Supplement safety

Dietitian, Annica Rust, educates us on when and how to take supplements in a safe manner.

The South African Health Products Regulatory Authority (SAHPRA) is an entity of the National Department of Health and is responsible for the regulation of all health products in SA.⁴

In SA a health supplement can be defined as substance, extract or mixture of substances as determined by SAHPRA, with the aim to restore, correct or to modify a physical or mental state by (a) complementing health; (b) supplementing the diet; or (c) nutritional effect.⁴ This excludes injectable preparations, medicines or substances listed as schedule 1 or higher.

Schedule 0 substances that may typically be considered to be a health supplement include: prebiotics; vitamins; minerals; amino acids; animal extracts, products and derivatives; fats, oils and fatty acids; carotenoids, bioflavonoids, saccharides and enzymes.⁴

Regulation on supplements in SA

SAHPRA will ensure that safety, efficacy and quality standards of medicines and medical devices are met. Supplements in SA are classified as schedule 0 and are not currently regulated by SAHPRA.

However, SAHPRA is working on an online directory of schedule 0 – 2 products that have been approved by them. This still needs to be released.⁴

Misconceptions of supplements

Just because it’s natural doesn’t mean that it’s a safe supplement to use. Supplements, such as garlic, ginger, ginkgo biloba and echinacea, are sold as natural, but may contain harmful chemicals, which should be removed prior to use.

Dosage is also related to safety; accordingly small amounts of supplements may be safe when consumed, but concentrated extracts sold as liquids or pills, may contain far greater amounts that are deemed to be safe.³

More is not better. A high intake of vitamins and minerals can be dangerous and toxic.³ For example, taking too much vitamin C (more than 3000mg daily) can cause kidney stones and gastro-intestinal side effects. Fat soluble vitamins, such vitamins A, D, E and K, can reach toxic levels because they will not be immediately excreted.³

It can hurt to take supplements along with regular medication. Remember that some supplements can slow down or speed up the body’s ability to absorb drugs in the bloodstream and shouldn’t be taken together.³

Do I need to take supplements after being diagnosed with breast cancer?

A recent study, on 1134 breast cancer patients, found that the use of antioxidant supplements (vitamins A, C and E, carotenoids and coenzyme Q10) before and during chemotherapy, resulted in a reduced survival rate. It’s, however, important to note that there was no increased risk associated with the use of multivitamins. Patients should thus be cautious when considering the use of supplements, other than a multivitamin, during chemotherapy and should accordingly discuss supplementation with their doctor and registered dietitian.²

There is no reason to start taking supplements if you don’t have a diagnosed vitamin deficiency. The majority of breast cancer patients will be able to reach their daily vitamin and mineral requirements from food sources, as studies haven’t been able to confirm an added benefit or improved survival outcomes when initiating supplements. High doses xof dietary supplements are also not recommended for cancer prevention.

The risk involved in taking supplements outweighs the potential benefit, therefore it remains the best to focus on oral food intake and to cut back on supplements.

References

World Cancer research fund & American Institute for cancer research www.wcrf.org/dietandcancer/recommendations/dont-rely-supplements
Dietary Supplement Use During Chemotherapy and Survival Outcomes of Patients With Breast Cancer Enrolled in a Cooperative Group Clinical Trial (SWOG S0221)
American Cancer Society https://www.cancer.org/treatment/treatments-and-side-effects/complementary-and-alternative-medicine/dietary supplements/misconceptions.html
SAHPRA: www.sahpra.org.za/who-we-are/

Annica Rust is a registered dietitian practicing at the Breast Care Unit at Netcare Milpark Hospital, as well as in Bryanston. She assists with medical nutritional therapy for cancer prevention, treatment, survivorship and palliation. She gives individualised nutritional care to prevent or reverse nutrient deficiencies, nutrition-related side effects and malnutrition to maximise quality of life.

MEET THE EXPERT – Annica Rust

Annica Rust is a registered dietitian practicing at the Breast Care Unit in Netcare Milpark Hospital as well as in Bryanston. She assists with medical nutritional therapy for cancer prevention, treatment, survivorship and palliation. She gives individualised nutritional care to prevent or reverse nutrient deficiencies, nutrition-related side effects and malnutrition to maximise quality of life.