Children and adults take supplements. Do you know the risks?

Americans spend billions of dollars each year on dietary supplements that claim to promote nearly every aspect of our health. But how much do you know about the supplements you’re taking?

A recent government study found that nearly 60 percent of adults take vitamins, minerals, fish oil, herbal capsules, melatonin, probiotics and other types of dietary supplements. Although most people used only one or two supplements (multivitamins and vitamin D were the two most popular products), it was not uncommon for people to report using three, four, or more supplements at the same time.

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Among some segments of the population, it’s not uncommon to down a handful of vitamins or supplements each day. About 15 percent of adults said they used four or more dietary supplements. Among older adults, the number who report using multiple supplements is even higher: About 25% of adults age 60 and older use four or more. About 35% of children and adolescents used dietary supplements, and almost 10% of children aged 2 to 5 years received two or more dietary supplements.

Experts say vitamin and mineral supplements are generally safe when taken in small to moderate doses, such as the amounts found in a basic multivitamin. Dietary supplements can be beneficial for pregnant women and for people with nutrient deficiencies and other health conditions. A clinical trial earlier this year found that for people 60 and older, taking a daily multivitamin helped slow memory loss. Other studies have found that probiotic supplements can help with gastrointestinal disorders such as irritable bowel syndrome.

But taking supplements comes with risks, and for many healthy adults, the research isn’t always clear that they outweigh the benefits.

In fact, some randomized trials have found that assigning people to take supplements with high doses of beta-carotene, selenium, and vitamins A, C, and E actually increased death rates. Rigorous clinical trials have also failed to support the hype surrounding vitamin D, finding that people who were assigned to take the popular supplement did not develop lower rates of cardiovascular disease, cancer or bone fractures despite the claims widespread marketing claims to the contrary.

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Supplements don’t follow the same rules as drugs

Many people assume that the Food and Drug Administration tests supplements for safety. But that’s not how it works.

Dietary supplements enter the market before there is an actual review by the FDA, said Amy B. Cadwallader, director of public policy and regulatory development at the United States Pharmacopoeia, a nonprofit organization that examines the quality of medicines, food and dietary supplements. .

Under federal law, businesses can operate on the honor system. The FDA’s role in regulating supplements is primarily to try to ensure that products are safe and accurately labeled after they have already entered the market.

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Will you get what you paid for?

In the United States, companies sell about 90,000 dietary supplements, representing a roughly $50 billion industry. As a result, some experts say, consumers who buy supplements can’t always be sure they’re getting what they paid for. Studies of melatonin, fish oil, probiotics, ginkgo biloba and other supplements have found that the doses and compounds listed on their labels are often not what is found on their bottles.

-In a study in the journal Pediatric Research, researchers tested 16 probiotic supplements and found that only one of them contained the specific bacterial strains listed on its label.

-In another study, researchers tested 30 dietary supplements that claimed to boost immune health and found that 17 of the products were misbranded. These supplements either lacked key ingredients listed on their labels, such as vitamin B12, garlic extract, ginger root, and folate, or contained a variety of unlisted ingredients.

-An FDA study estimated that less than 1 percent of all adverse events related to supplement use are reported to the agency. Another federal government study estimates that injuries caused by supplements are responsible for about 23,000 emergency room visits each year.

Howard Luks, an orthopedic surgeon and sports medicine specialist in New York, said he routinely encounters patients who worry about possible side effects from medications but have no problem taking 10 or 20 supplements they heard about. of people who influence health in social networks. He said many people who lost faith in public health authorities during the pandemic have turned to social media influencers for health advice.

They see supplements as holistic, natural, and therefore not potentially harmful to them, he said.

In a case study published in March, doctors in New Jersey described a 76-year-old woman who went to an emergency room after experiencing palpitations, dizziness and fainting episodes. It turned out she had been taking black cohosh, an herbal supplement often used to treat hot flashes. A few days after stopping the supplement, her heartbeat returned to normal and her other symptoms disappeared.

In another recent case, a 47-year-old woman in Houston suffered jaundice and liver damage after taking a supplement containing a mix of probiotics and herbal extracts. The case report noted that dietary supplements account for about 20 percent of drug-induced liver injury nationwide.

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How to buy supplements smarter

Here are some tips when buying supplements.

Look for third-party certifications: The United States Pharmacopoeia, or USP, reviews dietary supplements to ensure they meet high standards for factors such as purity and potency. USP has a voluntary program through which companies can routinely test and examine their supplements and facilities. Companies that meet the organization’s high standards can use a black and yellow USP verification logo on their products. You can find them using the product search tool on the USP website. NSF is another independent group that tests and reviews dietary supplements. You can look for the blue and white NSF logo on your supplements or go to the group’s website to search for products.

Do your homework. Consumerlab.com is an independent laboratory that tests dietary supplements to see if they contain the ingredients and dosages listed on their labels. The company publishes reports with its findings on a wide variety of supplements, which you can access on its website for an additional fee.

Talk to your doctor or pharmacist. Many people don’t realize that many supplements and medications use the same metabolic pathways and can cause dangerous side effects when you combine them, said Michael Schuh, assistant professor of pharmacy, family medicine and palliative medicine at the Mayo Clinic in Florida. . .

Vitamins E and K, ginseng, ginkgo biloba, resveratrol, turmeric, and CoQ10, for example, may interact with anticoagulant medications. Vitamin C may interact with statins, niacin, estrogen, warfarin, and chemotherapy drugs. St. John’s wort can make antidepressants and birth control pills less effective.

We see that with a lot of supplements, Schuh said. Even something like grape skin resveratrol – when you take it in concentrated form, it can interact with a lot of medications.

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