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<\/p>\n Email Link<\/p>\n \n Editor\u2019s note: The podcast Chasing Life With Dr. Sanjay Gupta explores the medical science behind some of life\u2019s mysteries big and small. You can listen to episodes here<\/a>.\n <\/p>\n \n (CNN) \u2014 <\/strong>Take a walk down the supplement aisle of any local drugstore, and you will be confronted with a floor-to-ceiling wall of choices. Not just the usual suspects \u2014 vitamins and minerals \u2014 but also items as varied as turmeric<\/a>, fish oil, probiotics and melatonin<\/a> <\/strong> \u2014 as well as combinations that purport to burn fat (not muscle!), cure erectile dysfunction and boost memory. The deluge of options doesn\u2019t stop there. Endless social media posts claim a life-changing supplement or regimen will help you eliminate \u201ccortisol belly,\u201d protect against the flu or \u201creset\u201d your hormones.\n <\/p>\n \n But exactly how many things do we humans need to buy in the race to optimize our health and live our best life? All this noise around supplements generates confusion and anxiety, obscuring what science there is and making it hard to separate fact from wishful thinking.\n <\/p>\n \n In the most basic sense, these products are meant to supplement the food in your diet with extra added \u201cdietary ingredients.\u201d You would not be faulted for thinking that the US Food and Drug Administration<\/a> regulates supplements \u2014 and the agency does, but probably not in the way you might think.\n <\/p>\n \n Thanks to a 1994 law called the Dietary Supplement Health and Education Act, or DSHEA, supplements are regulated more like a subcategory of foods, not a subcategory of medicine. This essentially means that the FDA does not have the authority to approve dietary supplements before they are marketed, unlike pharmaceuticals, which must be shown to be both safe and effective in clinical trials.\n <\/p>\n \n \u201cDSHEA is the current framework that all dietary supplements are sold in,\u201d supplement safety advocate Dr. Pieter Cohen told CNN Chief Medical Correspondent Dr. Sanjay Gupta recently on his podcast, Chasing Life.\n <\/p>\n \n The law, in part, allowed the industry to explode from approximately 4,000 products in 1994, to some 90,000 in 2017, according to estimates in a 2022 AMA Journal of Ethics policy paper<\/a>.\n <\/p>\n \n \u201cNow, that law in 1994 was initially \u2026 designed to better regulate vitamins and minerals,\u201d explained Cohen, an associate professor of medicine at Harvard Medical School and an internist at Cambridge Health Alliance, where he leads the Supplement Research Program<\/a>. \u201cWhat unfortunately happened \u2014 unfortunately, in my opinion \u2014 was that that same structure was expanded to include \u2026 all nature of botanicals; many different types of extracts, like, let\u2019s say, a cow thyroid extract; live microorganisms, like both bacteria and yeast, that are sold as probiotics; protein powders; amino acids. All this was lumped together under that same framework \u2026 and all of them were called \u2018dietary supplements\u2019 or \u2018dietary ingredients.\u2019\u201d\n <\/p>\n \n You can listen to the full episode here<\/a>.\n <\/p>\n<\/p>\n \n The FDA does have some power to take action against supplements that are adulterated or misbranded, but only after they are on the market. \u201cThe FDA is in the position of looking for problems out in the marketplace after supplements are being sold, and then working to try to identify the products, which is incredibly difficult, because they don\u2019t have an effective system to detect harms, and then to try to remove those dangerous products,\u201d Cohen said.\n <\/p>\n \n While regulations exist, \u201cit\u2019s companies selling us whatever they choose to declare and identify as a dietary supplement,\u201d he said. He called it \u201ca system that emphasizes access and minimizes the assurances of safety or at least leaves safety in the manufacturer\u2019s court.\u201d\n <\/p>\n \n What should consumers do before plunking down money at the health food store? Cohen explains what you should know about product claims and offers five tips when deciding which supplements to buy, keep or toss.\n <\/p>\n \n How the FDA can and can\u2019t regulate the supplement industry doesn\u2019t even address the issue of what actually works and what you might actually need.\n <\/p>\n \n Some studies show certain well-known vitamins or minerals can help particular conditions, but often recommendations change<\/a> after new information<\/a> comes to light. Good-quality clinical trials are expensive and hard to conduct (or data are gathered through epidemiological studies, so cause and effect can\u2019t be definitively proven); they rarely are done on less-well known (or blended) supplements.