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ConsumerLab.com Answers
Question:
Being over 50 years old, I'm looking to take a vitamin B-12 supplement. I see that many contain a form of vitamin B-12 called cyanocobalamin, yet I read on the Internet that this form is toxic. Should I be concerned? Answer: The most common form of vitamin B-12 (cobalamin) in supplements is cyanocobalamin and although this form includes a cyanide molecule, it is very safe. Why? Even at a very high dose, it would provide about a thousand times less cyanide than is toxic, and the cyanide is excreted in the urine. B-12 is also commonly available in supplements as methylcobalamin. Supplements with both types of B-12 are included in the B Vitamin Supplements Review and the Multivitamin Review. Some non-authoritative websites claim that methylcobalamin is better absorbed or more bioavailable than cyanocobalamin, but there is no clinical evidence supporting this claim. Other sites suggest that methylcobalamin supplements cannot yield one of the important, active metabolites of B-12, but this is not correct. More information about this, and another form of B-12, hydroxocobalamin, is found in the "Cobalamin (B-12)" section of the B Vitamin Supplements Review >> ConsumerLab.com Answers
Question:
What is Lipo-flavonoid and does it work for tinnitus or other ear problems? Answer: Lipo-flavonoid® Plus is a supplement promoted for ringing in the ears (tinnitus) and other ear-related conditions including vertigo, ear aches, ear infection, and Meniere's disease. The product is actually a formula consisting of several ingredients. The main ingredient is a lemon flavonoid extract containing eriodictyol glycoside and other flavonoids. The product also contains several B vitamins, vitamin C, choline, and inositol. In the 1960s, a paper was published describing 122 cases of Meniere's disease that were treated with a lemon flavonoid complex containing eriodictyol glycoside. Many people reported reduced vertigo and improved hearing (Williams, Ann Otol Rhinol Laryngol 1963). A paper published in 1947 described 87 cases of vertigo, often as a result of Meniere's disease, treated with pyridoxine (B6), usually 100 mg daily. Many people reported improvement (Lewy, Arch Otolaryngol 1947). Based on these reports, some have assumed that these ingredients would be beneficial for a variety of ear disorders including tinnitus and others. However, these reports are very preliminary. Neither Lipo-flavonoid Plus, nor its main ingredient, have been evaluated in reliable clinical studies for tinnitus or other ear-related conditions.
ConsumerLab.com Answers
Question:
Which supplements are important after bariatric surgery (i.e., weight loss or stomach-reducing surgery)? Are there any I should avoid? Answer: Weight loss surgeries such as gastric bypass, gastric sleeve, and gastric band procedures, reduce the amount of food and liquid a person comfortably digest in one sitting, leading to smaller meals and potentially, inadequate nutrient intake. Gastric bypass (re-routing around the stomach) and gastric sleeve surgery (removing a portion of the stomach) also reduce stomach acid and normal digestive action, leading to reduced absorption of various vitamins and minerals. The use of supplemental vitamins and minerals is recommended for gastric bypass and gastric sleeve patients, and sometimes for gastric band patients. However, for bypass and sleeve patients, the changes in digestion and nutrient absorption also mean that some supplements may not be tolerated or absorbed as well as others. For details about supplements to take or avoid, see the full answer >> ConsumerLab.com Answers
Question:
Are enteric coated supplements better than non-enteric coated ones? Answer: Enteric coatings help protect supplement ingredients from being released in the stomach and keep them away from stomach acid and enzymes. This allows the supplement to stay intact until it reaches the less acidic small intestine (where most nutrient absorption takes place). An enteric coating may also be desirable for ingredients which, for some people, otherwise cause an unpleasant aftertaste. Consequently, with ingredients that need protection it is sometimes worthwhile to purchase an enterically coated supplement. However, enteric coatings are not always necessary or beneficial, and, in some case, may just be an expensive gimmick. There are also some concerns about enteric coatings of which you should be aware. See the full answer (with information about enteric coatings for fish oil, marine oils, probiotics, garlic, and SAMe)>> ConsumerLab.com Answers
Question:
I take fluoxetine (Prozac), a SSRI drug to treat depression. Are there supplements I should avoid, or be taking, due to this drug? Answer: Fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil) and other selective serotonin-reuptake inhibitor (SSRI) drugs can be affected by taking supplements and can affect your ability to absorb certain vitamins and minerals. Certain herbal supplements, such as St. John's wort and Garcinia cambogia (HCA), may increase the risk of serotonin syndrome associated with SSRIs. Other supplements, like 5-HTP, and SAMe, may also increase this risk. On the other hand, folic acid, a B vitamin, may be beneficial for some people taking an SSRI. These interactions are explained in the SSRIs article, which is part of the extensive Drug Interactions section of our website (where you can look up interaction for other drugs you may be taking). ConsumerLab.com Answers
Question:
Do any supplements really help with brain function, like memory and cognition? Answer: There are a few supplements which may provide modest benefit with memory and cognition in certain people: These are fish oil, certain B vitamins, cocoa flavanols, curcumin (from turmeric), huperzine A, vinpocetine, and acetyl-L-carnitine. CoQ10 may help improve statin drug side-effects, including memory loss. However, be aware that some proprietary formulas which contain some of these ingredients, such as Procera AVH, may promise more of a benefit than clinical evidence suggests. Certain forms of choline may be help improve short-term memory and attention in older adults, or improve cognition in people with mild to moderate Alzheimer's disease, while other forms of choline have not been found to have a benefit. In girls deficient in iron, iron supplementation may improve learning and memory. Although green tea has been touted for improving brain function, this effect is not well established. Other supplements touted for brain function, such as Gingko biloba and vitamin E have, by and large, not been found to be helpful. Be aware that the FDA has specifically advised consumers to avoid supplements promoted to prevent or treat traumatic brain injuries. You can read more about the potential memory and cognition benefits of these supplements by using the links above. Also see ConsumerLab.com's Encyclopedia article about Enhancing Memory and Mental Function. ConsumerLab.com Answers
Question:
What is benfotiamine and can it really improve or prevent complications from diabetes? Answer: Benfotiamine is a derivative of thiamin (vitamin B-1) which may be more effective at raising thiamine levels in the body. There is preliminary evidence that benfotiamine may be helpful to people with diabetes. For more details, see the information about benfotiamine in the B Vitamins Supplements Review >> ConsumerLab.com Answers
Question:
The maker of my multivitamin says it doesn't include folic acid because too much from supplements can be harmful. Is that true? Answer: Although folic acid is an essential B vitamin with important functions, there are legitimate concerns about getting too much folic acid from supplements and fortified foods. For example, a high daily dose of folic acid from a supplement has been associated with a more than doubling of the risk of prostate cancer. High doses of folic acid from supplements can also complicate the diagnosis of vitamin B-12 deficiency and cause kidney damage. For details about how much is too much, and how this compares to the amounts of folic acid in the many popular multivitamins and B vitamins we've tested, see the Multivitamin Supplements Review and B Vitamin Supplements Review >> ConsumerLab.com Answers
Question:
Do any supplements help with migraines? Answer: There is evidence that magnesium, CoQ10 and riboflavin (B2) may help to reduce the frequency or severity of migraine headaches. The amino acid 5-HTP may also reduce frequency, although the evidence is mixed. Some herbal supplements, such as butterbur and feverfew may also be helpful. One preliminary study suggests ginger may help reduce the severity of migraine headaches. However, be aware that taking St. John's wort with migraine medications or the painkiller tramadol can cause adverse effects. One clinical study found that a DAO (diamine oxidase) supplement reduced the duration of migraine attacks by 30%, but did not reduce pain or frequency. Low blood levels of vitamin D have been associated with a moderate increase in migraine frequency (although not migraine severity), as well as with a higher risk of frequent headaches in general. For more information, see the article about Migraine in our Encyclopedia, and also use links above. ConsumerLab.com Answers
Question:
Can taking too much vitamin B-6 be dangerous? The label on my multivitamin states it contains 2000% the Daily Value! Answer: High doses of vitamin B-6 can cause nerve damage and skin lesions, increase the risk of hip fracture, and have other adverse effects. If your multi contains 2,000% of the Daily Value (DV), which is 2 mg for adults, then your multi has 40 mg of B-6. [Update: In 2016, the FDA reduced the Daily Value for B-6 to 1.7 mg, but this won't be reflected on most supplement labels until 2018 or 2019.] While that amount alone does not exceed the Upper Tolerable Intake Limit for adults, it is important to consider the total daily amount you are getting from foods and other supplements, combined. Furthermore, there does not seem to be solid evidence to support getting such a large amount of B-6 if you are not deficient in it. The mega doses of vitamins found in some daily multis may be driven more by marketing considerations than science. One clinical study found that 25 mg of B-6 taken daily as part of a B-complex vitamin was shown to increase the risk of heart attack, stroke and death in diabetes patients with advance kidney disease. Also, be aware that people taking certain medications may need to limit their intake of B-6 from supplements. Get more information, including the Recommended Daily Allowances and Upper Limits for B-6 (by age and gender), potential side-effects and drug interactions, plus ConsumerLab's tests and comparisons of popular supplements, in the B Vitamin Supplements Review >> You can check the recommended intakes of other vitamins and minerals here. ConsumerLab.com Answers
