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Chapter 10, Part 1: How to Choose and Use Dietary Supplements

Free Book Excerpt: A Guide to Complementary Treatments for Diabetes by Gene Bruno MS, MHS
August 10, 2016 (Updated: August 16, 2018)
Maritza Lizama

An excerpt from the book, “A Guide to Complimentary Treatments for Diabetes: Using Natural Supplements, Nutrition, and Alternative Therapies to Better Manage Your Diabetes” by Gene Bruno, MS, MHS. Read additional excerpts or buy the whole book.


The hunt for the right supplement can be a confusing and an intimidating process for anyone—especially for people who have not purchased or used supplements on a regular basis. If you are considering taking any of the supplements in this book, you likely have a lot of questions. I hope that this chapter will answer some of the main ones, thus making your transition into the world of supplements a bit easier.

The easiest way to find what you are looking for is to first understand what to look for, and to then ask the right questions if you can’t find what you need. After all, there are a myriad of brands and products to search through. But what should you be looking for? What questions should you ask? Read on and find out. In this chapter, you will find the common questions people have about dietary supplements. The information after each question is designed to provide you with some guidelines for wading through the confusing mass of dietary supplement labels. Additionally, you will gain knowledge about choosing and using the products that are most likely to meet your needs. The format of this chapter is a bit different from the other chapters in the book. It has been organized into a simple question-and-answer format, with a few charts and insets added where appropriate. I hope this makes it easy for you to locate answers to any questions you may have.

Why should I take more nutrients than suggested by the government?

Over the years, governmental dietary allowances and standards have been frequently revised and renamed. For the purposes of labeling, it began with the Minimum Daily Requirements (MDR) in 1941. The primary goal of the MDR was to prevent diseases caused by nutrient deficiencies. It was originally intended to evaluate and plan for the nutritional adequacy of groups—for example, the armed forces and children in school lunch programs—rather than to determine the nutrient needs of individuals.

In 1973, the FDA established a new standard called the United States Recommended Daily Allowances (U.S. RDA) for use in nutrition labeling. The U.S. RDA replaced the MDR, which had been used since 1941, in the labeling of food and dietary supplements. The U.S. RDA was deemed to be the amount of various nutrients needed by healthy people, plus an additional 30 to 50 percent to allow for individual variations. For example, if 1 milligram of vitamin B was deemed to be adequate, then increasing it by 50 percent to 1.5 milligrams was considered optimal to allow for individual variations. Nevertheless, it can be argued that this “one-size-fits-all” nutrient standard is not really the best way to establish the nutrient needs for a diverse population.

Then, in 1994, the Daily Value (DV) was created. Essentially, the DV is exactly the same as the U.S. RDA, with a couple of new minerals. The DV is the current governmental standard.

What each of these standards has in common is they represent the amount of a vitamin or mineral a person should consume daily to prevent a deficiency disease. However, many nutrition experts argue that while taking in the DV of a vitamin or mineral is enough to prevent a deficiency disease, the same amount is totally inadequate for modern lifestyle needs and disease prevention. For example, the DV for vitamin C is 60 milligrams, which would help prevent the classic vitamin C deficiency disease known as “scurvy.” However, research has shown that taking 300 milligrams of vitamin C a day (5 times the DV) can decrease the risk of death from cardiovascular diseases by 42 percent in men and 25 percent in women. Consequently, it often makes sense to consume vitamins in levels that exceed the DV. When it comes to minerals, however, the DV amounts are generally right on track for general health needs and disease prevention.

An alternative recommendation for vitamins is the optimal daily intake (ODI), a term coined by nutritionist Shari Lieberman, PhD. The ODI is based upon the results of published research, which demonstrate a clear benefit for most people in regard to consuming higher levels of vitamins and minerals than indicated in the DV. See Tables 10.1 and 10.2 for my ODI recommendations, as compared to DV.

