Tag Archives: supplement quality

Is It Worth It to Spend More on Nutritional Supplements?

Toronto Naturopathic Doctor

When I started writing this, the intent was to quickly summarize a conversation I’ve had on a number of occasions with patients trying to make educated decisions when choosing nutritional supplements and botanical medicines, but it turned into a bit of a manifesto.

There is a huge difference in the level of quality between a “professional grade” nutritional supplement or botanical medicine, and products sold at most national drug stores, Costco®, etc.

To offer a sense of perspective, The Comparative Guide to Nutritional Supplements evaluates multi-vitamins/minerals on a range of standards, including some of the topics discussed below, and awards each product a rating. In the 3rd edition of the Guide, Douglas Laboratories® UltraPreventative® X earned a rating of 95.4 (of a possible 100), and Jamieson™ Power Vitamins for Men rating was 3.51.

The bottom line: you get what you pay for.

For those with stuff to do, here’s a summary of what I discuss below in detail:

  1. Raw materials – More potent raw materials result in a more effective end products
  2. Nutrient form and absoption – Vitamins and minerals are available in a range of forms, some cheaper and some more expensive for manufacturers. Does the product use well-absorbed, potent forms of each nutrient?
  3. Manufacturing quality – High-quality manufacturers take extra steps throughout the development and production process to guarantee quality of the end product. Has the product been manufactured in such a way that quality ingredients maintain their potency and absorbability?
  4. Formulation – Is the “recipe” for the product developed by someone with actual clinical experience, or is it simply a haphazard “sum of it’s parts”?
  5. Non-medicinal additives – Does the product contain undesirable (even toxic) ingredients as fillers, flavouring agents, etc.?
  6. Dosage and potency – Although cheaper at time of purchase, does low product potency result in having to use many doses daily to obtain meaningful amounts of nutrients?

For those with less stuff to do, read on!

Whenever I have a new patient intake appointment, part of process of gathering complete information includes not only identifying what other treatments a patient may have used in the past or are presently using, and with what amount of success, but if nutritional supplements are being used, who are the manufacturers?

This is important information for me to have, because there is a wide range in quality between nutritional supplements.

Unfortunately, nutritional supplements are not regulated particularly rigorously. The main emphasis of regulation is safety, and reliability of advertising claims (i.e., “This product cures cancer” is not an allowable claim for a product to make unless they can provide scientific evidence of this fact). Importantly, product efficacy (unless the manufacturer is making specific health claims about their product) is not a consideration.

Individual pharmaceutical drugs each have a very specific chemical composition. If choosing to use a “generic” version of the drug, rigorous standards guarantee that the amount of active ingredients and the rate at which the drug is absorbed into the body are the same as the original. This provides some assurance that quite similar performance can be expected2.

The actual quality between two, for example fish oil products, can vary widely – a low-quality fish oil product and a high-quality fish oil product are really, the same in name only.

Not achieving the desired health results with the use of a low-quality nutritional supplement or botanical medicine does not necessarily mean that the specific nutrients or herbs are not potentially helpful to that patient, it may indicate they are using an ineffective product.

These are some of the differences between high-quality nutritional supplements and botanical medicines and their low-quality counterparts:

Raw Materials

Unlike generic and brand name pharmaceuticals, there is no “standard” starting point for nutritional supplements and botanical medicines.

Botanical medicine tinctures (those bad-tasting liquid medicines sold in amber bottles) are prepared by macerating (soaking) plant materials in a solvent (usually alcohol). The proportion of plant to alcohol, by weight, is usually included on the label, and gives the user a sense of how potent the medicine is. Only some companies use dried herbs (as opposed to “fresh/wet” herbs) as their raw material: dried herb = lower weight = more herb used in the tincture = more concentrated plant medicine.

A second example is standardization of ingredients. In many cases, the specific chemical responsible for a desired action in a plant is known. For example, important ingredients in the therapeutic effect of St. John’s Wort are chemicals in the hypericin family3. Products including St. John’s Wort should therefore include known, consistent amounts of hypericin in each dose.

Lastly, again in the realm of botanical medicines: how were ingredients grown? Agricultural research has demonstrated that organically grown/raised produce is more nutrient dense than it’s conventional counterparts4. It follows that organically grown plants will yield more potent botanical medicines – does a manufacturer use organically grown raw materials?

Nutrient Form and Absorbtion

Minerals (e.g., calcium, magnesium, zinc) are absorbed into the body attached to acids, for example amino acids or other organic acids (e.g., magnesium carbonate – the carbonate is added for magnesium absoption).

