About Supplements
The Good, the Bad, and the Ugly
UPDATED: January 28, 2026
Welcome to the Healthy Living Is Good Medicine Newsletter, presenting timely, science-based, original articles covering a wide range of preventive medicine and public health topics, along with critical commentaries on the politics and economics of the American healthcare system.
Forgive me for borrowing my subtitle from Clint Eastwood's 1967 spaghetti Western. I wanted this very important subject to get your attention.
SCAM ALERT
Beware of “doctors” who sell the supplements and botanicals that they recommend. They have a financial incentive that creates an unethical conflict of interest. Most of those products have no guarantee as to their purity and potency, and may not even contain what their labels say.
Nearly 60 million Americans take vitamins or supplements regularly, and the industry rakes in about $50 billion USD annually. Most of the supplements purchased by healthy adults who are not pregnant, nursing, or have problems with absorption, are unnecessary. Some of them may even be harmful.
The U.S. Food and Drug Administration (FDA) defines dietary supplements as products taken by mouth that include dietary ingredients, such as vitamins, minerals, amino acids and enzymes. Because they do not treat diseases, they are not required undergo clinical trials that demonstrate safety and efficacy.
Supplement labels and advertising can't legally claim to treat specific conditions and must therefore be intentionally vague, with statements such as "supports heart health" or "immune support." Those claims typically come with a squint-print disclaimer. Botanicals (herbals) and other non-drug “remedies” are similarly exempt from FDA regulation and oversight. That’s what prompted the U.S. Department of Defense to launch Operation Supplement Safety and the supplement Scorecard.
BOTTOM LINE, UP FRONT
In the United States, the lucrative wellness products industry, because it is mostly unregulated, is a form of legalized robbery. The predatory advertising practices, misleading claims, and deceptive labeling make those products modern day equivalent of old-time “snake oil” remedies and quack cures.
Unlike pharmaceutical products, the FDA does not approve dietary supplements and botanicals or assure their safety and effectiveness before they are marketed. Manufacturers are responsible for monitoring the quality of their products prior to sale. Fat chance of that actually happening, despite the medical profession's calls for reform. Money spent on influence peddling (lobbying) prevails in our ruthlessly capitalistic political-economic system.
With most over-the-counter dietary supplements and botanicals there isn’t any way for consumers to know what they are actually buying. In addition to not getting what’s on the label, some products are contaminated with toxic chemicals, or have been deliberately adulterated with undeclared ingredients. The FDA’s website listing safety alerts for dietary supplements will give you an idea about how pervasive business practices that endanger the public have become.
For example, a study of 30 commercial melatonin supplements found that almost three-quarters of the products tested misrepresented the melatonin content claimed on its label. The study also found that lot-to-lot variability within a particular brand could vary by as much as 465 percent. In addition, undeclared serotonin, a controlled drug, was identified as an adulterant in eight of the tested melatonin products.
According to a recent analysis of more than 2,800 different fish oil supplements, about 74 percent of them made at least one unsubstantiated health claim about their product. Think about that. Three out of four made false or deceptive claims, without any consequences. Where’s the public outrage? Protest by sharing this message, and boycotting unscrupulous supplement manufacturers.
I strongly suggest that you avoid purchasing any vitamin, mineral, or botanical supplements unless their label displays a USP or NSF seal, indicating that its contents have been USP or NSF laboratory tested, and the product is verified or certified as to its purity and potency. Without that independent testing by non-profit labs, you won't know what you’re really getting. It’s Caveat emptor, folks, in spades!
THE GOOD
It is always best to meet our nutritional needs by eating a diverse and balanced diet. Sadly, many people aren't. Vegans, and anyone else who has a highly restrictive diet, will have difficulty obtaining adequate amounts of certain nutrients. Pregnancy increases the need for folic acid and vitamin D supplementation, and there are medical conditions that interfere with digestion. Simply growing older makes people less efficient at assimilating enough key nutrients, and we may need extra amounts as we age. Taking a few supplements might be a good way to compensate for what we are missing.
