Food supplements - how to use them wisely?

What are food supplements?

According to the official definition of the Chief Sanitary Inspectorate, a food supplement is "a food product intended to supplement the normal diet, which is a concentrated source of vitamins, minerals or other substances with nutritional or other physiological effects, single or complex, marketed in a form that allows dosing".

In practice, food supplements can take the form of capsules, liquids with a dropper, sachets, ampoules or powders. They must always include the name of the substance, the declared content of the substance and the recommended daily intake.

However, it is important to remember what food supplements are not. Here are the key points:

• They are not a substitute for a healthy and varied diet. Supplements can be a complement, but never an alternative to a healthy diet.
• They are not an alternative to an active lifestyle. Supplements can help improve performance and athletic results, but they are not a substitute for regular physical activity.
• They are not an alternative to sleep and rest. Supplements can help you concentrate, but they cannot replace quality rest.
• They are not medicines. Dietary supplements are food products, while medicines are drugs. When supplements are brought to market, they are not subject to the same strict standards or testing as medicines. Even if a supplement and a medicine contain the same substance (e.g. vitamin D) or have a similar form (e.g. capsules), the differences between a supplement and a medicine are significant.

What should we supplement?

The answer depends on many factors: age, health, deficiencies, diet and even geographical location. Supplementation must be tailored to the individual - that is the most important rule. So if you are wondering which supplements to take, no article on the internet will give you a clear answer. Your needs and test results are the key.

Although optimal supplementation should be individualised, there are some general recommendations to consider:

1. Vitamin D (if you live in Poland)

Vitamin D supplementation is the only supplement recommended for all adults living in Poland from the beginning of October to the end of April (in doses of 1,000 to 2,000 units per day). If you do not spend at least 30 minutes in the sun between 10am and 3pm with exposed arms and legs between May and September, vitamin D supplementation is recommended throughout the year.

Recommended doses of vitamin D for Poles vary depending on age, but also, for example, on the degree of obesity or individual tests of 25(OH)D levels in blood serum. Vitamin D should be taken regularly, preferably in the morning with a meal containing a source of fat. In practice, it is best to take vitamin D every day with breakfast.

2. Omega-3 fatty acids (if you don't eat fish on a regular basis)

Omega-3 fatty acids play a key role in the body. Two omega-3 fatty acids, lanolin and alpha-linolenic acid, are classified as essential fatty acids (EFAs) and must be supplied to the body because it cannot produce them. The omega-3 group also includes two other fatty acids, EPA and DHA, which also play very important roles in the body.

Read more: Fats in an athlete's diet

The ESC 2021 guidelines recommend eating fish (including oily sea fish containing omega-3 fatty acids) 1-2 times a week to maintain good health and prevent cardiovascular disease. If this amount of fish is not consumed, supplementation with 250 mg of EPA + DHA per day is recommended.

People with elevated blood triglyceride levels may benefit from even higher doses, up to 2-3 g of omega-3 fatty acids per day. Omega-3 supplementation is generally safe and may be considered for other conditions such as acne, autoimmune diseases or an increased risk of cardiovascular disease.

3. Creatine (if you are an athlete)

Creatine is one of the best-researched supplements for athletes, helping them to achieve real benefits. It works by supporting ATP production during exercise, increasing muscle strength and power, and improving recovery. In sports that require short bursts of intense effort (such as sprinting or swimming), its main benefit is to increase power and improve performance. In strength sports, it contributes to strength gains and more efficient training, and in endurance events (e.g. long-distance running, cycling) it supports glycogen replenishment and recovery.

4. Vitamin B12 (if you follow a vegan diet or severely restrict animal products)

A 100% plant-based diet requires mandatory vitamin B12 supplementation. There are no vegetable sources of vitamin B12 (cobalamin) that would meet the body's needs for this nutrient. Unfortunately, vitamin B12 deficiency is common among vegans, affecting up to 50-70% of people on a vegan diet. For vegetarians, supplementation (or lack thereof) should be considered on an individual basis, depending on the other elements of the diet. The recommended dose of vitamin B12 supplementation is approximately 100 µg per day, in the form of cyanocobalamin.

5. Folic acid (if you are planning to become pregnant, are pregnant or are breastfeeding)

Folic acid supplementation, especially its active form (levomefolic acid) (5-MTHF), is recommended by experts from the Polish Society of Gynaecologists and Obstetricians (PTGiP) to all women planning to become pregnant.

It is recommended to take 400 µg of 5-MTHF and 400 µg of folic acid per day in the preconception period (at least 12 weeks before pregnancy) and 800 µg of 5-MTHF during pregnancy and lactation. Folic acid supplementation is essential to prevent neural tube defects in the foetus.

Supplementation during pregnancy can (and should) include other micronutrients, but folic acid is most important. Some doctors recommend supplementation even for women of childbearing age who are not planning to become pregnant, as a preventive measure to prevent possible foetal defects if they do become pregnant.

There are many other supplements that have been shown to be effective and can really help you achieve your goals. However, it is important to remember that there is no single, universal set of supplements for everyone. I would recommend different supplements to a person with an autoimmune disease, a student stressed by exams, and an elderly person taking multiple medications every day.

How do I choose the right food supplements?

Supplements should be chosen on an individual basis. It is important to consider the following:

1. The purpose of the supplements

The purpose is the most important factor to consider before deciding to start supplementation. There are no supplements that 'work for everything' or 'work for everyone'. A supplement should always be chosen for a specific purpose, not the other way around.

