FAmericans looking to improve their immunity and health have many options. These include multivitamins, melatonin and fiber. U.S. Centers for Disease Control and Prevention estimates that 58% Americans over 20 use dietary supplementation. This industry has a value of more than $30 million annually. Over the last few decades, supplement usage has grown rapidly along with the wellness market.
“The popular belief is that a supplement is going to be helpful for promoting health,” says Fang Fang Zhang, a professor at Tufts University’s Friedman School of Nutrition Science and Policy. It has been shown that those who take supplements regularly are more likely to have higher levels of education, higher incomes, healthier lives, exercise more, and to consume a better diet. “So those who are taking supplements are more health-conscious overall,” she says.
But if you’re already healthy, most supplements may not do much to improve your health or stave off death. “There’s no clear evidence to suggest benefits of dietary supplement use for many popular or common health outcomes,” says Zhang.
Supplement use can even prove to be dangerous in some instances. The 2015 Study published in New England Journal of MedicineThe study found that 23,000 Americans visit the emergency room each year for adverse effects related to dietary supplements. Many of these include issues with cardiovascular health, weight loss or energy. “Particularly when we use very high dose implementations, sometimes we might be doing more harm than good,” says Eliseo Guallar, professor of epidemiology and medicine at Johns Hopkins Bloomberg School of Public Health.
Experts call for stronger federal regulation in order to guarantee that supplements are effective and safe. Consumers should exercise caution when taking supplements.
For what are supplements useful?
Vitamins, minerals, and many other micronutrients are vital to the body’s functioning and are a crucial part of a good diet. However, nutrients can be taken as supplements or in foods. “Dietary supplement use is not a substitute for a healthy, balanced diet,” says Zhang.
When prescribed to people suffering from nutritional deficiencies or other illnesses, vitamin and mineral supplements are extremely beneficial. “High-quality supplements should be widely available, and we need them as part of medical treatment,” says Dr. Pieter Cohen, an associate professor at Harvard Medical School and an internist at Cambridge Health Alliance.
Although many packaged foods in America are fortified with extra nutrients, nutritional deficiencies in general have become rare. Most people may question the benefits of supplements.
An analysis was published in 2020 by the BMJZhang reviewed the data from many trials, and determined that no convincing evidence was provided to show nutritional supplements (vitamins and minerals) are beneficial in people who want to prevent chronic diseases such an as cancer or heart disease.
For certain botanicals (plant-derived nutritional supplements), the evidence is more complicated. While scientists are trying to understand the impact of many botanicals and nutritional supplements on the body, there is still a lot of confusion. “We know a lot,” says Guallar. “The problem is that sometimes the claims go beyond what we know.”
Some of the claims companies make about supplements may be extrapolated from animal results to human use, or rely on preliminary research. “These products should not be promoted as if they will have benefits for our health when it’s never been proven that they work in humans,” says Cohen.
This can lead to confusion among consumers about the benefits of certain supplements and make it difficult for them to understand what they are. “This is also combined with commercial pressure to promote some of these supplements,” says Guallar.
How dietary supplements are promoted and advertised is itself a function of how they’re regulated by the U.S. Food and Drug Administration (FDA).
These regulations are for food and not drugs
Even though many people take supplements because they want to improve their health, the FDA doesn’t regulate them as medications but instead as foods, under the Dietary Supplement Health and Education Act of 1994.
“What happened in 1994 was that all of these products from vitamins, minerals, to botanical extracts became subcategories of food,” explains Cohen. “It also created a completely different structure in terms of advertising, like the ability to advertise products to say things like ‘This will boost your immune system’, as code for ‘This will prevent infection,’” he says.
Supplement manufacturers aren’t required to prove their products are safe and effective before they are allowed to market them. Additionally, supplements do not have to be manufactured according to drug standards. Substandard products can occur. “It’s basically very difficult, if not impossible, to separate poor-quality products from higher-quality ones in the market, at least at present,” says Cohen.
Part of the problem is that the current system doesn’t do a good enough job of tracking when supplements cause harm, says Cohen. “I think we have to realize that for the public to have access to high-quality vitamins and minerals and botanicals, we’re going to need to reform the law,” he says.
