Immune boost or over-the-counter poison? Why your "health" supplements may do more harm than good

A $50 billion industry has grown around underregulated substances you probably don't need and may even hurt you

By Mary Elizabeth Williams

Senior Writer

Published August 12, 2023 10:00AM (EDT)

Herbs and supplement capsules (Getty Images / Voiculescu Alin / 500px)
Herbs and supplement capsules (Getty Images / Voiculescu Alin / 500px)

"They're taking this black liquid, and apparently parasites come out when you use the bathroom. That's what they claim," dietician Steph Grasso told her horrified followers recently on her TikTok, describing a tincture-like product that is being marketed as a health supplement. "They're taking this to de-bloat and detox their body."

But, as Grasso went on to explain, "Some researchers claim that those 'worms' that they're seeing is actually part of their lining of their intestine."

Clearly, a gut-melting liquid is going to do the opposite of improving your health. Yet you can buy this product, described as beneficial for "intestinal flora," from multiple sites with just one click.

"57.6% of adults aged 20 and over reported using a dietary supplement in the past 30 days" 

Ashwagandha for anxiety. Magnesium for tense muscles. Comfrey for period pain. Vitamin C to fend off a cold. Popping vitamins, mixing powders into our smoothies and sipping teas that promise certain benefits is a way of life for the majority of us. The CDC's most recent data estimates that "57.6% of adults aged 20 and over reported using any dietary supplement in the past 30 days." For women, that percentage shoots up to 63.8%. And nearly 14% of us take four or more supplements.

Naturally, it's a staggeringly lucrative business. We spend over $50 billion a year on powders, pills, gummies and beverages aimed at providing extra nutrients, balancing our health and improving our lives — and that figure has grown by nearly $10 billion in the last five years alone.

Nonetheless, many critics describe this industry as virtually unregulated, as they don't fall under the same scrutiny of the Food and Drug Administration (FDA) like pharmaceutical drugs — not that so-called Big Pharma is flawless, either. The May 2022 issue of the American Medical Association's Journal of Ethics, for example, was devoted to the risks of "underregulated supplements," cautioning that "labeling about content and claims about purpose, safety, or efficacy are best regarded as marketing."

It begs the question: are our ostensibly healthy habits doing more harm than good?

"Patients ask all the time, 'What supplements should I be taking?'" Dr. Jeffrey Linder, chief of general internal medicine in the department of medicine at Northwestern University Feinberg School of Medicine told Northwestern Now last year, adding. "They're wasting money and focus, thinking there has to be a magic set of pills that will keep them healthy." Instead, he said, "We should all be following the evidence-based practices of eating healthy and exercising." 

And wasting money or feeling no measurable benefits may be about as good as it can get with certain supplements. In April, TruVision Health — a "wellness" brand with a "weight management" angle — issued a recall for 12 of its products for containing "possibly unsafe" stimulants. Symptoms the FDA warned that some users reported included "chest pain, chills, diarrhea, dizziness/lightheadedness, fatigue, headache, high blood pressure, high heart rate, jitters, nausea, nervousness, rash, stomach pain or upset, sweating and vomiting."

Two months later, in June, "tens of thousands" of canisters of the popular, Jennifer Anniston-endorsed brand Vital Proteins' Collagen Peptides were recalled over concerns "that shards of a broken plastic lid contaminated the product." And when Lori McClintock, the 61 year-old wife of U.S. Rep. Tom McClintock died suddenly in 2021, the immediate cause of death given was dehydration due to gastroenteritis.

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Later, however, her death certificate was amended to add more specificity, that her condition was the result of "adverse effects of white mulberry leaf ingestion." Mulberry is a common, typically harmless herb that is sold in tea or capsule form — often as a weight loss supplement. 

"It is important to be aware of the potential risks and side effects associated with certain supplements," says Susanne Mitschke, CEO and Co-founder of Citruslabs. "Some supplements may interact with prescription medications or may not be safe for individuals with certain medical conditions.

For example," she explains, "St. John's Wort can interact with many prescription medications, including antidepressants, birth control pills and blood thinners. Vitamin K can interfere with blood thinners such as Warfarin and reduce their effectiveness. Magnesium can interfere with some antibiotics and may also interact with medications used to treat high blood pressure. Iron supplements can interfere with the absorption of some antibiotics, thyroid medications and some types of chemotherapy drugs. CoQ10 can interact with blood thinners and certain medications used to treat high blood pressure and heart disease." 