Additionally, sometimes exceeding the ODI levels can be beneficial. Instances when this is the case are discussed throughout this book in the supplement recommendations. For example, taking up to 1,000 micrograms of chromium daily has been shown to be beneficial for diabetics, even though the DV and ODI are 120 micrograms.

Table 10.1 Recommended ODI for Vitamins
Vitamin DV OTI
Biotin 300 micrograms 300 micrograms
Choline Not established 40 to 100 milligrams
Folate 400 micrograms 400 to 800 micrograms
Niacin (Vitamin B3) 20 milligrams 40 to 100 milligrams (as niacinamide)
Pantothenic Acid 10 milligrams 40 to 100 milligrams
Riboflavin (Vitamin B2) 1.7 milligrams 40 to 100 milligrams
Thiamin (Vitamin B1) 1.5 milligrams 40 to 100 milligrams
Vitamin A 5,000 international units 10,000 international units (as beta-carotene)
Vitamin B6 2 milligrams 40 to 100 milligrams
Vitamin B12 6 micrograms 40 to 100 micrograms
Vitamin C 60 milligrams 1,000 to 3,000 milligrams
Vitamin D 400 international units 1,000 to 2,000 international units
Vitamin E 30 international units 400 to 800 international units
Table 10.1 Recommended ODI for Minerals
Mineral DV OTI
Calcium 1,000 milligrams 1,000 to 1,500 milligrams
Chromium 120 micrograms 120 micrograms
Copper 2 milligrams 2 milligrams
Iodine 150 micrograms 150 micrograms
Iron 18 milligrams 18 milligrams
Magnesium 400 milligrams 400 to 750 milligrams
Manganese 2 milligrams 400 to 750 milligrams
Molybdenum 75 micrograms 75 micrograms
Phosphorus 1,000 milligrams 1,000 milligrams
Selenium 70 micrograms 70 micrograms
Zinc 15 milligrams 15 to 30 milligrams

What is the difference between natural and synthetic ingredients?

To understand the difference between natural and synthetic ingredients, we should first define the terms “natural” and “synthetic.” Unfortunately, there is not one definitive way to do this. Some people say that whether a vitamin is natural or synthetic depends on its source. Based on this fundamentalist position, vitamins that originate from food or plant sources are natural, while vitamins created in a laboratory are synthetic. In other words, the vitamin C found in a fresh glass of orange juice would be considered to be natural vitamin C.

Others believe that the chemical form of a vitamin (whether the molecule has a left rotation, designated as “L”, or a right rotation, designated as “D”) is the factor that dictates whether it is natural or synthetic. For example, since the chemical form of vitamin C found in orange juice is L-ascorbic acid (the scientific name for vitamin C), then L-ascorbic acid would be considered natural even though it was created in a laboratory using corn syrup as the starting point. In my opinion, this second definition is more meaningful, and therefore, this is the definition that will be used for the purpose of this text.

To illustrate the point further, consider the following. A cup of freshly-squeezed orange juice will provide you with about 124 milligrams of vitamin C. If you were able to cause all the liquid in the orange juice to evaporate—without destroying the heat and light-sensitive vitamin C—and then put the remaining powder in a capsule, you would still only get a little over 100 milligrams of “natural” (according to the first definition) vitamin C. If you wanted to take 1,000 milligrams a day, you would have to take about ten capsules, which is not practical. On the other hand, you could easily get 1,000 milligrams of vitamin C in a single tablet. However, to do that, the vitamin C would need to be derived from ascorbic acid that originated from the conversion of corn syrup to glucose. Additional enzymatic steps in the laboratory would need to be taken to ultimately yield purified, crystallized vitamin C. For those who believe in the second definition of natural, this form of vitamin C would still classify.

So, to answer the question, sometimes there is a significant difference between natural and synthetic. For example, natural vitamin E (d-alpha tocopherol/yl) is better utilized than synthetic vitamin E (dl-alpha tocopherol/yl). A 1981 study published in The American Journal of Clinical Nutrition demonstrated that natural vitamin E was 3.5 times more active in the human body than synthetic vitamin E, even though the same number of international units were used in the test subjects. However, most times there is not a significant difference between natural and synthetic, at least when vitamins are concerned.

