Supplements aren't regulated like drugs. Their makers don't have to prove that they're safe or effective. Let's talk about some of the pitfalls of using supplements, and how you can improve your chances of getting a pill that does what it's supposed to.
Challenging Assumptions: Why You Can't Trust the Label
You'd assume that vitamins and other supplements must pass some sort of approval process to be sold in stores. Australia actually has a two-tiered system for the regulation of medicines, which is overseen using a risk-based approach by the Therapeutic Goods Administration (TGA). However, medicines that are considered to have low-risk ingredients, like supplements, aren't checked as rigorously as higher risk products. These 'low-risk' medicines are listed as 'Aust-L' and the focus of the checks are on the safety of the product and the consistency of manufacturing and not so much on whether or not any of the claims they make.
The TGA relies on the manufacturers to provide the group with honest information about the quality of the ingredients used for the supplements and the manufacturing process but they don't have to prove that their products actually work. What is more concerning is that you can't really be sure the supplements contain the ingredients that are listed on the label.
Academic studies have shown similar results, including the idea that people perceive supplements as safe because they are available without a prescription and because they are "natural."
It's not hard to find examples of supplements that have caused real harm. Four Corners recently aired an investigation by the New York Times and PBS Frontline int he US that showed a number of supplements have been linked to liver injury and one particular weight loss supplement has even been linked to a death.
Bottom line: Just because the label says it will do something great for your body, doesn't mean it actually will; and just because it's on shelves and sold without a prescription doesn't mean it's safe.
Supplements May Not Contain What They Say They Do
Just like you can't trust the front of the label, it may also be unwise to trust the back. We've already mentioned above that regulation on supplements is more relaxed and rely on the honesty of manufacturers to provide truthful information about the ingredients used.
For athletes, it's a particularly bad problem: some sports supplements carry an extra kick from drugs that aren't on the label, and that could disqualify athletes under doping rules if those drugs show up on a test.
Here's what the Australian Sports Anti-Doping Authority (ASADA) has the say about supplements:
"Athletes who take supplements are at risk of committing an anti-doping rule violation. This is because substances prohibited in sport may be added deliberately during the supplement manufacturing process, or included inadvertently through contamination. As such, we are unable to advise athletes whether a specific supplement, or batch of a supplement, contains prohibited substances."
Even after supplements are recalled, they may still be on the shelves with the banned ingredients still present.
You Might Not Actually Need Supplements
When I asked supplement safety expert Dr. Pieter Cohen what his advice was for consumers, he began his response with a harsh reality check:
First off, do you actually need the supplement? Most, if not all, botanical supplements won't improve your health, so you can save your cash.
By "botanical" he means herbal supplements like St. John's wort, echinacea, ginkgo, and ginseng. (The list could go on to include hundreds of obscure plants that are sold as capsules or teas.) Similar advice applies to other types of supplements, including vitamins and probiotics.
An analysis by Consumer Reports concluded that only a third of supplements have any evidence supporting their safety or effectiveness.
Vitamins were hailed as medical miracles when they were first discovered, because debilitating vitamin deficiencies can be cured almost immediately by adding the vitamin back into the patient's diet. If you're not deficient, though, vitamins won't do much, or possibly anything, for you. As for taking a multivitamin for "insurance" against possible gaps in your diet, experts are divided. Some think it's a great idea; others are outspoken about vitamins for healthy people being a waste of money.
Probiotics, or supplements made of good bacteria, sound better and better as we learn more about how the microbiome impacts our health. Unfortunately the handful of species you can buy as a supplement don't take up residence in our gut. There's little to no evidence that they contribute to a healthy microbiome, which by the way, may be outside of our current abilities to define.
Herbal supplements include plants that are used more or less as drugs, aiming to treat or prevent disease (even if the label can't legally say that directly). They may contain whole plant parts or extracts, and often the active ingredient is unknown, as is the dose of the active ingredient since, in many plants, the dose varies by which part of the plant was used and when in the growing season it was harvested.
How to Find the Safest Supplements
If you do take supplements, how can you give yourself the best chance of buying ones that contain what you expect, no more and no less? I asked nutrition researcher Kamal Patel of Examine.com (an independent supplement information company; they don't sell any supplements) for tips for consumers. Here's what he wrote:
One anecdotal trend is for consumers to buy more "pure" supplement formulations. For example, instead of buying BCAA powder that's tropical fruit punch flavored, they will buy straight-up BCAA (which taste terrible) without any additives or fillers. The few companies who provide products like this appear to be more transparent with regards to their manufacturing practices and quality initiatives. At a recent conference, I talked to one researcher whose family uses mostly supplements where the specific brand has been tested in clinical trials. For example, lavender is a supplement that is used for anxiety. There is one specific brand that has been tested, called Silexan. There are a handful of big manufacturers who have supplements that are frequently used for clinical trials.
If you want to find out whether certain supplements are worth a shot, it's a good idea to refer to research done by consumer advocacy groups like Choice. The group looks specifically at vitamins and supplements regularly and have detailed information available on their website.
You can also look up your favourite supplements with these organisations and databases that report the results of supplement tests, such as the Australian Food, Supplement and Nutrient Database by Food Standards Australia and New Zealand.
Supplements may not always contain what's on the label, but with these tips and databases, you can be more confident that you know what you're getting.