Although many supplement bottles make general or vague claims of boosting health, be sure to check for certifications on the back of the bottle, according to Dr. Beth Floyd at Pennington Biomedical in Baton Rouge. (August 7, 2024).
On the back of this supplement bottle, USP certifies the use of the product with the text: "USP has tested and verified ingredients, potency, and manufacturing process. USP sets official standards for dietary supplements." Some physicians and researchers are voicing concerns as use some kind of supplement, with more than half identifying as regular users, according to a study from the and t About in the United States were caused by supplements, according to a study published in the in 2017.
In the seven years since that study, the dietary supplement market has grown. Americans spent nearly on supplements in 2023 — up from the spent on herbal products in 2019 — and group expects the market to grow. Read the fine print.
Note the "Guarantee" in the bottom left corner. Upon closer inspection than many users take, this supplement's label says "Guarantee 100% happiness." The number of adults taking supplements has been steady or on the rise since the COVID-19 pandemic in 2020 when people made efforts to with mass market products, according to the CDC’s National Center for Health Statistics report in 2020.
Supplement recommendations can be found anywhere — commercials, social media influencers, neighbors, friends and family. With all of the recommendations, choosing the right supplement, or deciding if a supplement is the answer, can be difficult. Evidence varies widely as to when and if supplements can be benefit health and which may be harmful.
Defining "supplements" is tricky — the word is often used as an umbrella term to refer to any ingestible substance used to replace nutrients in the body. Sometimes it’s in a concentrated pill form like zinc or turmeric tablets, sometimes vitamin C gummies and multivitamins, botanicals and even green tea. Dr.
Brian Ting, a liver specialist at Tulane Health Knowing the risks is important. Dr. Brian Ting, a liver specialist at Tulane Health who practices at University Medical Center in New Orleans, sees patients for liver failure, some even requiring liver transplants — many because they have used supplements.
Ting compares the way different people react to various supplements to the way different people are allergic to various things. Peanuts don't bother many people, but for some they can be deadly. The same is true with supplements — especially when in the concentrated form of a dietary supplement.
Black cohosh is a well-known supplement perimenopausal women use for symptoms like hot flashes or help in being able to sleep at night. Black cohosh, a dietary supplement made from a flowering plant native to North America, is often effective in providing relief for perimenopausal women. Therefore, they often recommend it to their friends.
The problem is that some women have a reaction to black cohosh that others don't. Ting says black cohosh has a "higher proportion" of liver toxicity. "I find it hard to fault my patient that I've listed now for liver transplant for taking black cohosh," Ting said, "because perimenopausal symptoms suck.
" Black cohosh doesn't cause every patient who takes it to have liver failure, but certain patients do — and sometimes early symptoms of problems aren't clear. Sometimes patients suffering liver damage don’t know there's a problem until it’s too late. “There are no early signs,” Ting said.
“By the time you get yellow and very itchy ...
" Ting says there are nonspecific signs, like fatigue, which point to potential health problems. "But it's hard for anybody who's taking a supplement to draw a straight line between fatigue and liver damage," he said. Ting recommends that patients take note of when they begin each supplement and be vigilant about communicating with physicians about which supplements they're taking — and for how long they've been taking them.
Just because a medication or supplement is over-the-counter doesn't mean physicians don't need to be aware that a patient is taking it. “If I had my way, I would say that, outside of very narrow, specifically studied compounds such as cranberry juice extract for the treatment of UTIs in women," Ting said, "people shouldn't be using supplements or have a very good reason before using them.” Even with a warning from a liver specialist, there are reasons why some supplements are so popular: Sometimes, they work.
Dr. Beth Floyd is associate professor and co-director of the Botanical Dietary Supplement Research Center at Pennington Biomedical Research Center in Baton Rouge. “There are supplements that I think there's good data that they do work,” Floyd said for the aging population.
“It's a very specific combination of vitamins and nutrients in a supplement for eye health that has been shown to delay onset of macular degeneration.” A.R.
E.N.D.
S. stands for “Age-Related-Eye-Disease-Supplement" and there's very good data, according to Floyd, that these supplements do work to delay the onset of the eye disease. Even so, Floyd recommends proceeding with caution when it comes to supplement use.
“It's really difficult for the consumer,” Floyd said. “I would say for any dietary supplement that someone takes, their primary health care provider absolutely needs to know they're taking it.” Supplements fall into a medical gray area for testing and regulation.
Medications must be approved, tested and observed by the Food Drug Administration before hitting the market, let alone for over-the-counter-use. Supplements, however, often bypass many of these steps. Floyd and Ting use many online tools to sort through hundreds of supplements on the market.
Ting uses an online database called when consulting with patients about supplementary use and liver toxicity. LiverTox gives herbal and dietary supplements a grade based on the likelihood of the substance to cause liver toxicity, and liver failure in some cases. "It's basically the dictionary of everything that can go wrong when you take either medications or supplements," Ting said of the National Library of Medicine site.
U.S. Pharmacopeia and the National Science Foundation check dietary supplements for active ingredients and give certifications based on the results.
Check that the supplement bottle or tablet has been certified before taking it home, Floyd recommends. Both and have online databases for consumers to search a supplement's certifications. Floyd says the extra step and precaution of checking is worth the effort.
When it comes to supplements, adhering to the golden rule of medicine is essential: Talk to your doctor. “I would say for any dietary supplement that someone takes,” Floyd said. “Their primary health care provider absolutely needs to know they're taking it.
” Even supplements that could be potentially helpful for a patient could have serious adverse effects in combination with medications a person might be taking. “Very clearly, there are ingredients in some dietary supplements that have cross reaction with other drugs that are bad, and the physician will need to know what the person is taking when they start prescribing medicine for them,” Floyd said. The bottom line is that anecdotal evidence of a supplement seeming to correct a problem for one person doesn't mean it will do the same for someone else — and worse, on occasion, the same supplement could cause an even more-serious problem for the other person.
“What works for your neighbor Joe," Ting said, "won’t always work for you.”.
