by Marion Nestle
Aug 9 2010

Supplements in trouble—again!

You have to pity the poor supplement industry.  It is taking a real beating these days.

First, the Government Accountability Office told a Senate committee that the dietary supplement industry routinely uses “questionable and deceptive” marketing practices and gives potentially dangerous advice.

USA Today agreed.  In an editorial, it noted that:

Industry spokesmen have gotten away for years with minimizing all this as just the work of a handful of bad apples. Lobbyists say responsible makers and distributors should not be burdened with more government oversight. But the problem is big enough that another GAO study last year found nearly 1,000 reports in a 10-month period of specific health problems linked to supplements, including nine deaths, 64 life-threatening illnesses and 234 hospitalizations. Nobody knows how many other incidents never got reported.

In defense, an industry spokesman blamed the FDA:

As FDA Deputy Commissioner Joshua Sharfstein acknowledged last week, DSHEA strikes the right balance, but FDA needs to do more to maintain that equilibrium. FDA must use the tools it was given under the law to address the issues that hurt the credibility of responsible companies and undermine consumer confidence.

And now, the September issue of Consumer Reports list the “Dirty Dozen” supplements that research links to nasty problems such as cancer, coma, heart problems, kidney damage, liver damage, or death: aconite, bitter orange, chaparral, colloidal silver, coltsfoot, comfrey, country mallow, germanium, greater celandine, kava, lobelia, and yohimbe.  The FDA has been warning about the ones shown in red for years.  But these and the others are still on the market.

Among other suggestions, Consumer Reports advises:

Beware of these categories. Supplements for weight loss, sexual enhancement, and bodybuilding have been problematic, the FDA said, because some contain steroids and prescription drugs.

Don’t assume more is better. It’s possible to overdose even on beneficial vitamins and minerals. Avoid any product that claims to contain “megadoses.”

Report problems. Let your doctor know if you experience any symptoms after you start taking a supplement…do it yourself at or by calling 800-332-1088.

Research in the right places. Be skeptical about claims made for supplements in ads, on TV and by sales staff. If a claim sounds too good to be true, it probably is.

Consumer Reports provides online links for assessing supplements at

Yes, I know half the U.S. adult population takes supplements and nearly everyone who takes them claims to feel better as a result.  The science, however, consistently produces reasons for skepticism, if not caution.

I discuss this discrepancy in Food Politics. Take a look and decide for yourself!

  • Pingback: Tweets that mention Food Politics » Supplements in trouble—again! --

  • The concerns are real because supplements can and do have benefit for good, just like pharmaceuticals can have benefit for good. The problem comes in the poor regulation of those able to recommend supplements.

    The high school kid working at the vitamin store down the street is often the source of vitamin recommendations rather than a trained professional.

    Registered Dietician’s are trained very well in terms of behavioral change and broad-scale diet changes, calorie counting, and reaching minimal nutrition standards. There are other professionals out their like Clinical Nutritionists who are required to take certification exams and have continuing education requirements just like many other professionals. Most of these practitioners have advanced professional degrees including MD’s, DO’s, DC’s, ND’s, etc unlike those with just a 4 year education.

    It’s difficult to appreciate multiple system interactions as well as potential drug-supplement interactions without advanced training in nutrition or some minimum standard of competence. Sometimes high dosages of certain nutrients are warranted, but for short-term use and individualized to the patient’s unique needs.

    This practice can be and is evidence-based. Unfortunately many doctors want a piece of the nutrition market, but yet have had very few credits of nutrition education. This leaves them susceptible to crafty marketing of companies out there trying to sell them prepackaged weight loss programs and detox programs as sources of extra income for the doctor’s practice, not necessarily for the health benefits of their patients.

    We need to look at not necessarily the supplements, but who’s recommending them. Many pharmaceutical drugs that are given high praise, would also be vilified if recommended by people unqualified to do so.

  • With all due respect, the product examples held up by the GAO at the Senate hearing were from companies that no one has ever heard of. There are crooks out there who make illegal claims and sell bad products, and all of that behaviour is illegal today. We do need more law enforcement to address this, not more laws.

