Supplement Overdose Series, Part 1: Supplement Basics

Have you considered the possibility of supplement overdose in your nutrition clients?

Nutritional supplements are fantastic tools.

Fantastic, but complicated. Sort of like an encapsulated multi-tool.

We have good evidence of the usefulness of some supplements. Others tend to be popular but possibly not effective (1, 2).

Supplement ingredients may differ by batch or manufacturer (3). And the same nutrient might be helpful for one person but harmful to another (4, 5).

Then there is the question of dosing. How much of a supplement should someone take?

The Food and Nutrition Board of the Institute of Medicine gives us nutrient recommendation guidelines—the Dietary Reference Intakes, or DRIs. DRIs include the Recommended Dietary Allowance (RDA), Adequate Intake (AI), and Tolerable Upper Intake Level (UL) (6).

supplement overdose series, part 1 — **A complete list of DRIs**.
**RDAs were originally established in 1941, while DRIs began to be established in 1997 (7).**

It’s important to remember that DRIs are guidelines. They are wonderfully helpful from a population perspective. But, they have their warts (8), one of them being that they may not be adequate for certain individuals.

In this vein, some practitioners have come to recommend doses of supplemental nutrients higher, and sometimes much higher, than the recommended DRIs. This practice was formalized by Linus Pauling in his 1968 article, Orthomolecular Psychiatry. Orthomolecular medicine, literally meaning “right molecule,” is the use of typically high-dose nutrients to address specific conditions. This practice aims to find the most effective doses of nutrients to create optimal health and well-being (9).

Jonathan V. Wright, MD (10), Alan Gaby, MD (11), and Alex Vasquez, DC, ND, DO, FACN (12) have popularized this niche of medicine through their clinical work, books, scientific publications, and course offerings. And, though the practice of Orthomolecular Medicine absolutely has its critics (13), there seems to be a case for the use of high-dose nutrients in specific populations or individuals (14).

To note, I don’t fully disagree with the critics, just as I don’t fully agree with all tenets of Orthomolecular Medicine. Those who have expertise in both clinical experience and the ability to interpret and apply evidence-based information will probably see patients who are in need of more aggressive medical nutritional therapy.

But who has the expertise to recommend high doses of supplements? And when does a supplement dose become a supplement overdose?

When review panels were established to edit the RDAs in the mid-90s, one consideration was adverse events due to excessive nutrient intake (7). In 1998, tolerable upper intake levels (UL) were established through the careful review and analysis of both observational and experimental studies (15). Interestingly, these levels do not apply to patients who are being treated with medical nutritional therapy.

The description of UL considerations also states, “The term “adverse effect” is defined as any significant alteration in the structure or function of the human organism, or any impairment of a physiologically important function…”

“Like all chemical agents, nutrients can produce adverse health effects if intakes from any combination of food, water, nutrient supplements, and pharmacologic agents are excessive.

The wiggle room between ULs and therapeutic doses is truly problematic. Why? The only guidelines available to make high-dose supplement recommendations are practitioner-dependent. And, again, who has this expertise?

This blog series aims to be both informative and (optimistically) cautionary.

Supplements can be used as medicine. But only medical professionals have the ability to recommend nutrients in this capacity.

The next few blogs will cover specific nutrients and corresponding case studies of supplement overdose that I have seen in my nutrition practice. Unfortunately, In some cases, the effects are highly detrimental.

The message to consider is this: The recommendation of nutrients at therapeutic doses, i.e., doses well above the UL or other DRI, may result in harm instead of healing. The risk of harm is inversely proportional to your level of expertise.

If you’d like more practical information on supplementation (including herbs!) in the family-building years, you can purchase my in-depth guides here.

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