Energy Supplements: Do they work? Are they safe? What's in them? Which are best?

Would you like to have ALL DAY ENERGY? Without the mid-afternoon slump?

Energy without the jitteriness of caffeine? In just one supplement?

Well, if you look online or in the stores, you'll find an abundance of supplements that are offering to do just that.

Do they work? Are they safe? What's in them? Which are the best?

These are the questions addressed in episode #45 of my podcast, Energize Your Life. 

My guest is Jennifer Neily, MS, RDN, known as "Neily." Neily is a registered dietitian nutritionist and a certified health coach based in Dallas. 

For all these answers, watch the video above, play the podcast below, or read this blog.

What Are Energy Supplements?

In this blog and podcast, we'll be talking about all those supplements - pills and powders - that promote energy on their label or in their marketing.

Not coffee or tea. Not energy drinks. 

They typically use terms like: "combat fatigue", "maintain energy levels", "renew energy", "maintain energy at the cellular level", "sustained energy throughout the day", "all-day energy without the crash". 

How Are Supplements Regulated for Safety?

Dr. Jo: A lot of people assume that supplements are natural and regulated and are therefore safe. Is that true? 

Neily: Not necessarily. The Dietary Supplement Health and Education Act, passed in 1994,  deregulated the supplement industry.

Dr. Jo: So we know that our foods are regulated and our prescription drugs are regulated. Supplements are not regulated in the same way?

Neily: Not in the same way that food and drugs are. Unfortunately, they do not need to be proven, safe and effective and they don't need the FDA approval before being marketed.

Dr. Jo: So a company can put a supplement out on the market without testing it?

Neily: Oh yeah. That's why the industry has grown from about 4000 supplements on the market in 1994 to an estimated 80 to 90,000 or more now. That's because anyone can get in the game. Which puts a damper on those supplement companies that are reputable.

Do They Work?

Dr. Jo: Okay, so if it says on the label that it promotes energy, does it?

Neily: Not necessarily. Supplement packaging can pretty much say anything that it wants.

Dr. Jo: From what I understand, as long as you're not making a statement about treating a disease.

Neily: Right. You can't say anything like anything related to a disease or a specific condition - likes lowers cholesterol. But there are no restrictions to saying "promoting energy."

Dr. Jo: They can get away with saying things that maybe are not even true, and not even tested?

Neily: Correct right yeah. Now there might be some study that the company is referencing, but sometimes it's so tiny.  

What's the Risk in Taking an Energy Supplement?

Dr. Jo: What I worry about, when people take energy supplements, is that people aren't getting treated for the underlying conditions. In other words, looking for a supplement to give you, energy, when you haven't figured out what's causing the fatigue in the first place.

Dr. Jo: The fatigue or lack of energy could be from not getting enough good quality sleep - or perhaps sleep apnea. It could be type 2 diabetes or thyroid disease. And, while a stimulant may help you feel a little bit better, it's not going to help with treating the disease - or the effects of that disease.

Dr. Jo: For example, a lot of women during their pre-menopausal stage of life might be deficient in some nutrients that would cause anemia, but it's not as simple as taking an iron supplement and hoping that'll give you energy, right?

Neily: Correct. I'm not a proponent of taking iron period unless you're diagnosed by the doctor. While it's just a tiny mineral, a trace mineral, too much can cause adverse effects.

Dr. Jo: Yes, I ran into somebody the other day that was still taking their one-a-day type supplement that they took when they were younger, before they went through menopause. She didn't realize that the difference between that one and the "senior" variety (she didn't like the term "senior") is that the "senior" doesn't contain that iron.

Dr. Jo: In our later years, unless we're deficient, we don't need all that extra iron. But again, a simple blood test can tell you whether it's a B6 deficiency or a B12 deficiency. You don't want to just take a supplement without knowing what your condition is.

Neily: And that's why it's so important to have regular conversations with a physician. Yearly checkups such as a well woman or well man exam. They are at no cost to us with our insurance.