Hedging Our Bets
In the absence of a medically diagnosed deficiency, there are still a few dietary supplements that might be recommended for most healthy adults. People's need for calcium is generally 1,200 mg per day up to the age of 50, when it increases to 1,500 mg/day. Calcium citrate is recommended for best absorption. Post-menopausal women are at the highest risk for developing osteoporosis, so calcium supplements are especially important for them.
Vitamin D3 (cholecalciferol) supplements go hand-in-hand with calcium, since vitamin D is necessary for calcium absorption. It also has anti-inflammatory, antioxidant, immune enhancement, and neuroprotective properties. Although our bodies can make vitamin D when our skin is exposed to sunlight, UV damage and an increased risk of skin cancer tilt the scales in favor of supplements. Before age 70, your daily requirement is 600 IU a day. After 70, it goes up to 800 IU.
Patients with normal kidney function who have osteopenia or osteoporosis should take the medically recommended amounts of vitamin D and calcium, if their serum level of 25-hydroxyvitamin-D is below normal. According to the NIH, the therapeutic range of total 25(OH)D level is 20-50 ng/mL. However, the normal range can vary, depending upon the lab that is doing the testing, and some vitamin D blood tests can give misleading results. The Endocrine Society's guidelines recommend against routine testing of vitamin D levels in the general population.
Women over the age of 30 should be getting 320 mg a day of magnesium, and men 420 mg a day, but most people in Western societies don’t get adequate amounts of magnesium from their diet. The richest food sources are nuts (especially almonds and cashews), seeds (particularly pumpkin seeds), dark leafy greens, and dark chocolate. Seeds, whole grains. and legumes are also good sources.
The common side effects of too much magnesium, particular the oxide form, include diarrhea, nausea, and upset stomach. The most easily absorbed forms of magnesium include citrate, lactate, or glycinate, while the oxide and carbonate are the least bioavailable forms. Magnesium glycinate may help with sleep issues. Men over the age of 70, people with type 2 diabetes, and those with gastrointestinal diseases are most likely to be deficient. Here’s a deep dive into magnesium:
People over the age of 50 could have a problem absorbing enough vitamin B12, and vegetarians probably don’t get enough of it from their diet. This important vitamin is necessary for red blood cell formation and for the nervous system to function properly. It would be a good idea to take a daily B12 tablet, preferably as 500 mcg of cyanocobalamin. B12 megadoses are available as an injection for those with a chronic B12 deficiency due to malabsorption.
Taking a daily multivitamin for 20 years didn't reduce the overall risk of death, or death from cancer, heart disease, or strokes, according to a recent analysis of three prospective cohort studies, although a previous large-scale, randomized, double-blind, placebo-controlled trial showed a modest reduction in the total risk of cancer. Even though a third of U.S. adults take them, the current consensus is that most people would be better off getting their vitamins from a healthful diet that is associated with greater longevity.
I've previously discussed the risk of developing deficiencies in essential omega-3 fatty acids by strict vegetarians, a warning that’s often dismissed by die-hard vegans. A recent study found that people with a genetic predisposition for developing elevated blood levels of cholesterol, LDL, and triglycerides can benefit from omega-3 supplements, along with lipid-lowering medications. For a deep dive into the subject, see:
While the current evidence suggests that incorporating fish that are high in omega-3s into one’s diet can be beneficial, taking fish oil supplements significantly increases the risk of developing atrial fibrillation, and that’s something that should be avoided. Consequently, I no longer recommend taking fish oil supplements.
Your primary care physician should be able to recommend specific dietary supplements for your health needs. It would be prudent to learn as much as you can about any supplements you might be taking. The NIH has hundreds of fact sheets covering almost every supplement available.
