Science Biweekly

Supplements range from Sammy Sosa’s Flintstones vitamins to a pill of Ginkgo biloba. Humans have long recognized the importance of supplementing their diet with important nutrients. As explorers conquered the world in the age of discovery, they were constantly under the threat of developing scurvy. The cure to scurvy was identified by Dr. James Lind in 1747 and was relatively simple; supplement the diet of sailors with citrus fruit. It took nearly 200 years for humans to discover citrus fruit contained high amounts vitamin C. In modern times, we can supplement our diet with vitamin C in multiple ways and scurvy is nearly eliminated. However, extremely high amounts vitamin C have been claimed to cure colds, and are distributed as supplements.

Unlike drugs, which have been shown to be efficacious for their intended use, supplements fall under a less stringent regulatory code and are potentially very dangerous. Consumers should understand how supplements are regulated and how to find reliable information about the safety and efficacy of supplements.

In the United States drugs are regulated through the Food and Drug Administration or FDA. From the lab bench to FDA approval, a drug usually takes 10-12 years to develop and is estimated to cost about 2.6 billion dollars (Bekerman, 2015). The FDA has stringent policies on drug approval and requires detailed safety information and proof the drug is efficacious. To obtain that information companies must spend massive amounts of money to obtain the data necessary for FDA approval. However, FDA regulations on supplements are far more lenient.

The Dietary Supplement Health and Education Act (DSHEA) of 1994 was legislation passed to regulate supplements that can be purchased in the United States. The act allowed companies to forgo FDA safety approval on supplements that were distributed before 1994. However, any new ingredients added after 1994 are reviewed by the FDA to verify there is adequate information for their safety. DSHEA does not require the FDA to review supplements for the efficacy, and supplements are required to state they are “not intended to diagnose, treat, cure, or prevent any disease.” The safety of supplements becomes a convoluted affair when addressing complex components like a plant leaf or a concentrated extract. If there is a problem with the supplement, it takes thousands of adverse reactions before the FDA can remove a product. There is a great review published by Abel-Rahman et al. I’ve cited that explains potential FDA safety problems in more detail.

Another major issue with supplements is quality control standards. There is little to no standards that supplements have to follow to indicate the ingredients are exactly as what is labeled. Nonetheless, there are third party labs that verify the contents of supplements like USP, NSF and AOAC international. The third-party verifications are typically found on the supplement’s label.

There is an old adage of treating your body like a temple. If you don’t know exactly what you’re putting in it, why potentially endanger it? If you do take a supplement, do your research (I suggest http://www.pubmed.com or http://www.ods.od.nih.gov ) and make sure you tell your physician as supplements may have unintended consequences or interact with other prescription drugs. One group of supplements that is potentially very toxic is pre-workout mixes. These have been shown in the past to contain anabolic steroids when independently assessed for quality. A vitamin supplement can be very beneficial for people but “miracle weight-loss” supplements may be far from helpful. Do your research, talk to your physician, and know the safety of each supplement you take.

Citations:

1. Bekerman, E., & Einav, S. (2015). Combating emerging viral threats. Science, 348(6232), 282-283.

2. Abdel-Rahman, A., Anyangwe, N., Carlacci, L., Casper, S., Danam, R. P., Enongene, E., ... & Hines, F. (2011). The safety and regulation of natural products used as foods and food ingredients. Toxicological Sciences, kfr198.