More than half of Americans take dietary supplements. You probably have a bottle of vitamins or an herbal supplement in your cupboard or medicine cabinet (I know I do!). The dietary supplement industry is big business — the projection is that by 2024, the supplement market will reach $278 billion. Supplements are touted everywhere — in drugstores, grocery stores, health-food stores, and, of course, on the Internet. Plus, entire stores (GNC, Vitamin Shoppe) are devoted to selling pills and potions to enhance health and performance. And let’s not forget the celebrities and sports stars pushing supplements on us, as well. But are dietary supplements all they’re cracked up to be? Does swallowing a fistful of pills every morning really make you healthier?
What’s considered a dietary supplement?
Dietary supplements encompass a whole host of items, including vitamins and minerals, herbs and other botanicals, enzymes, and amino acids. Supplements come in a variety of forms — tablets, capsules, softgels, gelcaps, liquids, and powders. Some common supplements include:
• Vitamin D
• Fish oil
Are dietary supplements approved by the FDA?
According to the FDA, “a dietary supplement is a product intended for ingestion that contains a ‘dietary ingredient’ intended to add further nutritional value to (supplement) the diet.” From that definition, taking a supplement sounds like a pretty good idea. Taking a multivitamin every day, for example, seems pretty benign, and for the most part, it is. However, the FDA does not “approve” dietary supplements. This means that supplement manufacturers are not required to obtain FDA approval to market their products. The FDA can’t review supplements for safety or effectiveness, either. Manufacturers are required to produce supplements in a quality manner and ensure that they don’t contain impurities or contaminants, and that they’re accurately labeled. They’re not required to prove that a supplement does what it claims to do, however. And safety isn’t guaranteed.
The FDA does monitor the supplement’s label to make sure that any health claims end with, “This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.”
Are dietary supplements dangerous?
It seems hard to believe that popping a daily vitamin D capsule or swallowing some calcium could be harmful. Many supplements are safe to take (as long as you’re not taking mega doses). Some supplements, though, can be dangerous and even deadly. According to Consumer Reports, lack of oversight from the FDA is a safety issue. And a study published in 2015 in The New England Journal of Medicine found that about 23,000 people end up in the emergency room every year after taking supplements. Supplement side effects that may prove deadly include rapid heartbeat, liver damage, allergic reactions, seizures, and drug interactions. The most common supplements that land people in the ER include those for:
• Weight loss
• Sexual enhancement
• Heart health
• Pain relief
What’s also scary is that, because dietary supplements are very loosely regulated, many supplements (mostly those geared toward weight loss, muscle building, and sexual performance) have been found to contain prescription and illegal drugs, and ingredients that are either known to be unsafe or that have never been tested in humans.
Dietary supplements can indeed be helpful for many reasons — they can help to correct nutritional deficiencies (for example, iron deficiency anemia), they can help minimize bone loss and reduce fractures (for example, calcium and vitamin D), and in the case of dietary restrictions, supplements can help “fill the gap” to ensure that you’re getting the nutrients that you need. Some dietary supplements hold promise: take probiotics, for example. Many health-care professionals are recommending them to people who have digestive issues or diseases, such as irritable bowel syndrome (IBS), Crohn’s disease, or ulcerative colitis. But the area of probiotics is new and still emerging, and there’s a lot that we don’t know yet. In some instances, such as a weakened immune system, probiotics could possibly be harmful.
So, what’s the best advice for taking and choosing supplements?
Food first. Taking supplements doesn’t make up for a nutrition-poor diet. And supplements don’t contain all of the nutrients found in food that work together to provide health benefits.
Don’t go overboard. The saying “if some is good, more is better” doesn’t apply when it comes to supplements. Vitamins and minerals are essential, for sure, but taking above and beyond the safe upper limit can be harmful.
Don’t be fooled by the term “natural.” Sure, we all want to limit our intake of harmful chemicals, but keep in mind that something that’s natural isn’t necessarily safe. Hemlock is natural, and look what happened to Socrates!
Be careful with antioxidant supplements. Taking vitamins E, C, or beta-carotene in an effort to prevent heart disease or cancer could backfire. For example, beta-carotene can increase the risk of lung cancer in smokers, and very high doses of vitamin C can promote damage by free radicals. People who are undergoing cancer treatment shouldn’t take antioxidants, as they can interfere with chemotherapy and radiation treatments.
Avoid these ingredients. Per Consumer Reports, steer clear of supplements that contain aconite (wolfsbane), bitter orange, caffeine powder, chaparral, colloidal silver, coltsfoot, comfrey, country mallow, germander, germanium, greater celandine, green tea extract powder, kava, lobelia, methylsynephrine, pennyroyal oil, red yeast rice, usnic acid, or yohimbe.
Check with your provider. If you decide to take a supplement, run it by your doctor first. Some supplements can interact with certain medications. For example, evening primrose oil can interact with warfarin to increase the risk of bleeding, while ginseng can interact with warfarin to increase the risk of a clot. Black cohosh may interact with statins and acetaminophen and damage the liver. Melatonin may interact with drugs such as sedatives, antihistamines, and some diabetes medicines. Red yeast rice contains the same ingredient as a statin.
Keep your health-care team informed. Always let your health-care team know about any and all supplements that you take, especially if you’re scheduled to have surgery or if you are pregnant or nursing.
Check for seals of approval. ConsumerLab.com, U.S. Pharmacopeia, NSF International, and UL seals mean that the product contains what it should contain and does not contain contaminants, like lead, arsenic, or bacteria. However, realize that these seals don’t mean that the product is necessarily safe or effective.
Be choosey about where you buy your supplements. Some experts say not to purchase your supplements online (especially from sites such as eBay), as you can’t be certain if the supplements are legitimate or safe. Also, be leery of inexpensive supplements, as well. If you do buy online, check to make sure the company is legitimate (go to the Better Business Bureau’s website) and look for a customer service number or a live chat option so that you can ask questions. Be especially careful about purchasing supplements from other countries, as they may not have safety standards in place.
Follow the directions. If you take a supplement, follow the dosing instructions on the bottle or package.
Keep track of and report symptoms or side effects. Pay close attention to any adverse effects from taking a supplement, such as dizziness, nausea, chest pain, etc. Let your doctor know (or head to the ER), and obviously, stop taking the supplement. In addition, check your blood sugars more often when you first start taking a supplement to see how it may affect them.
For more information about dietary supplements, visit the NIH’s Office of Dietary Supplements website.
Want to learn about drug-supplement interactions? Read “Supplements and Medicines: Can They Get Along?” by certified diabetes educator and registered dietitian Amy Campbell.