    And the “Dirty Dozen” by Consumer Reports is a list of 12 products that represent less than 0.2% of industry sales…hardly worthy of such shocking cover by the magazine. Quality issues need to be addressed, and the laws need to be enforced. But to slam the entire industry is simply not right.

    As for the nearly 1000 reports that USA Today and you refer to, these are Adverse Event Reports. They do not establish that the supplement or anything else caused the event. This system is used by FDA to monitor the broad landscape and look for trends and red flags. So, for example, if a bunch of reports come in for a product in a short period of time, that would suggest a possible problem and lead to investigation. To characterize these 1000 reports as the GAO report and USA Today did is not accurate. They either do not understand this monitoring system or they chose to mischaracterize it to support their premise or political agenda.

    And to put it in perspective, during that same time period (2009), the FDA received more than 500,000 adverse event reports for drugs. The data is on the FDA website at:

    The mainstream media continues to do a horrible job of covering this industry. Then again, it is the USA Today, which is not really the pinnacle of scientific or academic writing.

    Jon Benninger
    Business Development Director
    Virgo Publishing
    Phoenix, Arizona

  • JudyThomas

    Excellent post. I have been worried about these “drugs” for years. They are poorly studied, badly monitored, inconsistently constituted and their manufacturers seem to make absurd claims. At the very least they are useless, except to the supplement companies who make money off of easily convinced, desperate or uninformed people.

  • It’s amazing how some (perhaps most) people won’t even bother researching the chemicals and pills they put into their bodies.

  • In fact Ms. Thomas, they are not drugs. FDA regulates drugs, foods, supplements, medical devices, cosmetics, blood and plasma, radiological devices, etc. Each class of goods is clearly defined and has its own rules and regulations that have been developed over decades and are specific to that class of goods. Further, many supplements are very well studied. There are entire journals that focus on these issues, and the science is much more complex than whatever “study of the day” makes a headline. The majority of supplements are well made by good companies that comply with the law. Demographics of supplement users show that they are better educated and healthier than non-users. And to Dr. Axe, supplement users tend to conduct a lot of research into nutrition, health and what they are putting in their bodies.

  • Bobby

    Despite Mr Bennigers claims, news stories have been reporting for years that what manufactures of supplements claim to be on the label is never quite what is inside the bottle. It is time the FDA testes ALL of these products for 1) efficacy and 2) quality control. Because the manufacturers know that there are a ton of suckers out there who will put just about anything in their body if someone tells them it’s a good idea, and the supplement industry is a cheerleader about it’s products like none other, and with what is typically zero proof that the claims are true. There are lies, damn lies, and supplement maker lies. And at my house, we know that supplement makers are the biggest liars of all. And we are the kind of people that mr Benniger likes: ove-educated and healthier than the US norm (not that this claim is difficult to make!)

  • I agree that every product should be tested to ensure it contains everything that it claims and nothing else. FDA does not have the capacity (or will) to do that. The Good Manufacturing Practices (GMPs) that are now in effect will help with quality a bit as long as FDA does the inspections. Note that it took FDA 14 years to make these rules, even with industry asking the agency to do it.

    I would love to see an industry-funded, independently run product testing program, and I have been suggesting that to industry for years. Make it a non-profit (unlike ConsumerLab which is a for-profit company), scientific effort that is not managed by industry, but by independent researchers. All test results are made public. It would weed out the crooks who are selling poorly made products, it would enhance the reputation of the companies that make good products, and it would help all of us know which is which. Until that time comes, the best one can do is stick with established brands and be skeptical of outlandish claims.

    As for testing for efficacy, FDA simply does not do that, for drugs or supplements. FDA does review studies when a company submits them to get a claim approved or for other regulatory reasons. I do agree, though, that more well-designed research needs to be done.

  • Cathy Richards

    The word supplements confuses the public. This is a very broad category regulation wise.Typically, vitamin and mineral supplements by major companies are just fine.

    Most of the violations (detected and undetected) have been in sports supplements (such as protein powders) and powders/drinks advertised with various health claims like energy boosting or whatever.

    I try to follow the FDA and Health Canada alerts, and have noticed most violations nowadays are undeclared caffeine, steroids & prohormones, and sildenafil (like viagra).