The efficiency of absorption of a particular mineral is greatly influenced by the organic acid it is bound to. Inorganic mineral salts are less expensive to use in production, but offer poor nutritional value, under some conditions potentially causing net loss of a particular mineral from the body5. Magnesium carbonate or magnesium glycinate? One is cheaper, but not necessarily the better value.

Forms of nutrients are not only relevant in nutrient absorption. Alpha-tocopherol is the most common form of vitamin E used in nutritional supplements. It is available in a natural, d-alpha tocopherol form, and a synthetic d/l-alpha tocopherol form. The synthetic form is less expensive for manufacturers to source, but is also less bioavailable, and has only half the biological activity of the natural form of vitamin E5. Which form do you think Costco®’s Kirkland Signature™ brand vitamins use?

Manufacturing Quality

Raw materials aside, a company’s manufacturing standards can result in wide differences in quality of end products.

Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are the key active ingredients in fish oil products, and are concentrated in fish oil supplements by a process called “esterification” (EPA and DHA do not naturally occur in fish in the concentrations found in higher-quality fish oil supplements).

For optimal absoption in the body, however, the EPA and DHA should be “un-esterified” back into their natural, “triglyceride” form, which increases absoption by some 70%6. An “esterified” fish oil product may appear to be very concentrated, but will not ultimately offer the benefits a well-manufactured, “triglyceride form” product will, information not available on a product label.

In general, manufacturers who are quality focused will “go the extra mile” to ensure their products offer maximum benefit (and protect their reputation):

  • Metagenics® performs clinical trials on many of their products (most nutritional supplements are simply a combination of nutrients that have been identified as having some effect in a particular health condition, but the final combination/product itself is not evaluated).
  • MediHerb®7 and Douglas Laboratories®1 use a process called liquid chromatography to confirm potency of end products.

Formulation

In some cases, particularly in the case of botanical medicines, the formulation (recipe) plays as important a role in the effectiveness of the medicine as the specific medicinal ingredients included. Much like a recipe, which is more than the sum of it’s parts, a successful botanical medicine will often include herbs that act as “synergists”, plants that do not include chemicals acting directly on the primary health concern, but that increase the effect of the other plants included in the formula (e.g., cayenne acts as a circulatory stimulant, which when included in a formula can increase rate of delivery of other chemicals in an herbal medicine).

Both Viriditas Herbal Products and MediHerb® products are created by herbalists having decades of compounding experience. Can this be said of all brands?

Non-Medicinal Additives

Nutritional supplements include more than nutrients alone, in fact, in many cases the medicinal ingredients are less than the “other” ingredients. Are the “other” ingredients desirable or undesirable?

High-quality products will often have included “helpful” substances, for example vitamin E, an anti-oxidant, added to a fish oil product to prevent naturally occurring rancidity of any oil.

In contrast, Flintstones™ Complete Chewables Multivitamins include as “non-therapeutic” ingredients:

  • Aspartame (safe8, but none-the-less controversial) as it’s most plentiful ingredient
  • Sugar as three of the first seven ingredients (labeled as confectioner’s sugar, corn syrup solids, dextrose monohydrate)
  • Sorbitol, which may cause digestive upset
  • Several food colorings, including Red 40 and Yellow 6, both of which contain the carcinogen benzidine9

Potency, Dosage and Amount Needed for Effect

Sometimes the actual cost of a product is hidden in the dosage required for benefit.

For example, the “standard” daily dose recommended for many higher quality fish oil products offers, in the neighbourhood of 1’500 mg of combined EPA and DHA in each dose, the generally recommended “meaningful” dose for these recognized by experts10.

One capsule of 1000 mg Kirkland Signature™ Fish Oil contains 250 mg of combined EPA and DHA, a minimal dose11, 12, meaning one would have to take six capsules daily to meet the requirement for the “meaningful” recommended dose. (The label on the Kirkland Signature™ Fish Oil further suggests swallowing the capsules with water, which will reduce absorption of fat-soluble chemicals).

The bottom line (again): you get what you pay for.

The above is likely daunting. Even to person such as myself for whom this is my “job”, conversations with manufacturer’s representatives are often frustrating, like comparing apples to oranges: is a liquid fish oil including an anti-oxidant to prevent rancidity preferable to a fish oil in a supposedly more stable capsule form? It’s a rabbit hole (that you can continue down if you want to learn more about fish oil quality issues).

Self-serving as this may sound, my best advice is to trust your naturopathic doctor.

Although obviously a source of income for our office, the items in our dispensary are a quality-control mechanism for us, and selected after hundreds of hours of education, research and product meetings.

