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Dec. 28, 2023 \u2013 The market for <\/span>dietary supplements<\/a> \u2013 vitamins, minerals, botanicals, herbs, and other products promoted as ways to help you feel better, look better, perform better, sleep better, and stay healthy \u2013 is booming, and that boom isn\u2019t done. In 2021, U.S. consumers spent more than $48 billion on supplements; that number is projected to grow more than 5% annually over the next 5 years.\u00a0<\/span><\/p>\n The industry grew from about\u00a0<\/span>4,000 products<\/span><\/a> in 1994 to 80,000 in 2016.\u00a0At least half of U.S. adults take dietary supplements, according to 2021 federal\u00a0<\/span>statistics.<\/span><\/a>\u00a0Three-quarters of the people who took a 2023 consumer survey done by the Council for Responsible Nutrition, the trade association representing supplement makers and ingredient suppliers, said they take supplements.<\/span><\/p>\n Despite this enthusiasm, experts worry about adverse effects from mega doses and point out the lack of evidence of benefit for many supplements.\u00a0More government oversight is sorely needed, others say. Currently, the FDA\u2019s role in regulating supplements usually begins only after the product is on the market.<\/span><\/p>\n<\/section>\n Profile of a Supplement User<\/strong><\/span><\/p>\n While some consumers are seasonal or occasional users, others are passionate supplement takers like Suzanne Bank, an interior designer in Studio City, CA. Among her regular supplements are vitamin C, apple cigar vinegar for digestion, tri-magnesium for healthy muscle function, and cat\u2019s claw, promoted for brain health.\u00a0<\/span><\/p>\n \u201cThey have kept me going, kept me leading an active life,\u201d said Bank, who said she is past \u201ctypical\u201d retirement age but still operates her own business. \u201cI\u2019m healthy, I don\u2019t get sick, and I look far, far younger than my age.\u201d<\/span><\/p>\n Bank said she hasn\u2019t had any adverse effects, even after more than 40 years of regular supplement use.<\/span><\/p>\n So, Which Supplements Work?<\/strong><\/span><\/p>\n According to the FDA,\u00a0<\/span>dietary supplements<\/span><\/a> can help improve or maintain overall health, as well as help people meet the daily requirements of essential nutrients. It also says: \u201cWhile the benefits of some supplements are well established, other supplements need more study.\u201d It cautions that supplements should not take the place of a variety of foods crucial for a healthy diet.<\/span><\/p>\n<\/section>\n<\/div>\n Most people view supplements, at worst, as benign preventive products, said Jeffrey A. Linder, MD, MPH, chief of general internal medicine at Northwestern University\u2019s Feinberg School of Medicine in Chicago. But they aren\u2019t always harmless. With too much emphasis and reliance on supplements, Linder said, \u201cI\u2019m more worried that people are getting distracted from things that will actually help them be healthy, like exercise, eating a healthy diet, and maintaining a healthy weight.\u201d\u00a0<\/span><\/p>\n While there\u2019s no one-stop reference on which supplements are worth taking, various organizations as well as researchers attempt to summarize the evidence and issue conclusions. Recently, the U.S. Preventive Services Task Force issued\u00a0<\/span>recommendations<\/span><\/a> on the evidence for supplements in preventing cardiovascular disease (diseases of the heart and blood vessels) and cancer.\u00a0<\/span><\/p>\n Linder co-wrote an\u00a0<\/span>editorial<\/span><\/a> to go with those recommendations. In summary, he said, the task force concluded that \u201cthere is insufficient evidence about pretty much all supplements\u201d for preventing cardiovascular disease and cancer, and specifically recommended against vitamin E and beta carotene for preventing those diseases.<\/span><\/p>\n<\/section>\n Overall, some of the strongest evidence, Linder said, is for prenatal folic acid supplements to prevent birth defects, citing a\u00a0<\/span>previous recommendation<\/span><\/a> by the task force.\u00a0<\/span><\/p>\n While the task force rating of \u201cI\u201d for insufficient evidence given to most supplements isn\u2019t a vote for or against use, Linder said, current evidence shows that any benefit of a multivitamin in reducing the risk of death from heart disease is likely to be a small one.<\/span><\/p>\n Vitamin D supplements are popular for those hoping to boost bone health, reduce cancer risk, and ease inflammation. But proving vitamin D supplements help those who are not naturally deficient in vitamin D is difficult, Linder said, noting that the task force didn\u2019t find evidence that vitamin D reduced cancer or cardiovascular disease risk.<\/span><\/p>\n \u201cI think there are many more people taking vitamin D [supplements] unnecessarily than there are people benefitting from a vitamin D supplement,\u201d he said. Likewise, the task force didn\u2019t find evidence that vitamin C reduced cancer risk or cancer death risk.