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There are more than 90,000 vitamin and dietary supplement products sold in the US. They come in pills, powders, drinks, and bars. And they all anticipate some better versions of ourselves—selves with sturdier bones, slimmer waist lines, heftier muscles, happier intestines, better sex lives, and more potent noggins. They foretell of diseases dodged and aging outrun.

On the whole, we believe them. Supplements are a $30 billion industry in the US. Recent surveys suggest that 52 percent of Americans take at least one supplement—and 10 percent take four or more. But should we? Are we healthier, smarter, stronger, or in any way better off because of these daily doses?

The answer is likely no. Most supplements have little to no data to suggest that they’re effective, let alone safe. They’re often backed by tenuous studies in rodents and petri dishes or tiny batches of people. And the industry is rife with hype and wishful thinking—even the evidence for multivitamins isn’t solid. There are also outright deadly scams. What’s more, the industry operates with virtually no oversight.

The Food and Drug Administration is not authorized to review supplements for safety and efficacy before they hit the market. That means the bottles and capsules that line the aisles of grocery stores, pharmacies, and specialty shops may not contain what they say they do. They may have wildly variable amounts of supplements in each batch. They may have hidden, illicit components like amphetamines. They may even have harmful contaminants such as lead and cadmium.

And even after these potentially dangerous drugs hit the market, the FDA lacks the capacity to keep up with all the products and health claims in order to flush out bad actors. It’s hard to blame them. Doctors, too, have trouble keeping up with the 90,000 plus products.

To help out, two experts at Harvard have put together a quick guide of effective supplements recently. Preventative medicine experts JoAnn Manson and Shari Bassuk lay out which ones are actually effective and when. It’s a relatively short list. Here's what they and other experts recommend, along with a quick crash course for navigating the world of supplements.

Healthy adults don't need a multivitamin.
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If you're over 50 or on certain medications you may need more vitamin B12.
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Vitamin D supplements are recommended for breastfed babies.
Caltrate, a calcium and Vitamin D dietary supplement, may help reduce the risk of fractures in people over 65.
Women who are pregnant or trying to conceive should take folic acid.
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Omega 3 fatty acids are said to help with ADHD and autism, but there's not enough data to back that up.
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Supplements for muscle building, weight loss, and sexual performance are the most risky.
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Fresh tumeric, which contains a compound that may improve memory and help treat joint pain.
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First, the pair emphasizes: the best way to get vitamins and minerals is through food in a healthy diet. Eaten in food, micronutrients are often better absorbed into the body and present in optimal ratios. That’s in contrast to gulping a hunk of concentrated compounds in a pill.

Newer SPECT techniques with ECG gating improve diagnostic accuracy in various patient populations, including women, diabetics, and elderly patients [ 23 ]. Adding information from a simultaneously performed calcium score using MDCT may further increase the accuracy [ 24 ].

Cardiac MRI stress testing with pharmacological stressors can be used to detect wall motion abnormalities induced by dobutamine infusion or perfusion abnormalities induced by adenosine. Cardiac MRI has been applied only recently in clinical practice and therefore fewer data have been published compared with other established non-invasive imaging techniques [ 12 ].

A recent meta-analysis showed that stress-induced wall motion abnormalities from MRI had a sensitivity of 83% and a specificity of 86% in patient-based analysis, and perfusion imaging demonstrated 91% sensitivity and 81% specificity [ 25 ]. When evaluated prospectively at multiple sites, the diagnostic performance of stress perfusion MRI shows similarly high sensitivity but lower specificity.

MDCT can be used for perfusion imaging, but data obtained in clinical settings are scarce.

Studies with myocardial perfusion PET have reported excellent diagnostic capabilities in the detection of CAD. The comparisons of PET perfusion imaging have also favoured PET over SPECT [ 26 ].

Meta-analysis of data obtained with PET demonstrated 92% sensitivity and 85% specificity for CAD detection, superior to myocardial perfusion SPECT. Myocardial blood flow in absolute units (mL/g/min) measured by PET further improves diagnostic accuracy, especially in patients with MVD, and can be used to monitor the effects of various therapies.