Question:
Can taking too much vitamin B-12 be dangerous? The label on my B-complex states it contains 50,000% the Daily Value! Answer: If your B-complex contains 50,000% of the Daily Value (DV), which is 6 mcg for adults, then it has 3,000 mcg of B-12. For people without a severe B-12 deficiency, this is certainly more than necessary. [Update: In 2016, the FDA lowered the Daily Value for B-12 to just 2.5 mcg for adults, but this won't be reflected on most supplement labels until 2018 or 2019.] Taking some B-12 is advisable for people over the age of 50 (when you're less able to extract B-12 from food), as well as for those taking medications that interfere with B-12 absorption, strict vegetarians, alcohol and drug abusers, people recovering from surgery or burns, and those with bowel or pancreatic cancer. Although vitamin B-12 is generally considered to be safe, and no "Upper Tolerable Intake Level" has been established, there are some reports of doses of 20 mcg per day or higher causing outbreaks of acne and rosacea. There is also a study which showed that a high-dose B complex supplement (with 1,000 mcg of B-12) hurt, rather than helped, people with type 1 or type 2 diabetes and advanced kidney disease, resulting in a worsening of kidney function and an increase in the risk of heart attack, stroke and death. If you decide to take a B-12 supplement, you may want to choose one which has been tested and Approved by ConsumerLab.com. Be aware that sublingual and dissolvable B-12 supplements often contain sugar substitutes which can, in some people, cause gas, bloating, and diarrhea -- particularly if taking multiple pills. You can use the Ingredients listings in CL's Review to spot and avoid these ingredients. In women who are pregnant, excessive blood levels of vitamin B-12 have been associated with an increased risk of autism in their children. In general, it's best to avoid excessive doses of any vitamin if it is not needed. Get more information, including the Recommended Daily Allowance for B-12 (by age and gender), differences in the forms of B-12, potential side-effects and drug interactions, plus ConsumerLab.com's tests of popular products, in the B Vitamin Supplements Review >> You can check the recommended intakes of other vitamins and minerals here. ConsumerLab.com Answers
Question:
Which supplements help reduce the risk of colorectal cancer? Answer: There is good evidence that getting adequate folate and fiber from foods and supplements can reduce the risk of developing colorectal cancer. (Listen to ConsumerLab.com's Fiber Supplements Webinar for more on fiber and colon health). In people with low blood levels of selenium, selenium supplements have been found to reduce the risk of colon cancer, and in people who smoke, taking curcumin can reduce early changes in the colon that can lead to cancer. Maintaining higher levels of vitamin D in the body -- which can be achieved through exposure to sunlight or obtained from foods and supplements -- is associated with a reduced risk of developing colorectal cancer. Although preliminary research had suggested that calcium supplements might reduce the risk of colon polyps or colon cancer, large clinical trials failed to show a benefit with high doses. Intake of omega-3 fatty acids EPA and DHA from fish and/or fish oil supplements is associated with a lower risk of death from colorectal cancer. However, it may interfere with chemotherapy. Observational studies have also found an association between higher olive oil intake and a reduced risk of colorectal cancer. Green tea extract has been shown to reduce the recurrence of polyps, which can sometimes turn into colon cancer. Although a high dietary intake of CLA (conjugated linoleic acid) from high-fat dairy foods has been associated with a reduction of colorectal cancer by up to 39% in women, it is not known if taking CLA supplements has this potential benefit. For more information about each of these supplements, use the links above. Also see the Cancer Prevention article in our Natural Products Encyclopedia. ConsumerLab.com Answers
Question:
Do any supplements help relieve stress? Answer: Fish oil may blunt some of the effects of mental stress, such as increased heart rate and nervous activity. Several clinical studies show ashwagandha may help to relieve symptoms in people with anxiety. And, interestingly, a particular probiotic has been shown to lower levels of the "stress" hormone cortisol, and measures of psychological distress such as depression and anger. L-theanine, an amino acid found in black and green tea, has been shown to reduce stress responses without causing drowsiness, and there is some evidence that the herbs passionflower and lemon balm may be helpful for anxiety. One clinical trial found 500 mg of holy basil leaf extract taken twice daily significantly reduced measures of anxiety in men and women (Bhattacharyya, Nepal Med Coll J 2008). See the Encyclopedia article about Ayurvedic medicine for other uses for this herb - which is listed by its scientific name, Ocimum sanctum. Ginseng is sometimes promoted for reducing stress, although one clinical study found it did not have an effect on cortisol levels. There is weak evidence that valerian supplements may produce a calming effect in stressful situations. Be aware that low blood levels of iron and vitamin B6 have been associated with stress responses such as hyperventilation and panic attacks in women (Mikawa, Acta Med Okayama 2013), so be sure you're getting sufficient intake of these nutrients. There is some evidence that daily supplementation with a multivitamin-multimineral supplement may help people to cope with stressful situations. For more information, use the links above, and see the Encyclopedia article about Stress. ConsumerLab.com Answers
Question:
Do any supplements help with nerve pain, like sciatica or diabetic neuropathy? Answer: Several supplements have been shown to be helpful for nerve pain caused by conditions such as sciatica or diabetic neuropathy. These include fish oil, curcumin, alpha-lipoic acid (ALA) and GLA, and benfotiamine. Read the full answer for details and dosage >> ConsumerLab.com Answers
Question:
I have been having neurological symptoms, and a blood test showed I have toxic levels of vitamin B-6. My multivitamin contains 75 mg of B-6, but this is below the upper limit of 100 mg per day. Could my vitamin contain more than it lists? Answer: As noted in our B Vitamin Supplements Review, unless you are deficient, you only need to get slightly less than 2 mg of vitamin B6 per day from your diet (including supplements), while the daily upper tolerable intake level (UL) is 100 mg. When you exceed the UL, you start increasing your chances of side effects. [Update: In 2016, the FDA reduced the Daily Value for B-6 to 1.7 mg, but this won't be reflected on most supplement labels until 2018 or 2019.] Since supplements are required to provide at least 100% of their listed amounts of ingredients at the time you purchase them and, if properly maintained, until a listed expiration date, it is customary and acceptable for companies to put in a bit more (an "overage") than the listed amount of an ingredient to compensate for normal degradation. In fact, according the USP, up to 50% more is permitted for B vitamins. So, yes, it is possible that your multivitamin provided more than the daily upper limit of vitamin B6 -- putting you at some risk of toxicity. This is because your supplement provided an amount of B6 close to the upper limit (and much more than normally needed) and there is an allowable manufacturing overage, as noted above. However, side effects have generally been reported with daily intakes above 200 mg and, more typically, above 1,000 mg, so it would be unusual for the B6 in your supplement alone (if properly made) to cause the side effects you reported. Foods also contribute B6, but it would also be unusual for any non-fortified food to have put you over the UL since foods naturally rich in B6 (like liver, other meats, potatoes, and bananas) provide about 0.25 to 1 mg of B6 per serving. Be aware that Europe uses a more conservative daily upper limit (25 mg) than in the U.S. For more about vitamin B6 see the B Vitamin Supplements Review >> ConsumerLab.com Answers
Question:
I thought the B vitamins were all water soluble and did not build up in the body, so you would not build up toxic levels. Am I wrong? Answer: Although B vitamins are water soluble and don't stay long in your body, large doses of certain B vitamins can cause serious toxicity, as summarized below. The same is true of vitamin C, the other water soluble vitamin. Unfortunately, there is no requirement for supplement labels to warn of these toxicities. As we have shown in our B Vitamin Supplements Review, many vitamins and energy drinks exceed the established Upper Tolerable Intake Levels (which vary by age) for B vitamins. If you have an established deficiency, high doses may be necessary; otherwise, remember that "more" does not necessarily mean "better." Toxicities from B Vitamins
More information about the beneficial and toxic effects of these vitamins, including associated dosage, is found in the B Vitamin Supplements Review. ConsumerLab.com Answers
Question:
Do any supplements help for tinnitus? Is it true that some supplements can cause tinnitus? Answer: A number of supplements are promoted for tinnitus, or ringing in the ear, but only a couple are supported by clinical evidence. Tinnitus has been associated with use of certain supplements, although a causal effect has not been proven. For details, which includes a discussion of pine bark extract (Pycnogenol), melatonin, vitamin B-12, zinc, Ginkgo biloba, CoQ10, weight loss supplements, as well as vitamin D and calcium, see the Full Answer >> For more information, use the links above. Also see the Encyclopedia article about Tinnitus. ConsumerLab.com Answers
Question:
Does nicotinamide riboside (as in Niagen and Basis) really have anti-aging or other health benefits? Answer: Nicotinamide riboside (sold as Niagen and Niacel) is a form of vitamin B3 (niacin) that has been promoted as having anti-aging effects, such as increasing energy, improving cognitive function, and improving cholesterol levels -- without causing flushing. However, the evidence for these uses appears to be very preliminary, as discussed in the "Niacin" section of the B Vitamin Supplements Review. Like supplements containing Niagen and Niacel, the supplement Basis (Elysium Health) includes 250 mg of nicotinamide riboside per recommended daily serving (typically two capsules) but also contains 50 mg of pterostilbene. Details about a clinical study investigating the effects of this supplement can also found in the "Niacin" section of the B Vitamin Supplements Review >> ConsumerLab.com Answers
Question:
Do any supplements help prevent or improve cataracts? Answer: A number of supplements have been promoted to preventing or improving cataracts. These include multivitamins, vitamin A, C, and E: the B vitamins niacin, thiamin, and riboflavin; lutein, zeaxanthin, astaxanthin, carnosine, NACA, and St. John's wort. The evidence, however, is better for some than for others. Get the details in the full answer >> See the Encyclopedia article on Cataracts for more information. ConsumerLab.com Answers
Question:
Is sublingual vitamin B-12 really better than the pill form? Answer: Although sublingual B-12 is often promoted for better absorption, there does not appear to be much evidence for this. In fact, one clinical study comparing the same amount of B-12 given orally or sublingually found they were equally effective at correcting B-12 deficiency over a two-month period. Be aware that sublingual B-12 supplements often contain sugar substitutes such as sorbitol, mannitol or sucralose, which can cause gastrointestinal symptoms in some people. It should also be noted that unlike the vitamin B-12 in foods, the purified form of B-12 found in supplements, including tablets, does not require stomach acid for absorption -- a potential concern for people with low stomach acid (including many people over the age of 50) or those who take acid blockers such as Pepcid or Zantac, or proton pump inhibitors such as Prevacid, or Prilosec, who are at an increased risk for B-12 deficiency. For those who have difficulty with large pills, keep in mind that only a very small amount of B-12 is required to meet the recommended daily intake and can be obtained in small tablets (including some tested by ConsumerLab.com in its B Vitamins Supplement Review). For more information about buying and using B-12 supplements, plus our tests of popular products, see the B Vitamins Supplements Review >> ConsumerLab.com Answers
Question:
I take estrogen replacement (Vagifem), to help relieve the symptoms of menopause. Are there supplements I should avoid, or be taking, due to this drug? Answer: Oral estrogen replacements, as well as estrogen creams and tablets (Vagifem, Estrace) can be affected by certain supplements and foods. See the full answer >> ConsumerLab.com Answers
Question:
Is P-5-P really better than "regular" vitamin B6? Answer: Pyridoxal-5-phosphate, sometimes called P-5-P or PLP, is the active form of vitamin B6 (pyridoxine). Most supplements provide the pyridoxine form of B6, although some provide pyridoxal-5-phosphate, or a combination of both. Taken at recommended doses, both forms appear to be relatively safe and have similar bioavailability for most people. Although pyridoxal-5-phosphate is sometimes promoted as more beneficial for people with diabetes, there do not appear to be any studies in people to support this. For more details, see the "What to Consider When Buying" section of the B Vitamin Supplements Review >> ConsumerLab.com Answers
Question:
Which supplements can help to lower blood pressure? Answer: There are many supplements, including fish oil, curcumin, certain probiotics, cinnamon and others, which may lower blood pressure. However, if you already take medication to lower blood pressure, always consult your physician before using these supplements, as they may lower your blood pressure too much, or interfere in some other way with your current medication. Be aware that a number of supplements can increase blood pressure. Sign in to see the full answer >> See the Encyclopedia article about Hypertension for more information. ConsumerLab.com Answers
Question:
Do any supplements improve balance or reduce the risk of falls? Answer: Moderate doses of vitamin D may improve balance and reduce the risk of falls in older adults deficient in vitamin D; however, be aware that too much vitamin D may actually increase the risk of falls. When combined with resistance exercise, supplementation with protein or creatine may help to build muscle in older adults (muscle loss has been associated with an increased risk of falls). Also, be aware that being deficient in vitamin B12 can cause problems with balance and gait, which could increase the risk of falls. ConsumerLab.com Answers
Question:
Are lozenges and sublingual pills considered dietary supplements? Answer: Lozenges and sublingual pills are, according the FDA, not dietary supplements if they deliver their contents only to the mouth or throat to exert their effect. (An example of this is noted in an FDA Warning Letter sent to a company marketing a "Zinc & Echinacea" throat lozenge). Keep in mind that just because a product is sold as a sublingual does not mean that it's been proven to work sublingually. Also keep in mind that the ingredients in lozenges do, of course, make their way into the gastrointestinal tract and can have additional effects once there. For example, while the zinc in zinc lozenges may have a local effect on the throat to reduce cold symptoms when taken at the correct dosage and frequency, ingestion of too much zinc from lozenges can cause one to exceed tolerable intake levels and, over time, have detrimental effects (see the Zinc Supplements and Lozenges Review for more information). ConsumerLab.com tests lozenges and sublingual pills (such as some vitamin B-12 products) and holds them to the same standards as dietary supplements — making sure they contain what they claim, lack common contaminants, and that tablets will properly disintegrate. ConsumerLab.com Answers
Question:
I was told I have a MTHFR gene mutation. What do I need to know about taking B vitamins? Answer: The MTHFR gene mutation may make your body less efficient at converting folic acid and folate into L-methylfolate, the active form of folate in the body. People with this mutation may also be more likely to be deficient in vitamin B-12. Although certain forms of B vitamins are sometimes promoted for people with this mutation, they may not be necessary. For more about this, see the "What to Consider When Using" section of the B Vitamin Supplements Review >> ConsumerLab.com Answers
Question:
I read on your website that some B-12 vitamins can cause diarrhea due to added sugar substitutes like sorbitol. I have had diarrhea and never thought it could be caused by my vitamin B-12 supplement, until I read your article and stopped taking the supplement. My diarrhea stopped immediately. Can you help me find a brand of B-12 that doesn't contain sorbitol or sugar substitutes that could cause this problem? Answer: It's true that in order to taste good, some B-12 supplements (such as dissolvable tablets, liquids, and sprays) contain sugar substitutes which can cause gas, bloating, and diarrhea, as discussed in the B-12 section of the B Vitamins Review. If you want to avoid these ingredients, you can check and compare the complete list of ingredients for each product, or see CL's Top Picks among B-12 supplements, where there are specific product suggestions, including those which don't contain gas-causing ingredients. ConsumerLab.com Answers
Question:
Which supplements can help with indigestion and/or heartburn? Answer: A variety of supplements may help reduce indigestion or heartburn, including specific herbs, minerals, enzymes, and probiotics. However, be aware that certain supplements may cause indigestion or stomach upset. Sign in to see the full answer and get details on how to use these supplements >> ConsumerLab.com Answers
Question:
Does Alpha Brain really improve memory, focus and cognition? Answer: According to the website for Alpha Brain (from Onnit Labs Inc.), it "...may help you remember names and places, focus on complex tasks, and improve your mental speed in response to stimuli." However, company-sponsored studies of Alpha Brain suggest it may be helpful for improving only limited aspects of memory and these studies have been conducted only with young adults. Sign in and get the details about Alpha Brain, including its clinical evidence, ingredients, and potential side effects and drug interactions. ConsumerLab.com Answers
Question:
Do vitamin B12 patches, like those from PatchMD, really work? Answer: Patches containing vitamin B12, such as those from PatchMD and Vita Sciences, are often promoted as an alternative to oral B12 supplements for people who have trouble swallowing pills or have difficulty absorbing B12 — which would include older adults, people who take medication to reduce stomach acid, or people who have had gastric bypass surgery. We looked into the research behind these patches. Find out if they are truly a better alternative in our full answer >> ConsumerLab.com Answers
Question:
What are the most common, potentially dangerous interactions between supplements and drugs? Answer: Fifteen percent of men and women ages 62 to 85 in the U.S. are potentially at risk for a dangerous interaction between a prescription drug, over the counter drug (OTC), and/or supplement they are taking, according to a study published in 2016 (Qato, JAMA Intern Med 2016). The most common drug and supplement combinations with the potential for harmful effects, according to that study, are warfarin (Coumadin) interacting with fish oil or garlic; the ACE inhibitor drug lisinopril (Zestril) interacting with potassium; and statin drugs like atorvastatin (Lipitor) and rosuvastatin (Crestor) interacting with niacin. For more about these drug interactions, use the links above. You may also check for others in the extensive Drug Interactions section in the Encyclopedia. ConsumerLab.com Answers
Question:
My HDL (good) cholesterol level is low. Should I take niacin to raise my HDLs? Answer: Niacin, at very high doses, can raise HDL levels, as well as lower elevated triglycerides -- both of which would seem to be good objectives, since higher HDL levels are generally associated with reduced risk coronary artery disease, as are lower triglyceride levels. However, it's not necessarily a good idea to take niacin to raise HDLs and there are safer ways to boost HDL levels. See the full answer >> ConsumerLab.com Answers
Question:
I've been taking a Daily Advantage multi but am now concerned by the very high % DV for vitamin C (833% DV), niacin (325% DV), and B vitamins (over 1,000% DV for several). The company tells me this formula is based on clinical experience and the scientific literature. What do you think? Answer: Unless you are deficient in each of these vitamins you don't need to take such high doses of each. Some may being doing more harm than good. It's good that you are now studying the ingredients listed on the label. You may still benefit from a multivitamin, but one which is likely to fill your nutritional gaps without exceeding upper tolerable intake levels. The following resources on ConsumerLab.com can help you: Recommended Daily Intakes and Upper Limits for Nutrients ConsumerLab.com Multivitamin and Multimineral Supplements Review (which includes our latest tests, comparisons, and suggestions of CL Approved supplements based on age and gender, such as women's, men's, age 50+, prenatal, and children's) ConsumerLab.com Answers
Question:
Can prenatal vitamins have too much folic acid? Mine has 800 mcg, but isn't that more than what's recommended? Is this dangerous to me or my baby? Answer: Prenatal vitamins can have too much folic acid, many do, and there is potential risk associated with this. Folic acid is a synthetic form of the B vitamin folate (B9) which naturally occurs in foods, such as green leafy vegetables. Folate can help reduce the risk of your baby being born with spina bifida (a leading cause of childhood paralysis) and other birth defects. While most adults need 400 mcg of folate daily, pregnant women need 600 mcg. To be sure you get this, it's suggested that you take a supplement with 400 mcg of folic acid and that you get the rest of your folate from your diet — from foods such as dark green leafy vegetables, oranges, and grain products enriched with folic acid. Unfortunately, many prenatal supplements provide 800 mcg or more of folic acid — double the recommended amount from a supplement. That's not all. Folic acid is absorbed much better (about 70% better) than folate from foods. This means that a prenatal supplement with 800 mcg of folic acid gives you the equivalent of 1,360 mcg of folate. (Labels will start making this clear 2018, but current labels don't). On top of this, many manufacturers put in extra folic acid (30% or more is not uncommon), so it's quite possible that your supplement which lists 800 mcg of folate from folic acid is giving you the equivalent of about 1,800 mcg of folate. Add to that the 300 to 400 mcg of folate you're likely already getting from foods and you can see that this can easily total of over 2,000 mcg of folate per day! The upper tolerable intake level (UL) for folate is 1,000 mcg (which applies only to that consumed from supplements and fortified foods from synthetic forms like folic acid) — so any supplement with more than 586 mcg of folic acid will cause you to exceed the limit. It's best not to exceed this because prolonged intake of excessive folic acid can cause kidney damage and can complicate the diagnosis of vitamin B-12 deficiency (folic acid supplementation can mask a symptom of vitamin B-12 deficiency). Of particular concern to pregnant women is that excessively high blood levels of folate (>59 nmol/L) in their blood was found to be associated with an approximate twofold increased risk of autism in their children according to an observational study in Baltimore in which 10% of women exceeded this level (Raghavan, International Meeting for Autism Research 2016). The study also found that when blood levels of both folate and vitamin B-12 were excessively high, the risk of autism was 17.6 times greater. (Note: Getting adequate folate during pregnancy may reduce the risk of autism; the concern is with getting too much). So what should you do? ConsumerLab.com has tested and compared many prenatal supplements and other multivitamins. Unfortunately, most on the market tested by CL to-date have too much folic acid (more will be tested in mid-2017). For now it may be safest to skip a "prenatal" vitamin with 800 mcg of folic acid and, instead, choose a daily multivitamin which provides 400 mcg of folic acid. The multi should also provide other nutrients of particular importance during pregnancy such as iodine (150 mcg), vitamin D (600 IU), and calcium (1,000 mg per day is the daily requirement, but don't take more than 500 mg at a time from a supplement). A challenge, however, is getting adequate iron, since the daily requirement during pregnancy (27 mg) is higher than for other pre-menopausal women (18 mg). A women's multi can provide all the nutrients listed above, but typically just 18 mg of iron, so you'll need to get extra iron from your diet. Alternatively, you can choose another multi and take a separate iron supplement providing about 27 mg of iron.
Your Prenatal Vitamin Needs a Check-up with CL founder, Dr. Tod Cooperman ConsumerLab.com Answers
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What is Brain Bright and can it really improve memory or cognition? Answer: Brain Bright (BioTrust Nutrition) is promoted on the company's website as a "science-backed" "triple-action brain enhancement formula" which promises to provide: 1) greatly improved memory and recall, 2) immediate concentration and razor-sharp focus and 3) second-to-none long-term brain health (by shielding the brain from toxins). Evidence: While the ingredients (and the amounts of these ingredients) in Brain Bright are each supported by some research suggesting a potential benefit, there are no published clinical studies on the effects of these ingredients when combined. The claims made on the website appear to be based on an unpublished study, along with studies by others on the different ingredients listed in the product. BioTrust provided ConsumerLab.com with a summary of the unpublished clinical trial -- which is cited on the company's website and referred to in this blog post by a BioTrust Nutrition "affiliate" (someone who is paid a commission for referring customers). The study involved 29 healthy adults between the ages of 19 and 68 (average age not given). It found that 2 tablets of Brain Bright taken daily for one week appeared to slightly reduce the number of mistakes on a test of concentration and short-term memory (approximately 1 mistake vs. 2.5 mistakes, respectively), but did not improve reaction time, processing speed or attention, compared to placebo. However, as data was not provided and the study results did not undergo peer-review for publication, it's difficult to draw any meaningful conclusions. In addition, no information about adverse effects was included. Here is the evidence for each of the key ingredients in Brain Bright based on studies of the individual ingredients. You can use the links to get more information about each ingredient on ConsumerLab.com. Also shown is the amount of each ingredient listed in the suggested daily serving size of 2 tablets: B Vitamins (riboflavin (8 mg), B-6 (20 mg), folate (as folic acid) (800 mcg), B-12 (methylcobalamin) (500 mcg) - The same doses of B-6, folic acid, and B-12, taken together, were found in one clinical study to slow cognitive decline in people age 70 years or older with mild cognitive impairment (riboflavin, however, was not used in the study). Gingko biloba (240 mg of extract standardized to 24% glycosides, 6% lactones, and < 1 ppm ginkgolic acid) - Although this amount and type of extract is in-line with those used in some clinical studies for cognitive function, some experts have concluded there is little evidence that gingko improves cognitive function. The Brain Bright claim of "second-to-none long term brain health (by shielding the brain from toxins)" appears to be based on laboratory and animals studies demonstrating the antioxidant activity of ginkgo glycosides. However, we are not aware of any studies demonstrating long-term brain health benefits based on gingko's antioxidant properties. Rhodiola rosea (200 mg root extract standardized to 5% rosavins and 2% salidrosides) — Doses in this range have shown some efficacy for improving certain measures memory and mental fatigue in a few small studies. However, overall, due to contradictory findings and design flaws in the studies, some researchers concluded there is insufficient evidence for this use. N-acetyl-L-tyrosine (500 mg) - N-acetyl-L-tyrosine is converted into the amino acid tyrosine in the body. Although a few, small studies suggest tyrosine may improve memory or mental function in people who are sleep deprived or exposed to other forms of stress, it should be noted that these studies used higher doses of L-tyrosine (2,000 mg to 