Dietary supplements are products that people add to their diets. According to U.S. Food and Drug Administration, “they include vitamins, minerals, herbs, and amino acids. They can be pills, liquids, or powders. By law, companies that make these products cannot claim they prevent, treat, or cure disease. For example, a product cannot claim that it can 'cure cancer' or 'help you lose weight.'" We are also warned in ways like “Don't take supplements instead of eating healthy foods or prescription drugs… If you are having surgery, taking other supplements or medicines, or have health problems dietary supplements may be harmful.”

So, there are questions we need to ask before taking any supplements. NIH Office of Dietary Supplements has these advices:

• Check with your health care provider if you are scheduled to have any type of surgical procedure.
• 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?
• When, how and for how long you should take it?

NIH ODS also points out that "The term 'natural' doesn't always mean safe. A supplement's safety depends on many things, such as its chemical makeup, how it works in the body, how it is prepared, and the dose used. Certain herbs (for example, comfrey and kava) can harm the liver. 

In the face of aggressive marketing and the unfound claims touted by the supplement manufacturers, it takes effort to be an informed consumer. For example, agave nectar is often promoted as a healthier option than sugar and most effective for weight loss. However, Mayo Clinic’s article on “Artificial Sweeteners” finds that “these so-called natural sweetners often undergo processing and refining, including agave nectar," and "products sweetened with natural sweeteners may not help since they add the same amount of calories to your diet as table sugar."

Well, how are supplements regulated? In its website, the Food and Drug Administration (FDA) states that “Federal law does not require dietary supplements to be proven safe to FDA's satisfaction before they are marketed;” and “For most claims made in the labeling of dietary supplements, the law does not require the manufacturer or seller to prove to FDA's satisfaction that the claim is accurate or truthful before it appears on the product.” It also suggests that you consult with a health care professional before using any dietary supplement, as well as shows you how to be a safe and informed consumer.

For making decisions, we may return to  NIH ODS for “reliable information about the use, effectiveness, safety, and quality of diatary supplements." It includes fact sheets answers to common questions, and tips to help you choose dietary supplements. In addition, it shows you the steps in order to evaluate information on the Internet.

Last, but not least, Medlineplus features two excellent sections for us: one on Dietary Supplements with overview, news, specific conditions and more; and the other on Herbs and Supplements. Beyond all this, Medlineplus has a video: Evaluating Internet Health Information: A Tutorial which is well done and quite enjoyable. Have fun watch the video!

Image  Courtesy: NIH Office of Dietary Supplement.

Many of us receive advertisements for dietary supplements regularly. I saw recently, in a lifestyle magazine from a big-box retailer, an article on superfood touting acai berry as “one of the most nutritionally dense berries on the planet.” It so piqued my curiosity that I looked up Acai on medlineplus. One of the results titled “Acai” provided me with the essential information about this superfruit. Copied below are two critical paragraphs for you to see before I go on with my story:

What is it?

Acai, pronounced AH-sigh-EE, is a palm tree that is widely distributed in the northern area of South America. Its berries are used to make medicine.
People use acai for osteoarthritis, high cholesterol, erectile dysfunction (ED), weight loss and obesity, “detoxification,” and for improving general health. Acai gained popularity in North America after being promoted by Dr. Nicholas Perricone as a "Superfood for Age-Defying Beauty" on the Oprah Winfrey show.
As a food, the acai berry is eaten raw and as a juice. The juice is also used commercially as a beverage and in ice cream, jelly, and liqueurs.
In manufacturing, acai berry is used as a natural purple food colorant.

How effective is it?

Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, Ineffective, and Insufficient Evidence to Rate.
The effectiveness ratings for ACAI are as follows:

Insufficient evidence to rate effectiveness for...

 - Arthritis.

 - High cholesterol.

 - Improving general health.

 - Other conditions.

More evidence is needed to rate the effectiveness of acai.

I was fine until I ran across an online store’s website with a page posted with the identical contents from the first paragraph above, but followed by contents that have been altered from the above paragraph of “How effective is it?” Copied below are the altered:

What is Acai Berry Possibly Effective for?

 - Arthritis.

 - High cholesterol.

 - Improving general health.

Do you see the difference? Do you see the ambiguity in terms of the effectiveness of acai being represented here? There are no supporting data, references or sources cited for this page either. It bothered me. I felt compelled to look for 3^rd opinions. From a few trusted sources, like WebMD, Mayo Clinic, and Consumer Health Complete Database (a SJPL subscription,) I obtained more relevant data. Here is a brief list representative of the various assessments of “Acai” from the the above sources:

  WebMD Healthy Eating and Diet --

“Some studies show that acai fruit pulp has a very high antioxidant capacity with even more antioxidant content than cranberry, raspberry, blackberry, strawberry, or blueberry. Studies are ongoing, though, and the jury is still out…People eat acai berries to address various health conditions. But so far, acai berries have no known health benefit that’s any different than that of other similar fruits.”

  Mayo Clinic Health Information --

“Acai berries may be a good source of antioxidants, fiber and heart-healthy fats. But research on acai berries is limited, and claims about the health benefits of acai haven't been proved. Many fruits besides acai berries provide antioxidants and other nutrients that are important to your health. But if you'd like to try acai, check your local health food or gourmet stores — it can be consumed raw, in tablet form, in beverages such as juice, smoothies or energy drinks, or in other food products such as jelly or ice cream. “

  Consumer Health Complete - an article titled “Acai” --

“Although several in vitro and animal studies have been conducted, few human clinical trials have been performed to support the antioxidant and other claimed properties of the açaí berry.”

With these findings that are in agreement overall with Medlineplus's rating of acai, I feel informed and fine once more. What is the lesson then? The lesson, I think, is to compare - compare the sources of information, compare the quality of information. Find out who and how - who gives the information and how the information is prepared. I would talk about how to evaluate health information on dietary supplements again next time.

Image  Courtesy: NIH National Library of Medicine.