Not all supplements are created equal

Short answer, no. There are a number of factors to consider when purchasing a supplement:

1. The role of Health Canada and NPNs (Natural Product Numbers)
2. Is it 3rd party tested?
3. Does it follow Good Manufacturing Practices?
4. Does it have appropriate doses, active ingredients and what kinds of fillers does it have?

The Role of Health Canada and consumer protection

In Canada, we do have some assurances when it comes to supplements. Canada has some of the strictest guidelines in the world when it comes to natural health products. Health Canada requires a lengthy application for the product to be approved for use in Canada. This not only includes proper labeling but source of materials and manufacturing, safety, efficacy, product monographs and more.

For a product to be sold in Canada it must have a NPN on the product label. These eight digitnumbers are a clear indication that Health Canada has evaluated and approved the product. The presence of a NPN means the product has undergone a thorough review process to ensure its safety, effectiveness, and quality.

This does allow for some confidence when purchasing supplements, however this is not an infallible process. Health Canada relies on the manufacturers to provide correct information. Most manufacturing facilities are not inspected, and testing is accepted whether it be in house, or 3rd party tested. Health Canada does test some supplements and materials, but it is not all supplements or all that often, so occasionally products do fall through the cracks.

Take U-Dream for example, which was sold as a natural sleep aid. In 2019 U Dream was recalled because it contained zopiclone, a controlled prescription substance. It wasn’t until it was on the market and had some complaints about it that it was properly tested and found to have the prescription drugs in it. It was quickly pulled off the market, but it does prove the point that you still want to do your own research when it comes to your supplements. (1)

What is 3rd party testing and why it’s important

There are many supplement companies that will use 3rd party testing to ensure the following:

1. The supplement contains exactly (or close to) what is written on the label
2. The strength of the product is correct. For example, there is actually 50mg of B12 in the formula
3. That the product is free from contaminants (from everything from bacteria to dirt)
4. There is no secret or unlabeled ingredients
5. That the supplement dissolves and will be absorbed in the body.

Testing facilities should be ISO-certified, which means they follow strict international standards. ISO-9001 ensures the lab has a strong quality management system, while ISO 17025 focuses on the accuracy and reliability of the specific tests the lab performs. For supplement testing, ISO 17025 is especially important because it guarantees that the tests are standardized and produce accurate results. (2).

The most common testing facilities for companies are NSF, ConsumerLab, USURA, Labstat or USP. Some supplement companies will have this on their label, but more often than not the information is on their website.

Most supplement companies do have 3rd party testing to ensure objectivity. There are some that do in-house testing where there is risk of bias that does not come with a 3rd party test.

Bottom line: Do your research before picking anything up off the shelf. If you have favourite brands, check their websites to see if they 3rd party test. If the website does not refer to any form of testing or states “in house” testing, be wary and consider another brand.

Good Manufacturing Practices (GMP)

The next thing you want to ensure with products is knowing that the company follows good manufacturing practices. To be GMP certified in Canada means that the manufacturer of the supplements follows “the 5Ps of GMP” which are people, premises, processes, products and procedures.

1. People: People are properly trained in both safety standards and cleanliness standards for the facility.
2. Premises: The place is clean, avoids cross-contamination, equipment remains calibrated and functional
3. Processes: There is good documentation on procedures and operational guidelines to ensure consistency and safety
4. Products: Checked throughout the manufacturing process to ensure accuracy, safety, good handling and proper storage
5. Procedures: Good documentation on all manufacturing steps from beginning to end

Health Canada provides the certification for GMP for supplement manufacturing companies.
Any product with an NPN will have gone through this process.

Bottom Line: Good companies follow Good Manufacturing Practices and will tell you on their website. If it doesn’t mention GMP, don’t buy it.

The actual supplement: What are you buying?

Choosing your ingredients

Different supplements contain different amounts of ingredients and different kinds of ingredients. For example, Calcium has different forms. From calcium carbonate (least well absorbed) to gluconate to calcium citrate. All have different levels of absorption with calcium citrate being the winner with an absorption rate 27% higher than that of carbonate. So even though calcium carbonate is cheaper, it’s harder to absorb, and you need more of it. (3)

Amounts matter

The next thing to consider is how much per capsule. Take calcium again as an example. There are 1000mg capsules, but calcium needs to dissolve to absorb and anything over 500mg at a time is wasted. So you might think you are getting a deal on “more per capsule” but it’s not a deal if you aren’t absorbing it.(4)

Nonmedicinal Ingredients: Binders and Fillers

Fillers are another consideration. Apart from the vitamins, minerals or herbs you are purchasing they will come with a set of “nonmedicinal ingredients” These are substances that will be used to preserve the supplement or help it keep its shape, color or bind ingredients together. Not all additives are bad but there are some you want to avoid:

1. Titanium dioxide (found in a very common multivitamin): linked to intestinal inflammation and DNA damage (5,6)
2. Coloring additives like “red #40 and yellow #6: Can be carcinogenic and cause hyperactivity in kids (7)
3. Carrageenan: helps with creamier texture but also has been linked to stomach issues such as bloating and indigestion (8,9)
4. Talc – although considered safe to ingest is not recommended in powders or any product where you might inhale it or have it close to genital area due to its inflammatory and carcinogenic properties (10)

Somewhat controversial

1. Magnesium stearate: keeps the product from clumping during manufacturing, this is controversial due to a rat study that showed that stearate inhibits immune function. It has not yet been studied in humans to date and the jury is out if mag stearate is the same as stearate itself.
2. Stearic acid: this is a saturated fat from animal sources. There is concern overusing saturated fats in products although it is of minimal amounts in supplements. If you eat animal products you will be eating more via diet than in your supplement (11)

Better options:

1. Cellulose- plant fiber, not absorbed into the body
2. Citric acid: usually corn based and relatively safe (unless sensitive to corn)
3. Ascorbic Acid
4. Gelatin (unless you are vegan/vegetarian/kosher/halal)
5. Potassium sorbate: generally considered safe although some can have a sensitivity to it.
6. Corn derived (unless sensitive to corn)

Bottom line: It’s not as simple as pulling the cheapest supplement off the shelf. There are many considerations in buying a good quality product. If this is all too overwhelming to think about, your best bet is to chat with your health care provider about what brands and products they use and suggest. Naturopathic Doctors and Nutritionists are well versed in the supplement world and know what to look for. If you need help to find someone qualified, chat with the sanoMidLife staff to find a practitioner that is right for you.

References

1. https://recalls-rappels.canada.ca/en/alert-recall/health-canada-warns-canadians-about-u-dream-herbal-sleep-aid-products-after-tests
2. https://www.supplysidesj.com/certification/whats-really-in-an-iso-certification-
3. https://www.aafp.org/pubs/afp/issues/2000/1015/p1895.html
4. https://www.aafp.org/pubs/afp/issues/2000/1015/p1895.html
5. https://www.sciencedirect.com/science/article/abs/pii/S0378427414001143
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3442211/
7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2957945/
8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1242073/
9. Tobackman, J.K. (2001, Oct.) “Review of harmful gastrointestinal effects of carrageenan in animal experiments.” Environmental Health Perspectives. 109(10): 983–994
10. https://www.cancer.org/cancer/risk-prevention/chemicals/talcum-powder-and-cancer.html
11. Tebby, P.W., Buttke, T.M. (1990). “Molecular basis for the immunosuppressive action of stearic acid on T cells.” Immunology. 70: 379-384.