Ensuring Supplement Efficacy?

[jesse_the_k]

"Supplements" are substances which we can use like drugs. In the U.S. and Canada, supplements are not regulated for purity or efficacy: we must trust the suppliers to ensure these important qualities. When I started using them, my pharmacist was also learning about supplements, and we spoke at length about this issue. She claimed to have researched the best manufacturers. She chose (and therefore I used) "Nature's Bounty."

Supplements have been part of my treatment plan for a long time: they include fish oils, vitamin D3, mysterious Chinese herbs compounded by my acupuncturist, cranberry powder, and a magnesium/riboflavin/feverfew tab called Migrelief (which really relieves my migraines). I've periodically tested their efficacy by stopping, assessing, and restarting them. They help. If that difference is founded on the placebo effect, I don't care.

Last month I had an experience which jerked me out of that happy place.
I mentioned to my p-doc that I was having trouble staying asleep. She suggested I try melatonin. I asked how much; she said, "knowing you, start small." I was pleased to find a liquid version with a marked dropper so I began with 0.25 mg equivalent. And that was enough! Lovely stuff: easy sleepiness within 20 minutes, stayed asleep with energetic and creative dreams, woke refreshed 8 hours later.

When I traveled the following week, I forgot my liquid melatonin. I went to a health food store and discovered the smallest tablet was 1mg, four times as large. I was able to halve it without totally crumbly results, so I thought I'd sleep like a lamb at twice my previous dose. But no—ZERO effect. Was this due to dosing sublingually versus through my digestive system? I kept doubling the pill dose with no result. When I made it home, I was taking 5mg (the typical dose available) with no pleasant sleep. Switched back to 0.25 liquid and slipped into the ocean like a sleepy seal.

The moral of the story: I don't know if a supplement isn't working because it's not effective in my body, or because there's not enough, or not even any, of the active ingredient in the bottle I bought.

And then this week, propinquity! A fascinating article in BioMedCentral:
DNA barcoding detects contamination and substitution in North American herbal products
Newmaster, Grguric, Shanmughanandhan, Ramalingam and Ragupathy

It provides extensive detail on how unreliable supplement labels can be, from a Canadian group with zero ties to the supplement production industry.

So, supplement users, how do you ensure their quality?

Comments

[oyceter]

Oh, liquid melatonin sounds so much easier! I have been using a capsule, but 3mg apparently leaves me groggy, and splitting it in half involves a lot of guesswork. What brand are you using?

[jesse_the_k]

It's made by www.NATROL.com, although that link is to a 2.5mg solution, which may be stronger. The joy of liquid is it's so much easier to, well, titrate.

I just checked
www.nhs.uk
for info on how supplements are regulated in a sensible country. Couldn't find out, but they do have caution sheets re Melatonin interactions and "no more than 13 weeks at a time."

[branchandroot]

For myself, I shop for them on Amazon until I find a brand whose reviews reflect variable effect in the proportions that suggest human biological variation rather than placebo effect (basically, if there's a significant mid-range rather than a sharp works/doesn't division). It's not perfect, but it's been working pretty well so far.

[jesse_the_k]

Wow. Bring the statistical science! That's a profound insight.

[shehasathree]

Apparently there is some controversy as to whether smaller doses (less than 1mg) are actually more effective than higher doses (e.g. 8mg). Personally I take 9mg, but my partner takes 3mg and that works pretty well for him. We have tablets.

[jesse_the_k]

That actually makes sense — as much as anything connected with hormones does. I know from my thyroid dance that providing too much of one chemical messenger can completely bollocks up the message.

[j00j]

I don't currently take supplements, but it's good to have this information about melatonin's variability. I will try to remember to get your brand if I try it again. I bought Source Naturals 3mg tablets when I went to Israel and they did NOTHING for jet lag there or back here. Not sure if that means I need to take more, or if these just have nothing in them. Whereas my father swears by melatonin for sleep issues, and many people including my GP swear by it for jet lag/residency/other circumstances that result in issues with sleep schedules. But none of them had a specific brand to mention.

[jesse_the_k]

Yeah, the non-standardized nature of the substance could be underpinning the verying experiences people have with supplements. And fo course there are folks who just don't have the typical reaction to highly regulated prescriptions. Bodies, why so complex?

[bibliofile]

One friend swears by the stuff she gets from Trader Joe's. I know that TJ's does its homework on sourcing food products; maybe they do a decent job sourcing the supplements, too?

I sure wish that we regulated supplements and vitamins. Standards, people! Standards work wonders. (Not that it's completely fixed the generic drug industry, but clearly more regulation is needed.)

[lightgetsin]

Belated question -- who makes your liquid melatonin? I have proven remarkably uneffected by even enormous doses of the tablets I have, and want to try something else.

[jesse_the_k]

It's made by www.NATROL.com, although that link is to a 2.5mg solution, which may be stronger. The joy of liquid is it's so much easier to, well, titrate. If it's not at one of the 10,000 CVS in your area they even sell it on site.

It's still reliably working for me three weeks later, which is way past my usual poop-out point.

Best wishes.

[lightgetsin]

Looks like it's on Amazon, too. Thanks!