The incomparable Dr. Wilson explains how it is that vitamins don’t do much for your health, but they do give you more expensive pee:
Another Dr. Wilson video explains the deceptive marketing practices of the supplement industry, and how they are able to take advantage of a gullible American public that is poorly educated when it comes to critical thinking skills and scientific literacy:
Questionable Necessity
Promoted by supplement salespersons with medical degrees such as Mark Hyman and Casey Means, these so-called “functional medicine” doctors haven’t encountered a dietary supplement they didn’t embrace. Functional medicine is not a recognized medical specialty, but it provides yet another way to seduce conventional healthcare providers into the realm of pseudo-scientific alternatives to evidence-based medicine. Selling supplements to patients, while clearly an unethical financial conflict of interest, can be a cash cow for its practitioners. Some examples:
Collagen supplements have no known medical value. Just like any protein, they are broken down into amino acids during digestion. While some studies suggest ingesting collagen peptides benefits skin, joints, and hair, the evidence is conflicting, with industry-funded studies showing positive results rather than the independent ones. Focusing on a nutrient-rich diet and healthy lifestyle is a scientifically backed approach that supports the body’s collagen production capabilities.
L-glutamine supplements have little to no value because a healthy body can produce enough glutamine on its own. There is no scientific evidence supporting the marketing claims regarding muscle growth, immune function, or fat loss. While glutamine plays a crucial role in metabolism, such supplements are generally unnecessary for people who have an adequate diet. Research on benefits such as improved athletic performance or IBS relief show mixed or limited results, and must be viewed with skepticism.
Chondroitin supplements are another frequently promoted product without demonstrable value. Major studies have shown that they are no more effective than a placebo for arthritis pain. Some research suggests that they may even worsen joint pain for some individuals. Chondroitin can also cause side effects or adversely interact with prescription medications.
THE BAD
Some supplements aren’t necessary for people who eat a balanced diet that includes lots of whole fruits and vegetables. Unless you’re a smoker, you probably don’t need to waste your money on vitamin C. This is another essential micronutrient that becomes unhealthy if you take too much.
There is no good evidence showing that chondroitin and/or glucosamine are any better than a placebo for treating joint pain due to arthritis. Probiotics, other than what you get from fermented foods, are unnecessary. In rare instances, probiotics might be prescribed for specific medical conditions. Don’t take unregulated over-the-counter probiotic supplements.
There is also the risk of too much of a good thing becoming a bad thing. Drinking too much water can be fatal. Very high doses of vitamin D along with calcium supplements increases the assimilation of calcium, which is good for the bones, but not good for the coronary arteries. It now appears that very high levels of vitamin D, when combined with large amounts of calcium supplements, increase people's risk of coronary artery disease.
Anyone who is taking a high-dose vitamin D supplements should monitor their serum 25-hydroxyvitamin-D level and not let it get above the therapeutic range. People with reduced kidney function who are taking vitamin D and calcium supplements are at an even higher risk for cardiovascular problems due to coronary artery calcification.
Herbal Doesn’t Mean Healthy
Poisonous mushrooms and toxic oleander have found their way into herbal products. Natural substances aren’t necessarily safe. There are lots of things found in nature that can harm you.
The U.S. FDA routinely issues alerts about adulterated supplement, such as a recent addition to their list of herbs and dietary products containing toxic yellow oleander, which can cause adverse neurologic, gastrointestinal, and cardiovascular health effects that may be severe, and can even be fatal. Yet people continue to buy unregulated products without there being any guarantee of purity or potency, proving the 1806 adage that there’s a fool born every minute.
Even with herbs that have not raised alarms, dose and purity still matter. An example is turmeric, one of the biggest-selling herbal supplements out there. Claims for its benefits are not supported by rigorous scientific evidence, and taking turmeric can increase the risk of kidney stones. Large amounts of curcumin, the main active ingredient in turmeric, has been implicated as a cause of liver damage.
A new study found that nearly five percent of U.S. adults reported taking at least one herbal supplement in the last 30 days that might be damaging to their liver. That translates to an estimated 15.6 million U.S. adults at risk for liver injury due to taking botanical products sold as supplements. Do the manufacturers, distributors, and retailers care about poisoning people for profit? If there are no government regulations to stop them, and they’re not held accountable through class-action lawsuits, it is only informed consumers who can protect themselves and their loved ones.
