Many over-the-counter vitamins, minerals, and other non-prescription items are commonly recommended by healthcare providers. Some are considered “standard Therapy” for numerous medical conditions, including age-related macular degeneration (AREDS2 vitamins), anemia (iron), osteoporosis (Vitamin D and calcium), cardiovascular disease (fish oil), and birth-defect prevention (folic acid in pregnancy). Specific vitamin and mineral supplements can be essential for those with documented deficiencies.

            Even when recommended and taken for sound medical reasons like those above, supplements should be used under the guidance of a healthcare professional. Why? Because any of these can interact negatively with prescription medications or underlying health conditions.

Unless Specifically Recommended  by A Provider,

Supplements Should Be Just That!

          Those little bottles of overhyped, unregulated, usually expensive, non-prescription non-drugs should be considered at best helpful extras. They have the most potential benefit when added to a healthy Lifestyle (i.e., doing what our doctors have told us for decades: eat a nutritious Diet, Exercise, avoid excesses, etc.). 

          There is a reason why they are not called “Replacements.” If manufacturers could turn these into regulated FDA-approved drugs, one would assume they would do so.

Essential Facts About Supplements and Over-The-Counter (OTC) Products

              The necessary information is already right in front of us, legally required in every ad and on every package (although barely readable)!

“The Food and Drug Administration has not evaluated these statements. This product is not intended to diagnose, treat, cure, or prevent any disease.”

             Unlike with prescription drugs, the FDA does not pre-approve dietary supplements before they reach the market. In fact, over the last decade, hundreds of supplements have been targeted for removal due to mislabeling, contamination, and health risks. The incomplete list of recalls since 2018 found on the FDA website includes dietary supplementsremoved from the market for various reasons. These include being “tainted” with undeclared prescription drugs; contaminants like metallic mesh, lead, salmonella, and toxic yellow Oleander; or having “rodent activity at the distribution center.” (https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts)

Re: Dietary Supplements from the American Medical Association:

• “The FDA regulates them as a sub-category of food.”
• “The manufacturer can introduce anything into the market that they believe is safe.”
• “The FDA’s job is to identify products causing harm after they’ve been on the market and then remove them from store shelves.”
• “‘Natural’ doesn’t always mean ‘good for you.’”

“Herbal” Product Safety

           All plant-based products vary in potency, depending on the growing season, weather, soil conditions, plant genetics, storage, additives, and processing.  Once on the store shelf, one manufacturer’s hydroponically grown, meticulously manufactured “organic” plant-based dietary supplement is indistinguishable from another with an identical generic name.

          A product on the same shelf claiming the exact same “herbal” origin may appear to be a better bargain. However, it is impossible to determine where any such item came from or how it was manufactured. That identically labeled herbal product could just as easily (and much less expensively) be derived from some unverified weed harvested in a ditch behind a third-world landfill and shipped to the States in secondhand 50-gallon drums previously containing God-knows-what.

          In such unregulated products, the potency, quality, consistency, bioavailability, and potential for dangerous contamination vary tremendously and unpredictably. Of 5,957 commercial herbal products sold in 37 countries, 27% were found to be adulterated when their DNA content was tested against their label-claimed ingredients.

So What Can You Do?

          If you’re going to try a supplement (i.e., heavily advertised, “herbal,” “organic,” celebrity endorsed, “pharmacist recommended,” “homeopathic,” free sample, “Money-back guarantee,” coupon, “holistic,” “as seen-on-TV,” etc.,

THINK TWICE—and be honest with yourself.

          Are you already making those lifestyle changes that your doctor or other reliable source has recommended?  Have you discussed OTC products with your provider before starting one?

          A basic rule is to take nothing that could be harmful in any way. Don’t substitute supplements for proven medical, lifestyle, or cognitive interventions. Before trusting your future to jellyfish extract or other medically unsupported remedies, take the $45. a month and buy fruit, a gym membership, Yoga lessons, or copies of Aging or Alzheimer’s?  for your friends and family. (See Chapter 5 for a complete discussion).

          Consult Reliable Sources (see Appendix II). I favor AARP and Consumer Reports. Choose a product with a third-party seal from an independent testing group. (See Consumer Reports Magazine, September 2024): Reputable seals include UL, NSF International, and U. S. Pharmacopeia (USP). Go to the USP website to look up USP Verified supplements. The National Institutes of Health Dietary Supplement Label Database can help you compare products (https://ods.od.nih.gov/Research/Dietary_Supplement_Label_Database.aspx)

References:

Dietary Supplement Fact Sheets, from the Office of Dietary Supplements (ODS), the  National Institutes of Health (https://ods.od.nih.gov/factsheets/list-all/)

The U.S. Food and Drug Administration (FDA) on Dietary Supplements (https://www.fda.gov/food/dietary-supplements)

From the AMA: What doctors wish patients knew about vitamins and supplements. (https://www.ama-assn.org/delivering-care/public-health/what-doctors-wish-patients-knew-about-vitamins-and-supplements

Ichim MC. The DNA-Based Authentication of Commercial Herbal Products Reveals Their Globally Widespread Adulteration. Front Pharmacol. 2019 Oct 24;10:1227. doi: 10.3389/fphar.2019.01227.  (Freely accessible at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6822544/pdf/fphar-10-01227.pdf)