While vitamins and nutritional or dietary supplements can benefit your health, they can also pose health risks. Notably, the Food and Drug Administration (FDA) does not have the power to review the safety and effectiveness of dietary supplements before they are marketed. And with over 90,000 different supplements on the market, it can be confusing to figure out what’s safe and what isn’t.

Two AMA members took the time to discuss what doctors would like patients to know about vitamins and nutritional supplements. They are:

• Pieter Cohen, MD, internist at Cambridge Health Alliance and associate professor of medicine at Harvard Medical School.
• Fatima Cody Stanford, MD, MPH, MPA, physician-researcher in obesity medicine at Massachusetts General Hospital and Harvard Medical School.

“There have been a lot of changes, obviously, in all of our lives. And some of them have had dramatic effects on supplement sales and supplement use, ”Dr. Cohen said during an episode of the“ AMA Moving Medicine ”video series on dietary supplements and supplements. regulations.

“One is that during the first months of the pandemic, during the lockdown, it was difficult to access care,” he said, noting that “the approach to self-medication, especially the one where you can buy something directly from Amazon, have it delivered to your home, has become extremely attractive, even more so than before.

Although supplements are not allowed to be sold as if they prevent or treat disease, with language adjustment, these companies can easily make claims such as “immune boosting” or “maintaining a healthy immune system”. These claims are 100% legal and may imply for consumers that the supplement may protect them from COVID-19, but it is not, explained Dr Cohen.

Find out more JAMA network open Dr. Cohen commentary, “The FDA and Adulterated Supplements – Breach of Duty”.

“When it comes to vitamins, most of us are able to get the nutrients we need from our diet,” said Dr. Stanford. “If we have a well-balanced diet consisting of lean protein, whole grains, fruits and vegetables, then we should find that we don’t necessarily need vitamins or supplements on board. “

“Then for supplements, it’s a whole other category where people start to delve into a lot of things that they think they need because of a new story that’s come out,” she added.

“The FDA is responsible for regulating dietary supplements,” said Dr. Cohen, noting that although “we might consider them – because they are health products – to be a subcategory of drugs … the FDA does regulate them. as a sub-category of food.

“This has huge implications for the whole category of dietary supplements, vitamins, minerals, probiotics and all kinds of new ingredients,” he added. “What this means is that the manufacturer can bring anything to the market that they think is safe.”

“The FDA’s job is to identify products that cause harm after they hit the market and remove them from store shelves,” Dr. Cohen explained.

“There are certain medical conditions and disorders that require supplementation,” Dr. Stanford explained. “For example, in any patient who has had metabolic and weight loss surgery, there is a list of lifelong vitamins and supplements that we will recommend because we have altered the absorption of vitamins and minerals in their gut.”

“It’s not just metabolic and weight loss surgery,” she said. “If you’ve had alterations in any of these parts of the gut, from the esophagus to the intestines, obviously supplementation may be needed to remedy a deficiency someone might have.”

“The problem we’ve had recently, in recent years in particular, is that there has been an explosion of new ingredients,” Dr. Cohen said. “So it’s not just that we are concerned about ingredients that are legal and allowed in supplements or historically used in supplements for many years,” but that “there are a lot of these ingredients – they are compounds. individual found in plants or other substances that may pose health risks.

“Today we are seeing so many new innovations or new ingredients being introduced in supplements,” he said. “Again, because the FDA does not check these products before they appear on store shelves or on the Internet, what happens is they can present unpredictable risks.”

Find out more JAMA Internal Medicine research letter co-authored by Dr. Cohen, “Presence of Piracetam in Cognitive Enhancement Dietary Supplements. “

“If you look at the supplement industry, it’s a multibillion dollar industry where people make a ton of money from a lot of things for which research and data are limited,” Dr. Stanford said. . “I’m all for using anything that works whether natural or not, but unfortunately data is generally very scarce for most supplements, including natural ones.”

“People want to put an equal sign with the natural because it comes from the earth, but so do cocaine and heroin,” she said, adding that “there are a lot of things that come from the earth. ‘here so I’m trying to let people know that natural is not equal to good and there is no regulation about it.

This is why “I strongly encourage people to discuss supplements with their doctor,” because “the use of the wrong supplements can lead to several problems,” Dr. Stanford pointed out.

“Another big problem these days with the internet and social media is that even the very lax rules about promoting a supplement are really being pushed to the limit,” Dr. Cohen said. For example, “a supplement is not supposed to be able to advertise as if it helps treat an illness or disease.”

“Unfortunately, due to the way social media is, it’s very easy to link testimonials or small messages or tweets with items that will suggest consumers – and also microtarget consumers – who have diabetes… that this supplement could be helpful in maintaining healthy sugar levels. , “he added.” Basically, the social media environment really allows companies, manufacturers and others to promote these products as if they were treatments for disease. And that’s a particular problem. insidious for patients.

“There are a lot of negative things that we’ve seen in terms of the negative reactions patients have had to supplements,” Dr. Stanford said. “It’s not that I’m saying we never use a supplement, but just be very transparent with your primary care doctor about them.”

“It’s really important to keep in mind that most of our patients are taking supplements,” Dr. Cohen said. “Whether they told us about it or not, over 50% of American adults take supplements.”

“One perception I had, because I hadn’t heard of the supplements when I was in medical school either, was that they were expensive placebos,” he said. And “that if a patient takes it, okay I don’t have to worry about it because it won’t affect their health, it won’t affect their medications.

“What we have realized is that because supplements are so often formulated much more closely to drugs, it is extremely important for us to be careful about what our patients are taking and to recognize that they may be causing effects. direct and immediate, ”added Dr. Cohen.

Learn more about the JAMA Internal Medicine patient page, “Vitamins and Nutritional Supplements: What Should I Know?” “

“The bottom line with all vitamins and supplements is that you have to tailor these things to your own body,” Dr. Stanford said. For example, “if you are a woman who is planning to become pregnant, folic acid is extremely important”.

“We often have to particularly adapt vitamins and maybe even supplements to suit where you are” in terms of life stages or chronic illnesses, she explained. “You can’t look at somebody else and say, Oh, this person that’s like me takes this or that, so that’s what I have to do. It really has to be tailored to meet the needs of each person.

Find out why tougher rules and better advice are needed in the dietary supplement market.

For more detailed information on the subject, see a recent report from WADA’s Council on Science and Public Health which updated and modernized WADA’s policy on dietary supplements.