Protein-packed shakes that “taste like chocolate!”, fruit-flavored multi-vitamin gummies, and bottle after bottle of vitamin tablets line the shelves of grocery stores. Shops dedicated to selling every vitamin and mineral under the sun seem to have popped up everywhere. Across the country, dietary supplement use is on the rise. Nearly 75% of Americans take at least one of the tens of thousands of dietary supplements on the market, according to a 2023 Council for Responsible Nutrition (CRN)/IPSOS survey. Dietary supplements are products intended to supplement the diet. They are not medicines and are not intended to treat, diagnose, mitigate, prevent, or cure diseases. Medicines must be approved by FDA before they can be sold or marketed. Supplements do not require this approval. Supplement companies are responsible for having evidence that their products are safe, and the label claims are truthful and not misleading.
Supplements promise to give you essential nutrients, help you sleep better, improve athletic performance, and support your overall health, with many claiming to be “all natural.” Sounds great, right? Well, you know the saying: If something seems too good to be true… Before jumping on the supplement train, make sure to learn the truth about dietary supplements.
What are Dietary Supplements?
Dietary supplements are products you add to your diet in addition to conventional food. They’re consumed via ingestion and come in many shapes and sizes, like pills, powders, liquids, bars, skin patches, and gummies. Dietary supplements are manufactured to provide the body with nutritional support. In addition to vitamins, dietary supplements can contain minerals, herbs or other botanicals, amino acids, enzymes, and many other ingredients.
Products sold as dietary supplements come with a Supplement Facts label that lists the active ingredients, the amount per serving (dose), and other ingredients, such as fillers, binders, and flavorings.
Types of Dietary Supplements
Dietary supplements come in a variety of forms, including tablets, capsules, gummies, and powders as well as drinks and energy bars. Common supplements include:
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- Vitamins: such as multivitamins or individual vitamins like vitamin D and biotin
- Minerals: such as calcium, magnesium, and iron
- Botanicals or herbs: such as echinacea and ginger
- Botanical compounds: such as caffeine and curcumin
- Amino acids: such as tryptophan and glutamine
- Live microbials: commonly referred to as “probiotics”
Benefits of Dietary Supplements
Despite the risks, supplements aren’t necessarily off the table. There are times when supplements can be beneficial. Supplements can help you meet your daily requirements for essential nutrients if you have trouble meeting those requirements naturally.
Some dietary supplements can help you get adequate amounts of essential nutrients if you don’t eat a nutritious variety of foods. However, supplements can’t take the place of the variety of foods that are important to a healthy eating routine. Some dietary supplements can improve overall health and help manage some health conditions.
In these cases, your provider may recommend over-the-counter supplements or prescribe stronger ones. For example, people following a vegan diet often don’t eat enough foods with vitamin B‑12. As people get older, their skin has a harder time producing vitamin D. Situations like these can lead to deficiencies, which can cause problems ranging from fatigue to bone pain to irregular heartbeat. By taking supplements, you might be able to avoid deficiencies. When they’re taken correctly and safely, supplements may help with:
- Building strong bones and reducing bone loss, like Vitamin D along with Calcium found in foods.
- Having regular bowel movements if suffering from chronic constipation with psyllium as evidenced by RTCs and meta-analysis (Pubmed).
- Slowing down vision loss in people with intermediate age-related macular degeneration (AMD), specifically AREDS2 formula (NIH).
Supplements and Pregnancy
During pregnancy, it’s critical to meet nutrient requirements. Nutrients help with a healthy pregnancy and protect your developing baby’s health. While diet is the best way to get these nutrients, pregnant women often fall short on nutrients. That’s where prenatal vitamins come in.
It’s recommended that women who are or may become pregnant take 400 mcg of folic acid daily, as well as 600 mcg of folic acid during pregnancy (CDC). Folic acid is the most important vitamin to take during pregnancy, as it reduces the risk of certain birth defects and supports a fetus’s growth and development.
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Another very important vitamin during pregnancy is iron, 27 mg/day. Iron helps your red blood cells supply oxygen to the fetus. It can also decrease the risk of anemia (when your blood doesn’t have enough healthy red blood cells).
Depending on your needs during pregnancy, your provider may also recommend taking additional prenatal vitamins, such as calcium, vitamin D, or iodine.
Risks and Potential Side Effects of Dietary Supplements
Unless you have trouble getting nutrients naturally or your provider prescribes supplements, you might be wasting your money. There isn’t enough research to show that supplements are effective. The studies that have been conducted generally show that extra vitamins and minerals do not protect against disease or improve overall health in people who are otherwise healthy.
In addition to not always working, it can be risky to take dietary supplements. Many supplements contain active ingredients that can have strong effects on the body. You are most likely to have side effects from dietary supplements if you take them at high doses, or instead of prescribed medicines, or if you take many different supplements. Some supplements can increase the risk of bleeding or, if taken before surgery, can change your response to anesthesia. Supplements can also interact with some medicines in ways that might cause problems.