Dr. Jo: Yes. When I turned 50 my doctor ordered a B12 test. I initially thought, "What a waste of money, I am not a vegetarian." That's because people who don't eat any animal products need to take a supplement of B12 - unless they're getting some other fortified source of it.

Dr. Jo: That wasn't me; I'm not following a vegetarian lifestyle. But I had the test and found out I was deficient in B12. When I call my mom to let her know she said, "That's not surprising, Little Papa had B12 deficiency. And, it tends to runs in the family."

Do B Vitamins Create Energy?

Neily: There's a complex of B vitamins. They help our macronutrients (protein, carbs, and fat) make energy. But, the B vitamins, by themselves, don't give us energy. Yet, how often do you see promotions for vitamin B12 shots for this? We think we're going to get this boost of energy when we take B vitamins, and that is not the case. There's going to be no help whatsoever if you're not deficient in B12.

Dr. Jo: No help at all. It might even be an issue. People assume because B vitamins are water soluble vitamin that, "if I take more than I need, the body will simply flush out the excess." And, that's not true.

Dr. Jo: Studies have shown that high doses of B6, which a lot of women were taking for menstrual pain, was causing irreversible nerve damage. So don't assume a vitamin is water soluble and, therefore, you can take whatever you want. It doesn't work that way.

The Dose Makes The Poison

Neily: A number of the vitamins and minerals have a recommended intake and then there's also some of them have an upper tolerable intake level. Just because some is good doesn't necessarily mean more is better. The dose makes the poison.

Dr. Jo: That's right. I always encourage people to do a simple blood test to find out which nutrient they are deficient in. And, if you think you need some "insurance",  you're probably safe with a taking a 100% daily supplement from a reputable company

Dr. Jo: That's just pennies a day versus what these energy supplements are costing -  sometimes upwards of one or more dollars a day.

Neily: You bring up a great point. A lot of people think that the more you spend the better the supplement is and that's not necessarily the case. One of the resources that I really like is ConsumerLabs.com. It actually looks at like how much supplements cost per dose.

Neily: And they test them. And you can get a good quality multivitamin for 10 cents a day. But, some of them can be as much as $1 a day. You don't need to spend that money. 

Neily: Reputable companies including the Target brand and Kirkland from Costco. They offer quality supplements because they have a lot to lose if their products are bad.

Dr. Jo: That that's right. Even though the FDA doesn't regulate supplements in the same way as prescription drugs, if people get sick with supplements they get involved. 

Dr. Jo: I recently read that 23,000 people go into the emergency room each year with issues related to supplements and that's probably undercounted. And, unless there's some serious issues FDA doesn't even get involved.

Neily: Remember the supplemental ephedra? Years ago it caused more than 100 deaths, before it was taken off the market. With the law, the FDA has their hands tied to regulate the supplement industry more. 

Neily: Every semester, I have my students do a discussion board about supplements. And, the discussion is always, "Why isn't the FDA and doing more..." The problem is that the law is written in such a way that there's only so much they can do.

Neily: Some people think, "Oh it's natural. It's safe. I don't have to worry about it." But just look at a medical questionnaire. It always asks you about which drugs and supplements you're taking because your primary care provider needs to know. Because there's a potential to cause interactions. 

Dr. Jo: Especially when taking energy supplements with medications for high blood pressure. And let's face it, our risk for developing high blood pressure increases as we age.

What's in Energy Supplements?

Dr. Jo: Probably the number one ingredient that I see in a lot of these energy supplements that are promising to help you have better energy than a cup of coffee...is caffeine.

Neily: And, it might even be disguised as guarana.

[Guarana has four times the amount of caffeine as coffee beans. Want more information on guarana? READ THIS]

Neily: It's a natural source of caffeine, so the label may not say caffeine, but in fact, that's basically what it is.

