Dietary supplements or herbal remedies
Some people like to use dietary supplements or herbal remedies and unfortunately it remains extremely common for many CAM practitioners to prescribe supplements in the absence of quality evidence for their need or efficacy.(4) Currently there’s little evidence they’re helpful, and some may even be harmful. Some supplements may also interfere with your treatment and have interactions with other medications such as blood thinners and Blood pressure medications, so let your medical team know if you’re taking any.
Most people should be able to get all the nutrients they need by eating a balanced diet, without taking supplements and large doses may be bad for your health.
If you do choose to take supplements, two terms that may have value to you include Recommended Daily Intake (RDI) and Upper limit (UL). A summary of RDI, s and UL, s for selected nutrients is presented in table 1
- RDI is the average daily dietary intake level that is sufficient to meet the nutrient requirements of nearly all (97–98 per cent) of the population
- UL is the highest average daily nutrient intake level likely to pose no adverse health effects to almost all individuals in the general population
If you choose to take supplements do not take any more than the RDI and defiantly do not exceed the UL. Some individuals may need to take specific supplements for medically diagnosed conditions, For example, if you’re on hormone therapy, your doctor might recommend calcium and vitamin D supplements, please Always discuss supplements with your doctor.
Current Australian regulation of supplements and CAM products #
In Australia, medicinal products containing such ingredients as herbs, vitamins, minerals, nutritional supplements, homoeopathic and certain aromatherapy preparations are referred to as ‘complementary medicines’ and are regulated as medicines under the Therapeutic Goods Act 1989(link is external)
Australia currently has a risk-based approach with a two-tiered system for the regulation of all medicines, including complementary medicines:
- Lower risk medicines can be listedon the Australian Register of Therapeutic Goods (ARTG).
- Higher risk medicines must be registered on the ARTG.
Typically all complementary medicine is considered low risk and listed while pharmaceuticals are considered high risk and registered. Some complementary medicines are exempt from the requirement to be included on the ARTG, such as certain preparations of homoeopathic medicines.(7)
What risks might this pose?
The current system is based on trust. Australia’s medicines regulator, the Therapeutic Goods Administration (TGA), does not assess the claims of the vast majority of complementary medicines (labelled AUST L) before they go to market. Rather, the company simply promises that it holds evidence to support any health claims it makes.
Companies also promise that the product only contains ingredients the TGA regards as relatively safe and that production follows good manufacturing practice. The TGA only occasionally checks if the companies’ promises can be confirmed by post-marketing reviews.
Areas of concern
One researcher suggested that an average of 1800 products are being listed on the ARTG each year as such this has led to a risk management process where only some products are tested being implemented in regards to compliance. That author found that in the last six months of 2014, the TGA listed 1022 new products but only initiated 72 post-marketing reviews which is approximately 7% of listed products. In the same period, 60% of reviews found manufacturers weren’t compliant. Another Australian author found looking directly at the quality of herbal medicines, including traditional Chinese medicine (TCM) published in nature scientific reports in 2015 found that nearly nine in ten of the medicines tested had some form of undeclared substance in them as either adulteration or contamination and many of these contaminants were of considerable concern. (8)
In our current regulatory system while individual patient beliefs and preferences needs to be taken into account and supported choosing CAM products carries potential risk and limited proven benefit. There remains a significant risk that the product may not contain what it claims to contain and may not hold any reasonable proof that it is effective.
# Update .
Please note the TGA is undergoing and extensive review of this system and information can be found here
Many of these changes will hopefully lead to improvements in a system that is struggling to deal with a significant problem.
There are many submissions on the proposal the one i have linked is probably the most independent from the group choice
Highlights from the choice submission
“Just because a product is considered low risk, this does not mean it should be sold to
consumers with misleading claims as to its efficacy”
Research shows that consumers do not understand the
current labelling system, and the market is crowded, with over 11,000 ‘listed’ products.