<\/span><\/p>\n<\/section>\n<\/div>\n What Works? Research on Supplements for Musculoskeletal Health<\/strong><\/span><\/p>\n In a special issue of the journal\u00a0<\/span>Nutrients<\/span><\/i>,<\/span><\/a> researchers submitted 13 studies and four reviews of studies, concluding that a wide variety of supplements can help improve the health of bones and muscles in people with and without certain diseases.<\/span><\/p>\n A sampling of their findings:<\/span><\/p>\n Supplements du Jour<\/strong><\/span><\/p>\n In recent years, \u201cbeauty\u201d supplements that promise to improve skin, hair, and nails have gotten more popular, with their use\u00a0<\/span>doubling<\/span><\/a> from 2012 to 2020, according to a national health survey of nearly 41,000 people.\u00a0<\/span><\/p>\n Consumers should be cautious taking these, said Rajani Katta, MD, a Houston dermatologist who is on the volunteer faculty of McGovern Medical School at the University of Texas and Baylor College of Medicine in Houston. Katta has published\u00a0<\/span>information<\/span><\/a> on these types of supplements. Biotin, which supplement makers claim can help with hair and skin health, for instance, can interfere with thyroid and cardiac function testing, she said. Heavy metals have been found in collagen supplements.<\/span><\/p>\n<\/section>\n \u201cIf you are on a supplement with high levels of biotin, you need to tell your doctor,\u201d Katta said. \u201cIt could interfere with testing.\u201d Avoid supplements that list \u201cproprietary blends\u201d as an ingredient, she said, as that does not tell you which ingredients are in it.<\/span><\/p>\n Solution: More Oversight?<\/strong><\/span><\/p>\n The 1994 Dietary Supplement Health and Education ACT, or\u00a0<\/span>DSHEA,<\/span><\/a> established regulations for dietary supplements. Under it, the FDA typically does not review dietary supplements before they go to market, and supplement makers don\u2019t have to give the FDA basic product information, such as names or ingredients, before putting them up for sale.<\/span><\/p>\n As a result, the FDA mainly relies on post-market surveillance to monitor product safety, restricting use or ordering a recall only if there\u2019s proof that a product or ingredient is not safe.<\/span><\/p>\n<\/section>\n<\/div>\n The growing market for supplements means growing risk, according to\u00a0<\/span>experts pushing for<\/span><\/a> more oversight. In spelling out the need, researchers writing in the <\/span>AMA Journal of Ethics<\/span><\/i> cited a study finding that the FDA\u2019s central reporting system (CFSAN Adverse Event Reporting System, or CAERS) received more than 15,000 health problem reports linked to supplements, including 339 deaths and nearly 4,000 hospitalizations.\u00a0<\/span><\/p>\n<\/section>\n Bipartisan legislation to beef up the oversight of the supplement industry was introduced in the Senate in 2022. The\u00a0<\/span>bill,<\/span><\/a> by Senate Majority Whip Dick Durbin (D-IL) and Sen. Mike Braun (R-IN), would require dietary supplement makers to list their products with the FDA. Introduced in April, 2022, it was referred to the Committee on Health, Education, Labor and Pensions.\u00a0<\/span><\/p>\n Industry Views<\/strong><\/span><\/p>\n The Council for Responsible Nutrition counters that solid evidence backs the use of many supplements. In 2022, it issued a report,\u00a0<\/span>Supplements to Savings,<\/span><\/a> about the health care cost savings with the use of targeted supplements for specific conditions. They found benefit for, among other supplements, omega-3 fatty acids for cardiovascular disease, vitamin D for osteoporosis-related fractures, and magnesium for cardiovascular-related disease events. Vitamin D with calcium, for instance, reduced the risk of a fracture by 14%.\u00a0<\/span><\/p>\n The industry supports the idea of more oversight, said Steve Mister, CEO and president of the Council for Responsible Nutrition. For instance, he said, his organization strongly supports the Durbin bill, which wants supplement makers to list their products with the FDA. \u201cThe basic idea of the bill is something that CRN is strongly supportive of.\u201d<\/span><\/p>\n<\/section>\n It\u2019s a problem, he said, that the FDA has no way of knowing how many supplement products are on the market. The Durbin bill would have set up a registry of sorts, not premarket approval but access to information about products, which Mister sees as something the FDA needs.<\/span><\/p>\n The existing law will be 30 years old in 2024, Mister pointed out, and it\u2019s past due for an overhaul to achieve reform and maintain safety.\u00a0<\/span><\/p>\n Consumer Actions<\/strong><\/span><\/p>\n You can do much on your own to ensure the safety of the supplements you take. Tell your doctor about any supplement you are taking or planning to take, and expect your doctor to bring up the topic during visits.<\/span><\/p>\n<\/section>\n<\/div>\n When shopping, look for a label that says the supplement has been inspected by an outside lab, such as\u00a0<\/span>NSF<\/span><\/a> or\u00a0<\/span>Consumer Lab.<\/span><\/a><\/p>\n Consult <\/span>interaction checkers<\/span><\/a> to be aware of which supplements don\u2019t mix well with which medicines. You can report any problems with supplements to the FDA\u2019s\u00a0<\/span>Safety Reporting Portal<\/span><\/a> online.<\/span><\/p>\n\n