15,000 mg). In addition, it's not clear how much N-acetyl-L-tyrosine is actually converted into tyrosine in the body (Magnusson, Metabolism 1989; Van Goudoever, J Parenter Enteral Nutr 1994). Acetyl-L-carnitine (500 mg) - There is some evidence that acetyl-L-carnitine may provide some help for age-related memory impairment, however, typically at a higher dosage (1,500 to 2,000 mg). L-theanine (100 mg) - There is evidence that taking 50 mg of this amino acid (which is also found in black and green tea) may increase alpha brain wave activity, which plays an important role in attention, within less than an hour of taking. This research may be part of the basis for the claim that Brain Bright promise of "immediate concentration." Brain Bright also contains 5 mg of black pepper extract (BioPerine), an ingredient which is sometimes added to supplements to enhance the bioavailability of certain ingredients. Safety: It's important to note that the directions for use state: "Take 1 tablet 2 times daily, preferably without food, or, for enhanced concentration take 2 tablets as needed. Do not exceed 6 tablets per day." Taking the maximum recommended dosage of 6 tablets would provide three times the dosages of each ingredient as listed above. There are risks associated with taking such high doses of some of these ingredients, including vitamin B-6, B-12 and folic acid. Furthermore, there are no published studies on the safety of taking all of these ingredients together. For example, both Ginkgo biloba and Rhodiola may lower blood sugar, and both Rhodiola and L-theanine may lower blood pressure. There are also potential interactions with medications for some of these ingredients. More information about potential side-effects and drug interactions for each ingredient can be found in the "Concerns and Cautions" sections of ConsumerLab.com's product reviews, which you can find by clicking on the above links to each review. ConsumerLab.com has not tested Brain Bright to determine whether this product contains what it claims, and without contaminants. Cost: Brain Bright costs $49 for a bottle containing 60 tablets - a 30 day supply if you take the recommended 2 per day. The website claims there is a one-year money back guarantee and you will not be enrolled in an auto-delivery program. The bottom line: Brain Bright contains several ingredients in doses which some small studies suggest may help to improve memory and cognition. However, there are no published clinical studies showing that these ingredients are safe or effective when taken together as in the Brain Bright formula. Furthermore, the overall evidence for two of its main ingredients, ginkgo and rhodiola, is currently considered insufficient for memory and cognition, and the evidence for the other ingredients is quite preliminary. See the Encyclopedia article about Enhancing Memory and Mental Function for more information. ConsumerLab.com Answers
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Are the "% DV" numbers on vitamin supplement labels really based on what I need? Answer: Yes and no. The most current DVs (Daily Values), updated by the FDA in 2016, do accurately reflect the basic daily intake requirements for vitamins and minerals. However, companies are not required to use the updated DVs on product labels until at least 2020. In the meantime, many vitamin and supplement labels will be misleading — providing "%DV" values based on terribly out-dated DVs establish in the 1960s. The new DVs include separate values for infants, very young children, and women who are pregnant and lactating. Some important changes in 2016 to the DVs for most adults and children over age 4 include the following. (Keep in mind that your supplement label is most likely still based on old DVs):
ConsumerLab.com lists the new DVs (as well as RDAs and Upper Tolerable Intake Levels (ULs)) for each vitamin and mineral at www.consumerlab.com/rdas. You'll find further information about each nutrient within our Product Reviews, including our tests, reviews, ratings, and comparisons of products. ConsumerLab.com Answers
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Are there any supplements I should avoid when taking an antibiotic? Are there any that may be helpful? Answer: Antibiotics can be affected by the supplements you take, and they can affect your ability to absorb certain vitamins and minerals. The interactions will depend on the type of antibiotic you are taking. You can search for the specific antibiotic you are taking by name in the Drug Interactions section of our ConsumerLab.com. Some of the most common antibiotics are listed below, followed by the supplements with which they can interact. Use the links for more details: Amoxicillin (Amoxil, Trimox, Wymox): Bromelain, vitamin K Cephalosporins (cephalexin (Cefanex, Keflex, Keftab, Biocef), cefdinir (Omnicef), etc.): Vitamin K Fluoroquinolones (ciprofloxacin (Cipro), levofloxacin (Levaquin)): Calcium, magnesium, iron and zinc, fennel, Dong Quai, St. John's Wort Tetracyclines (doxycycline (Bio-Tab, Doryx, Doxy-Caps), tetracycline hydrochloride (Achromycin V, Panmycin etc.): Calcium, magnesium, iron and zinc, Dong Quai, St. John's Wort, citrate (i.e. potassium citrate) Trimethoprim/sulfamethoxazole (Bactrim, Cotrim, Septra, Sulfatrim): Folate, PABA (para-aminobenzoic acid), potassium, white willow, St. John's wort Interestingly, some of the supplements noted above (folate and vitamin K) may, at times, be helpful when taking certain antibiotics, as can probiotics. ConsumerLab.com Answers
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Which supplements help with Raynaud's phenomenon? Answer: As discussed in the Raynaud's phenomenon article in the Encyclopedia, fish oil, Ginkgo biloba, inositol hexanicotinate (a form of the B vitamin niacin), and ginseng have shown some benefit in Raynaud's phenomenon (abnormal sensitivity of hands and feet to cold). Several other types of supplements have been tried without success. For more information, including dosage and clinical evidence, use the links above, and see the Encyclopedia article about Raynaud's phenomenon. You can also find information for many other medical conditions in the Conditions section of the Encyclopedia, and by searching our index of Health Conditions. ConsumerLab.com Answers
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I've heard that having low B-12 or B-6 can cause depression. Is that true? Answer: Yes, being deficient in vitamin B-12 or B-6 can cause depression. Correcting a deficiency in one of these vitamins may help improve symptoms of depression, and some B vitamins may increase the effectiveness certain antidepressant medications, such as SSRI's. For more about B vitamins and depression, see the "What It Does" section of the B Vitamins Supplements Review >> ConsumerLab.com Answers
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Can vitamin B-12 help prevent or reduce canker sores? Answer: In people with recurrent canker sores (also known as aphthous stomatitis), a daily dose of vitamin B-12 was found to reduce the number and duration of outbreaks, as well as decrease pain, according to one study. For details, including dose, and our tests of B-12 supplements, see the B Vitamins Supplements Review >> (There is also some evidence that the amino acid L-lysine may help to prevent canker sores and reduce healing time.) For information about other proposed treatments, see the Encyclopedia article about Canker Sores. ConsumerLab.com Answers
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Which supplements help to improve energy and decrease fatigue? Answer: Getting adequate sleep, eating a healthy, well-balanced diet, and regular exercise are the best ways to maintain your energy. However, we all have times when we could benefit from an energy boost. (If you are frequently tired, be sure to consult your physician about potential causes, as discussed below). Certain supplements may help increase energy and decrease fatigue. CoQ10, which plays a role in energy production in cells, has been shown to decrease fatigue in people with conditions such as heart failure and Gulf War Illness. One small study suggested it may increase self-assessed "vitality" in older adults. (Be aware that taking CoQ10 in the evening can cause insomnia in some people). Curcumin (from turmeric) has been shown to reduce fatigue in older men and women using a particular branded formula. Ashwagandha may reduce fatigue in middle-aged adults with moderate to severe anxiety. Cocoa flavanols may help reduce self-reported mental fatigue in healthy adults, according to one study. Ginseng is a popular ingredient in supplements promoted for increasing energy and vitality. Although there is little evidence to support this effect in healthy people, there is some evidence it may increase energy in people with cancer-related fatigue. Carnitine may help reduce fatigue in older men with symptoms of sexual dysfunction, depression and fatigue. B vitamins are involved in the metabolism of food to release energy, and deficiency in vitamin B-12 is known to cause fatigue. However, if you already get an adequate amount of the B vitamins in your diet and are not deficient in them, supplementing with additional amounts of B vitamins is not known to improve performance. Be aware that energy drinks often contain much higher doses of B vitamins than needed — sometimes amounts above tolerable limits. Energy drinks also commonly contain significant amounts of caffeine or ingredients which naturally contain caffeine such as guarana and cola nut. Although caffeine does not actually provide energy, it acts as a stimulant and can reduce fatigue. Be aware that energy drinks can increase blood pressure, and stroke and liver injury have been reported in people consuming certain energy drinks. Energy bars, or nutrition bars, can be a good source of real energy (calories), especially if you are on the go and haven't had a chance to eat a real meal, and also provide vitamins and minerals. It's important to choose carefully as some are high in sugar, or contain sugar substitutes that may upset your stomach. Some also contain caffeine. Supplements that provide iodine, such as kelp supplements and potassium iodide, are often promoted to increase energy. However, there is little evidence for this effect unless they are being used to treat hypothyroidism due to iodine deficiency. Rhodiola rosea and maca supplements are sometimes promoted to increase energy or reduce fatigue, however, there is not enough evidence to support these supplements for this use. Iron deficiency can cause fatigue. Consequently, correcting iron deficiency with iron supplementation can reduce related fatigue. Interestingly, iron supplementation has even been shown to reduce fatigue in women who are not anemic but have ferritin levels in the lower end of normal range. If your fatigue is caused by difficulty sleeping, melatonin or other supplements for sleep may be helpful. (Note that taking high-dose vitamin D may reduce your body's natural production of melatonin). Be aware that St. John's wort can cause fatigue when you take it, or if you abruptly stop taking it. Because there are many possible causes of fatigue, it's important to consult with your doctor if you feel tired frequently. See the Encyclopedia article about Fatigue for more information. ConsumerLab.com Answers
