75% of Americans including this doctor are on supplements and unfortunately it is a highly unregulated area. You see, supplements do not have FDA (Food and Drug Administration) approval for anything.
Let’s review the most common ones.
The most popular supplements are multivitamins and minerals, which are likely harmless, though unproven to produce health benefits for most people.
A 2019 Annals of Internal Medicine study (https://annals.org/aim/fullarticle/2730525/association-among-dietary-supplement-use-nutrient-intake-mortality-among-u) found that vitamins and minerals had no effect on overall mortality. So you are not going to have less cancer or heart disease by taking a multiple vitamin.
Actually, calcium supplementation was associated with a significantly higher mortality rate due to heart disease. Higher dosages of this mineral p get deposited in the coronary arteries which feeds the heart nutrients and oxygen.
This mineral has fallen out of favor lately for the prevention and treatment of osteoporosis or bone loss
However, when vitamins and minerals were ingested from regular food sources, there was a lower mortality rate. In other words, it is much healthier to eat fish rather than consuming fish pills. The same is true for multivitamins. The actual food source is a much better way to get natural combinations of vitamins and minerals.
Still, vitamin and mineral supplementation make up about 40% of the supplement business. It is tough to change emotional beliefs even when the science says that a healthy diet is more than adequate for most people.
Many men take these products to increase both libido and erections but a significant number of supplements contain illegal prescription drugs such as fluoxetine (Prozac) or sildenafil (Viagra).
Sildenafil can interact with nitroglycerin and cause a life-threatening drop in blood pressure. Fluoxetine, an antidepressant, also has a number of side effects and interactions.
Even though such illegal drugs are found in these pills, the label will not list them as the manufacturer would be shut down by the FDA for an obvious violation of the law.
20% of supplement users take weight loss agents with unapproved ingredients such as Sibutramine. This medicine was taken off the market in 2010 because of excess cardiovascular harm. Often other undeclared substances are found in weight loss supplements such as stimulants. These amphetamine like drugs can raise blood pressure and cause strokes. Literally, some people are dying to lose weight and this is most unfortunate.
30% of supplement users are trying to build muscle. Similarly, these pills also contain undeclared ingredients. The most common one is anabolic steroids which can cause heart disease, strokes and liver disease.
Supplements for sexual enhancement, weight loss and body building are particularly worrisome because often these agents actually have a higher potential for harm due to some of the unapproved ingredients that I have listed.
For example, from 2007-2016 the FDA issued warnings to 776 manufacturers because they contained illegal prescription drugs.
Worse yet, despite FDA warnings, many manufacturers continue to put illegal substances into their pills according to a recent study. https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2707947
Besides these illegal, adulterated supplements, most people are under the misconception that if it is natural, then it must be good for you.
All natural substances are like drugs because they have interactions and side effects. Prescriber’s Letter, an international medical newsletter, has the largest data base for nutraceuticals in the world.
Much of it can be found at the following link: https://www.webmd.com/vitamins/index
You will see that each vitamin or herb listed has a whole host of side effects and interactions.
For example, green tea capsules seem pretty harmless yet liver failure has been reported as a side effect. While drinking green tea is safe, the supplement poses a small but significant risk to the liver.
Dr’s. Rx No supplement has approval for any indication whatsoever. It costs 10 million dollars to file for a drug application in addition to submitting many well controlled clinical trials. So the supplement business is not well regulated by the FDA as opposed to the pharmaceutical industry.
While multivitamins just provide you with expensive urine, sexual enhancers, weight loss agents and body building supplements pose the greatest risk to the consumer due to undeclared, illegal drugs.
Certainly if one is malnourished or pregnant, a multivitamin has its place.
Besides the previously listed data base for supplements, The FDA has a fraud alert site at https://www.fda.gov/forconsumers/protectyourself/healthfraud/ucm299437.htm
Your best bet is to eat a healthy diet such as the Mediterranean diet and let your doc know which supplements that you are taking. Keep a list of your meds and supplements on your phone or in your wallet for any doctor you might see.
Most medical errors arise from a faulty medicine and supplement list.
Evan L Lipkis MD