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community weblog

You are the guinea pig

Supplements are regulated like foods. They look like medicines, appearing in powders and pills with vague promises to enhance performance, improve mood, and boost your immune system. But regulatory agencies in the US, the EU, and Canada (and probably most others) do not view them as medicines and they are not regulated as such. In the US supplements are not required to be tested for safety or efficacy before being put on the market. In fact, the FDA is not authorized to do any testing until a product is already on the market.
Independent testing labs like ConsumerLab find that many supplements for sale in the US contain heavy metals, prescription drugs, or other contaminants, and others do not contain what's on the label, or the contents are not in a bioavailable form. Regulatory agencies only step in when people get injured. And the $146 billion supplement industry is booming, as you've probably noticed from the explosion of ads in your podcasts and socials. And the industry continues to push "consumer choice" legislation to further limit safety oversight. A couple of podcast resources: - A Body of Evidence podcast episode on supplements in Canada - A New Zealand podcast investigative series on Athletic Greens For those who enjoy reading legalese, here is the text of the regulations in the US and the EU: - The text of DSHEA - Text of EU regulations on supplements
posted by antinomia on Nov 15, 2024 at 6:49 AM

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In the USA, for DSHEA, thanks orrin hatch and tom harkin (spits) .
posted by lalochezia at 6:59 AM

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I'm curious to see what The Onion does with the records (or lack thereof) from Infowars' supplement business.
posted by zamboni at 7:11 AM

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Regulatory agencies? Post Chevron and with RFK Jr at HHS?
posted by snuffleupagus at 7:14 AM

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One the one hand, people should know better than to take random supplements that haven't been approved by the FDA, but on the other hand, they very clearly don't, and that stuff should 100% be regulated, because if there's anything I've learned is that people are just absolutely stellar at not knowing things.
posted by grumpybear69 at 7:30 AM

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I feel that we're in the midst of another seismic shift in political idealogies akin to the mid-20th century. George Wallace and Strom Thurmond were deep-south Democrats at the starts of their careers. Their beliefs are of course abhorrent and antithetical to the modern Democratic party. They were just two terrible individuals at an inflection point in our nation's political landscape.

Meanwhile, in the late 20th-century and early 21st, a lot of the skepticism and push for supplements, homeopathy, anti-vaxxers, etc., was led by suburban liberals. Suddenly everything is upside-down and conservatives are pushing the pseudo-science. A lot of it stems from a feeling that government overreached during Covid and scientists can't be trusted. Of course, these are just a couple areas among many that have flipped (size of government, freedom of speech, tariffs/free trade, etc.)

But now you have far right-wingers basically playing the Goop strategy.
posted by robot_jesus at 7:33 AM

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some of them, like phenibut and tianeptine, are actual prescribed drugs from foreign markets.
posted by AlbertCalavicci at 7:33 AM

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Deeply badly wanted to enter that market with a homeopathic snake oil supplement. (diluted sufficiently that even the finest lab would not find anything but pure Dihydrogen Oxide, but with a guarantee that at least one snake had been squeezed) .... but while waiting in line saw an existing product.
posted by sammyo at 7:44 AM

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mid-20th century

Ehh, alien exclusion acts, import tariffs, wildcat specie and patent medicine have a decidedly 19th century feel.

Giddyap, pardners.
posted by snuffleupagus at 7:46 AM

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some of them, like phenibut and tianeptin

For a second there I thought you were referring to some Metafilter user names.
posted by Kibbutz at 8:05 AM

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I know that one brand claims that their products are tested by USP, and independent laboratory. Anyone know how reliable and independent they really are?
I take supplements on the advice of my doctors, like I suspect that a lot of people do.
posted by Spike Glee at 8:10 AM

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when a younger man, I did an excellent job of living like an idiot and ended up having something of a health crash in my late 20s. Nothing that serious. I was just kinda sick and depleted for many months. My doctor called me an idiot (politely) and recommended things like eating better, sleeping better, drinking less, exercising more etc.

"What about vitamins," I asked?

He shrugged. "It's a pretty harmless way to get expensive and colourful urine."

