A significant place in the shelves of pharmacies is occupied by dietary supplements, products that are very similar to drugs n their form, but in essence they aren't. It is believed that in the USA, half of the adult population regularly uses some of the dietary supplements, that in Europe the demand is little lower, but equally under strong marketing pressure. We are witnessing their growing popularity in Serbia every day. The market for dietary products has been constantly expanding and their turnover has experienced a dramatic jump since 1994, when the US Congress passed a law defining these products for the first time as product that should complement the food consumed.

They contain one or more nutrients such as vitamins, minerals, substances that have beneficial effect on human health, and are in dosage forms, designed to be taken in measured individual doses (capsules, tablets, drops, etc...). Although they are in a form atypical for food, they are.

They aren't used in ordinary food and can't replace individual meals. In our dietary supplements, according to current regulations, are classified as dietary foods.

Why are they popular?

There are numerous reasons for the popularity of dietary supplements. People are becoming more and more aware of the importance of proper nutrition in health promotion, but they are also aware that for many reasons (lifestyle and pace of life with constant stress, skipping meals, special diets, reduction diets, vegetarianism,...) they are not able to provide nutrition everything they need. Among the main reason for the use of supplements is people's concern for their own health, but also the popularity of self-medication. Who hasn't heard the advertisements that supplements can help with certain diseases such as: arthritis, hypertension, hypercholesterolemia, cancer, obesity? Unable to cope with the demands of everyday life, people exposes to daily increased efforts easily reach for supplements, so among the most popular are those intended to increase energy levels and general strengthening of the body.

Also, among the very popular dietary supplements are those intended for athletes, as well as supplements for weight reduction. At the Center for Sports nutrition and Supplementation, most people use supplements to lose weight, or quite the opposite, to gain weight. The fact that the Center employs several doctors, pharmacists, but also a doctor of biochemistry and a bodybuilder speaks volumes about how demanding it is.

Dietary supplements are easily available, don't require a medical examination or prescription, they are available in pharmacies, health food stores, but they are also available online.

Who really needs dietary supplements?

Supplements are needed to by people who, due to lifestyle or special dietary regime, can't get the necessary, balanced amounts of necessary nutrients. There are also conditions in which the need for certain nutrients is increased, so they need to be taken in supplements. Older people, children, adolescents, women in special conditions and periods of life can benefit from well-designed supplementation. I still remember the faces of pharmacists when I asked if it was normal for our menopausal woman not to be affected by proper supplementation, as women in the West and Japan do.

Only those who have tried it know how much evening primrose, red clover, or isoflavones, (plant estrogens) help in some situations. At the same time, it should always be borne in mind that the amount of a substance ingested is the sum of the intake of food and supplements. However, the problem is also in the habits. Thus, for example, our women don't take in approximately the same amount of isoflavones as Asian women do, because they don't have the habit of using soy. On the other hand, in the case of the use of dietary supplements, the rule is is no longer better, but measure and patience is necessary. Supplements aren't taken for a couple of days, but usually for months, because, as it was said, they are not drugs, but food, and they need time to get involved in human metabolism.

Classification of dietary supplements

Although there is no universally accepted division of dietary supplements, it is very often used that divides dietary supplements into two groups. The first group includes vitamins, minerals and other basic nutrients (amino and fatty acids, coenzyme Q...). The second group, in addition to substances of botanical origin (herbal supplements), also contains substances of their origin (enzymes, probiotics). Supplements of both groups can be both mono-component and poly-component. They can also be classified in relation to the organic system on which they show a positive effect (supplements intended for the locomotor tract, cardiovascular system, gastrointestinal tract...). They can be divided according to different periods in a person's life.

Interactions of supplements and drugs

When using supplements, care must be taken about their possible interaction with drugs and during this simultaneous use, a doctor should be consulted. Namely, supplements and drugs can have a similar effect, so the effect of a drug can be potentiated. Thus, the anticoagulant effect of warfarin (a drug used by heart patients) can be enhanced with supplements of fish oil, ginkgo, garlic. There is also possibility of the opposite effect. The effects of immunosuppressants and corticosteroids may be reduced if vitamin E supplements of echinacea-based supplements are used. It is well known that calcium supplements interfere with the resorption of tetracyclic antibiotics, and that St. John's wort accelerates the elimination of drugs.

Risk of using supplements

Despite the numerous positive effects they have, the use of supplements carries certain risk. It is known that even vitamin-mineral products carry certain dangers (vitamin A can have a side effects on the liver, vitamin D on the kidneys, while vitamin B6 in overdoses can cause neurological disorders). Some supplements are risky for certain population groups (magnesium supplements for kidney patients, garlic supplements for diabetics on antidiabetic therapy). Dietary supplements shouldn't be taken as a substitute for medical therapy.

In case of any doubts when using dietary supplements, you should consult a doctor. Since the doctor is often mentioned as a counselor in supplementation, we should be aware of the fact that most doctors don't know enough about supplements and that only small number practically work with and can give the right advice.

The dangers associated with the use of dietary supplements may be related to the patient's misinformation, resulting in the absence of the expected effect. All this results in unnecessary material cost. On the other hand, the situation is much more serious in the case of causing an adverse health effect. A recent drastic example of the illicit presence of sibutramine in green coffee, which is used as a weight loss product, whose use was very widespread, pointed to many problems. After several deaths due to stroke and cardiovascular events in Europe, its use is definitely banned in Serbia. The reaction of our costumers (mostly women) was such that they ran to pharmacies with the aim of making stocks. It is amazing that a small number of them talk about the harmful effects due to the withdrawal of green coffee that contain illicit subutramine.

Also, great care should be taken when using herbal supplements and taking into account the length of their use. Although, herbal supplements are of natural origin, this doesn't mean that they are inevitably safe.

Images and literature: Lily magazine, free editions, September, page 52.