How to choose dietary food supplements correctly? How to find high quality food supplements? How to select high quality brand of any dietary supplement?
How to choose the correct food supplements? Dr. Anton Titov, MD. How to evaluate the quality of dietary food supplements? How to find the correct brand of fish oil or St. John's Wort? Which food supplements are used in integrative medicine therapy? What to look for in dietary food supplements? How to avoid toxicity of food supplements? Liver toxicity of food supplements. Do capsules that contain food supplements dissolve in the body? Video interview with top expert in integrative medicine. Dr. Anton Titov, MD. Medical second opinion ensures that seasonal affective disorder diagnosis is correct and complete. Top holistic medicine doctors tells how to choose dietary food supplements correctly. Medical second opinion helps to choose the best holistic natural treatment strategy for seasonal affective disorder. Seek medical second opinion on seasonal affective disorder and be confident that your holistic natural treatment is the best. Dr. Anton Titov, MD. How to Choose High-Quality Dietary Supplements correctly? Dr. Kevin Barrows, MD. Integrative Medicine specialist, UCSF. Sometimes we say dietary food supplements are a lot of different things. Some of food supplements are not evidence-based. And use of some food supplements is evidence-based. Sometimes we talked earlier in this interview. There are certain indications that fish oil works well for high triglycerides. St. John's Wort is a great example of an effective therapy for depression. We have a few dozen randomized control trials on that. We have a Cochrane review. It concluded St. John's Wort equally effective to pharmaceutical anti-depressants. It has fewer side effects. So some dietary food supplements are indicated. And for some food supplements there's just no evidence-based data. So then it becomes a question. You could try a food supplement that is safe to take. You can just try food supplement. But you don't really know that it's going to help. Then the next question is this. You want to buy St. John's Wort supplement. How do you know which one to buy? There's probably a hundred varieties on the shelf. Dr. Anton Titov, MD. How do you know which one is the best one? There are different ways to assess quality of food supplements. There's a subscriber website that does independent testing of many food supplement products. They will go and collect twenty different brands. In the case of St. John's wort, they will buy many brands of St. John's Wort. They will test them in the laboratory. These are independent from the manufacturers. It's a third-party testing services. They ask this. Does the pill have the amount of St. John's Wort as the bottle says it does? Does it have any contaminants, like lead, cadmium? Will the capsule dissolve and allow you to absorb the medicine. Is active substance of food supplement present? Because sometimes the capsule doesn't dissolve. Then you just pass food supplement through intestines without getting any potential benefit from the supplement. Similarly with fish oil. They were evaluating fish oil food supplements. So you can see which brands pass these tests and which brands have not passed the test. Dr. Anton Titov, MD. This is a very important point, so it's not just looking at the label and saying "St. John's Wort”. It’s not just about any particular food supplement that has been shown in clinical trials to work. But it is important to be certain that there is the actual substance contained in food supplement. You have to make sure this is true. There is no additional harmful substances that are contained in the vial of supplement. It's also important to be sure that the dietary supplement is contained in the form that would be beneficial. The form of food supplement has be used by the buyer. That is a very important point. Dr. Kevin Barrows, MD. It is, and it's an extra hurdle unfortunately for Integrative Medicine to overcome. With pharmaceutical medicines you can be pretty assured of production quality. Sometimes a pharmaceutical medication finally gets to the point of being dispensed in the pharmacy. The purity, the integrity and all of the processes to make that substance are reliable. And therefore the products are reliable. That’s 99,9% true. Dr. Anton Titov, MD. At least in the industrialized world. Dr. Kevin Barrows, MD. That's correct. That's true. In integrative medicine, with dietary food supplements, we can prescribe St. John's Wort. But now we have to go the extra step. We have to say this. Okay, which brands of St. John's Wort we know are good? There are three ways to assess that. One is this website that tests food supplements independently. Another method to check the quality of food supplement is this. Sometimes you go to the original studies, you actually can look at the original scientific studies on St. John's Wort. You can see what brand did they use in the clinical trials. And that brand is likely a good bet. Although it doesn't necessarily prove that it's not contaminated. It can show that it is effective or not. A third level of evidence that a food supplement has adequate quality of production is not quite as good. There are certain characteristics of a product that you can see in the label. I will give you a simple example. Sometimes there's no lot number and no expiration date. That's a bad sign. That means that company might not be tracking their manufacturing process. And so sometimes they produce a bad batch, contaminated batch. How would they trace it? That suggests this maker of dietary food supplements is not fully on top of their manufacturing process. There's also in the US a certification called Good Manufacturing Practices. Dr. Anton Titov, MD. High quality producers adhere to Good Manufacturing Process (GMP) standards. Dr. Kevin Barrows, MD. Yes. That is general rules about assessing quality of food supplements. Because it is the wild west. Food supplement industry is unregulated or mostly unregulated compared to pharmaceuticals. Dr. Anton Titov, MD. Do you envision the time when food supplement will be more regulated and better quality-controlled? Will the requirements for food supplements be similar to traditional pharmaceuticals? Dr. Kevin Barrows, MD. I'm gonna guess probably not. But there has been a trend, a slow trend toward increasing regulation. You never know. Sometimes some unfortunate terrible catastrophe happened. There might be a public outcry to tighten regulation of these things. But up until now the general public opinion has been against more regulation of food supplements. We don't want it so tightly regulated, we want the freedom to have access to these products. We don't want things to be like with traditional pharmaceuticals. It's the criticism saying that FDA processes are too tight. US FDA takes too long and too much money to get a product through. And so it limits how many products we can have. Dr. Anton Titov, MD. But at the same time there were reports in the New York Times of patients needing liver transplants because they took dietary food supplements. And these food supplements contained some toxic substances. Dr. Kevin Barrows, MD. Yes, so you need to look at those cases. As you know as a physician, liver toxicity is quite an entity. It happens unpredictably sometimes. And most of these dramatic liver toxicity cases are case reports. No, I don't doubt it. There are some very solid case reports on toxicity of food supplements. Where it does look like the supplement caused the liver damage. But there's also a lot of cases where there was another problem. A patient was taking the herbal supplement. But so many other things could be overlapping. So it could be a coincidence. Yes, could be a coincidence. But there have been at least a few dozen of serious cases of hepatotoxicity, it's true. How to choose dietary food supplements? How to evaluate quality of food supplements? Which brand of dietary supplement has best quality? How to avoid toxicity of food supplements.