Many adults and children in the United States take one or more vitamins or other dietary supplements. In addition to vitamins, dietary supplements can contain minerals, herbs or other botanicals, amino acids, enzymes, and many other ingredients. Dietary supplements come in a variety of forms, including tablets, capsules, gummies, and powders, as well as drinks and energy bars. Popular supplements include vitamins D and B12; minerals like calcium and iron; herbs such as echinacea and garlic; and products like glucosamine, probiotics, and fish oils.
The Dietary Supplement Label
Products sold as dietary supplements come with a Supplement Facts label that lists the active ingredients, the amount per serving (dose), as well as other ingredients, such as fillers, binders, and flavorings. The manufacturer suggests the serving size, but your health care provider might decide a different amount is more appropriate for you.
Some dietary supplements can help you get adequate amounts of essential nutrients if you don’t eat a nutritious variety of foods. However, supplements can’t take the place of the variety of foods that are important to a healthy eating routine. To learn more about what makes a healthy eating routine, the Dietary Guidelines for Americans and MyPlate are good sources of information.
Some dietary supplements can improve overall health and help manage some health conditions. For example:
Many other supplements need more study to determine if they have value. The U.S. Food and Drug Administration (FDA) does not determine whether dietary supplements are effective before they are marketed.
Safety and Risk
Many supplements contain active ingredients that can have strong effects in the body. Always be alert to the possibility of a bad reaction, especially when taking a new product.
You are most likely to have side effects from dietary supplements if you take them at high doses or instead of prescribed medicines, or if you take many different supplements. Some supplements can increase the risk of bleeding or, if taken before surgery, can change your response to anesthesia. Supplements can also interact with some medicines in ways that might cause problems. Here are a few examples:
- Vitamin K can reduce the ability of the blood thinner warfarin to prevent blood from clotting.
- St. John’s wort can speed the breakdown of many medicines and reduce their effectiveness (including some antidepressants, birth control pills, heart medications, anti-HIV medications, and transplant drugs).
- Antioxidant supplements, such as vitamins C and E, might reduce the effectiveness of some types of cancer chemotherapy.
Manufacturers may add vitamins, minerals, and other supplement ingredients to foods you eat, especially breakfast cereals and beverages. As a result, you may get more of these ingredients than you think, and more might not be better. Taking more than you need costs more and might also raise your risk of side effects. For example, too much vitamin A can cause headaches and liver damage, reduce bone strength, and cause birth defects. Excess iron causes nausea and vomiting and may damage the liver and other organs.
Be cautious about taking dietary supplements, beyond a standard prenatal supplement, if you are pregnant or nursing. Also, be careful about giving supplements to a child, unless recommended by their health care provider. Many supplements have not been well tested for safety in children and in those who are pregnant or nursing.
If you think that you have had a bad reaction to a dietary supplement, let your health care provider know. They may report your experience to the FDA. You may also submit a report directly to the FDA by calling 800-FDA-1088 or completing an online form. You should also report your reaction to the manufacturer by using the contact information on the product label.
The FDA has established good manufacturing practices (GMPs) that companies must follow to help ensure the identity, purity, strength, and composition of their dietary supplements. These GMPs can prevent adding the wrong ingredient (or too much or too little of the correct ingredient) and reduce the chance of contamination or improper packaging and labeling of a product. The FDA periodically inspects facilities that manufacture supplements.
Several independent organizations offer quality testing and allow products that pass these tests to display a seal of quality assurance that indicates the product was properly manufactured, contains the ingredients listed on the label, and does not contain harmful levels of contaminants. These seals do not guarantee that a product is safe or effective. Organizations that offer quality testing include:*
- NSF International
- U.S. Pharmacopeia
* Any mention of a specific company, organization, or service does not represent an endorsement by ODS.
Talk with Your Health Care Providers
Tell your health care providers (including doctors, dentists, pharmacists, and dietitians) about any dietary supplements you’re taking. They can help you determine which supplements, if any, might be valuable for you.
Keep a complete record of any dietary supplements and medicines you take. The Office of Dietary Supplements website has a useful form, ”My Dietary Supplement and Medicine Record,” that you can print and fill out at home. For each product, note the name, the dose you take, how often you take it, and the reason for use. You can share this record with your health care providers to discuss what’s best for your overall health.
Keep in Mind
- Consult your health care provider before taking dietary supplements to treat a health condition.
- Get your health care provider’s approval before taking dietary supplements in place of, or in combination with, prescribed medicines.
- If you are scheduled to have any type of surgical procedure, talk with your health care provider about any supplements you take.
- Keep in mind the term “natural” doesn’t always mean safe. Some all-natural botanical products, for example, like comfrey and kava, can harm the liver. A dietary supplement’s safety depends on many things, such as its chemical makeup, how it works in the body, how it is prepared, and the amount you take.
- Before taking any dietary supplement, use the information sources listed in this brochure and talk to your health care providers to answer these questions:
- What are its potential benefits for me?
- Does it have any safety risks?
- What is the proper dose to take?
- How, when, and for how long should I take it?