    You’ll never catch me recommending a sports powder to anyone, anyhow, anytime. See the NYTimes article about this . Instead, I suggest making smoothies and adding yogurt, skim milk powder or tofu if I want a protein boost. (BTW, I boost protein to help modify the glycemic index — most athletes don’t need extra protein, just extra calories).

  • Mike

    The problem with an industry funded program is that it would only be as independent as the 800 lb. gorilla funding it. Let’s face it, every industry has one.

    We need to get the corporate/special interest/lobbiest problem out of Washington, D.C. and the government would again become the “independent” influence that would protect consumers. It’s time to put our government back in the roll of public servants. They seem to have strayed from that roll.

    I’d rather give the FDA the capacity to do independent product testing, rather than trust the industry that has a legal obligation to their stockholders.

  • Cynics who bash nutritional supplements obviously have never tried them. I’ve been taking supplements, and lots of them for 33 years; I have all the proof I need.
    The FDA does an abysmal job just with prescription meds, and they’re already stretched too thin. Prescription drugs kill over 100,000 users every year. And that’s just from properly-prescribed drugs, not overdoses and accidents. They approve things like Vioxx, Avandia and Gardasil when it’s clear these drugs are lethal and don’t work any better than placebos.

  • JE

    I see no reason to pity the supplement industry. Annual sales continue to increase – about $27 billion in 2009. Like 150 million other Americans, I take dietary supplements and my health is better for it.

    Bobby, The FDA has a way of monitoring the manufacture of supplements: The new Good Manufacturing Practices (GMPs), which are fully implemented as of June, 2110:

    Companies must keep extensive records and perform testing at every stage of the manufacturing process. The FDA has announced plans to inspect hundreds of these facilities every year.

    Reports of adverse events are actually quite few compared with: a)the billions of bottles of supplements sold annually b)the number of AERs reported for foods or drugs. According to the FDA, drugs were responsible for 63,000 DEATHS in 2009. Where is the outrage over this?

    Consumer Reports’ sensationalistic cover story deals with twelve supplements which virtually no-one takes. Marion Nestle fails to mention that, in the same issue, Consumer Reports has a list of recommended supplements people should consider taking.

    The article is right about one thing – adulteration occurs almost exclusively in the product catagories of weight loss, sexual enhancement, and body building. Consumers should exercise caution when purchasing any of them. The FDA should pursue stronger enforcement action against these illegal, potentially harmful products.

  • Advertising/marketing can be really misleading sometimes, but it’s up to the consumers whether they should believe the claim or not. Consumers should examine closely the product before trying it out. We cannot fully rely on these marketers/advertisers to always uphold the truth. It is our job to be cautious; checking the label helps answer questions. Like for example, “No approved therapeutic claim” is a disclaimer common in supplements. This alone should warn us not to expect health or healing benefits a typical vitamin gives. It is up to us to know the difference. Learn how to Advertise Your Business .

  • Excellent comments. The problems do seem to be mainly in the weight loss, sports performance, and sexual performance categories. FDA has been putting more resources into these areas, but even more are needed. I agree that these categories should be viewed with a very skeptical eye. And anyone selling a product adulterated with a prescription drug or steroid should face criminal charges. Walk a few of these crooks out of their offices or homes in handcuffs on the news and others will be deterred from this activity.

    By an industry-funded program, I mean some type of per-unit fee assessment that is required to be in the business. As long as the group doing the testing is independent from industry and science-based, it could be government, NGO, university or whatever. The industry has tried to get companies to donate voluntarily for such testing for years with no success. With so many attacks on their credibility, I find it hard to believe that the good companies still have not circled their wagons and created some kind of meaningful quality testing program for consumers. They each have their own quality programs, but there is no independent, non-profit authority that consumers can rely on. It is certainly not Consumer Reports or ConsumerLab.

  • Bobby

    I am glad so many people get such good results with supplements. I myself have been experimenting with the concept of eating real food and getting regular exercise. The results have been amazing! I would support naming P.T.Barnum is the Patron saint of the Supplements industry. For he has clearly inspired countless among this industry to really excel and do the thing they do best of all: generate self-promoting hype that bamboozles all kinds of people, even the one the industry is smoothly complementing as over-educated and healthier (oh, your complements make me feel good, so I should buy these little pills, yes, yes I must buy these expensive little pills).