When "big wellness" is everywhere we turn, it can be tempting to self-medicate in the seemingly safe space of a drugstore aisle or a browser window. But that methodology can be at best imprecise, especially when it comes to whatever new "promising" herb or ingredient is trending on TikTok. But in the vitamin and supplement world, the claims around many of these ingredients are simply not backed up with solid, peer-reviewed evidence.

There's also often very little information to help you determine the quality of the ingredients on the bottle — or if they're even in there at all. When a 2018 report from the US Government Accountability Office looked into "memory enhancing" supplements, including the tree extract Ginkgo biloba and fish oil, they found "two of the three memory supplement products tested either did not contain their stated ingredients or did not contain the ingredient quantity stated on the label." One of them didn't contain any Ginkgo at all.

There is, for many of the millions of us taking vitamins and supplements, a kind of magical, aspirational thinking around them. And if we confine ourselves to the relatively safe and sometimes helpful things, there's likely no problem. I take a Vitamin D supplement on my doctor's recommendation, based on my health history and needs. It doesn't make me feel any different, but I haven't shattered any bones lately.

"Some people would benefit with a vitamin or mineral supplement," says Joan Salge Blake, Program Director and Clinical Professor, Nutrition at Boston University College of Health & Rehabilitation Sciences. "Pregnant women need to have folic acid, because it can help reduce the risk of birth defects and babies. Vegans that should be taking a supplement, especially vitamin B 12, or making sure they have enough fortified foods. But now we get into these dietary supplements that make claims that are confusing to the consumer. They can say, 'Vitamin C is needed for a healthy immune system.' That's great, but that doesn't mean that this product is going to boost your immune system."

"These supplements make claims that are confusing to the consumer. "

I'm admittedly the kind of serenity chasing consumer who's intrigued by those $90 GOOP supplements with clever names like High School Genes, aimed at "women who feel like their metabolism might be slowing down" or Why Am I So Effing Tired? which promises "to help support balance in an overtaxed system." And with lofty claims that they're relying on the "best doctors and experts" who "work tirelessly in their fields on protocols to help as many patients as possible," products like these seem to confidently stride the line of alternative and medicine — even if the products are not evaluated by the FDA, nor "intended to diagnose, treat, cure or prevent any disease."

During an intense period a few months ago, I decided to experiment with a celebrity approved "de-stress" supplement that promised to "Calm your mind and fight mental fatigue." I'd been drawn in by the promise of a cocktail of "L-tyrosine, GABA, ashwagandha and rhodiola rosea root," despite not knowing what any of those things really are or purportedly do.

In retrospect, I can see some of the logic behind the ingredient list — Mount Sinai explains that in the body, L-tyrosine is "an essential component for the production of several important brain chemicals called neurotransmitters, including epinephrine, norepinephrine, and dopamine." For the treatment of depression, however, "Studies have found that it has no effect." Likewise, the neurotransmitter gamma-aminobutyric acid (GABA) helps slow down the nervous system and calm it, but Cleveland Clinic notes that "It's not known what effects — if any — taking dietary GABA supplements may have on your brain."

Just because your body can make something that helps you feel good, it doesn't necessarily follow that ingesting more of it is helpful. We have endogenous opioid peptides in our bodies, but we don't pick up cute little bottles of morphine at Target. And just because something claims to be "natural" doesn't make it good for you. That's why we don't make salad with belladonna. Unfortunately for me, all my bottle of supplements did for me was make me nauseated.

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So what can we do, when we all just want to feel better? Registered dietician Meaghan Greenwood suggests, "Do your research and choose reputable brands. Look for third-party certifications, such as the United States Pharmacopeia (USP) or ConsumerLab.com, that verify the purity and potency of the supplement."

Dr. Julie Guider, founder of My Good Gut, notes, "To ensure safety, consult with a healthcare professional before taking any supplements, especially if you have underlying health conditions or are taking other medications." And Joan Salge Blake advises remembering that "Just because it's over-the-counter, doesn't mean that it is not without risk." She also suggests you eat your vegetables. "I don't want you spending your hard earned money on supplements that have no health benefit, or potentially harm," she says, "when you can take that money and go buy some produce." 



By Mary Elizabeth Williams

Mary Elizabeth Williams is a senior writer for Salon and author of "A Series of Catastrophes & Miracles."

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