Questioning Supplements

Dietary supplements are big business. Three out of four Americans take one or more on a regular basis, and for older Americans the fraction is four out of five. One in three children also take supplements. The estimated number of supplement products increased from 4,000 in 1994 to 50,000-80,000 today. Out of pocket expenditures for herbal and complementary nutritional products are about $50 billion, reports Henry Miller. ¹ Supplements have become a massive industry with plenty of enthusiastic promoters. But for all the research telling us how certain vitamins and nutrients affect our bodies, taking supplements can't always deliver the results we may hope and expect. ²

Northwestern Medicine scientists report that for non-pregnant, otherwise healthy Americans, vitamins are a waste of money because there isn't enough evidence they help prevent cardiovascular disease or cancer. ³ Most studies suggest that taking vitamins and supplements is usually completely unnecessary and might be harmful. A study of almost forty thousand women, for instance, found no benefit to taking a range of supplements and concluded that there was little justification for the general and widespread use of dietary supplements. ⁴ Based on a systematic review of 84 studies the United States Preventive Services Task Force (USPSTF) has new guidelines that state there was 'insufficient evidence' that taking multivitamins, paired supplements or single supplements can help prevent cardiovascular disease and cancer in otherwise healthy, non-pregnant adults. ⁵ Other studies have found that many supplements are often not what they say they are. A 2013 study from the University of Guelph, for example, did a blind study of commercially available supplements and found that 'most of the herbal products were of poor quality, including considerable product substitution, contamination and use of fillers.' Remarkably, these researchers found some product substitution—the use of another, unlabeled herb in the place of the main ingredient—in products of 83 percent of the companies tested. In other words, only 17 percent of the companies were providing products that matched what the label said. This is, of course, both dangerous and unethical. ⁴

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Unlike prescription drugs, the Food and Drug Administration (FDA) does not regulate the safety or quality of nutritional supplements before they are on the market. Instead, it is the responsibility of each manufacturer to ensure that safety standards are met and that the supplement actually contains the ingredients and potency listed on the label. ² Unfortunately, this is not always the case. A 2012 government study found that 20 percent of dietary supplements marketed for weight loss or to support the immune system made illegal claims on the label. The FDA has also found prescription drugs in thousands of products sold as nutritional supplements. ⁶ How bad are supplements? There are plenty of hard data to answer that question. Results were reported by the Centers for Disease Control and Prevention and FDA researchers which analyzed representative surveillance data from 63 hospital emergency departments over a 10 year period (2004-2013). The statistical analysis projected about 23,000 emergency room visits annually resulting from ingestion of supplements. ⁷ These findings were confirmed by a 2017 study published in the Journal of Medical Toxicology, which found that US Poison Control Centers receive a call every 24 minutes, on average, due to exposures to dietary supplements. The rate of calls increased by almost 50 percent from 2005 to 2012, with a total of 274,998 incidents reported from 2000 through 2012. About 4.5 percent—more than 12,300 cases—resulted in serious medical complications.¹ Popping vitamins is no substitute for eating nutritious foods. A decade-long observational study of more than 30,000 people finds that certain vitamins and minerals may help extend your life and keep you from dying of cardiovascular disease but only if you get those beneficial nutrients from foods, not supplements. ⁸ There's no magic set of pills to keep you healthy. Diet and exercise are key.

References

1. Henry I. Miller, “Will dangerous dietary supplements finally be reined in?” henrymillermd.org, April 23, 2019
2. Zrinka Peters, "The ins and outs of supplements," principia- scientific.com, July 4, 2022
3. Jenny Jia et al., "Multivitamins and supplements--benign prevention or potentially harmful distraction?", JAMA, 327 (23), 2294-2295, 2022
4. Timothy Caulfield, Is Gwyneth Paltrow Wrong About Everything, (Boston, Beacon Press, 2015)
5. Kristen Samuelson, "Massive review finds supplements are a waste of money," realclearscience.com, June 22, 2022
6. "Health Fraud Product Database," US Food and Drug Administration, July 18, 2022
7. Andrew I. Geller et al., “Emergency department visits for adverse events related to dietary supplements,” New England Journal of Medicine, 373, 1531, 2015
8. Fan Chen et al., “Association among dietary supplement use, nutrient intake, and mortality among US adults: a cohort study,” Annals of Internal Medicine, May 7, 2019