    Walk into any location that sells these things and you will wonder how you manage to be alive without consuming pretty much everyone thing on the shelves. They are all so important for good health. I have noticed, inconveniently, that all these magical medical ingredients are available in regular (non-fast/industrial) food. Food which is available at quite reasonable prices at my local grocery store. Unlike the expensive arsenal of pills these hucksters are relentlessly and unethically promoting.

  • Wow Bobby. If a supplement picked on you as a child, I apologize on its behalf. Seriously though, there are a lot of valuable dietary supplements. They are not intended to replace food (or exercise), which is why they are called “supplements.” There are also hucksters and crooks and cheats. When I come across them, I turn them in to the FDA and the FTC. To characterize the entire supplement universe as either all good or all bad is quite a stretch. Folic acid prevents birth defects, calcium/magnesium/vitamin D prevents bone fractures, omega 3 fatty acids benefit the heart, mind and immune system. Fiber is great for many reasons. Basic vitamins and minerals, if someone is not getting enough (and many people are not) can have important impacts on health. And vitamin A supplements will prevent more than 20 million children around the world from permanently losing their eyesight this year due to vitamin A deficiency. This does not even touch on the long, important history of herbal/botanical medicine from nearly every culture on the planet. Do I think that a supplement can make your hair (or other parts of your body) grow? Or make you lose weight while you eat bacon cheeseburgers on the couch? Or cure a life-threatening disease? No. But I do believe they can be an important part of a healthy lifestyle, and they should be an important part of our nation’s effort to improve public health. After we convince everyone to eat real food and get regular exercise of course.

  • That was an excellent review. It is unfortunate that a handful of supplements are tainting the whole industry. Why does the FDA not regulate the supplement industry. There should be some sort of check and balance. the least the supplement companies could do is to provide proof of what is contained in a supplement before it could be released to the public. The FDA needs to do spot checks from time to time to test the contents of the supplements.

  • scary..but i knew deep down that having too much supplements may not be healthy after all. it’s just a scary thought that it is a confirmed fact and im surprised that one can be over-dosed in vitamins.

  • One can take too much of anything. Supplements, like everything else, need to be used wisely.

    The FDA does regulate supplements. They must contain what is on the label and nothing else, or else they are adulterated and in violation of the law. They cannot make drug claims (like curing or treating a disease). They cannot make health claims without FDA pre-approval. They cannot contain “New Dietary Ingredients” without FDA pre-approval. All structure function claims (claims about how a nutrient affects the structure or function of the body) must be substantiated, and FDA must be notified in writing of such claims. Products must be made under Good Manufacturing Practices (GMPs), and FDA is finally inspecting companies to verify this. Companies must report to FDA within 15 days all serious adverse event reports from consumers, whether the product is likely responsible for the event or not. These are just a few of the regulations that apply to the supplement industry.

    The biggest issue is that the FDA failed to implement or enforce the laws for more than a decade. Why? According to an article by former FDA chief counsel Peter Barton Hutt that we published last year, it was because former FDA commissioner Dr. David Kessler instructed the agency to not enforce the law so the bad actors could run wild and the industry would look bad. Here is a link to that:
    The FDA is finally getting more aggressive at going after the bad guys, but the agency has many years of negligence to make up for.

  • People don[‘t understand the placebo effect. Your wiener is not going to get larger, you aren’t going to lose any weight (they all say to change your diet, that’s where the weight loss is). These are the same snake oil salesmen as the last 150 years.

  • Cathy Richards

    Jon — not sure where you got the 0.2% of products are adulterated stat. Is that based on FDA reports? As you pointed out, their testing/enforcement has been lacking for quite a while.

    A Sports Dietitian reported at the 2005 Dietitians of Canada conference that In 3 studies of sports supplements, 14.8% contained undeclared prohormones, 22% contained prohibited (undeclared) steroids, 14.5% contained undeclared caffeine or ephedrine. Bottom line: 1 in 5 supplements are contaminated with undeclared potentially unsafe ingredients.

