Dietary Supplements: Safety, Regulation, and Red Flags

Many health professionals cringed when Senator Robery Kennedy Jr was appointed to head the Health and Human Services division of our government.

The supplement industry however, rejoiced. Many practitioners, trained in either traditional or alternative medicine, sell supplements as a form of revenue. Way back, chiropractors were known to do it. Now there are many people who create engaging content or “shocking grocery store videos”, all as a front to push you to put their supplements into a shopping cart.

Arguments that suggest that “traditional medicine” and “modern food” is making us sick, are a simplistic and unhelpful. Those in favor of less regulation (instead of more research and testing) for supplements, may unknowingly push the country away from “Big Pharma” to “Big Herbal”, which won’t make us any healthier either.

Follow the Digital Shopping Cart

The wellness industry has been growing exponentially. And it’s not for the reason you may think – “Oh we want to get back to nature and find wellness because modern medicine and food is making us sick”. No, these “wellness influencers” are driven by the same thing that drives pharmaceutical companies – profits.

There simply is no evidence to support many of the claims made in the wellness space. Many of my colleagues and I have been fighting against the misinformation and unethical practices of holistic practitioners for more than a decade. Naturopathic doctors, functional or holistic medicine practitioners, herbalists, and some barely-trained lay people (who pass a short test for a certificate) are making boatloads of money.

When you read about organizations like the “Council for Responsible Nutrition”, you may think this is an important nutrition and health organization. That is by design. They created a title that sounds like they care about your overall diet, health, diet and well being. However they are simply a supplement trade group, and have nothing to do with food or health. They represent the companies that manufacture nutrition supplements.

Are Supplements Regulated? Yes and No 

The supplement industry is a labyrinth of promises, from boosting energy to curing all sorts of ailments. But how safe are these products, and do they even work?

Dietary supplement regulation in the United States is primarily governed by the Dietary Supplement Health and Education Act (DSHEA) of 1994, which places these products under the FDA’s food regulations, rather than the more stringent drug regulations. However they aren’t regulated in the same way foods or drugs are. This creates significant gaps in safety oversight. Unlike pharmaceuticals, supplements are not required to undergo pre-market approval for safety and efficacy. 

It’s funny, because the natural products industry often views the food industry to be in a conflict of interest when they present any of their own funded research (even when it’s done by independent scientists). However supplement manufacturers are given the responsibility to ensure their own products are safe, without any oversight from the FDA. There are no provisions in the law for FDA to approve dietary supplements for safety before they reach the consumer. Yet that’s not a conflict of interest?

The FDA’s role is largely limited to post-market surveillance, meaning they typically only intervene after adverse events are reported. This allows new supplements to get to market with no proof of efficacy nor safety – and they are only investigated or reviewed once something goes wrong. This regulatory framework leaves consumers vulnerable to products containing undeclared ingredients, inaccurate labeling, and potentially harmful substances.

Buyer Beware: Safety and Hazards

Unlike pharmaceuticals, dietary supplements are regulated by the FDA as foods, not drugs.  However, as mentioned, they don’t undergo the same rigorous pre-market testing for safety and efficacy. Manufacturers are responsible for ensuring their products are safe, but the FDA primarily steps in after problems arise. This leaves room for misleading health claims and potentially harmful ingredients.

For one thing, it’s well known that supplements can interact with medications. It’s especially important to let your doctor and surgeon know what you taking, as some supplements adversely interact with anesthesia. Some supplements can also cause adverse effects, and even contain undeclared ingredients. Be particularly cautious about:

• Weight loss supplements: Often contain stimulants or other potentially dangerous substances.
• Muscle-building supplements: May contain steroids or other banned substances.
• Herbal supplements: Can interact with medications and have unknown long-term effects.

Questionable Practices: When “Natural” Isn’t Always Safe

Who can you trust for reliable advice? Functional or holistic practitioners sometimes recommend supplements without adequate scientific evidence. While some may offer valuable insights, many have no formal education or training and promote unproven remedies or misinterpret test results. Be cautious with:

• Practitioners who claim supplements can “cure” chronic diseases.
• Practitioners who claim supplements can fix a multitude of vague symptoms (brain fog, fatigue, achy joints, gut problems).
• Practitioners who sell their own line of supplements.
• Practitioners who recommend expensive, unnecessary testing (which generally results in: “Buy my supplement”).

Who to Trust: The Nutrition Experts

For safe and effective dietary advice, turn to qualified professionals:

• Registered Dietitian Nutritionists (RDNs): RDNs are the food and nutrition experts. They have completed rigorous education from credentialed universities and participate in qualified training experiences. They can provide personalized dietary advice and medical nutrition therapy. Most states have a licensure law that only permits registered dietitians to deliver medical nutrition therapy. Most RDNs do not recommend taking multiple supplements, however some supplementation can be of benefit, when it is personalized. A registered dietitian can review your medical status and determine your personal nutrition needs. We are qualified to give advice on who should take a supplement, and which ones may be of benefit. Any conflict of interest (such as  any affiliate relationship with a brand, or when a dietitian is working with a supplement company) should be disclosed.
• Physicians (MDs or DOs): Your doctor can assess your overall health and determine if supplements are appropriate for you, and check for drug interactions. They can refer you to a RDN. Both your physician and your dietitian can interpret lab work.
• Pharmacists: Pharmacists are drug experts and can help to identify potential interactions between supplements and medications.

Look Out as You Scroll

Social media is filled with misinformation. Ask questions. Get another opinion. Reach out to subject matter experts. When it comes to your decisions on supplements:

• Do your research before taking any supplement.
• Talk to your doctor or an RDN about your supplement use.
• Be skeptical of exaggerated claims and “miracle cures.”
• Remember, a balanced diet is the foundation of good health. A dietary supplement is designed to do as its name implies, supplement a good diet.

Stay informed and seek advice from qualified professionals.