Dr. Jo: And so you have to ask yourself when those supplements do give you a burst of energy...is it coming from those "proprietary ingredients" or is it just the high levels of caffeine?

Where Does Energy Come From?

Dr. Jo: And let's face it, caffeine won't give us energy. If you've been listening to my podcast you know that energy comes from food.

Dr. Jo: As we chew, swallow, and digest, food breaks down into smaller pieces which then get into our bloodstream. And, then into our cells and BAM produces ATP. That is energy. Caffeine might make you feel energized, make you feel a little bit alert, but caffeine can't truly give you energy.

Dr. Jo: No energy to run on. No mental energy or emotional energy. For all that, we have to have food.

Neily: So energy supplements don't give us energy. It's more of a stimulant making you feel more energized.

Dr. Jo: Yes, that's it. They make you feel like you have energy but it's not true energy. If you need a little bit more motivation, if you need some more energy, to get out there and work out harder and faster, caffeine isn't going to help. You need food to fuel you.

What are "Proprietary" Ingredients

Dr. Jo: The ingredients in those energy supplements that really concern me are those so-called "proprietary herbs." What do you think of those "secret" ingredients.

Neily: Again, realize that herbs are under the regulation of the Dietary Supplement Health and Education Act. In a 2013 study, a group of 44 herbal supplements were tested. And, 30 out of the 44 had some kind of a product substitution.

Dr. Jo: A product substitution?

Neily: Meaning that's there was something in the supplement that was not listed on the supplement facts label. Only two of the 12 companies had products with no substitution or contamination or filler.

Dr. Jo: Okay what do you mean by contamination? What's in the supplements?

Neily: Well, who knows. It could be lead, it could be just be fillers. So when you buy a supplement you really don't know what might be in there.

Dr. Jo: I remember reading about a supplement that proposes to help to lower your cholesterol. A client of mine was actually taking it and saying that it was working even better than when he was taking a prescription drug.

Dr. Jo: When I looked in ConsumerLab.com, I found out that this prescription drug was actually found in this supplement.

Dr. Jo: But, it was unregulated. Meaning one pill might have one dosage while the next pill might have another dosage. That's a huge concern with me. Not just the sawdust contaminants but the pharmaceutical drugs that are sometimes found in them.

Neily: You're absolutely right, Jo. There's actually three classes of supplements, that are the most adulterated. Such as weight loss supplements that might have drugs in them that are no longer on the market.

Dr. Jo: And no longer allowed because they were proven to be unsafe.

Neily: Exactly. And, supplements for physical performance that offer to help you with your strength.

Neily: They might have like actually anabolic steroids in them. And the third one is male enhancement.

Neily: So those three types of supplements are more likely to have real drugs in them.

Dr. Jo: So they might be contaminated with things like lead, crushed stone or saw dust or could even have prescription drugs in them.

Dr. Jo: You mentioned that there are some ways to assess whether your supplement is likely to be safe and free from contaminants and having what it says in the bottle.

Dr. Jo: Again this is not saying that the supplement will work, but at least it has in the product what it says to have on the label.

Third Party Verification

Dr. Jo: So Neily, you mentioned that there are some ways to figure out if the supplements that you're interested in has what it says that it has on the bottle. In other words, it's not going to tell you whether you need the supplement. It's not going to tell you whether that supplement works. But there are ways to figure out if what they say, is in the bottle is actually all that's in the bottle.

Neily: Right yeah.

Neily: There are three. One is ConsumerLab.com. They look at hundreds of supplements. They take different supplements in different areas of the country and test them for purity and potency. Again, like you said, they can't tell you that it's going to do what it says it's going to do, but at least they know they met the test for what's on the product label.

Neily: They check for disintegration. If the supplement say that's got 200 milligrams of an ingredient, does it? Are there any contaminants?

Dr. Jo: I'm glad you mentioned about checking for the supplement to dissolve. I remember, probably a decade or more ago, there were all these supplements that weren't getting dissolved and were just passing in your poop. In other words, it didn't even break down so you are getting nothing from it, you were spending money not getting anything.