    That’s 20%, not 0.2%, at least for sports supplements.

    Sorry, I don’t have a webpage reference for this. The University of Calgary Sports Medicine Clinic pre-tests supplements and provides “cleared” ones for their Olympic trainees so they don’t get an unintentional doping result.

  • Sarah Williams

    I am responding to Mr. Benninger’s comment about dietary supplement manufacturers: ” They each have their own quality programs, but there is no independent, non-profit authority that consumers can rely on. It is certainly not Consumer Reports or ConsumerLab.”

    In fact there are two well-respected, independent, nonprofit, nongovernmental public health organizations – NSF International and U.S. Pharmacopeia (USP) – that conduct dietary supplement testing to verify content accuracy, purity, and freedom from contaminants. Dietary supplement companies can voluntarily submit their products for testing by one of these organizations to provide consumers with the assurance that an independent, nonprofit organization, not just the manufacturer, has tested and verified purity and potency of a particular supplement. Both organizations list the companies that have submitted their products for independent testing on their website, and also indicate which products from these companies have been tested. Further, a product that has been tested and found to be in compliance with the requirements set by NSF or USP will bear a seal on the label indicating that the contents of the product have been certified/verified. As such, NSF and USP provide consumers with critical information about product quality, and the assurance that the information is coming from a well-respected, independent authority.

  • Thank you Sarah. Those are both great programs, though voluntary. I would like to see a testing program that is mandatory someday. You can’t sell a supplement without it being certified.

    Cathy, to your point, the 0.2% is the percentage of total supplement sales that is attributed to the 12 ingredients that Consumer Reports calls the “Dirty Dozen”. This stat comes from Nutrition Business Journal, one of my competitors, but a very good source of industry stats. Here is the link to that data:

    The adulteration issue is a separate topic. In 2004, the International Olympic Committee tested 110 products that were promoted as “stimulants” and found that 14 of them contained undeclared caffeine. Again, these were stimulant products, which is an area that does have problems and needs to be addressed. These results can certainly not be applied to the entire dietary supplement category. Similar with the sports supplements, a category with problems needing law enforcement activity. Here is a link to an abstract of the 2000-2001 study that found the contamination: That was 10 years ago, before GMPs were in place and during the FDA’s “Dark Ages” of no enforcement whatsoever. I am hopeful and confident that things have improved, though there is still work to be done to weed out and prosecute those still doing this.

    To say that 1 in 5 supplements is contaminated is not accurate. The contamination issue seems to be focused on the sports nutrition, energy, weight loss, and sexual performance products. FDA, the Department of Justice and State Attorneys General are taking legal action (civil and criminal) against companies and individuals involved in these unscrupulous practices. And we need them to put even more efforts into this area. But, to apply this to the entire supplement industry is not correct.

    This does support the point that the responsible companies making quality products need to prove to you, me and everyone else that they are not part of the problem. It is time for the industry to take ownership of this situation and fix it, but to do so will require the law enforcement and regulatory agencies to go after the bad guys. Either that or we can ban all dietary supplements completely, which would be like banning all driving because some drivers speed or drive drunk. We have to go after the bad guys.

    We have written thousands of articles about the industry for more than 15 years, and we cover the adulteration issue a lot. Here is the section of our site that includes all articles relevant to adulteration:
    As you can see, most of the recalls, FDA warnings, etc are related to bogus sexual performance, weight loss, and sports performance products. I turn suspect companies in to the regulatory agencies frequently, and we will continue to report on this important issue.


  • JE

    One correction to my earlier comment: I meant to say, “The new Good Manufacturing Practices (GMPs), are fully implemented as of June, 2010” (not 2110).

    Cathy Richards, you quoted Jon Benninger incorrectly. He stated, “And the “Dirty Dozen” by Consumer Reports is a list of 12 products that represent less than 0.2% of industry sales – hardly worthy of such a shocking cover by the magazine.” Nothing to do with adulteration.