Federal Regulation of Dietary Supplements
Dietary supplements are products intended to supplement the diet. They are not medicines and are not intended to treat, diagnose, mitigate, prevent, or cure diseases. The FDA is the federal agency that oversees both supplements and medicines, but the FDA regulations for dietary supplements are different from those for prescription or over-the-counter medicines.
Medicines must be approved by the FDA before they can be sold or marketed. Supplements do not require this approval. Supplement companies are responsible for having evidence that their products are safe, and the label claims are truthful and not misleading. However, as long as the product does not contain a “new dietary ingredient” (one introduced since October 15, 1994), the company does not have to provide this safety evidence to the FDA before the product is marketed.
Dietary supplement labels may include certain types of health-related claims. Manufacturers are permitted to say, for example, that a supplement promotes health or supports a body part or function (like heart health or the immune system). These claims must be followed by the words, “This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.”
Manufacturers must follow good manufacturing practices (GMPs) to ensure the identity, purity, strength, and composition of their products. If the FDA finds a dietary supplement to be unsafe, it may remove the product from the marketplace or ask the manufacturer to voluntarily recall the product.
The FDA monitors the marketplace for potential illegal products that may be unsafe or make false or misleading claims. The Federal Trade Commission, which monitors product advertising, also requires information about a supplement product to be truthful and not misleading.
The federal government can take legal action against companies and websites that sell dietary supplements when the companies make false or deceptive statements about their products, if they promote them as treatments or cures for diseases, or if their products are unsafe.
Federal Government Information Sources on Dietary Supplements
NATIONAL INSTITUTES OF HEALTH (NIH)
NIH supports research and provides educational materials on dietary supplements.
U.S. FOOD AND DRUG ADMINISTRATION (FDA)
FDA issues rules and regulations and oversees dietary supplement labeling, marketing, and safety. Recall notices are also posted on the FDA webpage or you can subscribe to receive FDA notices of recalls, market withdrawals, and safety alerts.
FEDERAL TRADE COMMISSION (FTC)
FTC regulates health and safety claims made in advertising for dietary supplements.
U.S. DEPARTMENT OF AGRICULTURE (USDA)
USDA provides information on a variety of food and nutrition topics.
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES (HHS)
HHS provides wellness information, personal health tools, and health news.
This fact sheet by the National Institutes of Health (NIH) Office of Dietary Supplements (ODS) provides information that should not take the place of medical advice. We encourage you to talk to your health care providers (doctor, registered dietitian, pharmacist, etc.) about your interest in, questions about, or use of dietary supplements and what may be best for your overall health. Any mention in this publication of a specific product or service, or recommendation from an organization or professional society, does not represent an endorsement by ODS of that product, service, or expert advice.
Have you ever seen research questioning the value of vitamin and mineral supplements and wondered what the whole story was? Yes, ideally, we’d get all our holistic nutrition from food. But since most soils are deficient in nutrients, (especially minerals) due to industrial food production practices, getting all our nutrition from food is not realistic. So most of us pop vitamins and other dietary supplements to ensure we’re getting optimal levels of necessary micronutrients. Some of us pop more than others. And we’re getting handed them, just like this packet of samples my doctor recently gave me. [See photos below.]
But what if dangerous ingredients are lurking in your vitamin and mineral supplement? “No”, you exclaim. “Surely not! Those knights in shining armor at the FDA would spring into action to protect us…”
Sigh. Yet again, the political powers that should be protecting us are letting us down. And the industrial powers that be are tossing lots of lovely toxic fillers into your vitamin pills.
Here are the 5 worst (or most dangerous) things to look for in your dietary supplements. If you find them, don’t buy those supplements. Seriously. It’s best to avoid a side of carcinogen with your micronutrients. Maybe it’s all the junk in vitamins and minerals that leads to the studies questioning whether they actually help us. B vitamins with a side of Red #40 probably aren’t going to lead to an optimal health outcome.
Dangerous Ingredient #1: Artificial Colors
Take a look at ingredient lists for any of the following synthetic (artificial) food colorings, all approved by the FDA:
– FD&C Blue No. 1
– FD&C Blue No. 2
– FD&C Green No. 3
– FD&C Red No. 3
– FD&C Red No. 40
– FD&C Yellow No. 5
– FD&C Yellow No. 6
Why, oh why are there artificial colors in your vitamins?
The FDA states that these artificial colors in your vitamins are added to: “Offset color loss due to exposure to light, air, temperature extremes, moisture and storage conditions; correct natural variations in color; enhance colors that occur naturally; provide color to colorless and ‘fun’ foods.”
Do we really care if our vitamin pill has a lovely shade of red? Especially considering the FDA itself has “probed” into the connection between artificial food dyes and children’s behavior! Red #40 has been linked to hyperactivity and the Center for Science in the Public Interest, among others, wants the FDA to ban artificial food colors. After all, artificial colors in your vitamins serve no function other than making food look more “fun”, or even worse, cover up the fact that the active ingredients in the vitamin has been degraded by exposure to light, air, moisture, heat, or poor storage conditions.
