I have tons of patients on supplements. I have blogged for years about how you need to be careful- supplements are not a well regulated industry. What a supplement says it has may not be accurate- in what it is, the amount it has, and what it says it does. At the same time, they DO have activity. They can do some of what they say they do- help hair, nails, heart, etc- but they can also wreak havoc- cause liver failure, blood thinning, etc.
The FDA tests medications. When they do, the manufacturer of the drug needs to document it does what it says it does, it is the strength it says it is, it contains what it says it contains, and it needs to document it is safe.
Herbals and supplements do not have to do this.
So I went to my handy dandy go to when I want to research what is out there- PubMed. I found this review in the Annual Rev or Pharmacologic Toxicology from 2018, “Adverse Effects of Nutraceuticals and Dietary Supplements.” I have read many published papers, and this one I thought was thorough and cited many of other studies in its review.
They start their introduction with some basic facts I found interesting:
- 70% of Americans take some form of dietary supplement
- They are not regulated by the FDA. They do not need to be registered or approved by the FDA.
- DSHEA, the Dietary Supplement Health and Education Act of 1994, states that the FDA IS RESTRICTED TO ADVERSE REPORT MONITORING POST MARKETING.
So in 1994, the supplement industry bloomed. According to the DSHEA, a dietary supplement
- Is intended to supplement the diet. It includes: vitamins, minerals, amino acids, herbals, botanicals
- It can be in a pill, capsule, tablet, or liquid
- No clinical trials need to be done
- They can put a disclaimer, “This statement has not been evaluated by the FDA. This product is not intended to diagnose, treat, cure, or prevent any disease.”
I am not saying all herbals, vitamins, and other supplements are bad. But I think you need to be thoughtful. I have had patients in liver failure from supplements and they didn’t know it. There was a NYT article years ago, which documented some well known brand herbals when tested had no active ingredient, or arsenic, or other issues. (to read that blog click HERE)
There are some groups trying to do quality control for herbals. There are independent groups which evaluate medications to confirm ingredients, strength, etc. There is also likely better quality control for those made in plants in the US vs other countries. The three best known independent evaluators are ConsumerLab.com, NSF International, and U.S. Pharmacopeia (USP). They actually check the brands at least yearly by buying the product in a store and testing it.
- USP is a nonprofit organization sets standards for supplements.
- The not-for-profit NSF offers two types of certifications: NSF Contents Certified and NSF Certified for Sport.
- ConsumerLab.com, a for-profit company, regularly tests and certifies supplements.
If you see something says it is “certified” or “verified,” unless it has a seal of one of these three groups, the words are meaningless.
Read on to see the insights on different types of supplements: vitamins, minerals, fish oil, protein, and nutraceuticals.