Cohen previously proposed changes to existing regulations. This included standardizing manufacturing, rigorously vetting new ingredients, as well creating higher standards in terms of claims supplement manufacturers could make.
For now though, there are a few points consumers should keep in mind as they decide whether or not to use supplements.
How to navigate the Supplement aisle
When evaluating supplements, be wary of extravagant claims, as they’re unlikely to hold true. Be aware that certain supplements might contain more pills or more servings than necessary. “Sometimes these supplements are promoted at doses that are much higher than what you would get with diet,” says Guallar.
In general, consult your doctor about any supplement use, as many supplements can interact with medications you’re taking. These supplements may not be safe for use during pregnancy, breastfeeding, treatment of cancer, and other medical procedures.
It is important for consumers to know the signs of poor quality products. “My general advice to patients is to stick to supplements that list only one ingredient, and avoid a mixture of things, with the exception being multivitamins,” says Cohen. Cohen cites NSF International and USP certifications as indicators of high-quality products.
Be aware of weight loss supplements, muscle builders and sexual enhancements. Previous investigations found that these products can contain illegal or unidentified ingredients such as synthetic chemicals and pharmaceutical drugs. Supplements of this nature may have hidden ingredients.
Consumers can also find information about specific vitamins and minerals on trusted websites such as those managed by the Memorial Sloan-Kettering Cancer Center or the National Institutes of Health.
Let’s get to the bottom
“We don’t eat a single nutrient; we eat a food,” says Zhang. “That’s why a lot of supplements don’t achieve the same effect as the natural nutrients coming from food sources,” she says.
Zhang says that scientific evidence can always be improved as more research is done on nutritional supplements. For now however, it is possible to get better health by using more reliable methods. “Dietary supplement use shouldn’t be a substitute for a healthy diet and lifestyle,” says Zhang. “There’s no magic pill, unfortunately.”
What you need to know about popular supplements
It is generally considered to be useful
Pregnancy: Folic acidIt is known that folic acid supplementation in pregnancy can help to prevent birth defects. “That’s considered a success story,” says Guallar.
Fiber: Fiber supplements like psyllium may help reduce constipation, prevent heart disease, and lower cholesterol—though getting fiber from your diet also provides the vitamins and micronutrients found in whole foods.
Melatonin:You may experience jet lag relief. The evidence supporting its use in treating insomnia and other sleep disorders is not strong.
Menopause and calcium after vitamin D: Supplementation with calcium and vitamin D may help to protect bone health for postmenopausal females.
For adults suffering from age-related macular disease, a supplement mixture is available: People with this eye condition may experience reduced vision due to a combination of vitamins C, E, zinc, copper, lutein and zeaxanthin.
There is mixed evidence or none.
Multivitamins: They’re extremely common—an estimated third of U.S. adults take them—yet there’s no clear evidence that they help reduce mortality or prevent major chronic diseases, such as cancer or heart disease, in healthy people. But experts say that multivitamins probably won’t hurt you, either.
Echinacea: It may slightly reduce chances of catching a cold, but the evidence is weak, and there’s little proof that it helps treat colds or respiratory infections.
Ginkgo biloba: Studies have found that this supplement does not seem to improve cognitive performance or prevent Alzheimer’s disease or dementia.
Glucosamine, chondroitin There’s mixed evidence they help ease symptoms of osteoarthritis.
Vitamin D: Despite a lot of interest in its many potential health benefits, it’s still unclear if D supplements do much for healthy people. And in people who don’t have a deficiency, Zhang has found that very high doses of vitamin D may increase risk of all-cause and cancer mortality.
Antioxidants: Vitamins A, C,, and E as well as selenium beta carotene and folate are all antioxidants. However, they’ve not been able to live up to their claims. They don’t appear to protect against heart disease, stroke, or cancer, and some may be harmful at high doses.
Omega-3 Fatty Acids: Eating foods rich in omega-3 fatty acids, like fish, has been shown to protect against heart disease—but whether they offer the same protection when consumed in supplement form is still unclear. While some studies suggest that omega-3 fatty acids may be beneficial in certain conditions of the heart, others have not shown any benefit.
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