Supplements and Safety: What you need to know.
Supplements versus prescription drugs: which group is safer? It’s not surprising that instinct tells us supplements. After all, supplements are branded as “natural, holistic, and less toxic.” They come beautifully packaged, have celebrity backing, and are sold at Whole Foods. Medications, in contrast, are considered “chemicals,” risky and dangerous with side effects listed on double-sided inserts. They are dispensed in lock-top tubes with notable “warning” stickers. Clearly, not the favored.
But what are supplements?
Before 1994, only vitamins and minerals belonged to the supplement category. These products have nutritional value and are safe when taken in recommended doses. Someone deficient in Vitamin D, for example, can “supplement” with Vitamin D to restore reserves. Vitamins and minerals can be assayed and tested and easily manufactured to the same standards as conventional prescription drugs. After 1994, however, the Dietary Supplement Health and Education Act expanded the supplement category to include other botanicals, herbs, and medicinals. The problem with these products is they don’t “supplement” the diet and can cause severe side effects, even if used as directed.
Botanicals and herbal remedies are effectively crude, unpurified drugs – possibly with hundreds of ingredients and unclear product standards. Indeed, many prescription drugs available today have botanical origins, like aspirin, which comes from bark of the willow tree. But, drugs have an edge over less refined plants. Drugs are standardized to yield predictable and reproducible effects. Active ingredients within a plant are isolated, purified and sometimes modified to enhance a drug’s effects or improve its tolerability. Drugs are initially tested in vitro (in test tubes), then often in animals, and finally in people to establish safety, efficacy, and clear dosage guidelines. Companies must adhere to strict protocols where variation in drug purity and amount per dose is minimized.
Unfortunately, none of this goes for supplements. Consumers are at the whim of manufacturers to supply what they advertise with little oversight. Quality control is a big issue surrounding supplements. Multiple manufacturers have been cited for unsanitary conditions or for having grossly different drug doses, even up to 456% off from that stated on labels1. Others have been sited for not even including the advertised plant in their preparations at all. One investigation, for instance, showed only 2/12 companies distributed products that contained all of the plants listed on their labels, and almost 60% of products contained other not-listed ingredients, some being potential allergens or toxins2,3.
Adulteration is second concern surrounding supplements. Some, especially those marketed for weight loss, increased energy, or enhanced sex drive, are adulterated by other-the-counter medications or prescription drugs. Yes, your energy booster may actually contain an amphetamine, and no one may have tested it to know. These additives can cause severe or deadly side effects alone or when combined with other medications. Until recently, manufacturers were not required to report supplement adverse events to the FDA, so most of our data on toxicity comes from Poison Control Centers and Emergency Rooms, which likely underestimates the problem.
Finally, efficacy is another problem that plagues supplements. In general, claims for supplement effectiveness are based on anecdotal evidence and traditional teaching. While it is likely that some supplements, or at least specific ingredients within them are medicinally effective, rigorous clinical trials haven’t supported this. Large studies supported by the National Institute of Health didn’t find a significant benefit beyond a placebo effect for a number of popular supplements, including Echinacea, ginkgo biloba, ginseng, black cohosh, isoflavones, saw palmetto, and glucosamine4.
Consult a Board-Certified Dermatologist
So, before jumping at the next beautifully branded dietary supplement, even if it promises healthier glowy skin, consider its risks and benefits. With widely varying doses and actual ingredients, sticking with reputable products manufactured in this country or with the vitamins and minerals contained in healthy diverse foods may be your safest and surest options. And if you really want to improve your skin? Consider working with one of our board-certified dermatologists who will customize an evidence-based treatment protocol based on your healthier skin goals!
- T. Tsouderos. Dietary supplements: Manufacturing problemswidespread, FDA inspections show. Available at: http://articles.
chicagotribune.com/2012-06-30/news/ct-met-supplement-inspections-20120630_1_dietary-supplements-inspections-american-herbal-productsassociation [21 April 2015].
- ConsumerLab.com. FDA finds problems at 62% of supplement manufacturing sites in US and abroad. Available at: https://www.
consumerlab.com/recall_detail.asp?recallid=10799 [21 April 2015].
- S. G. Newmaster, M. Grguric, D. Shanmughanandhan, S. Ramalingham,S. Ragupathy. DNA barcoding detects contamination and substitution in Norh American herbal products. BMC Med. 2013, 11, 222.
- P. Offit. Studying complementary and alternative therapies. JAMA.2012, 307, 1803.