Which has stuck with me over the years. It does seem that there are some useful supplements out there, but not many, and they tend to be the ones that get recommended by a proper (ie: licensed) medical/health professional.

As for the options the various online guru types and whatnot are pushing, unless they're complete fools, I imagine it conforms with what my doctor said way back when. Mostly harmless, mostly useless, not cheap. "Regulatory agencies only step in when people get injured" and all that.

All good grift.
posted by philip-random at 8:12 AM

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I have to use lactase pills to eat ice cream and other dairy items now. Brand name Lactaid works, but it's expensive. So I tried a couple of no-name versions, and I was sort of shocked that my latest bottle is a complete crapshoot. Sometimes those pills seem to work, sometimes they definitely don't.

Lactase turns out to be a "supplement," not a medicine, and the packages of even the good stuff do reflect this status if one looks closely.

This was eye-opening for me, because real lactose intolerance is so vanilla, so common. I'm not dabbling in woo, here. I'm not chasing vague promises, I've got very specific symptoms and I desire well understood solutions. I knew supplements were a minefield at best. I thought I was safely removed from that issue, but it turns out I'm not.
posted by Western Infidels at 8:30 AM

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people should know better than to take random supplements that haven't been approved by the FDA

A lot of things classified as supplements aren't "random" though.

E.g. melatonin is classified as a supplement (and therefore not regulated by the FDA). If you are at a drug store buying a bottle labeled "5 mg melatonin", you have no idea whether there is any melatonin in it at all, or conversely whether the melatonin is 10x the labeled amount. It's entirely unregulated.

This is a very real problem and shouldn't be pooh-poohed.
posted by splitpeasoup at 8:57 AM

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Yes, I find the consumer choice to take a thing distinct from the consumer right to... be sold something pretending to be the thing? How did we let those get tied up together?
posted by clew at 9:07 AM

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In some sense, this was inevitable under the current global stupidity.

...it's very nearly the ultimate capitalist enterprise -- a clean exercise in marketing. You don't have to worry about the product itself, because it doesn't exist, you only have to worry about how you'll sell it. It's like selling a god -- there is no god, so you get to spend all your time on the fancy trappings and rituals that draw in your customers. Leave the right spots blank, and they'll fill in whatever they need while emptying their pockets into your bank account.
posted by aramaic at 9:16 AM

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In some sense, this was inevitable under the current global stupidity.

This isn't new, though. Long before this crap flooded your local stores, there were MLMs like Shaklee (still going strong after over 65 years) pushing supplements through home distributors.
posted by Thorzdad at 9:20 AM

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E.g. melatonin is classified as a supplement (and therefore not regulated by the FDA). If you are at a drug store buying a bottle labeled "5 mg melatonin", you have no idea whether there is any melatonin in it at all, or conversely whether the melatonin is 10x the labeled amount. It's entirely unregulated.

I'm sure I'm not the only menstruating person who has been directed to take iron supplements but not given a prescription for it, just told to buy some at the drugstore -- it's meant to be helpful, like hey this is cheaper and you don't have to try and get to a pharmacy during open hours about it, just grab some.

I did notice that when my partner was recently prescribed Vitamin D they wrote an official prescription and he has to go pick up the pills; I wonder if that is because they now realize the store varieties are likely to be nothing but sugar and wax.
posted by We put our faith in Blast Hardcheese at 9:24 AM

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Glad CpnsumerLabs was mentioned in he post. It shouldn't be needed, but, since it is, it's a great resource to have. Been a paying subscriber for some years now since I'm supposed to take a few supplements like CoQ10 and vitamin E to support my meds
posted by Hairy Lobster at 9:33 AM

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Wait, what? A mention of Athletic Greens, pushed for years by Andrew Huberman, in the same thread discussing an already challenged regulatory body that is likely to get functionally shredded by the incoming band of other self-promoting narcissists?
posted by armoir from antproof case at 9:42 AM

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One the one hand, people should know better than to take random supplements that haven't been approved by the FDA

The truly insidious thing about the drive to destroy government safety and effectiveness regimes for the sake of profiteering is that they have worked so well for so long that people now assume "They couldn't sell it if there was anything wrong with it." They can and they are, and it will only get worse for at least the next four years.
posted by Horace Rumpole at 9:50 AM

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I did notice that when my partner was recently prescribed Vitamin D they wrote an official prescription and he has to go pick up the pills; I wonder if that is because they now realize the store varieties are likely to be nothing but sugar and wax.