\n <\/p>\n \n The label required on US supplements, in essence, occupies a gray zone, and the average consumer might not know that they are expected to read between the lines.\n <\/p>\n \n A product label is permitted to contain a claim about the effect of the supplement on the body\u2019s structure or function (for example, \u201chelps support flexibility\u201d). But the label \u201cmay not claim to diagnose, mitigate, treat, cure, or prevent a specific disease or class of diseases,\u201d according to DSHEA<\/a>.\n <\/p>\n \n The law allows manufacturers to make those gray-zone, health-adjacent claims as long as they include a disclaimer that the claim has not been evaluated by the FDA.\n <\/p>\n \n The situation is not likely to change any time soon.\n <\/p>\n \n \u201cA core concern I have with the current regulatory framework that really inhibits us moving forward is that there is no incentive for manufacturers to conduct carefully done clinical trials,\u201d Cohen said.\n <\/p>\n \n \u201cOne thing we haven\u2019t talked about yet is that one other part of the law is that supplements can claim to have health effects without it being proven in humans,\u201d he noted. \u201cSince you can do that without doing a clinical trial, what\u2019s the incentive to invest in all that money, millions of dollars, to do a clinical trial?\n <\/p>\n \n \u201cThe only potential outcome is negative \u2014 because if you\u2019re right, you were already advertising it as it was beneficial to your health and all you did was to prove that your claim is correct,\u201d he said. \u201cBut more likely, if it turns out it doesn\u2019t really work like you had hoped it did, and all that money is wasted, and then you\u2019ve got a problem. But the good news, I guess, is that you can still keep on selling it as if it does work, even when the studies come out negative.\u201d\n <\/p>\n \n The FDA has certain best practice rules in place when it comes to manufacturing, but it lacks oversight to ensure what is on the label is actually in the supplement, according to Cohen. That\u2019s why it\u2019s essential to choose supplements with a discerning eye.\n <\/p>\n \n \u201cToss away all supplements that do not include the official stamps from NSF (NSF International<\/a>) or USP (US Pharmacopeia<\/a>),\u201d said Cohen said via email, referring to two independent, not-for-profit agencies that test supplements and then certify them.\n <\/p>\n \n \u201cThe FDA does not test supplements before they are sold,\u201d he said. \u201cUnless supplements have been certified by a high-quality third-party organization, such as NSF or USP, it is not possible to know what\u2019s really inside the bottle.\u201d\n <\/p>\n \n \u201cBoth those groups do deep dives into the quality of manufacturing,\u201d Cohen told Gupta on the podcast. \u201cThey look at the original ingredients that are coming (so that) when consumers are going in to purchase this online or in a store, that the label accurately represents what\u2019s in the product.\u201d\n <\/p>\n \n Another reputable third-party tester is ConsumerLab.com<\/a>.\n <\/p>\n \n But remember, none of these organizations test for efficacy, that is whether a supplement does what it claims to do.\n <\/p>\n \n \u201cIf you say something\u2019s good for gut health or will boost your immunity, those claims are not assessed by these companies,\u201d Cohen told Gupta. \u201cThe companies are just looking at \u2014 is the powder in the bottle the same as what\u2019s on the label?\u201d\n <\/p>\n \n A good rule of thumb when checking ingredient lists for supplements is less is more.\n <\/p>\n \n \u201cToss away all supplements that list two or more botanical ingredients on the label,\u201d Cohen said.\n <\/p>\n \n \u201cManufacturers are not required to share the details of each ingredient when mixing multiple botanical ingredients in the same supplement,\u201d he said. For example, you might not know the ratio of one ingredient to the others, how fresh each one is, or the process by which each is prepared and then blended together.\n <\/p>\n \n \u201cThe only way to ensure that sufficient information about the botanical is provided on the label, (is to) select only single-ingredient supplements,\u201d he added.\n <\/p>\n \n When you shop for dietary supplements, avoid products that claim in vague language to promote health benefits, Cohen said, such as \u201cboosts immunity\u201d or \u201cimproves cognition.\u201d\n <\/p>\n \n \u201cSupplement claims are not vetted by the FDA, and manufacturers do not need to perform studies of the supplement to demonstrate any benefit before selling the product,\u201d he noted.\n <\/p>\n \n Cohen said it\u2019s best to avoid supplements with these types of claims and instead \u201cobtain information about benefits and risks of supplements from a reliable, independent source, such as the National Institutes of Health\u2019s Office of Dietary Supplements<\/a>.\u201d\n <\/p>\n
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