The combination of anatomical and functional imaging has become appealing because the spatial correlation of structural and functional information of the fused images may facilitate a comprehensive interpretation of coronary lesions and their pathophysiological relevance. This combination can be obtained either with image coregistration or with devices that have two modalities combined (MDCT and SPECT, MDCT and PET).

Single-centre studies evaluating the feasibility and accuracy of combined imaging have demonstrated that MDCT and perfusion imaging provide independent prognostic information. No large or multicentre studies are currently available.

In common practice, many patients with intermediate or high pretest CAD likelihood are catheterized without prior functional testing. When non-invasive stress imaging is contraindicated, non-diagnostic, or unavailable, the measurement of FFR or coronary flow reserve is helpful. Even experienced interventional cardiologists cannot predict accurately the significance of most intermediate stenoses on the basis of visual assessment or quantitative coronary angiography [ 27 , 28 ]. Deferral of PCI [ 15 , 28 ] or CABG [ 27 ] in patients with FFR > 0.80 is safe and clinical outcome is excellent. Thus, FFR is indicated for the assessment of the functional consequences of moderate coronary stenoses when functional information is lacking.

Participants requested an app with more detailed sample meals for both trigger and nontrigger days, as they feared erroneously consuming trigger foods on a nontrigger day. Focus group participants were also concerned about the assumption that trigger foods result in symptom onset within 4 hours. The majority of survey respondents (80%) did however agree that their symptoms occurred within 4 hours after eating. Participants were also concerned that trigger foods could result in symptoms lasting longer than 24 hours. They were also wary of foods being categorized either too broadly or narrowly (e.g., testing “nuts” vs “almonds”). These concerns suggest additional design opportunities such as experimenting with different symptom onset periods or iteratively categorizing foods.

Seventy percent of participants in our survey selected breakfast as their preferred test meal. Focus group participants shared part of their rationale behind this preference: they thought breakfast would be the most feasible mealtime to eat the same type of food and drink for the duration of the study, unless the trigger food was an unconventional breakfast food (e.g., alcohol). Participant response to our framework’s requirement that independent variables being controllable and actionable therefore influenced test meal preferences. Further exploration should be conducted to determine how this influence might affect the framework’s efficacy.

Focus group participants were concerned about inconsistent symptom ratings over time. The symptom scales allowed “too much room for interpretation.” They expressed the desire to customize symptom scales to be personally meaningful. We explored this issue further in the survey. We first asked the survey participants to generate their own custom scale with labels, then offered them a selection of four scales to choose from: 7-point with labels, 5-point with labels, 5-point with only endpoint labels, and 3-point with labels ( Figure 5 ). Participants developed custom scales ranging from 4 to 10 points. Fifty-seven percent preferred one of our predefined scales over their custom scale whereas 25% preferred their custom scale. Of the 57%, 47% preferred scale 6b.

Although focus group participants felt they could adhere to self-experiments, most preferred shorter 8-day study, even when told that a longer 12-day study would likely result in higher confidence levels. In the survey, 83% said they would be “extremely likely” or “likely” to complete an 8-day study without giving up or missing days, compared to 67% for a 12-day study.

All focus group participants preferred the frequency visualization over the standard and daily visualization designs (refer to Figure 3 ). However, participants also wanted access to the standard or daily visualizations. Participants felt the calendar associated with these could help them recall details of individual measures and events leading up to them. For all visualizations, participants valued seeing individual data points, as each represents a specific measure to which they could relate. Because data corresponded to each individual, and not to a group of other IBS patients, participants felt more trust that summary statistics described their situation. Participants with stronger backgrounds in statistics preferred interpreting the graphs over the summary statistics because the graphs allowed them to better identify and understand the impact of outliers. All participants expressed a desire for an easy way to share and communicate results with their healthcare providers.

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