OK, this at least, I do have some evidence that the vitamin D supplements I've been taking seem to have real vitamin D in them—I was deficient, but after taking them for just a few months, I no longer was, and I haven't been in years as I've continued to take them. I rarely go outside in full sunlight for long. I get Nature Made vitamin D3, which is USP-tested and came up on a list (maybe it was ConsumerLab, but I don't remember anymore) from a company that ran independent tests on supplements.

So that's one small data point. I mostly try to get my vitamins and other supplements from them.
posted by limeonaire at 9:51 AM

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Also, there was a great arc about supplements on The Resident, which might be the best medical drama I've ever watched.
posted by limeonaire at 9:53 AM

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I knew, deep in my heart of hearts, that people would take the first part of my comment to dunk on and leave out the part where I advocate for regulation. But whatever, that's on me, because by my own standards I should have known better.

Grumpybearbride takes magnesium supplements and had do to a lot of research to find the brand that actually contained bioavailable magnesium since many brands contain magnesium that just passes through your body. It really is s scamtastic market.
posted by grumpybear69 at 10:43 AM

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Have not looked at TFA but am broadly familiar with the topic. It would be amusing (were it not so tragic) to compare the non-regulation of the supplements industry with the War on (Some People Who Use Some) Drugs. One key talking point of the latter, IIRC, was "you never know what's in it."
posted by Aardvark Cheeselog at 10:45 AM

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I do take one supplement that has improved my quality of life immensely; but because I would prefer not to be badgered and gaslit into believing it doesn't work, I will not be mentioning it here, lol.
posted by kittens for breakfast at 10:45 AM

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For those in the US, it is really easy to order your own blood work, and probably much cheaper than you are billed by insurance (it is for me). And you won't have to go through all the gatekeeping of insurance for what they will and won't test for.
posted by nanook at 10:46 AM

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I have to use lactase pills to eat ice cream and ... my latest bottle is a complete crapshoot.

TMI, yo.
posted by Ice Cream Socialist at 12:39 PM

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I need to have extraneous doses of vitamin B12 beyond what I'm able to get from food or I'll die. I almost did die (from pernicious anemia) before I was diagnosed.

I have two choices: a prescription for vitamin B12 shots or a very high potency B12 supplement of 4000 times the recommended daily allowance.

I doubt a regulatory regime would allow the sale of supplements 4000 times as strong as people generally need because they help a tiny, tiny minority even if they knew we exist, which they probably wouldn't because none of the people I've seen in medical appointments over the last year have known anything about PA, including its existence. They were all PAs, since it's now almost impossible to see an MD on an initial appointment as well as subsequent appointments in some cases, but I managed to keep myself from pointing out the irony of PAs being completely ignorant of PA. Barely.

Gatekeeping is a huge problem for sick people in the US and the UK and elsewhere.

But you can get supplements and herbal remedies without convincing gatekeepers who will make more money by denying you treatment, and in most cases will deny there's anything organically wrong with you in the first place.

And that's the reason I prefer the current regime to any of the regulatory schemes I've seen so far.
posted by jamjam at 12:42 PM

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pure Dihydrogen Oxide

You know that stuff can kill you, right?
posted by Thella at 1:14 PM

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I've surreptitiously gotten to see the inside edge of the industry, from being close with someone who was running a small supplement company who legitimately was doing their best to make a quality product that matched what their medical research had worked out.

They were contracting out the actual manufacturing to local, US based companies and the manufacturers were so unbelievably bad. Basically every one they went to would screw some part of the product up in a substantial way. Lab tests would find issues with the makeup of the ingredients. They'd include the wrong (cheaper) form of the main ingredient, or not meet the granular size specified, or get the percentages wrong. Or they would put them into capsules that couldn't even survive transit or sitting in a warehouse. Sometimes the capsules would leak before they even got to the shipping department. Other times the wrong number, or size of the supplements. Not to mention running months behind schedule or screwing up simple things like the blister pacs or cardboard boxes. (And these are just times that I can recall being told about...)

