WELLNESS EDIT | No. 19 |
Supplements
Walk into almost any pharmacy, supermarket, or health food store and you will find shelves of supplements promising everything from better sleep and sharper focus to improved immunity and healthier aging. Their availability can make them feel inherently safe. But being easy to buy is not the same as being well tested, effective, or appropriate for everyone.
Dietary supplements can be extremely useful, particularly when they are correcting a deficiency or addressing a specific nutritional need. But they are regulated very differently from prescription and over-the-counter medications, and the quality, dose, formulation, and evidence behind them can vary considerably.
Understanding that difference is one of the most important things to know before choosing what goes into your supplement cabinet.
Here’s what you need to know.
Supplements are loosely regulated
In the United States, dietary supplements are regulated by the Food and Drug Administration (FDA), but they do not go through the same premarket approval process as medications.
For most supplements, manufacturers do not have to demonstrate to the FDA that a product is effective before putting it on the market. Manufacturers are responsible for ensuring their products are safe and properly labeled, while the FDA can take action against products that are found to be unsafe, adulterated, or improperly marketed.
That is very different from a new drug, which generally has to undergo extensive testing and demonstrate safety and effectiveness before receiving FDA approval.
What the FDA does and doesn’t do
One of the biggest misconceptions about supplements is that because they are regulated, someone has independently tested every bottle before it reaches the shelf.
That is not the case.
The FDA oversees dietary supplement manufacturing, labeling, safety reporting, and marketplace compliance. But it does not routinely test or approve individual supplements for purity, potency, effectiveness, or bioavailability before they are sold.
This means the quality of one supplement can be very different from another, even when the labels appear remarkably similar.
A product may contain more or less of an ingredient than expected, have problems with contamination, or contain a form of a nutrient that differs in absorption or tolerability. Herbal products create another layer of complexity because their chemical composition can vary considerably.
Not all supplements are created equal
Two bottles containing the “same” supplement are not necessarily equivalent.
The source of an ingredient, its chemical form, dose, formulation, manufacturing standards, storage, and independent testing can all matter.
Price isn’t necessarily a reliable guide either. An expensive supplement with beautiful packaging and impressive marketing is not automatically more effective than a less glamorous alternative.
This is where independent testing can be useful.
Organizations including ConsumerLab, NSF, USP, BSCG and Labdoor evaluate various aspects of supplement quality. Depending on the organization and certification, testing may include whether a product contains the ingredients and amounts stated on its label and whether it meets standards for contaminants or other quality measures.
Third-party certification does not prove that a supplement will improve your health. What it can provide is greater confidence that the product itself meets certain quality standards.
How to protect yourself
Because supplement quality can vary, it is worth doing a little homework before buying.
Look for products from reputable manufacturers and retailers, and check whether they have been independently tested. Third-party testing cannot tell you whether a supplement will work for you, but it can provide greater confidence that the product contains what the label says it does and has been screened for contaminants.
Research supplements carefully. Look for independent testing and certification to ensure quality and safety
ConsumerLab — Tests supplements for ingredient accuracy, purity, and quality.
Labdoor — Provides laboratory testing and analysis of supplement ingredients, label accuracy, and safety.
BSCG (Banned Substances Control Group) — Screens supplements for banned substances, contaminants, and other quality concerns, particularly in sports supplements.
NSF (National Sanitation Foundation) — Certifies products against established safety and quality standards.
USP (United States Pharmacopeia) — Verifies that participating products contain the listed ingredients in the stated amounts and meet standards for quality and contaminants.
A little research can go a long way. Independent testing does not guarantee that a supplement will be effective for you, but it can help you make a more informed choice about the quality of the product you are buying.
Supplements can interact with medications
Supplements are frequently left off medication lists, yet they can interact with prescription and over-the-counter drugs.
Some supplements can affect the way medications are absorbed or metabolized. Others may amplify a medication’s effects. Depending on the combination, this can potentially affect blood pressure, blood glucose, bleeding risk, sedation and other physiological processes.
“Natural” does not mean pharmacologically inactive.
If you take medication, are preparing for surgery, are pregnant or breastfeeding, or have a medical condition, supplements deserve the same conversation with your healthcare professional as medications do.
Be careful where your supplement advice comes from
Social media has made supplement information extraordinarily accessible. It has not necessarily made it more accurate.
Anyone can describe themselves as a “nutritionist” in many settings, and the title does not necessarily indicate a particular level of education or clinical training. Credentials matter, particularly when someone is recommending high doses, multiple supplements, or products that could interact with medications.
The problem works in both directions. I have seen useful supplements dismissed as dangerous without good evidence, while other products are enthusiastically promoted with little discussion of dose, interactions or whether the person taking them actually needs them.
Bottom line
Supplements can be very beneficial in supporting your health, but they are not automatically safe. Their widespread availability, polished marketing, and association with health can create a level of trust that is not always warranted. Price, branding, and popularity do not guarantee quality or effectiveness.
They are also easily overlooked when something starts to feel off. Headaches, stomach problems, changes in mood, anxiety, fatigue, or other symptoms may be blamed on something else when a supplement, its dose, or an interaction with medication could be contributing.
Dietary supplements can alter the absorption or metabolism of certain prescription medications, potentially reducing their effectiveness or increasing the risk of side effects. Taking too much of some supplements can also cause problems of its own, including gastrointestinal symptoms and, in some cases, liver injury.
Like medications, what works well for one person may not suit another. A supplement should earn its place in your routine rather than simply being assumed to be beneficial because it is marketed as healthy.