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Which supplements reduce the risk of stroke? Which increase the risk of stroke? Answer: Certain supplements have been shown to reduce the risk of stroke, while others may increase that risk. In addition, certain nutrients from foods may reduce the risk of stroke — although the benefit does not necessarily carry over to those nutrients when obtained from supplements, as discussed below. Also be aware that some supplements may increase the risk of stroke, as noted below. Keep in mind that there are different causes of stroke. The most common type of stroke, called ischemic stroke, occurs when blood flow to a part of the brain is blocked, either by a blood clot or plaque build-up in arteries (atherosclerosis), depriving the brain of oxygen. The second, less common, type of stroke is hemorrhagic stroke, which occurs when a blood vessel inside the brain leaks blood or ruptures, creating pressure which damages brain cells. Risk factors for stroke include high blood pressure, diabetes, high cholesterol, atherosclerosis, atrial fibrillation, heart failure, and carotid artery disease (build up of plaque in the main artery in the neck which carries blood to the brain). Lack of physical exercise and being overweight, frequent use of NSAIDS (such as ibuprofen), stress and depression also increase the risk of stroke. Supplements that may reduce the risk of stroke: (Use the links for more details such as dose.) Getting a certain amount of vitamin D per day from food and/or supplements may reduce the risk of ischemic and hemorrhagic stroke in men, but this benefit has not been shown in women. Folic acid (vitamin B-9) supplementation may decrease the risk of stroke in people who have very low or deficient levels of folic acid. However, be aware that there are risks associated with getting too much folate, and current supplement labels may mislead you to consume more folate than you need or is safe for you. It's also important to note that consuming high doses of other B vitamins from supplements, such as B-6 and B-12, may increase the risk of stroke, as well as heart attack and death, in people with diabetes who also have advanced kidney disease. Nattokinase supplements may decrease blood-clotting factors in the blood, however, there are no published clinical studies in people showing that these supplements reduce the risk of blood clots (which, as discussed above, can cause ischemic stroke). A daily dose of NAC (N-acetyl cysteine) was found to reduce the incidence of cardiovascular events, including ischemic stroke and heart attack, by 40% compared to placebo in people with end-state renal failure. As discussed in the Encyclopedia article about Strokes, several other supplements, such as policosanol, vinpocetine and glycine have been proposed to help reduce the risk or improve recovery from stroke, although the evidence for these is not strong. Be aware that taking a daily multivitamin has not been found to reduce the risk of stroke. Foods that may reduce the risk of stroke: The following types of foods may reduce the risk of stroke — although the substances in these foods have not been shown to provide the same benefit when given as supplements. Higher intakes of calcium from foods are associated with a reduced risk of coronary artery calcification (a form of atherosclerosis), while the use of calcium supplements is associated with an increased risk. Higher intakes of vitamin K2 from foods are also associated with a reduced risk of coronary calcification — while this benefit has not been shown from vitamin K supplements. Eating fish has been associated with a 6% to 12% lower risk of ischemic and hemorrhagic stroke, depending on how many servings of fish per week were consumed. However, taking fish oil supplements has not been found to have the same benefit. Getting more magnesium from your food can help reduce the risk of stroke: One study found that people who consumed more magnesium per day than average had an 8% lower risk of strokes of any kind and a 9% lower risk of ischemic stroke. However, this does not mean that magnesium supplements necessarily have the same risk-lowering effect. In men and women at high risk for cardiovascular disease, consuming a certain amount of extra-virgin olive oil daily, as part of a Mediterranean diet was found to reduce the risk of ischemic and hemorrhagic stroke, heart attack and death by 30%. In observational studies, drinking several cups of green tea per day was found to reduce the risk of ischemic stroke by up to 21%. Supplements that may increase the risk of stroke: There is concern choline from supplements and foods can increase the risk of stroke. However, a specific form of choline may help to improve recovery from stroke. People who have had a stroke or are at risk for a stroke, should not take Ginkgo biloba. Be aware that a case of hemorrhagic stroke associated with the consumption of a popular energy drink has been reported. Also, be careful if you choose to use a weight loss supplement — the FDA has issued many warnings about weight loss supplements found to contain undeclared sibutramine, a drug which can substantially increase blood pressure and pulse rate in some individuals, and may present a significant risk for people with a history of stroke (Scroll down to the "Warnings" section here for a list of some of these products). ConsumerLab.com Answers
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Do biotin supplements really improve hair and nails? Answer: Biotin supplements are often promoted to improve hair growth, strength, or sheen -- possibly because biotin deficiency can cause symptoms such as dry, thinning hair and loss of hair color. However, biotin deficiency is quite rare -- the recommended daily intake of biotin is easily obtained from food, and there is no evidence biotin improves the growth or texture of hair in people who are not deficient. Preliminary evidence that biotin supplementation may strengthen brittle nails. Be aware that biotin, especially taken at high doses, can interfere with certain medications and laboratory tests. For details, see the Biotin section of the B Vitamin Supplements Review, which includes CL's test results of products >> and CL's Top Pick among biotin supplements. ConsumerLab.com Answers
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Which supplements can cause diarrhea? Answer: There are a number of supplements which can cause diarrhea. Discussed below are some of the most common culprits. Diarrhea can also be caused by certain medications, illness and infection, and certain health conditions, such as irritable bowel syndrome (IBS) and lactose intolerance -- so be sure to consult with your physician if you experience severe or chronic diarrhea. Supplements with a laxative effect: Magnesium supplements can cause diarrhea and, in fact, are often taken for their laxative effect. However, if you are taking magnesium for other reasons, and want to avoid this effect, certain forms of magnesium are less likely to cause diarrhea. Taking your magnesium supplement with food can also reduce the occurrence of diarrhea. Aloe supplements containing latex are also known for their laxative effect. If you are taking aloe for a different purpose, be sure to choose a product labeled as aloe gel or vera leaf juice which has been processed to remove the latex. Be aware that many weight loss supplements contain herbs with laxative properties, such as cascara, frangula, rhubarb root and senna, so be sure to carefully read the label if you are taking a supplement for weight management or "cleansing", such as certain acai supplements and drinks. Certain types of fiber can also have a laxative effect, but do not necessarily cause diarrhea — some forms of fiber, in fact, may be helpful for diarrhea associated with IBS. Other common supplements that can cause diarrhea: Fish oil and other supplements containing omega-3 fatty acids, or a combination of omega-3 and omega-6 fatty acids, such as flaxseed oil and borage oil, can cause diarrhea. Taking smaller doses throughout the day, rather than a single, large dose, may help reduce this effect. Taking large doses of vitamin C can cause diarrhea. Other supplements which can cause diarrhea when taken in high doses include ashwagandha, NAC (N-acetyl-cysteine), lysine, iodine and kelp supplements which contain iodine, D-limonene, and yacon syrup. Other supplements which can cause diarrhea include curcumin/turmeric, St. John's wort, berberine, creatine, 5-HTP, nattokinase, chlorella, modified citrus pectin (MCP), and beta-sitosterol, a common ingredient in cholesterol-lowering supplements and prostate supplements. Unexpected sources: An often-over-looked cause of diarrhea from supplements can be from added sugar substitutes such as sorbitol. Sorbitol can be found in protein and nutrition bars (ConsumerLab.com lists amounts of sugar alcohols (such as sorbitol and mannitol) in popular bars in its Review) and some protein powders and drinks and meal replacement and weight management meals and shakes. These chemicals can also be found in certain zinc lozenges and some B12 supplements, especially dissolvable tablets, liquids and sprays, although occasionally in regular tablets as well. ConsumerLab.com Answers