It was so bad that pretty much every time they'd do the next major order, they would have to start from scratch to find a replacement manufacturing company. It was eye opening, to say the least.
posted by rambling wanderlust at 1:50 PM

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I am deeply curious about two-fisted tales of the supplements industry. I can believe the stories about inconsistent manufacturing, having seen it in other contexts.
posted by Typhoon Jim at 1:59 PM

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My favorite were the capsules that dissolved into some slimy gel. Who knows what the hell the shells were made of...
posted by rambling wanderlust at 2:17 PM

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There's a meme image captioned "The free market will regulate itself!" showing a kid with his science fair project titled, "HOW MUCH SAWDUST CAN YOU PUT IN A RICE CRISPY TREAT BEFORE PEOPLE NOTICE?"
posted by AlSweigart at 3:05 PM

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"What about vitamins," I asked?
He shrugged. "It's a pretty harmless way to get expensive and colourful urine."

Just stopping by to point out that this cavalier advice only holds true for people who do not have a vitamin or mineral deficiency.

For those of us that do have a deficiency, insurance often won't cover prescription vitamins when affordable but unregulated OTC options are available. The best we can do is reach for USP or NSF certified products, even though those certifications are paid for by the manufacturers themselves.

Fun fact about melatonin: while it's unregulated in the US but only available with a prescription in the UK
posted by evidenceofabsence at 8:24 PM

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Also:

I have to use lactase pills to eat ice cream and ... my latest bottle is a complete crapshoot.
TMI, yo.
posted by Ice Cream Socialist

Eponygastronomical.
posted by evidenceofabsence at 8:25 PM

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In total agreement here that most supplements are crap. I keep getting told by 'helpful' friends that I don't need my bipolar meds or heart meds if I would just take these
"miraculous" vitamins and minerals. I finally completely cut off a friend, a dietician no less!, who shills for Juice Plus.

On occasion I have gotten suckered into trying (or been given) melatonin, Omega Bs, various minerals, turmeric, and hyaluronic acid/glucosamine/chondroitin--none of which had the marvelous outcome I was told to expect.

My current doc must have attended the same med school as philip-random's, because she has told me the same thing:
Multi--Vites are "... a pretty harmless way to get expensive and colourful urine."

There are four items that I do take with my doctor's approval, and I just realized that my husband has traded out my Nature Made brand for Walmart's Spring Valley!

For years I've taken Super Vitamin B- complex, and it did make me feel better, but I was wondering if just getting older was playing havoc with my nervous system....

Two years ago, I felt like total shit, and it turned out my vitamin D level was in the toilet--scary low--and I was given prescription D. When I was back to normal, it was so wonderful! I was told to take OTC D3. I'm have been wondering if it's been working, though, because I'm starting to have muscle pain and bone aches, weak muscles, pins and needles, and that familiar depression. I'm not good at remembering sunscreen, so there's still plenty of proof I was in the sun all summer. Time to get some bloodwork. I'll let you know my opinion on Spring Valley D3 when I do.

Meanwhile, I'm headed back to Costco and picking up Nature Made JIC!

The other two items I take with her blessing are soluble fiber gummies and a probiotic, instead of RX Colestipol, which wasn't cutting it. The gummies actually seem to be helping a bit, although they were a lazy choice, and my doctor suggested capsules. The Probiotic 10 (Nature's Bounty) doesn't seem to be doing much.

Actually, it probably won't be worth taking any supplements of any kind once the FDA's been totally gutted in a couple months, so I might as well spend my money on the unregulated fruits and vegetables.

Oh, and if you think the human supplements quackery has gotten out of hand, you ought to look at the pet and equine supplement industry!! Holy Shit, is there a lot of crap out there. Wait, let me shove some aromatherapy up my critter's nose. As opposed to, you know, actually spending time training a horse or dog.
posted by BlueHorse at 9:20 PM

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evidenceofabsence:
...this cavalier advice only holds true for people who do not have a vitamin or mineral deficiency.

I missed your post as I was typing mine--this is indeed true, but most people are cavalier in assuming that they need to take multivitamins or minerals without any testing or consultation with a doctor or nutritionist.

