Do you take OTC Dietary Supplements? You need to know this!

Earlier this month, the Journal of the American Medical Association (JAMA) published an article that adds to a strong body of evidences showing that Over the Counter supplements are not always as harmless as most people think.

I’ll never forget a night when I was on-call during residency and a young lady came to the ER. Her husband brought her in, she was very anxious, to the point that she couldn’t talk. Her heart rate was very high, blood pressure up, she was trembling, sweaty and cold. Her labs showed all sorts of electrolytes imbalances. We were puzzled, what’s going on with this previously healthy young lady? Once we stabilized her, she started talking: “I’m taking a natural supplement to help me lose weight”. Her husband brought the pill bottle and we sent it to the lab to be analysed. We were shocked when the results came back. This “natural supplement” contained not one but three unapproved ingredients: a strong diuretic, an amphetamine and thyroid hormones!

On this Original Investigation article published by JAMA, the researchers found that from 2011 to 2016, a total of 776 adulterated dietary supplements were identified by the FDA, and 146 different companies were implicated. We need to keep in mind, that the FDA does not require premarket safety and effectiveness testing for dietary supplements, only postmarket adverse effects are investigated. Most patients don’t associate adverse reactions to supplements therefore most times they go unreported. Given these facts, we can assume, that there are more adulterated supplements out there that have not been identified yet.

The study showed that most of the supplements with unapproved ingredients were marketed for sexual enhancement, weight loss or muscle building. For sexual enhancement, the most common adulterant was sildenafil (Viagra); for weight loss, sibutramine; and for muscle building, anabolic steroids. There were other adulterants in the supplements as well, all of which were not included in the labels and they were not supposed to be there!

This is a multi-billion dollar industry, more than 50% of Americans report taking at least one OTC dietary supplement. We can only imagine how competitive this business is and how much it’s invested on marketing to convince the public and create the need to buy their products.

So, with this in mind:

  • Always check with your health care provider before taking any OTC supplement.
  • Don’t assume that because it’s “natural”, it’s risk-free.
  • Think what are you trying to solve with that supplement and ask for professional medical advise first. For example, if you are trying to boost your energy level, don’t you think you might need a fatigue evaluation first?
  • Most times, you can get what you need from a well-balanced diet.
  • Don’t believe all you see on adds. Remember: they are selling something, they are not trying to treat you.
  • Be particularly cautious with “blends” or combinations for specific symptoms or conditions. In general, it’s better to buy the ingredients separately: for example, for “bone health”, it’s better to take the amount of Vitamin D3 recommended by your provider based on your case, than to take combinations that might contain too much Calcium for your body.
  • If you choose to try a supplement to achieve certain benefit, try it for some time and if it doesn’t help you, stop it! I’ve seen many patients taking supplements for symptoms that they continue to have, so what’s the purpose to keep taking it?
  • To continue to take supplements just because “it’s not going to hurt me”, is not a good reason to keep buying it. One of the most common side effects of supplements, it’s actually in your wallet! $$$ Save that money to buy more fruits and vegetables 🙂



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