However, most B vitamins can only be made synthetically, with no natural alternative. Consequently, the argument is academic in the case of using synthetic B vitamins. If you decided that you wanted only natural vitamins, you would have to prepare yourself to accept the fact that there is almost no way you will be able to achieve high intakes of virtually any B vitamin in supplemental form.

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Sticking with the second definition of natural, in the case of amino acids, you can tell whether or not they are natural by the “L” designation in found of the front of their name (such as L- carntitine). Most commercial amino acids are derived from the microbial fermentation of beet sugar. This “L” rule, however, does not hold true for all supplements. For example, in a previous paragraph about vitamin E, the D-form designates a natural produce.

What is a standardized ingredient?

Standardized ingredients, particularly in the case of herbs, are an important part of the world of dietary supplements. You may have noticed that throughout this book when doses for certain supplements are given, the term “standardized” is used to designate a specific percentage of some component found in an herb or other ingredient. Naturally, this raises the question of what standardized means.

Well, all standardized really means is that the supplement, typically an herb, has been analyzed in a laboratory, and that it has been verified to contain a certain percentage of an active constituent or compound that is naturally found in that particular herb. For example, the active constituents in the herb milk thistle are collectively referred to as “silymarin.” In the case of a good milk thistle extract, the herb will be standardized to provide 80 percent silymarin by weight. If, on the other hand, the herb was not standardized or was standardized for a lower percentage of silymarin, it can be assumed that the effectiveness of the herb will be significantly less.

The natural constituents and compounds that make up an herb can very depending on how, where, and when the herb is grown. Having a standardized herb guarantees consumers that they are getting a consistent quality product, and can probably expect the same results from one batch to another.

In some cases, the compound being measured may be an active component in the herb, and in other cases it is just an easily identifiable marker used to determine quality. In either case, standardized herbs have the advantage of being natural medicines with reproducible effects every time they are consumed. Conversely, if an herb isn’t standardized, you would not know if it provided a consistent amount of its active components from batch to batch, and you would not necessarily experience the same results every time you consumed it.

Whenever using herbs, I recommend standardized herbs for consistency and quality. However, there are two exceptions to the rule. One is if studies on an herb were conducted on a non-standardized herb. In that case, it would be accept- able to use the herb in its non-standardized form. The other exception is Chinese herbs used in traditional Chinese medicine. Chinese herbs have been used for thousands of years without any standardization.

How should supplements be stored?

Supplements should be stored in a cool, dry place—ideally, a cabinet in your kitchen—but not one to close to the stove or oven, which could result in heat exposure. Do not store them in your bathroom medicine cabinet, because the humidity from taking a bath or shower will work its way into the bottle, potentially ruining the tablets or capsules.

If you have probiotic products (such as Lactobacillus acidophilus), you should store them in your refrigerator to help extend their shelf life. This is because probiotics are live, viable microorganisms. Since vitamins and minerals are not alive, they do not need to be refrigerated.

How long will a dietary supplement last on the shelf?

If you have purchased your supplements from a good company, the product labels should provide an expiration date. The date will let you know how long the active ingredients—vitamins, minerals, herbs, etc.—in the product will be good for. You should always stick to this date—and if you still have some of the supplement left after its expiration, throw it out. If there is no expiration date, then switch to another brand.

If switching brands seems like an extreme recommendation, consider the fact that some supplements are manufactured and stored at the manufacturing facility for months— sometimes for over a year. Then, these supplements are shipped to the vitamin companies for whom they were manufactured, only to sit on their shelves for months. By the time they are shipped to distributors and placed on shelves that consumers can purchase them from, they may be well into their second or third year. If there is no expiration date on the product label, you have no idea how old the product is. This is a real problem, since many vitamin formulas have a twenty-four month shelf life. Why take a chance? Only purchase dietary supplements that have expiration dates.


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