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Do any supplements help for restless legs syndrome? Answer: Although no large studies have been conducted, smaller studies suggest a possible role of supplements in reducing the symptoms of restless legs syndrome (RLS), a condition that causes uncomfortable "creepy-crawly" sensations, agitation, and the need to move the legs when trying to fall asleep. Women are twice as likely to suffer from restless legs syndrome than men, and it occurs more often with increasing age (Wang, Sleep Med 2009). People with deficient or low blood levels of iron are also more likely to experience RLS. As discussed in more detail in the "What It Does" section of the Iron Supplements Review, a study found that taking a combination of high-dose iron and vitamin C (which helps to increase iron absorption) can decrease symptom severity in people whose blood levels of iron are low. However, it's important to consult your physician before supplementing with iron for RLS. As discussed in the "What It Does" section of the Magnesium Supplements Review, a preliminary study suggested that taking magnesium in the evening could be helpful for RLS; however, there have not been large, well-controlled studies investigating this treatment. Similarly, as discussed in the "What It Does" section of the Potassium Supplements Review, one preliminary study suggested that potassium may help reduce the severity of RLS symptoms, but no well-controlled studies have been conducted to prove this. As discussed in our Encyclopedia article about Restless Legs Syndrome, there is very preliminary evidence that folate and vitamin E might be helpful. Be aware that melatonin supplements may increase leg movements in people with restless legs syndrome RLS. Caffeine, alcohol, SSRI antidepressants, antihistamines, and most antipsychotic and antinausea medications can potentially increase RLS symptoms (Cotter, Ther Clin Risk Manag 2006). Also be aware that RLS can occur as a result of kidney or liver disease. People with these conditions should consult with a healthcare professional before taking supplements (Cotter, Ther Clin Risk Manag 2006; Franco, J Clin Sleep Med 2008). ConsumerLab.com Answers
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Do Sugar Bear Hair Vitamins make hair shine, nails stronger, and help both to grow? They taste good but are super expensive. Answer: These gummy supplements, labeled as "SugarBearHair Hair Vitamins" were launched in 2016, are extensively promoted, and appear to have become popular, particularly on college and high school campuses. The website that promotes them claims that "The majority of our customers found their nails and skin quality improved over time while taking SugarBearHair." However, there doesn't appear to be any published study showing that the specific formula in SugarBearHair improves hair or nails. The dominant ingredient in SugarBearHair is biotin. The daily requirement for biotin (vitamin B7) is just 30 mcg (micrograms) for adults and 25 mcg for 14 to 18 year-olds, and nearly everyone gets this and more from the foods they regularly eat (see the Biotin section of the B Vitamins Review). A daily serving (2 gummies) of SugarBearHair is listed as providing 5,000 mcg of biotin -- 167 times the adult daily requirement. The apparent rational for this mega dose is a small study (by a pharmaceutical company) published in 1990 that showed a 25% increase in nail thickness and a reduced tendency for split nails when 2,500 mcg of biotin was taken twice daily for 6 to 9 months, and another study suggested that biotin deficiency may be common among women complaining of hair loss. However, there are no studies to suggest that biotin supplementation improves hair growth or texture in people who are not deficient in biotin. On Amazon.com, the current price for SugarBearHair Hair Vitamin is about $32 for a bottle of 60 gummies — or about 53 cents per gummy, so over $1 per day for 2 gummies, which is very expensive based on its ingredients. If you want to get 2,500 mcg of biotin, you can get it for much less from other supplements on the market. For example, in our most recent B Vitamin Supplements Review we tested and Approved a hair, skin, and nails formula that costs just 10 cents per pill and provides 2,500 mcg of biotin, as well as a product that provides the entire 5,000 mcg in a single pill for even less — 5 cents. SugarBearHair appears to be safe based its listed ingredients (ConsumerLab.com has not yet tested this product, but may in the future): None of the ingredients exceed Upper Tolerable Intake Levels. The gummies include moderate amounts of vitamins A, B5, B6, B12, C and D, E and relatively small amounts of iodine, choline, and inositol. But don't expect these gummies to provide all the vitamins and minerals that are found in a multivitamin/multimineral -- it does not contain any iron (important to women prone to iron deficiency) or calcium (to support bone growth, particularly in young women). If you need these, there are many good multivitamins that provide all the essential vitamins and minerals and cost as little as 7 cents per day. One of these, plus a biotin supplement, would provide everything in SugarBearHair and more at roughly half the price. Be aware that high-dose biotin in SugarBearHair Hair vitamins can potentially throw off results of variety of blood tests such as those for thyroid function. If you are getting blood tests, be sure you tell your doctor and consider discontinuing use of the vitamin at least several days prior to the tests. The bottom line on SugarBearHair Hair Vitamins:SugarBearHair Hair vitamins are not likely to help you unless you have a vitamin deficiency, and if you do a have deficiency, other supplements are available that are much less expensive. Also, be aware that these vitamins don't provide minerals such as iron or calcium, which would be found in a multivitamin/multimineral supplement. If you take SugarBearHair Hair vitamins, tell your doctor that you are taking high-dose biotin, as it may affect results of blood tests. ConsumerLab.com Answers
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What are the symptoms of vitamin B6 deficiency? Answer: Although mild deficiency may not cause apparent symptoms, severe deficiency in vitamin B6 (pyridoxine) can cause changes in the tongue and skin, mood, as well as nerve damage. People with certain medical conditions and those who take certain antibiotics or anti-epileptic medications may be at greater risk of deficiency. B6 supplements can help to correct a deficiency. More details can be found in the Vitamin B6 section of the B Vitamin Supplements Review (also see our Top Picks among B6 supplements). Be aware that getting too much B6 can also cause nerve damage as well as skin lesions, and B6 supplements can increase or decrease the effectiveness of certain drugs. ConsumerLab.com Answers
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I read that aging lowers the body's capacity to produce vitamin D. Even regular sun exposure will not suffice and one may have to take a vitamin D3 supplement during old age to meet our body's regular requirements. Please comment on this. Answer: This is not entirely correct. Older people are certainly able to produce vitamin D from sun exposure and can produce adequate amounts, but, for a number of reasons, vitamin D levels tend to be lower in older people, making it important for many to increase sun exposure and/or increase vitamin D in the diet (which may include supplements). More details about this are found in the "What to Consider When Buying" section of the Vitamin D Supplements Review >> You may also be interested in these related CL Answers: Is it possible to get too much vitamin D? >> As vitamin D is a fat-soluble vitamin, why is it necessary to take it every day? >> Is it true that vitamin D can increase the risk of prostate cancer in men? >> Which supplements help with depression and anxiety? >> Which supplements help reduce the risk of colorectal cancer? >> ConsumerLab.com Answers
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Which supplements help with depression and anxiety? Answer: A wide variety of supplements have shown some benefit in reducing anxiety and/or depression, as summarized below (with links to more details -- including dosage -- within our reports). Fish oil has been found to be helpful for both depression and anxiety. Supplementing with fish oil with a high percentage of the omega-3 fatty acid EPA has been shown to improve symptoms in moderate and major depression (although not in mild depression) and may help to improve the effectiveness of various antidepressant medications. Similarly, fish oil high in EPA has been shown to significantly reduce anxiety. Certain strains of probiotics have been found to reduce symptoms of depression and anxiety in short term studies, and one prebiotic product has been shown to lower levels of the "stress" hormone cortisol, as well as improve responses in a test associated with anxiety and depression. A small clinical study in people already taking prescription medication for major depression found daily supplementation with curcumin significantly reduced depressive symptoms after four weeks and the effect was greater in those with atypical depression. The study found that anxiety was also reduced in those taking curcumin, although this reduction did not reach statistical significance. A saffron extract was found to decrease self-reported symptoms of depression and anxiety (including separation anxiety, social phobia, panic, obsession and compulsions) compared to placebo in a two-month study of 80 adolescent boys and girls with mild-to-moderate