosting supplements, work similarly to most prescription antidepressants, and taking both could lead to serotonin toxicity. Likewise, melatonin, often included in sleep supplements, is a hormone that, in high doses, can act as a contraceptive and may inhibit the efficacy of some antidepressants.  We can’t just walk down to the local drugstore and buy testosterone or estrogen because that would be dangerous. We can, however, do this with melatonin, and this can have equally significant implications.

It's important to review with your physician the supplements you’re taking to minimize contraindications and to start a dialogue about other treatments that may be more effective than swirling anxiety-reducing powder into your morning coffee. While nutrient deficiencies may contribute to mild feelings of fatigue or malaise, they are unlikely to be the primary cause of more serious conditions like anxiety or depression. The diagnosis and treatment of these conditions are best left to your physician.  If someone is struggling with mental illness and turning to a supplement for relief that may be cause for worry. Bottom line: Supplements are not magic pills, even in cases in which a nutritional deficiency is contributing to a lack of focus, sluggishness or dull skin. If you’re talking about your metabolism or energy production, these are going to be long-term challenges to correct and manage. The ingredients found in most supplements have existed for decades, and their impact is modest at best.

Your overall nutritional status plays a role in skin health as well, so ensuring you have adequate levels of nutrients is important. But since nutritional interventions can often take time, consumers should not expect instant, dramatic results. There is also a potential placebo effect of taking a supplement, which can make you feel a difference, even if there is no discernible change to the brain or body. And there is evidence that taking daily supplements may positively impact other behavior. By feeling you’ve gained some control over a stressful situation, you can positively impact the brain and body in ways that may be just as helpful as ingesting that OTC gummy or pill. Sometimes the nonspecific effects are the most powerful.

Gerard Sanacora, MD