Or at the very least, don’t buy on price alone.

Good luck!

Jonah Lusis, ND

References

  1. MacWilliam L. Comparative guide to nutritional supplements™. 3rd professional ed. Northern Dimensions Publishing; 2003. pp. 68, 111, 117.
  2. US Food and Drug Administration [Internet]. Facts about generic drugs. [cited 2017 May 10]. Available from: https://www.fda.gov/drugs/resourcesforyou/consumers/buyingusingmedicinesafely/understandinggenericdrugs/ucm167991.ht.
  3. Drugs.com [Internet]. St. John’s Wort. [cited 2017 May 10]. Available from: https://www.drugs.com/npp/st-john-s-wort.html.
  4. Średnicka-Tober D, Barański M, Seal CJ, et al. Higher PUFA and n-3 PUFA, conjugated linoleic acid, α-tocopherol and iron, but lower iodine and selenium concentrations in organic milk: a systematic literature review and meta- and redundancy analyses. The British Journal of Nutrition. 2016;115(6):1043-1060. doi:10.1017/S0007114516000349.
  5. MacWilliam L. Comparative guide to nutritional supplements™. 5th professional ed. Northern Dimension Publishing; 2014. pp. 54-7.
  6. Dyerberg J, Madsen P, Moller JM, Aardestrup I, Schmidt EB. Bioavailability of marine n-3 fatty acid formulations. Prostaglandins Leukot Essent Fatty Acids. 2010 Sep;83(3):137–141.
  7. MediHerb [Internet]. Quality assurance of herbs. [cited 2017 May 10]. Available from: http://www.mediherb.com/about-us/quality-assurance.aspx.
  8. Arnarson A. Aspartame: good or bad. Authority Nutrition: An Evidence-based Approach [Internet]. [cited 2017 May 10]. Available from: https://authoritynutrition.com/aspartame-good-or-bad/.
  9. Potera C. Diet and nutrition: the artificial food dye blues. Environmental Health Perspectives. 2010;118(10):A428.
  10. Burford-Mason A. Using nutritional supplements in practice part 2 – recap and update. Nutrition for Docs 2009; 2009 May 30-31; Toronto, ON: Ontario Society of Physicians for Complementary Medicine and The Complementary Medicine Section, Ontario Medical Association; 2009.
  11. Hjalmarsdottir F. How much omega-3 should you take per day? Authority Nutrition: An Evidence-based Approach [Internet]. [cited 2017 May 10]. Available from: https://authoritynutrition.com/how-much-omega-3/.
  12. Mayo Clinic [Internet]. Omega-3 fatty acids, fish oil, alpha-linolenic acid. [cited 2017 May 10]. Available from: http://www.mayoclinic.org/drugs-supplements/omega-3-fatty-acids-fish-oil-alpha-linolenic-acid/dosing/hrb-20059372.

 

Posted: 2017 May 10

Should You Pay More for Better Fish Oil Supplements?

Toronto Naturopathic Doctor

A while ago we were interviewed on fish oil supplements in general, but practically, is there a difference in quality between products (which, as with most things, is generally reflected in cost of products on the market).

Ultimately, the interview wasn’t published, but the information is useful, so here it is:

Do you think all fish oil supplements are created equal?

No. As with all things, you get what you pay for.

From a safety perspective, any product sold at a major retailer in Canada is “safe enough”.

However, there are important differences between “retail” products available at major pharmacies (e.g., Swiss Natural®) and “professional” products (e.g., Metagenics®) available through healthcare professionals or selected health stores.

A key question is: are you getting what you’re paying for? The “point” of using fish oil is that it is rich in eicosapentaenoic Acid (EPA) and docosahexaenoic Acid (DHA). These are the specific chemicals present in fish oil that have been demonstrated to provide the various benefits associated with fish oil consumption. Higher quality products will usually have a much greater standardized (“guaranteed”) amount of these chemicals in every dose.

As an example, a common retail brand’s (Swiss Natural® Wild Salmon and Fish Oil 1000 mg) product contains only 180 mg of EPA and 120 mg of DHA per capsule, approximately 1/5 the generally recommended daily dose. A higher quality product (e.g., Nordic Naturals® Ultimate Omega® Xtra; 800 mg of EPA and 200 mg of DHA per capsule) contains more than three times as much EPA and DHA. Fewer required daily doses means lower (or at least comparable) “true cost”, and in most cases, improved patient compliance.