Severe liver injuries have required transplants, and some cases have been fatal. The risk is increased by taking turmeric along with black pepper. Piperine, a compound in black pepper, increases the bioavailability of curcumin by about 2,000 percent. Other potentially hepatotoxic botanicals include brindle berry (Garcinia cambogia), black cohosh, ashwagandha, red yeast rice, and green tea extracts. When taken in high doses, these supplements can produce acute liver injury and liver failure. Here’s an exposé of the ashwagandha scam:
Among the supplements most frequently implicated in liver injury are turmeric, green tea extract, kava, black cohosh, and usnic acid. In many cases, the liver injury appears idiosyncratic or immune-mediated, and may be exacerbated by piperine (black pepper extract), which enhances systemic absorption but also may interfere with drug metabolism.
The risk of acute liver injury is increased when hepatotoxic supplements are taken at the same time as any of the following medications: Acetaminophen, amoxicillin-clavulanate, azathioprine, captopril, chlorpromazine, ciprofloxacin, clarithromycin, erlotinib, fluconazole, isoniazid, ketoconazole, lenalidomide, levofloxacin, metronidazole, moxifloxacin, prochlorperazine, stavudine, sulfamethoxazole-trimethoprim, or thalidomide.
Lack of Supplement Industry Oversight
When you buy a supplement, you may not know what you're getting. Unless a product has been USP, NSF or UL independently tested, you're buying a pig in a poke. In the worst cases of abusing the public, products may contain dangerous contaminants, undeclared drugs, or otherwise be toxic. Adulteration of Chinese herbal remedies with prescription medications is not uncommon. Because government oversight is lacking, health authorities and regulatory agencies might not intervene until enough people have been harmed.
The FDA maintains a database of health-related products that have had been a concern. These products have been the subjects of warning letters, online advisories, recalls, public notifications, and press releases. Although the FDA’s database includes only a small fraction of the potentially hazardous products marketed to consumers online and in retail establishments, it is still worth checking the list before purchasing any dietary supplements.
For example, the FDA recently told the manufacturer of GURU Herbal Dietary Supplement Capsules to recall the product after they were found to contain acetaminophen, diclofenac, and phenylbutazone. Acetaminophen in excessive amounts can cause liver damage. Diclofenac is an NSAIDs that can increase the risk of heart attack and stroke, as well as causing severe gastrointestinal damage. Phenylbutazone is an NSAID banned for human use in the U.S. due to life-threatening bone marrow toxicity. Unfortunately, herbal preparations and dietary supplements containing dangerous pharmaceuticals is not a rare occurrence.
Some supplements can alter the absorption, metabolism, or excretion of prescription medications, resulting in people getting too much or too little. Some can impact blood clotting, and should be discontinued prior to surgery. That's why your doctor, and possibly pharmacist, should be informed about all the supplements that you are taking.
Don’t purchase any over-the-counter supplements from your healthcare provider. Selling dietary supplements (“nutraceuticals”) and botanicals (“herbal remedies”) to patients is a common practice among naturopaths, chiropractors, acupuncturists, and physicians practicing “functional medicine.” Despite any claims about carrying those products in-house as a “convenience” for their patients, it is considered to be unethical.
The sale of any health-related products raises concerns about financial conflicts of interest that can undermine the primary obligation of physicians to serve the interests of their patients before their own. The American Medical Association has a strict code pertaining to physicians who choose to sell health-related products from their offices, through their websites, or via other online venues. Patients who are pressured into purchasing such products from their healthcare provider should consider changing providers.
Private label supplements are typically generic products manufactured by a third-party company but sold under the brand name and logo of another business. This allows small businesses to create their own branded supplement line by outsourcing the manufacturing to a specialized company, while they focus on marketing and selling their products directly to their customers, clients, or patients.
