DOCTOR IS IN: How do we know supplements are safe and effective?


    Professor of medicine, Emory University School of Medicine, and director of the Emory Clinical Biomarkers Laboratory.

Supplements that claim to help maintain healthy memory, alertness, immune function, protection from infection, healthy joints, youthful vigor, etc., offer many options for consumers to help manage their own health. They also raise questions about effectiveness and possible side effects.

Some history: The Dietary Supplement Health and Education Act, enacted by Congress in 1994, defined “dietary supplement” and allowed manufacturers to make claims about a product’s ability to affect the structure or function of the body or a person’s general well being.

It also put the burden of proof on the Food and Drug Administration to remove unsafe products. This differs from food additives and therapeutic drugs, where the burden of proof is on the manufacturer. This legislation allowed a dramatic increase in the availability of supplements and the claims they make for improved health.

Researchers are providing more data everyday that shows appropriate supplements can enhance individual health and provide a useful complement to usual medical care. Many advances have been made in understanding how differences in genetics, lifestyle, diet and environmental exposures affect an individual’s health.

New technologies promise more systematic ways to predict individual needs and possible benefits. These methods will make it easier to assess whether certain amino acids, higher doses of vitamins or phytochemical supplements are likely to improve specific aspects of an individual’s health.

FDA said consumers should stop using Zicam Cold Remedy nasal gel and related products because they can permanently damage the sense of smell.

FDA said consumers should stop using Zicam Cold Remedy nasal gel and related products because they can permanently damage the sense of smell.

Meanwhile, a few straightforward principles can help guide our decision-making about the role of these supplements in managing our health.

• Don’t confuse dietary supplements with medical care. Dietary supplements are not intended to treat disease and cannot replace regular medical checkups and appropriate medical treatments for disease.

• Be wary of supplements that sound like inexpensive “natural” forms of drugs. Even though supplements are not regulated like drugs, they can still have drug-like effects or toxic side effects. Many of the therapeutic drugs in use today were derived from natural products, and natural products do provide “natural” remedies. However, therapeutic drug development focuses on improving effectiveness, removing toxic substances and providing a preparation that can be administered in safe and effective doses. Supplements are not required to go through the same procedures and are not necessarily administered under appropriate medical supervision.

• Always consider the source of a supplement. Reputable manufacturers will make every effort to avoid marketing toxic products simply because of the liability, and this is perhaps the most important assurance of safety.

• Knowledge of personal health habits and exposures, characteristics of skin, gastrointestinal irregularities and intestinal flora, and responses to specific supplements, can provide a better basis to evaluate the use of supplements. Public health recommendations already suggest the benefit of supplements for different groups. For instance, individuals likely to have low vitamin D levels due to dark skin color or little exposure to sunlight are advised to take vitamin D supplements.

Everyone has a personal responsibility for managing his or her health, but we must do so knowledgeably and responsibly. Use of available products to improve health, including supplements, can be an important part of the solution to the national healthcare crisis. This is a relatively new aspect of health management that is still developing and maturing. Consulting with individuals knowledgeable about the effects of supplements, and library and Internet searches can also help avoid undesired or toxic responses.

But even with such caution, and with the FDA’s responsibility to remove unsafe products from the market, we can expect that individuals will differ in responses, that manufacturing errors will occur and that there will be a small risk from even the best and most reliable products. Just as therapeutic drugs are not always effective, supplements with intended outcomes are not always effective. There are risks with some products, but these can be reasonably managed.

  • (Information provided by Emory on this site is intended solely for general educational purposes and is not intended or implied to be a substitute for professional medical advice. Always seek the advice of your physician or other health provider for any questions you may have regarding your health and medical condition. If you rely on any information available through this website, you do so at your own risk. You understand that you are solely responsible for any damage or loss you may incur that results from your use of or reliance on any material or information provided by Emory through this website.)
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7 comments Add your comment


June 29th, 2009
1:15 pm

Should government-run health care be enacted as the president and Democrat members of Congress desire, the result will be the rationing of care. Canada and the U.K. are examples where this rationing by government occurs.

If this rationing of health care occurs in the U.S., many people are likely to self-treat with supplements the FDA classifies as foods rather than drugs. While some of these people may be helped, others will receive no relief while still others will encounter the side effects you described. Plus, many people will take FDA-approved OTC medications as an alternative to professional care and will suffer the consequences. An elderly arthritic patient who increases her consumption of aspirin (because she cannot see a physician) and experiences G.I. bleeding is an example.

