Not-so-safe supplements

Dietary supplements are sometimes erroneously perceived as inherently healthy. And because of the way many supplements are advertised, it’s easy to overlook that improper administration can lead to adverse outcomes.

The classification of a supplement is defined in the United States Dietary Supplement Health and Education Act of 1994 (DSHEA) as a vitamin, mineral, herb or botanical, amino acid, and any concentrate, metabolite, constituent, or extract of these substances. In the U.S., the Food and Drug Administration (FDA) is the governing body that oversees the regulation of dietary supplements. If a supplement has been reported to be causing serious adverse events or reactions, the FDA has the authority to pull it from the market. However, no safety testing or FDA approval is required before a company can market their supplement. The lack of oversight authority given to the FDA has even drawn the attention of late night talk shows hosts like John Oliver, who humorously covered the issue in this YouTube video.

Many adults are using one or more supplements to address illnesses or symptoms, and to maintain or improve health^[1]. Half of all U.S. adults have reported using at least one supplement in the past 30 days^[1]. Twelve percent of college students have reported taking five or more supplements^[2] a week. Now, more than ever, there are seemingly endless options to choose from. The number of supplement products currently available on the market is thought to be in excess of 55,000. Compare that to the mere 4,000 available in 1994, when DSHEA was passed.

Furthermore, confidence in the safety and efficacy of these supplements is very high despite the lack of rigorous oversight by the FDA. A survey conducted by the trade association, Council for Responsible Nutrition, found that “85% of American adults … are confident in the safety, quality and effectiveness of dietary supplements.” An independent survey^[3] has echoed these results, finding that 67.2% of respondents felt extremely or somewhat confident in supplement efficacy and 70.8% felt extremely or somewhat confident about their safety.

While the majority of Americans trust in their supplements, more than one-third have not told their physician^[4] about using them. There are numerous documented drug-supplement interactions ranging from the mild to the severe. The herb St. John’s Wort is thought to be able to reduce symptoms in people with mild to moderate depression. But this ‘natural’ supplement also has 200 documented major drug interactions, including some with common depression medication. However, no good data currently exists to document how common adverse events related to dietary supplements may be. The authors of the present study have used surveillance data to try and fill this knowledge gap.

Due to DSHEA, supplements remain largely unregulated by the FDA. But dietary supplements are becoming ever more popular, as about half of U.S. adults report using one or more in the past 30 days. Trust in the safety and efficacy of these supplements also remains high. The authors of this study aimed to investigate how many annual adverse events are caused by improper supplement usage.