What Do You Know About Supplements?
Dietary supplements are herbs, vitamins, minerals, or other products that are supposed to “supplement” your regular diet. A lot of patients forget to mention what supplements they take when we go through their medication list at a visit. They think, “It’s a supplement, it doesn’t really matter, right?” Wrong! I’ll get to why in a second, but first, you might be surprised at how little regulation there is for supplements.
Did you know that the Food and Drug Administration (FDA) is not required (and in fact, does not have the authority) to test or approve any supplements that are available over the counter? You may have noticed that every supplement has the label:
The FDA makes the rules for supplement labeling, marketing, and safety, but doesn’t actually proactively monitor for bad effects of supplements, the way they do for medications. In fact, instead of a manufacturer having to prove to the FDA their drug is safe and effective, the FDA has to prove the supplement is unsafe to pull it from the market. For instance, this past April you may have heard about how a kratom supplement out of Las Vegas was contaminated with salmonella and made people in 35 different states sick. The FDA was only made aware of the issue after consumers and heath care professionals reported it. The company responsible, Triangle Pharmanaturals, refused to pull their product from the market, so the FDA ordered a recall. (For the record, there is no scientific evidence that kratom is safe or effective at treating anything, contaminated with salmonella or not.) Because there is usually no governmental testing of supplements unless a complaint is made, look for a seal of approval from a reputable organization that tests supplements such as the U.S. Pharmacopeia, ConsumerLab, or NSF International. Supplements must earn these seals by passing stringent quality tests ensuring they have been manufactured properly, contain the ingredients listed on the label, and do not include any harmful contaminants.
Be very suspicious of any supplement making claims that are too good to be true, because they probably are. If ever you see a product advertised as:
- Completely safe!
- No side effects!
- Discontinue use if you lose too much weight!
…it’s probably garbage. Trust me, if it was that amazing, some pharmaceutical company would have exploited it and turned it into an FDA approved drug by now. That’s what they did when willow bark became aspirin, red yeast rice became statins, and mold became penicillin. And just because something is “all natural,” doesn’t make it safe. Just remember arsenic and hemlock.
Be aware, even if a supplement has a seal of approval from one of the supplement monitoring organizations, is what it says it is, in the amount it should be, and isn’t contaminated with anything, it might still interact with your prescribed medications. For instance, Vitamin K interacts with warfarin, calcium and iron can decrease absorption of levothyroxine, and St. John’s wort can decrease the effectiveness of some medications. When in doubt, ask your medical provider or pharmacist.