So one of the unintended consequences of “helping people” under the guise of so-called “universal health care” will be people who would like to be treated by their physician–but since care is rationed they get sicker as a result of self-medicating.

That two industries (supplement makers and the funeral industry) will be excited by ObamaCare should cause thoughtful people to withhold support for socialized medicine in the U.S.


June 29th, 2009
4:04 pm

If the Drug Companies and Doctors in the USA had not been raising their Prices 10 to 12% EVERY YEAR for the last 20 Years and thus Shutting out about 20% of the Population from Health Care then we would not be in this mess now. GREED on the part of the Drug Companies and Most Doctors is the Main Factor in out of control Health Care costs. Twenty Years ago Doctors made around $100,000 a year and now most make over $500,000.
Many make over a Million a year. Doctors Should be well paid but not at the level they are now….and every year they want more and more!
The Drug Companies are much worse. Twenty years ago they made Big Profit on a per pill basis and now….They Make HUGE unbelivable per pill profits in the USA. But in most other countries the Govt. regulates the Drug Companies and they still ONLY make Big Profits for each pill. Heath Care used to be about 5% of the average persons expenses and now it’s close to 12% and going higher every year.


June 29th, 2009
9:37 pm

I don’t know of many supplements that have killed as many people as the “regulated drugs” the FDA have allowed – with a little kick back from the drug companies. Go do something about the FDA and the collusion between it, the drug companies and doctors and you might be able to make a case. Anyway didn’t Emory just have a professor that had more than a vested interest in the drugs and the money from them versus if they worked – that’s rhetorical.


June 29th, 2009
11:48 pm

People will get sicker as they self-medicate waiting for doctors….people get sick waiting six months or more for their normal MD. People buy supplements now…just because they’re available; they also self-medicate themselves with liquor, off the street drugs and sex waiting for the “preferred doctor” or trying to figure out how to pay their next premium or deductible.
I am a Republican. However, I detest knee-jerk Republicans that just run 180degrees out of phase to any recommendation by a Democrat.

How many Republican & Democrats that have run for office in the past 50 years have absolutely promised to tackle health care and make it available to everyone. That ration of campaign promises has come from every house, state, Federal office seeker at each and every campaign. Whether I like the man or not….I respect the office of the current president that is actually coming up with a solution.

If you don’t like the solution….come up with a better one. At present, I’m doling out $1200 a month for my wife and I for health insurance; I’d much rather dump that $14K a year and pay into a tax line against my income. It’s bound to be a lot cheaper than giving my cash away for a policy that keeps raising it’s premium for each birthday.

You’re afraid you won’t see your favorite doctor while in the hospital? Well bunkie….many if not all Hospitals do NOT allow your doctor into the hospital; you have to use the sub-contractor doctors as the hospitals and MDs try to eliminate the paper trail back to them for the myriad of suits that compound the hospital liability each day.

We’re already in a form of Socialized Medicine…except we’re paying big out of pocket and still getting sub-standard care; we’re still waiting for doctor appointments for days to months at a time; we’re still paying a large chunk of cash in deductible at each doctor visit….and we’re still arguing the fine print for insurance companies that attempt to evade making payment.

Try running the numbers rather than just being argumentative due to philosophy. I’m sick of paying top dollar for health care insurance that I have to continually fight to validate coverage. For what it’s worth, my mother is on Medicare and social security…I know exactly what to expect in her health care costs and the various doctors that she has to visit…accept her cards like cash. If it’s an example of Socialized Medicine to see MDs that accept her coverages….I’m not unhappy.


June 30th, 2009
8:08 am

The writer of this article is obviously part of the medical, drug company, FDA establishment. For years they have been pushing treatments – such as HRT for example – that later turn out to be very harmful. They are an arrogant monopoly that can not be trusted. Unless this changes and they come clean and stop attempting to restrict free choice for people in the area of health, I for one will not trust anything they say. Their continued propaganda push makes me trust anything that is said by mainstream medicine LESS and LESS.

Ralph Emerson

July 1st, 2009
5:33 pm

If Canada and their health care system are so bad, how come they have better health than we do at much lower cost?

And if they are rationing health care thereby exacerbating already existing health problems, how come they just published substantial decreases in the incidence of cardiac disease? And their longevity is still going up, rather than stabilizing or going down like the U.S.

Something isn’t adding up. Where did you get your information about Canadian health care–the Heritage Foundation?

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