In this business model, a manufacturer creates a product from an existing formula, which the client then brands and sells as part of their own line of supplements. Businesses can customize the product’s packaging to match their brand identity and sales target. This practice has become popular as an easy way for entrepreneurs, practitioners, and small retailers to enter the lucrative supplement market and build their own niche brand. Of course, there won’t be any independent laboratory verification of the products’ purity and potency, as is the case with most of the products sold by the supplement industry, and the prices are typically higher than what can be found at your neighborhood big box store.
If you are currently taking supplements, you may want to check this website created by the U.S. Department of Defense called “Operation Supplement Safety.” The link provides a supplement safety scorecard that allows you to screen your supplements.
THE UGLY
The 1994 Dietary Supplement Health and Education Act exempts dietary and herbal supplements from most FDA regulations, and allows them to be marketed without any scientific backing for their health or safety claims. As a result, American consumers have been continually fleeced by unscrupulous players in this industry. There are more than 100,000 such products on the market, but people don’t have critical information about most of them.
Consequently, outright scams promoted by the wellness industry abound. Unregulated “Liver cleansing” pills and “menopause supplements” are raking in big bucks. Analyzing the reviews for supplements on Amazon, Fakespot found that only about 35 percent of positive reviews were genuine. The top ten menopause supplements generated more than $3BN per month in sales, yet none of those product contained ingredients that could potentially relieve symptoms. People need to wise up and stop getting ripped-off by buying expensive placebos.
One of the ugliest aspects of the $50 billion a year supplements industry is its ability to corrupt federal legislators. Once again, legislation has been introduced by Senator Dick Durbin (D-IL) to require tighter standards for transparency, consumer safety, and efficacy commensurate with advertising claims. Consumer reports of harms caused by supplements are filed with the FDA, and currently exceed 50,000 claims a year.
Predictably, a massive lobbying effort is already underway to defeat the proposed creation of a Federal Food Administration that would have a centralized and exclusive regulatory control over food and dietary supplements. It remains to be seen if Congress will take any action during this election cycle to protect consumers, when so many legislators receive campaign contributions from industry sponsored super-PACs.
For a deep dive into the ugliness surrounding the pseudoscientific promotion and deceptive advertising of antioxidant supplements, see:
Doctors for Sale
Another ugly tactic of the industry is to hire doctors who are willing to advertise dietary supplements. Take, for example, the TV commercials for Qunol CoQ10. Coenzyme Q10 is a nutrient produced by the body that plays a role in cellular energy production. While some medical conditions have been associated with reduced blood levels of CoQ10, causal relationships have not been established.
Consequently, there is no convincing scientific evidence for any of benefits claimed by purveyors of CoQ10 supplements, but when has a lack of evidence ever stopped “snake oil salesmen” from hawking their wares? In 2020, the FDA issued a warning letter to the manufacturers of Qunol Ultra CoQ10 for violating the Federal Act that prohibits claiming that a dietary supplement can cure, mitigate, treat, or prevent any disease.
Quack Cures
Prevagen is a flagrant example of consumers being misled by unproven health claims. This OTC product alleges that it increases brain function and improves memory, targeting older adults in their ads. The company says results should be apparent within 90 days, typically requiring an expenditure of about $180 USD. By then, most people would be reluctant to admit that they had fallen for a scam, and might even persuade themselves that it works.
As with other kinds of supplements, this heavily advertised product’s vague health claims aren’t regulated by the U.S. Food and Drug Administration (FDA). The company can get away with misleading the public as long as its marketing doesn't make reference to any specific diseases.
A class-action suit against Prevagen's manufacturer for making false and unsubstantiated claims was settled in 2020, but consumer advocates said the suit didn't go far enough. On May 8, 2024, a federal judge in Manhattan accepted a jury’s finding that Prevagen's manufacturer and four corporate defendants made fraudulent and deceptive statements about the supplement, in violation of New York’s Consumer Protection Laws.
The company continues to claim that Prevagen's benefits have been “clinically proven,” but the research cited was performed by the parent company, Quincy Bioscience, and there was no peer review of the study. That fact alone should raise serious concerns about conflicts of interest and confirmation bias.