Higher quality products will more likely contain EPA and DHA in “triglyceride” form (as opposed to ethyl ester form). Fish oils are “esterified” in the process of concentrating EPA and DHA from the raw material. To return them to their natural, triglyceride form is costly, but at least one (small-size) study found that this measure increases absorption in the body by approximately 70% (note: some manufacturers claim esterified EPA and DHA are not less absorbed, but only more slowly absorbed, and owing to the relatively long life of fatty acids in the cell membrane, the speed at which they are absorbed is not relevant). Whether or not a product contains ingredients in esterified or triglyceride forms is not a labeling requirement, so you will have to check the manufacturers web site to confirm this. If a company’s product is in triglyceride form, they will be keen to let consumers know this, so it should be easy to determine.

Higher quality products will often also contain added, beneficial nutrients, for example vitamin D, which is a very important bone health, and is well-absorbed in an oil base; or plant sterols, which are beneficial for cardiovascular health (the reason many use fish oil supplements).

Finally, EPA and DHA have different benefits. I alluded to a generally recommended dose above, but research supports the use of different amounts of EPA or DHA as being beneficial for different conditions. Higher-quality brands often offer “high-EPA” or “high-DHA” options that better suit a patient’s specific requirements.

Are there processes in the manufacturing of omegas that make one brand cleaner than another?

“Molecular distillation” is considered the most effective method purifying fish oil products. Some reputable companies (Metagenics®) refer to “proprietary processes” which, for obvious reasons, can’t be assessed.

For the purpose of assessing safety, the most reasonable approach is to see if a company’s product is evaluated for a safety and purity by some third party.

A second consideration with regard to “cleanliness” of fish oil products is how well it is preserved after production. High quality products should contain anti-oxidants that protect the finished product from rancidity during the time it moves from producer to retailer to consumer.

What are some of the concerns or dangers with brands that do not have certifications? Do we even need to worry about this in Canada when products have an NPN?

I wouldn’t say there are “dangers” associated with products not having independent certifications, but “concerns” are all those listed above with regards to quality.

Natural Product Numbers (NPNs) offer only the most basic protections, primarily against false claims (e.g., preventing a fish oil manufacturer from claiming that their product can make you taller), but does not much address true differences in quality between products.

An analogy may be regulations regarding automobiles sold in Canada: there is a basic safety and quality threshold that must be met for a manufacturer to sell their car in Canada, but there is a definite “gap” in quality between (most) luxury cars and (most) economy cars.

How do we know a product is free from heavy metals. For example, if a fish oil is derived from Tuna which can be high in mercury is it safe to assume that if it’s molecularly distilled it will be free from contaminants?

“Molecular distillation” is considered the most effective means of purifying fish oils. It does not guarantee 100% purity (which, I don’t know if is possible), but reduces contaminants (e.g., mercury, polychlorinated biphenyls [PCBs]) to very, very low, safe levels (to the order of less than 0.01 parts-per-million mercury).

Is there an advantage to taking a liquid omega vs a capsule?

There are several considerations when choosing between liquid and capsule forms of fish oils:

The advantages of capsules include that they are more stable/less prone to rancidity (the capsule material provides a barrier between the fish oil and oxygen; liquid forms often contain anti-oxidants that protect against rancidity – there is research that supports this, but I can’t recall the reference), and may be more palatable to some.

Fish oils in liquid form often contain higher levels of EPA and DHA than capsules, and therefore are more cost-effective. From a taste perspective, many are now quite good-tasting, and for this reason may be preferred by persons who can not swallow large capsules.

Anything else you want to add?

Fish oils are best absorbed from fish itself, certainly if when compared to esterified supplements. Although fish oil supplements allow for greater concentration of EPA and DHA than dietary fish, they should not be considered a substitute for fish consumption.

Fish oil is best absorbed with oily foods. If adding a liquid fish oil supplement to a smoothie, do not use water as the smoothie base.

If your fish oil supplement has a “fishy” taste or smell, it is likely compromised and should be replaced.

Vegetarians often substitute flaxseed oil for fish oil, because it is rich in alpha-linolenic acid (ALA) which is converted to DHA in the body. ALA, however, is a poor substitute for fish oil because only 1-9% is converted to DHA, and it does not, ultimately, result in increased levels of DHA in the blood.

An effective alternative for vegetarians is microalgae oil, the EPA and DHA of which offers the same benefits as the EPA and DHA from fish.

Lastly, there is no “perfect” fish oil product. As a guideline, select a fish oil supplement that:

  • Is tested for purity by a third party
  • Offers EPA and DHA in triglyceride form if possible
  • That you tolerate well

 

Posted: 2017 May 9