Possible side effects of dietary supplements include:
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- Nausea
- Vomiting
- Headache
- Constipation
- Excessive sleepiness
Supplements can also have long-term complications and risks, such as:
- Liver or other organ damage
- Reduced bone strength
- Fetal development abnormalities
- Increased risk of bleeding
- Changes in your response to anesthesia
- Reduced effectiveness of chemotherapy
- Nervous system damage
You Can Get Too Much of a Good Thing
Your body only needs a certain amount of each nutrient per day. When you go over that amount, there are several risks. For instance, here’s what could happen if you get too much of certain nutrients:
- Vitamin A: Nausea and vomiting, drowsiness, irritability, and beta-carotene supplements (a precursor of vitamin A) have shown an increased risk of lung cancer in current and former smokers, according to large trials (CARET, ATBC).
- Calcium: Irregular heartbeat, confusion, kidney damage, and increased risk of kidney stones or, rarely, milk-alkali syndrome.
- Niacin (Vitamin B3): long-term high dosing can lead to liver injury, ocular effects, and glucose issues (NIH).
- Biotin (Vitamin B7): often used for nail and hair growth, can interfere with lab tests, including troponin, leading to false results (FDA). Be sure to tell your clinician before labs if you are consuming this.
Supplements Can Interact With Other Medications
Be careful not to fall into the trap of thinking that, just because supplements are natural, they are safe - especially if you take daily medication or have certain medical conditions.
Just like medications, supplements can cause bad side effects if they are mixed with medications you are currently taking or other supplements. For example, St. John’s wort can reduce the effectiveness of other drugs, including many heart medications (blood thinners, statins, and heart rhythm medications). It can also affect medications that prevent organ transplant rejection, anti-HIV medications, and birth control pills by potentially causing breakthrough bleeding and increasing the likelihood of a woman getting pregnant. Vitamin C and other antioxidant supplements have shown they may worsen outcomes in chemotherapy; it is recommended to discuss use with your oncologist if consuming. Taking vitamin E supplements when you’re on the blood thinner warfarin can result in an increased risk of bleeding, and some analyses have linked high-dose Vitamin E with increased risk of hemorrhagic stroke.
They Aren’t Regulated the Same Way as Medications
Dietary supplements are regulated by the US Food and Drug Administration (FDA), but not necessarily in the way you think. Supplements are regulated by the FDA under the Dietary Supplement Health and Education Act (DSHEA). They’re not approved for safety or efficacy before marketing; manufacturers are responsible for safety and labeling, must follow cGMPs, and certain new dietary ingredients require a 75-day premarket notification. The FDA takes post-market action when needed if a supplement has been reported to cause harm after its been broadly available for consumption.
In other words the FDA has light regulation protocols for supplements that are not as stringent as medication regulations. Ultimately, they are responsible for monitoring supplements after they’ve hit the market to ensure they aren’t causing harm, inspecting manufacturing facilities, and, if needed, removing them from the marketplace.
How to Choose and Use Supplements Wisely
Given the potential risks and benefits, it's crucial to approach dietary supplements with caution and make informed decisions. Here's how:
Getting Those Nutrients In
Supplements should never replace a healthy diet. Whether you’re taking supplements or not, look for natural ways to get the nutrients you need through the foods you consume. Eat foods that are packed with essential nutrients, including fruits and vegetables, whole grains, and nuts and legumes. Stay physically active, since exercise helps nutrients get where they need to go in your body. If you’re taking or are interested in taking supplements, make sure you follow these steps for taking them safely and maximizing their benefit.
Consult with a Healthcare Professional
The most important thing to do is to work hand-in-hand with your provider. They can help you find ways to get the nutrients you need, whether it’s adjusting your lifestyle, taking supplements, or a combination of both. Only take supplements after talking to your provider or with a provider’s prescription. Always speak with a medical professional before starting a vitamin or supplement.
Follow Dosage Directions Carefully
Follow dosing directions carefully and don’t take more than recommended. Never substitute a supplement for a prescribed medication.
Inform All Your Healthcare Providers
Let all your providers (including your primary care provider, specialists, and providers at immediate care centers or emergency rooms) know about any supplements you’re taking before labs or procedures.
Be Aware of Potential Interactions
Keep in mind the term natural doesn’t always mean safe. Some all-natural botanical products, for example comfrey and kava, can harm the liver.
Report Any Adverse Events
If you think that you have had a bad reaction to a dietary supplement, let your health care provider know. They may report your experience to FDA.
Regulatory Landscape and Quality Assurance
Dietary supplements are regulated by the FDA, but the regulations are less stringent than those for prescription and over-the-counter drugs. The FDA does NOT have the authority to approve dietary supplements for safety and effectiveness, or to approve their labeling, before the supplements are sold to the public. Supplement companies are responsible for having evidence that their products are safe, and the label claims are truthful and not misleading.
The FDA can take action against adulterated or misbranded dietary supplements only after the product is on the market.
FDA has established Good Manufacturing Practices (GMPs) that companies must follow to help ensure the identity, purity, strength, and composition of their dietary supplements. These GMPs can prevent adding the wrong ingredient (or too much or too little of the correct ingredient) and reduce the chance of contamination or improper packaging and labeling of a product.
Several independent organizations offer quality testing and allow products that pass these tests to display a seal of quality assurance that indicates the product was properly manufactured, contains the ingredients listed on the label, and does not contain harmful levels of contaminants. These seals do not guarantee that a product is safe or effective.
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