    One of Consumer Report’s “Dirty Dozen” is colloidal silver. Byron Richards has a good article on the history and uses of colloidal silver:

  • Interesting discussion. I take mainstream supplements (vitamins not exotic herbs) and they have made real , noticeable difference in handling stress, keeping energy up to exercise and lose weight correctly. I am not into sports supplement, just taking good whey protein. Anyone thinking of taking a supplement to achieve an immediate specific result without changing overall habits need to get their head examined.
    Sometimes I wonder if the bad rap supplements get in main media is due to some drug industry funded messaging.

  • Bill

    Yes, I know half the U.S. adult population takes supplements and nearly everyone who takes them claims to feel better as a result. The science, however, consistently produces reasons for skepticism, if not caution.

    Quote from the article, I guess it would take to much time to do some simplr research on the benfits of supplements. As a skeptic why don’t you check out the research paper by the Harvard Medical School on the benefits of vitamin d. Or the double blind study at the Creigton School of Medicine about the preventive qualities of vitamin D. Or go to the Office of Dietary Supplements and their annual report based on research studies. The facts are that the FDA is beholding to the drug industry and has been on a crusade for years against dietary supplements.
    Some of the comments allluded to the number of deaths from drugs, but no comment from you. Compare the number of adverse events mentioned in CR to the number of adverse events from prescription drugs. Given Ms Nestle’s history she is hardly an unbiased critic.

  • William Ash

    The latest in vitamin D news is this: International experts are calling for an increase in the amount of vitamin D that is recommended daily. Scientists writing in the July 28 issue of Experimental Biology and Medicine call for a change to the global policy on the sunshine vitamin. They say: “Responsible medicine demands that worldwide vitamin D nutritional guidelines reflect current scientific knowledge about vitamin D’s spectrum of activities.”

    Increasing the amount recommended daily of vitamin D to 2,000 international units (IU) per day, the authors say, would reduce the frequency of certain diseases — such as childhood rickets, adult osteomalacia, cancer, autoimmune type 1 diabetes, hypertension, cardiovascular disease and obesity — as well as cut medical costs while increasing longevity.

    Conventional wisdom used to be that our bodies would produce enough vitamin D to keep us healthy by being exposed to sunlight. But as skin cancer became a concern, and more people started staying indoors more, our vitamin D levels declined. More and more research began to reveal that sun exposure doesn’t provide enough vitamin D to ensure optimal health, and that vitamin D supplements are the best way to get enough. The vitamin D news is out, and hopefully it won’t be long before the nutritional guidelines are revised to reflect current findings.

    Current recommended daily intakes (RDIs) for vitamin D lie between 200 and 600 IU per day, even though science shows that healthful and preventive benefits can be better achieved with levels closer to 2,000 IU per day without safety concerns.


    Proceedings of the Society for Experimental Biology and Medicine (now known as Experimental Biology and Medicine). doi:10.1258/ebm.2010.010014
    it is now nearly three years since the Canadian Cancer Society started recommending that everyone take vitamin d to prevent cancer. The data on vitamin D and the prevention of cancer is now as extensive as the data on smoking causing cancer and still no one appears to know about his. Take a look at where you will find all the information

    I would suggest anyone interested in the benefits of Vitamin D just check out the above website
    I would love to here Ms. Nestle’s comments on this research. Basically she is a shill for the FDA based on her previous association. The FDA is a criminal organization that has withheld life saving supplements from the public. They support whatever the drug companies ask for. Unfortuneately like most supplement bashers she is not concerned with facts, she picks and choses whatever supports her position, like the biased CR report.

  • Jon, great idea about an industry-funded obligatory quality program. Sarah, the public can’t rely on NSF or USP because of their spotty coverage. NSF has certified only 412 products from 30 companies. With such low participation, not bothering with USP or NSF brings little or no discredit to manufacturers and marketers; and with so many familiar brands and products without either of those marks on the label, the few that do probably get little to no return (in sales) for their efforts (the cost and risk of getting products tested for certification). There’s thus little incentive for voluntary certification programs.
    Marc Lemay

  • NoGluten

    Celiacs are often advised to take supplements, particularly when they are first diganosed. It is very common for the digestive system to be underperforming. Deficiencies in D, B, and iron are common.

  • lpzpiuugnqkj