anxiety and/or depression. Those who took the extract reported an average decrease in symptoms of 33%, compared to a 17% reduction in those who took a placebo. The dose of the extract (affron® -- standardized to 3.5% lepticrosalides) was 14 mg taken twice daily. Parents of those taking the saffron extract reported a 40% reduction in symptoms, compared to a 26% reduction perceived by parents of those taking placebo. (See the Encyclopedia article about saffron). The study was funded by the manufacturer of the extract, Pharmactive Biotech Products (Lopresti, J Affect Disord 2018). One study found 5-HTP to be as effective as fluvoxamine (Luvox) for depression, with fewer side-effects; it was also found to be effective in people suffering from anxiety disorders, although not as effective as the prescription medication clomipramine. There is evidence for a number of other supplements that may be helpful specifically for depression, including St. John's wort, SAMe, DHEA, and Rhodiola rosea. In women, daily supplementation with folic acid has been shown to increase the effectiveness of the antidepressant SSRI drug fluoxetine (Prozac) and increase the rate of recovery from depression compared to treatment with Prozac alone. Some, but not all research suggests that L-theanine, an amino acid found in black and green tea (also sold in tablet and capsule form) may reduce stress and anxiety without causing drowsiness. Having low blood levels of vitamin D is associated with a higher risk and severity of depression. One study found that supplementation with high-dose vitamin D significantly improved mood in women with type 2 diabetes who had serious depressive symptoms. Having low blood levels of magnesium, and having a low intake of magnesium from foods are also each associated with an increased risk of depression. One small clinical study suggests magnesium supplementation may help reduce symptoms of depression. In one clinical study, taking ashwagandha daily, in addition to a multivitamin, was shown to significantly reduce anxiety compared to treatment with a weekly psychotherapy session and a placebo. It has also been shown to reduce symptoms of anxiety mixed with depression and panic disorder. NAC has been shown to significantly reduce the anxiety-related compulsion to pull hair, known as trichotillomania. The herbs passionflower and lemon balm may also be helpful for anxiety. Although melatonin and valerian are sometimes promoted for anxiety, there is not enough evidence to support their use for this purpose. There is weak evidence, however, that valerian may produce calming effects in stressful situations. A number of studies suggest kava may reduce symptoms of anxiety; however, be aware there are potential safety issues and drug interactions. (See the Encyclopedia article about Kava for more information). In addition to their potential as stand-alone agents, a review of clinical studies investigating the use of supplements along with antidepressant medications (including SSRI drugs such as fluoxetine and sertraline and tricyclic drugs such as amitriptyline) found that SAMe, EPA from fish oil, methylfolate and vitamin D may increase the benefits of these drugs (Sarris, Am J Psychiatry 2016). Deficiency in B-3 (niacin), B-6, and/or B-12 can cause depression and some studies show that giving B-6, B-12, or folate may help with depression, particularly among those deficient in these vitamins. However, if you are taking a prescription medication to treat depression or anxiety, consult your physician before taking any of the supplements mentioned above as there could be a risk of drug interactions. For more about this, see the extensive Drug Interactions section of our website. Consult with a qualified health professional for any serious symptoms of anxiety or depression. ConsumerLab.com Answers
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Is there cause for concern with "gummy vitamins?" There are many different gummies out there. Are some better than others? Answer: Tests by ConsumerLab.com have found that some gummy supplements -- particularly gummy multivitamins -- do not contain their listed amounts of vitamins or minerals, or contain impurities. We continue to find more problems with candy-like vitamins like gummies than with traditional forms, such as tablets and caplets. Manufacturing challenges associated with candy-like products likely explain the higher incidence of problems. Gummies are notoriously difficult to manufacture because it is hard to measure in the correct amounts of vitamins and minerals (some are simply sprayed on a candy base) and the ingredients in a gummy are more likely to degrade, so manufacturers often put in more than the listed amount -- resulting in products with too much of a vitamin, such as folic acid, when first produced and decreasing amounts over the course of their shelf-lives. Some companies seem to do a better job making gummy vitamins than others. You can see which gummies we have reviewed lately -- and which passed or failed our tests -- in our reports on multivitamins, vitamin C, vitamin D, and calcium, and B vitamins. A benefit of gummies is that they may be more palatable than a pill. Also, being chewable, there is not the risk that the product won't properly break apart, as there is with a tablet. A risk with any candy-like supplement, particularly for children, is that too many will be consumed, potentially resulting in toxicity. It's therefore best to give young children vitamins as needed and not leave them out. Also, keep in mind that not all vitamins, minerals, and other ingredients are easily incorporated into gummies or are not included due to poor taste (such as iron, which would cause a metallic taste), so, if you are interested in a gummy supplement, check that it lists the ingredients you want. You can check the ingredients in gummy supplements in "Ingredients" table in each of our reports listed above. ConsumerLab.com Answers
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Are liquid vitamins better than pills? Answer: There are pros and cons to liquid vitamins. Pros: A benefit of a liquid is that you avoid the risk that an improperly made pill will not break apart and fully release its ingredients. ConsumerLab subjects the tablets and caplets it reviews to a disintegration test for this reason and has come across many pills that don't break apart at all or, more often, only partially break apart. For example, in 2017, multivitamins from two different companies failed to break apart fully after 30 minutes (the required time as per the U.S. Pharmacopeia) and still had not fully disintegrated after another 30 minutes. Another issue avoided with liquids is the trouble some people (particularly young children and older adults) with swallowing tablets or capsules. Liquids may be preferable for people who have trouble with digestion due to gastric surgery or other reasons. Having a supplement in liquid form also makes it easier to modify the dose. For example, if a supplement, like vitamin D liquid drops or a fish oil liquid, is being shared among family members, it is very easy to give each person their specific dose by changing the number drops or fraction of a teaspoon that you administer. Some ingredients in supplements are hygroscopic, i.e., they attract water, and pills containing them can quickly become "wet" from moisture in the air. Magnesium chloride a good example of this, but it is also the preferred form if you need to take high-dose magnesium as it is less likely to cause diarrhea than other forms. It is therefore better to take magnesium chloride as a liquid than as a pill. See our Magnesium Supplements Review for our Top Picks for magnesium supplements, including magnesium chloride. Cons: A risk of a liquid is that some ingredients are less stable in a liquid environment, resulting a loss of ingredient over time. This is of particular concern with vitamins such as vitamin C and folic acid. ConsumerLab has also come across this problem with creatine supplements, where creatine breaks down to creatinine. You will also need a pill form rather than a liquid if you need to delay the absorption (such as with a timed-release melatonin), or are trying to deliver the ingredient intact to the intestine without being digested in the stomach, such as with some enteric coated probiotics and fish oils. Some liquid supplements may require refrigeration making it difficult to take with you during the day or when travelling. ConsumerLab.com Answers
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Do any supplements help prevent or reduce eye floaters? Answer: A variety of supplements have been promoted for preventing or reducing eye floaters including vitamin C and lutein, ginkgo, milk thistle, collagen and hyaluronic acid. Find out if any of these have been shown to be helpful in clinical trials. See the full answer >> ConsumerLab.com Answers
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Do any supplements help reduce the symptoms of premenstrual syndrome (PMS)? Answer: There is fairly good evidence that calcium supplements can significantly reduce the major symptoms of PMS, such as mood swings, pain, bloating, irritability, depression, back pain, and food cravings. There is also some evidence that magnesium, vitamin E, Gingko biloba, royal jelly, and chasteberry, may be helpful for reducing symptoms of PMS. The evidence is mixed on whether or not other supplements which are commonly promoted for PMS, such as vitamin B6 and evening primrose oil, are helpful. More about the evidence for these supplements, dosage, and information about other proposed treatments, is found in the Encyclopedia article about Premenstrual Syndrome. In addition, be aware that women with a high intake of iron from certain sources have been shown to have a lower risk of suffering PMS than those with lower intakes -- while high intakes of potassium have been associated with an increased risk of PMS. See these related CL Answers: Will pregnenolone help slow down aging? THIS CONTENT IS COPYRIGHT PROTECTED
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