Making your choice
If you choose to use supplements and CAM products choose those with the “AUST L” Label this will not guarantee that the product will do what it claims or contains what it should be increases the likelihood it will. Avoid buying supplements online or from overseas as there may be no reliable way of knowing what they contain.
Further information research
The University of Maryland has a very good evidence based online resource on CAM and also lists potential interactions. Complementary and alternative medicine guide
Where possible i will be posting new research on supplements and diabetes in my posts including a summary of the evidence
Decision making when seeking advice
It can be very challenging to sort through all of the nutrition information from CAM sources typically if it sounds too good to be true it probably is. Nutrition has a significant impact on many diseases and play’s a significant role in keeping us well, as yet we do not have significant evidence on specific supplements or nutrients the best evidence comes from foods.
11 statements that should lead you to question the information you have been given
- They claim that most Australian are poorly nourished and “Supplements” and “Health Foods” are required for Everyone
- They Allege That Modern Processing Methods and Storage Remove all Nutritive Value from Our Food
- They claim to cure diseases
- They Routinely Sell Vitamins and Other “Dietary Supplements” as Part of Their Practice
- They Use Anecdotes and Testimonials to Support Their Claims
- They claim that sugar is a deadly poison
- They Offer to Determine Your Body’s Nutritional State with an Invalid Test or a Questionnaire.
- They Claim They Are Being Persecuted by Orthodox Medicine and That Their Work Is Being Suppressed Because It’s Controversial
- They Encourage Patients to Crusade for Their Treatment Methods
- They Warn You Not to Trust Your Doctor
- they sell practitioner only supplements . (This is a sales technique) if practitioner only supplements are better why are they not readily available everywhere ? what are they better than if the standard supplements do not work why sell them to me ? why do they cost twice as much ? . Hint none of them work to do anything other than lighten your wallet
When an alternative medicine has been proven to be effective it is no longer called ‘alternative. It is simply called medicine”
Table 1 Recommended daily intakes (RDI) AI (Adequate intake) and Upper Limit (UL) for selected nutrients. Source
|Thiamine||1.2mg||Not enough data|
|Riboflavin||1.3mg||Not enough data|
|Vitamin E (as alpha tocopherol equivalents)||10mg||300mcg/day|
|Vitamin A (as retinol equivalents )||900mg/day||3000mg/day|
|Calcium||Age 51-70 1000mg
Age 70+ 1300mg
|Vitamin C||45mg||No UL for vitamin C, but 1,000 mg/day is a prudent limit.|
|Chromium||30µg||Not enough data|
|Magnesium||420mg||Not enough data|
|Vitamin D||Age 51-70 5µg
Age 70+ 10µg
- Alternative health Therapies in Australia: Market Research Report. IBIS World industry research provider. Alternative Health Therapies Market Research Report | ANZSIC X0015 | May 2016 accessed 20.8.2016. http://www.ibisworld.com.au/industry/default.aspx?indid=1914
- Complementary, Alternative, or Integrative Health: What’s In a Name? : National Center for Complementary and Integrative Health (NCCIH) https://nccih.nih.gov/health/integrative-health Accessed 20.8.2016.
- Endeavour college of natural health http://www.studiesinaustralia.com/profile/endeavour-college-of-natural-health More information about Endeavour College of Natural Health. Assessed 20.8.2016
- The Practice and Regulatory Requirements of Naturopathy and Western Herbal Medicine a summary report. School pf public health Latrobe university 2005
- Unregulated naturopaths putting lives at risk Jon Wardle Director of the Network of Researchers of Public Health in Complementary and Alternative Medicine at the University of Queensland.
8 Combined DNA, toxicological and heavy metal analyses provides an auditing toolkit to improve pharmacovigilance of traditional Chinese medicine (TCM)
Source abc news accessed 20.8.2016 http://www.abc.net.au/news/2010-10-21/unregulated_naturopaths_putting_lives_at_risk/40276