Neily: So Consumerlab.com is one source to check. Another one is US Pharmacopoeia.

Dr. Jo: That label will show a USP logo.

Neily: That's right. The third one is NSF. And, in particular like NSF for sports for athletes that test those types of supplements.

Dr. Jo: Yeah it's really important for athletes. Because they can get banned from an activity if they're found to have certain drugs in their system. Sometimes they're taking you know supplements over the counter not realizing that it's been contaminated.

Neily: Exactly.

Dr. Jo: So I think it boils down to buyer beware, with some of these supplements. Make sure you go to your medical care professional and find out what is causing your fatigue or low energy. Maybe it's a disease state that can be treated and you don't even need to have the supplement.

Dr. Jo: A lot of people will say oh, "Just give me some more caffeine, I'll be fine" when caffeine is just a stimulant drug that makes you feel like you have energy but it isn't real energy.

Dr. Jo: For example, even with stimulant drugs, you still end up doing stupid things when you don't get enough sleep. In addition, not getting enough good quality sleep can increase your risk or heart disease, type 2 diabetes, certain types of cancers, and also increase your risk of dementia. So, it's best to not to just take something to make us feel better for that moment, but to do something that will make us well again.

Neily: And there are natural energy boosters you know that I talk about. One of them is just food. Better quality food and not not necessarily organic - just more wholesome food.

Dr. Jo: In other words, instead of chips and crackers and puffed vegetable snacks - just eat more whole foods.

Neily: Exactly exactly.

Neily: Hydrate hydrate. And, move more and and get the sleep you need.

Neily: It could be as simple as making some of those changes versus paying money for a supplement you think is going to help you get that energy.

Dr. Jo: Right. And for those who want to know more about caffeine, check out podcast episode 37 where Danielle Robertson Rath and I talked about caffeine, and how much is safe.

Dr. Jo: How much caffeine you need to give you that feeling of alertness and focus. Turns out the research studies show that small amounts several times a day is better than that big gulp in the morning.

Dr. Jo: And Neily, you mentioned water. When you're dehydrated - just down one or 2% of your total body weight, which isn't very much... might be a couple of cups of water, then we tend to have lower energy levels.

Dr. Jo: Dehydration can bring on fatigue and dizziness and and low performance levels. And, realize that many of us wake up first thing in the morning, we go to the bathroom and what color is that urine first thing in the morning?

Dr. Jo: it's like the color of this wall right behind me (yellow) which is a sign that we're probably dehydrated. So when people think they need more coffee, what they actually might need is more water. And that's why they're craving the coffee.

Dr. Jo: So good points about the the three things we need to look on the label to find out if the supplement has what we think we're paying for.

Dr. Jo: Anything else you'd like to add to that discussion about supplements and energy supplements in particular.

Neily: I'm doing research online for energy supplements. I found a number of the ingredients have some studies. But the studies were all small pilot studies. And, the studies were done by the company that makes that particular brand.

Neily: I'm not not necessarily saying that that's always a bad thing. But, I couldn't find any sources outside of those studies.

Neily: Sometimes you also find out that the studies that have been done, have nothing to do with energy.

 Dr. Jo: For those of you who like to go deep into the research, you can go to PubMed.

Dr. Jo: it's a government website, in which you can look up all the different studies that have been published.

Neily: I use Google Scholar. It's really easy to use and it gives you the full text in many instances.

Dr. Jo: How can people reach out to you, Neily?

Neily: NeilyOnNutrition.com is my website. You can find me on social media - Instagram and Facebook @NeilyOnNutrition

Dr. Jo: And, Neily, as a health coach what kind of clientele do you work with?

Neily: I work mostly with women over 40. I help my clients make peace with food and with their body.

Dr. Jo: All right, well, thank you all for joining me today and I'll talk to you next Monday.

Neily: Thank you.