2. Interactions, contraindications and limitations

Supplements can be involved in metabolic pathways and therefore have a real effect on the body. This means that their use may also be associated with side effects. It is therefore worth evaluating supplements not only in terms of 'works - doesn't work', but also in terms of whether they can harm a particular person.

Tip: To help you choose the right form and dose of supplement for your needs, consult an experienced dietitian, doctor or pharmacist.

3. Tests before starting a supplement

Testing before starting supplementation can detect any deficiencies, but also identify better tolerated forms of a particular substance (for example, the MTHFR gene mutation requires supplementation with methylated folic acid, as other forms are less effective). Of course, not every supplementation needs to be tested - sometimes it is enough to achieve the desired goal and combine it with a substance that has been shown to be supportive. For example, if your goal is to reduce the risk of upper respiratory tract infections, the probiotic Lactobacillus rhamnosus GG may be the way to go.

Important: Tests are very helpful in identifying deficiencies or conditions and diseases. However, not every test will directly tell you what to supplement with and at what dose. Tests should be interpreted by a healthcare professional, as misinterpreting certain parameters can be dangerous. For example, a low blood sodium level does not necessarily mean that you need to supplement.

In addition, it should be stressed that supplementation 'based on tests' does not always consist of supplementing the ingredients that the tests show we are lacking. Sometimes a supplement can support natural physiological mechanisms or metabolic pathways. A good example is red rice, a supplement that helps lower blood cholesterol levels. It works by blocking an enzyme that is essential for cholesterol production in the body. The same applies to probiotic therapy. A recommendation to supplement with a particular strain of bacteria does not necessarily mean that this strain is lacking in our gut or body.

Consequences of reckless supplementation

The consequences of reckless and ill-considered supplementation can be very serious. Incorrect dosage or failure to follow recommendations can lead to toxicity and overdose, the symptoms of which vary depending on the substance: from excessive sweating, to a metallic taste in the mouth, to irregular heartbeat, kidney damage and even death.

Careless supplementation without consulting a specialist can also lead to interactions with other medications. Individual supplements can either enhance or weaken the effects of medication. For example, omega-3 acids can increase the effect of anticoagulants, melatonin can increase the effect of sleeping pills, and high doses of fibre can reduce the effect of thyroid medication.

Supplements can also interact with each other, weakening or completely neutralising each other's effects. Examples of supplements that should not be combined include iron and calcium, and magnesium and calcium.

It is also important to mention the potential contamination of dietary supplements, which can reach up to 30% of samples. Dietary supplements are marketed without significant restrictions (unlike, for example, pharmaceuticals). Studies carried out by the National Audit Office (NIK) or independent organisations have shown discrepancies between the composition of dietary supplements as stated on the packaging and the actual composition of the product. There have been cases of contamination with substances considered to be doping agents (athletes, take note!), detection of faecal bacteria, exceedance of standards for heavy metals or reduced active ingredient content. The number of dietary supplements on the market is growing and the authorities and control bodies do not test all of them.

How to choose supplements with quality ingredients?

If you decide to take supplements, there are a few important things to consider:

• If possible, choose a medicine over a supplement. Medicines are guaranteed to be of the highest quality because they go through a series of tests and trials before they are put on the market.
• Check the ingredients. Good supplement companies are always transparent about the ingredients in their products. Do not trust supplements with a 'proprietary formula' that remains a secret. At best, you will simply be overpaying for the product; at worst, you could be putting your health at risk.
• Check the form of the active ingredient. Some forms of ingredients are more readily absorbed than others (for example, magnesium citrate is considered the most readily absorbed form of magnesium, but many supplements use magnesium oxide, which is cheaper and less readily absorbed).
• Look for ingredients that aid absorption. Well-designed and well-considered supplement formulations may include ingredients that facilitate absorption of the active ingredient (e.g. curcumin + piperine, vitamin D in oil). This is an added benefit that improves the quality of the supplement.
• Choose a reputable brand. When it comes to supplements, it is very difficult to check the quality of a product yourself. It pays to choose reputable companies that have been on the market for years, and to follow the results of independent supplement quality tests. Of course, there are exceptions, and even reputable companies sometimes make mistakes. There is no way to be 100% sure that a chosen supplement is of excellent quality.
• Be aware of advertising. Online testimonials, reviews and sponsored posts on social media are paid for by supplement companies. They are not always dishonest, but remember that you may come across adverts when looking for other users' reviews.
• Buy supplements from reliable sources, such as pharmacies or reputable manufacturers' shops. A very low price may mean poor quality or low levels of active ingredients. Some supplements also require special storage (e.g. in the fridge) and failure to follow these instructions will result in a loss of product quality. There is usually no way to check this, so you have to rely on the trustworthiness of the manufacturer and seller.
• Look at the recommended doses of active ingredients. Check that the doses recommended by the manufacturer are in line with what is scientifically recommended and what has been tested and shown to work. The doses that are right for you may also vary depending on your goal (e.g. whether you want to prevent or correct deficiencies).
• Seek professional advice. Seek the help of a dietician, doctor or pharmacist who will analyse the composition and research the effectiveness of a particular ingredient in your case. They will recommend a specific ingredient and select a suggested dosage with proven effectiveness.

^References:

1. ^{Regulation of the Minister of Health of 9 October 2007 on the composition and labelling of food supplements (Journal of Laws of 2018, item 1951).}
2. ^{Nutrients; „Guidelines for preventing and treating vitamin D deficiency: a 2023 update in Poland”; Płudowski P. et al.}
3. ^{ESC/EAS guidelines on the management of dyslipidaemia: how to reduce cardiovascular risk by treating lipid disorders (2019), Kardiol Pol 2019; suppl. 3: 12-103.}