Supplement Manufacturers Don't Tell You Everything

The wellness industry and biohackers are driving the worrisome trend of over-supplementation, which leaves doctors deprescribing dozens of pills.

Dr. Danielle Belardo, a preventative cardiologist, recently described the case of reaching the record for de-prescribing supplements.

"Lovely new patient with coronary artery disease taking a total of 132 supplements per day (yes, you read that right!) thanks to all of the 'longevity' experts who love a grift. We replaced them all with $4 rosuvastatin. Wellness is unwell," Belardo wrote on X.

Other doctors in the comments shared similar stories of deprescribing multiple supplements and teas or patients undergoing procedures not approved by the U.S. Food and Drugs Administration, such as plasma exchange.

Supplements are a profitable market, predicted to increase from $57 billion last year to $133.94 billion in 2033. The industry is growing despite the limited evidence of supplementation benefits, especially in the generally healthy population.

Supplements provide a false sense of hope

Belardo pointed out that half of the patient's supplements came from protocols touted by famous longevity scientists from top medical universities, such as David Sinclair and Andrew Huberman.

However, the problem of excessive supplementation use goes way back to before the boom of the longevity industry.

Peter Cohen, an associate professor at Harvard Medical School, says supplement companies can advertise their products as having any number of beneficial health effects in humans, even if they have never been tested in a single study.

"That creates an environment where the advertising of supplements gets far away from reality and attracts many consumers to try to obtain these imagined health benefits," Cohen tells Healthnews.

Three-quarters of American adults take dietary supplements, and 55% qualify as "regular users," according to a 2023 survey. The high demand drives the expansion of the supplement market, which grew from approximately 4,000 products three decades ago to 95,000 products last year.

Many patients see mineral and vitamin supplements as "natural" and "non-medical" approaches to managing acute and chronic health conditions, says Eric Wooltorton, associate professor of family medicine at the University of Ottawa.

For some patients, they provide a sense of hope that they are doing something when other health professionals may have told them there is little that can be done.

Wooltorton

However, the effectiveness of supplements in randomized controlled trials has often been disappointing or inconsistent, according to Wooltorton. For example, vitamin D supplements did not necessarily prevent osteoporotic fractures when taken by relatively healthy patients without vitamin D deficiency.

The increasing use of social media has opened new avenues for marketing supplements. A 2023 study found that only 1% of Instagram posts advertising skin, hair and nail supplements contained a visible Supplement Facts label. Moreover, the products contained potentially harmful ingredients when taken at exceedingly high doses, such as vitamin A, which increases the risk of miscarriage, saw palmetto, and biotin.

While some influencers sell individual products with questionable health benefits, others go to extremes.

Fashion model Bella Hadid, who is launching her wellness brand, recently shared a video of her swallowing a handful of pills, followed by sea moss gel, fulvic acid, and liquid trace minerals.

The self-proclaimed Glucose Goddess now sells supplements to reduce glucose spikes after eating, something that is a natural body response.

Former tech billionaire, Bryan Johnson, takes up to 100 pills of supplements and prescription medications daily in his quest for eternal life. And biohacker, Dave Pascoe, takes over 150 supplements daily, all of which are listed in his protocol available online.

Supplement risks aren’t only financial

Cohen says supplements can be formulated with individual ingredients with potent effects on the body, just like prescription drugs. However, it is impossible to take potent supplements without the ingredients potentially having downsides.

"That's how the body works. If you nudge it with supplements in one direction, it might cause problems in other areas. Once you start combining a lot of different supplements, then it gets more complicated. How the supplements interact with one another is often not known, and usually, no one has studied combining multiple supplements together — so you're really experimenting with your body," Cohen tells Healthnews.

Wooltorton says the harm from vitamin supplements taken in recommended doses is generally pretty rare. In his clinical practice, he has rarely seen patients taking supplements in doses greater than the therapeutic concentration.

But there is a harm I have seen — the financial harm of patients taking unnecessary and often costly supplements. Or patients are taking what amounts to cereal bowls full of tablets instead of eating food.

Wooltorton

Controlled clinical trials do not support the benefits of supplements in lowering the risks of cardiovascular disease, cancer, or type 2 diabetes in healthy people with no clinical nutritional deficiencies.

What is proven to reduce the risk of these diseases is regular physical activity and a healthy diet, both of which are more difficult to adhere to in the long run compared to taking a supplement pill.

Fish oil, one of the most commonly used supplements in the United States that is marketed for a wide range of benefits, only has strong evidence for lowering triglyceride levels.

In some cases, risks may outweigh possible benefits. A clinical trial suggests that supplementation with beta-carotene does not reduce the risk of developing lung cancer in smokers and might even raise it.

Certain supplements can interfere with medications, posing significant health risks. For instance, vitamin K can weaken the ability of warfarin, a blood thinner, to prevent blood clots. St. John’s wort may cause dangerous and potentially life-threatening body-levels of serotonin, and reduce the effectiveness of antidepressants, birth control pills, and heart medications.

Vitamins C and E can make some types of cancer chemotherapy less effective. Last year, a man in Britain died from vitamin D overdose after taking supplements for nine months.

Supplements are beneficial for some

Despite mixed evidence, Wooltorton says there are some very important supplement uses for diagnosed conditions. For example, vitamin and mineral supplements for a certain form of age-related macular degeneration can improve quality of life and prevent blindness.

Moreover, iron supplements are useful to menstruating women who are anemic, while pregnant women at higher risk of having a baby with a neural tube defect can benefit from folic acid supplementation, Wooltorton adds.

Patients with malabsorption problems due to intestinal diseases, gastric bypass surgery, or people with restricted diets may require multiple specific vitamin and mineral supplements.

Additionally, patients with conditions like Crohn's disease or diabetes taking metformin can develop deficiencies of vitamin B12, requiring special supplementation.

Wooltorton says, "The key message should be that most healthy adults should be able to get adequate nutrition from a balanced diet and do not require special supplements."


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