No Prescription Necessary

They sit on a shelf, their plastic bottles bearing labels daring and tempting you to “enrich your life”. Most of the time, you ignore them, but there are moments when you wonder if you’re risking a long and healthy future by refusing to give in to the promotions. Available in supermarkets, drug stores and some convenience stores, dietary supplements are always in demand. The shelves are often divided into several segments: sports, herbal, general nutrition (multivitamins), women’s health, men’s health and teenagers’ development.

According to Lukas Arfandi, a branch manager at Century Healthcare Pharmacy, dietary supplements are the bread and butter of a modern drug store. In a single month, the sales of dietary supplements may outstrip the other items sold in the store – and a customer rarely buys just one kind of supplement; they usually go for two or three different types. Now you know why the sales assistants always make a beeline for you when you enter the store.

“Vitamins E and C are a huge sell,” says Lukas. “The next one is herbal tea extracts: chamomile, green tea, ginger. And lately fish oil is quite popular … for better eyesight.”

According to the definition in the U.S. Dietary Supplement Health and Education Act of 1994, a dietary supplement is “a product consumed orally that contains dietary nutrients lacking in a person’s diet”. These nutrients can be any number of things: vitamins, minerals, herbs, amino acids or substances such as enzymes, metabolites, glandular and organ tissues.

What do supplements do?

The more appropriate question is, perhaps: What don’t they do? Each supplement promotes health benefits associated with the nutrient it carries. Antioxidants, for one, are believed to possess the unique ability of slowing the progress of aging or preventing the development of bad cells caused by oxidation (a process of chemical reactions in the body that produces damaging molecules called free radicals). Aloe vera, for another, may function to treat diabetes, epilepsy or skin problems. For every known disease (with the exception of terminal illnesses, such as AIDS), there seems to be a supplement that supposedly helps prevent or diminish the symptoms.

There’s little doubt about dietary supplements’ popularity among consumers. In Indonesia alone, between 2004 and 2006, the market value rose from $170 to $230 million, with a total import value of $190 million, according to a rough estimate released by the Association of Indonesian Health Supplement Companies and the National Agency of Drug and Food Control (BPOM).

Whether it’s vitamins, selenium, zinc extract or Omega-3 … we want them all. A large number of these supplements are imported, with half of the entire market coming from the United States.

“The market responds extremely well to products from Australia, China and the U.S.,” says Nikko Ragil, the marketing manager of a health supplement distributor based in Jakarta. “To say that U.S. products dominate the market is a bit speculative – it really depends on what people are looking for.”

For instance, Nikko adds, “China is the top manufacturer of herbal teas and ginseng, whereas Australia specializes in fruity essences like cranberry concentrates and grape seeds. The U.S. is big on multivitamins, which are a common buy.”

It should be noted that each country’s authorities look at dietary supplements in a different way. Some consider them foods, others drugs. The policies attached to their distribution also vary, although they are usually less restrictive than the policies regulating the distribution of pharmaceuticals that correspond directly to certain medical conditions. Indonesia places dietary supplements in the same category as health foods, indicating that they are organic substances that the human body will sooner excrete than compound in excess over time.

“We run a standard check on every brand of dietary supplement that comes in,” says Ivan Banu, a BPOM employee. “We make sure they’re safe for consumption and in good condition. We require manufacturers to hand in the results of all preliminary tests and – once those check out – it’s good to go.”

Ivan elaborates on why they are categorized as food instead of drugs: “The level of chemical exposure is very, very low. As long as they are taken responsibly they are virtually harmless.”

But how do we know when we’ve gone too far? Is there such a thing as overdosing on nutrients?

“Too much of anything is never a good thing,” says Lucy Gunawan, a heart specialist who runs her own clinic at Mitra Keluarga Hospital in Kelapa Gading. “I always advise my patients to consume in moderation. People have a tendency to overstuff themselves with what they think is good for their bodies, yet, believe it or not, our bodies have their limit, too.”

Last year, Reader’s Digest published an investigative piece titled “A Bitter Pill” about whether antioxidants, one of the more familiar dietary supplements, actually live up to their supposed benefits. Writer Lisa Melton listed concerns linked to several dietary supplements that contradict their initial purpose and posed subtle questions.

“Evidence gathered over the past few years show that, at best, antioxidant supplements do little or nothing to benefit our health. At worst, large doses could have the opposite effect, promoting the very problems they are supposed to stamp out,” she wrote.

The National Institutes of Health (NIH) – a medical research center based in the United States – has discovered there’s a lot to be cautious about when it comes to the consumption of dietary supplements. More than 120 advertising complaints were reported between 1984 and 2003 in the United States, which led to various lawsuits, most of which were settled out of court.

NIH director Paul Coates was quoted in Melton’s article as saying, “Just because a food with a certain compound in it is beneficial to health, it does not mean a [pill containing the same compound] is.”

A similar sentiment is expressed by Kartika, an advocate at the Indonesian Consumers’ Protection Agency.

“It’s very important to remember that by assuming something is good for you doesn’t automatically make it true,” she says. “Be mindful of your choices. There are millions of dietary supplements out there – chances are some will be good and others won’t be. Make sure you know everything there is to know about what you’re taking before you take them.”

In other words, do your own research. When reading a specific label attached to a bottle of dietary supplement, for example, look at all the ingredients and be aware of side effects and counter-indications. Pregnant women are especially vulnerable to a number of compounds, as are children below the age of five.

“The safest way to do it?” Lucy says. “Eat more fruit and vegetables, less meat. Exercise regularly and avoid harmful vices like cigarettes and alcohol. There’s no magic pill that can substitute for a healthy lifestyle.”

Illustration by Lucynda Gunadi

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