An independent analysis of the study's results showed that there were no significant overall cognitive improvements for participants who took Prevagen. There have been no independent clinical trials of Prevagen because its claims lack biological plausibility. In other words, legitimate scientists already know that those claims are B.S., so there’s no reason to test them.
Here’s why: The main ingredient in Prevagen is apoaequorin, a protein derived from aequorin, a luminescent compound that's found in the crystal jellyfish (Aequorea victoria). In Prevagen capsules, apoaequorin is a synthetic version of this protein, manufactured in a laboratory. For any supplement to enhance brain function, it would need to remain intact during digestion, and then cross the blood-brain-barrier. However, when proteins are eaten, they are digested into their component amino acids. Even if by some miracle Prevagen was able to evade digestion and enter the brain's circulation intact, in the doses provided it would be unable to produce a detectable effect.
With more than 50 million people worldwide suffering from dementia, and over 10 million new cases diagnosed each year, OTC products claiming to improve cognitive function have proven to be highly profitable. Companies have learned how to manipulate people's fears of cognitive decline and prey upon the elderly. Prevagen, among many other “brain health” supplements marketed with empty promises, is a predatory scam. For more debunking of Prevagen, see:
The bottom line: Don’t waste your money on Prevagen, unless you want to prove that you’re no smarter than a jellyfish! Here’s yet another deep dive into the science debunking this scam.
Unfortunately, even the current pharmaceuticals that do have FDA approval for managing the symptoms of Alzheimer's dementia have limited effectiveness. Anti-amyloid, monoclonal antibodies, given by intravenous infusions, appear to slow the disease's progression in patients with mild cognitive impairment. Donanemab seems like the better choice of anti-amyloid drugs right now, albeit with some safety concerns.
So, how do we explain the parade of people in Prevagen commercials claiming to have benefitted? Even if they weren't paid for their appearances, such testimonials are all subjective anecdotes. So-called "anecdotal evidence" does not pass muster for being scientifically valid, especially when those first-person reports are cherry-picked. Please ignore what your Facebook friends tell you about any supplements or home remedies that are allegedly helping them. Hearsay is not evidence.
What about all the positive reviews of Prevagen on Amazon? Well, there's no denying the power of the placebo effect, when your brain convinces your body that a fake treatment is the real thing. This effect can be amplified when people have paid a high price for something, known as the "sunk cost" bias. It is difficult to abandon a course of action or an investment when you don't want your resources to have been squandered on something that's worthless.
People are typically reluctant to admit to themselves that they've been suckered by a sales pitch. Consequently, the subconscious mind will try to find any way to justify foolish purchases. That includes imagining that one is experiencing the product's claimed benefits. Skeptics would be justified in asking if the people who gave Prevagen good reviews actually had taken before-and-after objective cognitive tests that would support their subjective impressions. You can count on the number who did that being zero. For more information, see:
Bottom Line
What you see on the supplements’ labels are not necessarily what you'll get. Most products’ health claims are bogus. Some ingredients could be downright dangerous. With scant oversight, the powerful and politically-connected supplement industry has been running roughshod over consumers for decades. Except for a few supplements with verified purity and potency that have been recommended by a physician, consumers should avoid taking supplements, and use the money they will save to buy healthier foods.
If you’re in good health and are eating a healthy diet, you shouldn’t need supplements. Aye, but there’s the rub. How many of us can honestly check both those boxes? So, to make sure we’re not missing anything, a daily multi-vitamin and mineral tablet won’t hurt. For seniors, there are special multi formulations. And, everyone could benefit from a healthier diet:
For an in-depth look at the nutritional principles behind a healthy diet, how to make healthy meal preparation easier, and 100 recipes to inspire your culinary creativity, check out my eBook, “Rx for Healthy Eating.” It is available from Barnes & Noble, Google Play Books, and the Amazon Kindle Store. The book costs less than a burger and fries, and comes with free updates. Unlike fast food, it could actually prevent a heart attack.
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