I would say that your username might possibly be eponymous in certain cases.
posted by BlueHorse at 9:32 PM

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So I'm a clinical researcher and have interacted with the FDA in that capacity, filing for (and receiving!) an investigational new drug (IND) application for a substance that's been in medical use for 5000 years and it's currently sold willy-nilly at gas stations all over the country. The process took months and if we wanted to bring the IND to market it would take 5-10 years and tens of millions of dollars.

On one hand, that's good! It's important that your medicines are safe and that the process by which they are made is tightly regulated! Definitely don't want to go back to the days of snake oil and horse paste.

On the other hand, the FDA's regs were basically written by the pharma companies, and there is a convincing argument that those regs prevent competitive practices like comparative effectiveness research between, for instance, cannabis and Rx opiates. Full-spectrum cannabis extract would, according to current regulations, basically require INDs for each of its constituent 240+ compounds, which to date has proven an impossible task. Wonder who that benefits!

Reversing regulatory capture by industry could go a long way in bringing supplements in out of the wilderness and encouraging research that would subject them to safety and effectiveness standards. Of course, putting a guy with literal brain worms at the helm of the FDA probably won't help things much.
posted by Richard Saunders at 10:08 AM

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One the one hand, people should know better than to take random supplements that haven't been approved by the FDA, but on the other hand, they very clearly don't, and that stuff should 100% be regulated, because if there's anything I've learned is that people are just absolutely stellar at not knowing things.

It doesn't help the government itself lets fraudsters pose as government agencies like the Medicare advantage debacle. Almost all the bullshit supplement companies have fake associations that validate their products when in reality they are often single purpose "associations" created to validate just a single company's products. It's kind of like the '9 out of 10 dentists' claim that toothpaste companies used to make. People assume it is inferential statistics with proper population sampling but it was really just 10 dentists who accepted a trip to hawaii.

The big point of regulation is that ordinary citizens should not have to be chemists, should not have to buy electron microscopes and chemical analysis equipment and such. If you want to adopt a caveat emptor society and economy then the burden on the consumer becomes Heraclean combined with Sisyphean. If the FDA with a $7 billion budget thinks it can't manage it how the hell is the median household income of $80K supposed to?
posted by srboisvert at 1:02 PM

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> My current doc must have attended the same med school as philip-random's, because she has told me the same thing:
Multi--Vites are "... a pretty harmless way to get expensive and colourful urine."

I can confirm that this was the standard doctor answer 50 years ago. Vitamins -> expensive urine has a long history.
posted by Aardvark Cheeselog at 6:53 AM

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There are two separate regulatory capture scenarios playing out here, or rather a corruption-interacting-with-regulatory-capture scenario.

The corruption is the straight-up buying of legislators by the supplement-makers, or maybe to some extent the ignorance of legislators who get bamboozled by the supplement-makers. The regulatory capture is the cause of what @Richard Saunders describes. 50 years ago the Feds decided to shove the entire cost of drug safety and efficacy studies entirely onto the industry, because geez that research is expensive. This move has not resulted in the good effects for consumers that made the case for selling it, to say the least.

I am not in favor of pure Federal control of what gets to be a medicine and what doesn't. There are medications I depend on for decent quality of life for which the initial investigations for efficacy would never have been approved, probably, by a bureaucracy that is subject to the kind of Puritanical moral-panicking that any US regulatory agency would be. Try to imagine a Fed bureaucracy that could keep a program going for Plan B, in the situation where the longest run of D control of the Executive is 8 years. But there does need to be some Federal role for safety and efficacy studies of thing that aren't patentable.

Another issue is the very paradigm of what constitutes a "drug" in modern medicine. The interest in using purified substances is for good reasons, but a lot of smoke is blown and bullshit is slung around that. It's one thing to prefer purified substances when these are easily shown to be really what you're interested in. It's something else to deny that minimally-processed botanical substances can be medically useful, just because they aren't standardized the way that pills or shots of USP purified substances are. Claims that the latter are controllable dosages while the former are not is just pure bad-faith or stupidity in some combo.
posted by Aardvark Cheeselog at 7:08 AM

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