​How to Figure Out If Your Supplements Are Safe

Supplements aren't regulated like drugs. Their makers don't have to
prove that they're safe or effective. Let's talk about some of the
pitfalls of using supplements, and how you can improve your chances of
getting a pill that does what it's supposed to.

Challenging Assumptions: Why You Can't Trust the Label

You're not alone if you assume that vitamins and other supplements
must pass some sort of approval process to be sold in stores (59% of
adults agreed in a 2002 Harris poll), that any claims on the label would have to be supported by scientific evidence (55%), or that supplements with dangerous effects would have to carry a warning label (68%).

None of this is true.

By law, US companies can't market supplements that are "adulturated or misbranded," but no testing or approval is required. The FDA states on its website:

By law (DSHEA), the manufacturer is responsible for ensuring that
its dietary supplement products are safe before they are marketed.
Unlike drug products that must be proven safe and effective for their
intended use before marketing, there are no provisions in the law for
FDA to "approve" dietary supplements for safety or effectiveness before
they reach the consumer. Under DSHEA, once the product is marketed, FDA
has the responsibility for showing that a dietary supplement is
"unsafe," before it can take action to restrict the product's use or
removal from the marketplace.

In a supplement industry survey, 85% of Americans agreed they were
"confident" in the "safety, quality, and effectiveness" of supplements.
Academic studies have shown similar results, including the idea that
people perceive supplements as safe because they are available without a prescription and because they are "natural."

It's not hard to find examples of supplements that have caused real harm: Hydroxycut was finally recalled after causing liver damage for years; a supplement called Total Body Formula turned out to contain massively damaging overdoses of selenium, way more than what was listed on the label.

The FDA has the authority to challenge supplement makers who make
drug-like claims, and to recall products (like the ones above) that are
clearly unsafe, but they only have the budget to go after a handful of
companies each year, and their system of collecting safety reports is clearly inadeqaute.

Bottom line: Just because the label says it will do something great
for your body, doesn't mean it actually will; and just because it's on
shelves and sold without a prescription doesn't mean it's safe.
Supplements May Not Contain What They Say They Do

Just like you can't trust the front of the label, it may also be
unwise to trust the back. A recent DNA analysis of several herbal
supplements (sold at big name retailers like Target and Walgreen's)
showed that some of them didn't contain any of their purported ingredients.
The New York attorney general called for the products to be taken off
the shelves on the basis of those results, although recently experts
have identified potential problems with the test
that was used. Even if the results turn out to be wrong, we still know
that such a situation is possible, given the lack of oversight.Even though we can't say for sure whether some supplements are
missing their ingredients, we do know that others contain too many. For
athletes, it's a particularly bad problem: some sports supplements carry an extra kick from drugs that aren't on the label, and that could disqualify athletes under doping rules if those drugs show up on a test. The US Anti-Doping agency maintains a list of known risky supplements,
but before you can see the list, you have to click through an agreement
that you acknowledge that the list isn't complete, and other risky
supplements could be out there.
Even after supplements are recalled, they may still be on the shelves with the banned ingredients still present. A study by Dr. Cohen's team found
that 85% of recalled sports supplements, bought on average three years
after their recalls, still contained the banned substances, including
anabolic steroids.
You Might Not Actually Need Supplements

When I asked supplement safety expert Dr. Pieter Cohen what his advice was for consumers, he began his response with a harsh reality check:

First off, do you actually need the supplement? Most,
if not all, botanical supplements won't improve your health, so you can
save your cash.

By "botanical" he means herbal supplements like St. John's wort,
echinacea, ginkgo, and ginseng. (The list could go on to include
hundreds of obscure plants that are sold as capsules or teas.) Similar
advice applies to other types of supplements, including vitamins and
probiotics.
An analysis by Consumer Reports concluded that only a third of supplements have any evidence supporting their safety or effectiveness.Vitamins were hailed as medical miracles when they were first discovered, because debilitating vitamin deficiencies can be
cured almost immediately by adding the vitamin back into the patient's
diet. If you're not deficient, though, vitamins won't do much, or
possibly anything, for you. As for taking a multivitamin for "insurance"
against possible gaps in your diet, experts are divided. Some think it's a great idea; others are outspoken about vitamins for healthy people being a waste of money.

Probiotics, or supplements made of good bacteria,
sound better and better as we learn more about how the microbiome
impacts our health. Unfortunately the handful of species you can buy as a
supplement don't take up residence in our gut. There's little to no evidence that they contribute to a healthy microbiome, which by the way, may be outside of our current abilities to define.
Herbal supplements include plants that are used moreor less as drugs, aiming to treat or prevent disease (even if the label
can't legally say that directly). They may contain whole plant parts or
extracts, and often the active ingredient is unknown, as is the dose of
the active ingredient since, in many plants, the dose varies by which part of the plant was used and when in the growing season it was harvested.

How to Find the Safest Supplements

If you do take supplements, how can you give yourself the best chance
of buying ones that contain what you expect, no more and no less? I
asked nutrition researcher Kamal Patel of Examine.com (an independent supplement information company; they don't sell any supplements) for tips for consumers. Here's what he wrote:

One anecdotal trend is for consumers to buy more "pure"
supplement formulations. For example, instead of buying BCAA powder
that's tropical fruit punch flavored, they'll buy straight-up BCAA
(which taste terrible) without any additives or fillers. The few
companies who provide products like this appear to be more transparent
with regards to their manufacturing practices and quality initiatives.


At a recent conference, I talked to one researcher whose family uses
mostly supplements where the specific brand has been tested in clinical
trials. For example, lavender is a supplement that is used for anxiety.
There is one specific brand that has been tested, called Silexan. There
are a handful of big manufacturers who havesupplements that are
frequently used for clinical trials.

Other than NSF, there are a
few other testing organizations and product databases. This has its
pros and cons, as certification doesn't necessarily mean quality, since
some quality criteria can differ depending on the specificsupplement.
And private organizations that test don't have to be transparent with
how they test and how that changes over time.

Consumer Reports
is traditionally what people went to, but they seem to be doing not so
hot financially. It's almost as important to have organizations looking
at the veracity of health claims plastered on the supplementlabel (like
Consumer Reports does) as it is to test the actual supplement. The
over-the-counter immune supplement Airborne lost a big settlement in
2010, and had to fund a two-year grant for combating deceptive
advertising in supplements. Some (or most?) of the money went to
Consumer Reports.

You can also look up your favorite supplements with these
organizations and databases that report the results of supplement tests:

• NSF Certified for Sport
• The United States Pharmacopeia's verified supplement list
• The Natural Products Foundation, funded by the supplement industry
• Labdoor, which sells and tests supplements
• Consumerlab, another independent group

Supplements may not always contain what's on the label, but with
these tips and databases, you can be more confident that you know what
you're getting.

Images by J.Pramote, Mike Mozart, Super Fantastic, Dr. Wendy Longo, and Dylan.



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