Additionally, European lawmakers now require a warning label on foods that contain artificial dyes. The label must state: “May have an adverse effect on activity and attention in children.”
Dangerous Ingredient #2: Hydrogenated Oils
Here you thought you were avoiding hydrogenated fats by passing on the margarine. Did you know that your dietary supplement may also have these little toxic nasties? And, to make matters worse, its often partially hydrogenated soybean oil—one of the major fillers in the majority of vitamins today. Unless soy is organic, you can pretty much guarantee it’s genetically modified. So you’re getting a dose of franken-soy with your vitamins.
The FDA knows that hydrogenated fats are bad for us. The 2010 Dietary Guidelines for Americans specifically states: “Keep trans fatty acid consumption as low as possible by limiting foods that contain synthetic sources of trans fats, such as partially hydrogenated oils, and by limiting other solid fats.”
The CDC chimed in, posting in January 2014 that:
Consuming trans fat increases low-density lipoprotein (LDL, or ‘bad’) cholesterol. This risk factor contributes to the leading cause of death in the U.S. – coronary heart disease (CHD). Trans fat may also have other adverse health effects like decreasing high-density lipoprotein (HDL, or ‘good’) cholesterol. Further reducing trans fat consumption by avoiding artificial trans fat could prevent 10,000-20,000 heart attacks and 3,000-7,000 coronary heart disease deaths each year in the U.S.
So why does the FDA allow these dangerous ingredients in your supplements? They’re cheap fillers. People still have this idea that bigger is better. Until we realize that smaller can be just as good, manufacturers will use cheap nasty fillers to give us bigger horse sized pills.
It’s up to you to avoid them, folks.
Dangerous Ingredients #3: Lead, Mercury, & PCBs
Essential fatty acids (EFAs) are on everyone’s mind lately. They’ve been shown to be particularly important for pregnancy women, babies, and toddlers, as well as for brain and heart health. But not all brands are created equal. Since fish high on the food chain can accumulate mercury, lead, and other contaminants, those metals can make their way into your fish oil supplements. Yuck! Maybe these contaminants are the reason some research showed that fish oil supplements increased prostate cancer risk?
The high levels of PCBs in fish oils led to a lawsuit in California in 2010 claiming that supplement manufacturers should have placed warning labels stating the cancer risk on their fish oil supplements. Testing by Consumer Reports in 2011 showed 1/3 of the fish oils tested had high PCB levels.
What? You don’t want a toxic heavy metal or some PCBs with your EFAs today? Then you’d better be careful of what brand of Omega-3 or EFAs you buy. This is not the time to choose the cheap option—make sure that you choose a variety that has been meticulously tested for lead or mercury contaminants. Your best choices should state that they are “Molecularly distilled and 3rd party tested to ensure PCBs, dioxins, mercury, lead and other contaminants are below acceptable limits set by the Council for Responsible Nutrition and other advisory agencies,” or something similar.
Here’s an even better option: choose wild fish, pasture raised eggs, or greens for a good dose of Omega-3s!
Dangerous Ingredient #4: Talc or Magnesium Silicate
Yes, it’s true. The same powder your grandmother used as deodorant can be found in many supplements as a cheap filler and anti-caking agent. Nasty!
Magnesium silicate is similar in composition to asbestos and can cause lung problems when inhaled (bad news for the workers who have to mine it). It is also often contaminated with asbestos in the mining process and is suspected to cause problems when ingested. For example, the Japanese prefer rice that has been treated with talc (it’s whiter) and this has been linked to the high rate of stomach cancer in Japan.
Talc is not currently considered food grade by the FDA. Although they were considering setting upper limits for asbestos fibers and adding it to the GRAS list way back in 1979, I couldn’t find whether any upper limits have yet been set. (Mind you, the FDA website is pretty impossible to navigate!) But talc is still found in supplements. Yuck!
Dangerous Ingredient #5: Titanium Dioxide
Titanium dioxide is yet another one of the nasty and dangerous ingredients in your vitamins or supplements; it is used as a colorant (it’s also used in many cosmetics). Titanium dioxide has a raft of health implications.
Titanium dioxide has been shown to cause lung inflammation and damage, so it’s yet another substance that has impact on workers at the production level. It has also been implicated in immune system function, with some studies showing DNA damage by Titanium dioxide nanoparticles, albeit marginal damage. Just a wee bit of DNA damage with your vitamins.
Taken internally, it has been shown to cause kidney damage in mice and to induce small intestine inflammation. This is scary considering how many people suffering from Chrohn’s and gluten sensitivity are probably taking supplements containing Titanium dioxide.
Yet again, our health is risked so our vitamins can be a pretty color. Very disturbing. Avoid it.
The big picture solution is to have an FDA that actually prevents toxic materials getting into our food supply (and dietary supplements are a part of that food supply). But since that seems unlikely any time soon, we have to take matters into our own hands:
- The best solution: Eat certified organic whole foods and take food-based supplements that are tested for heavy metal contamination.
- Read labels. If you spot any of these nasties in vitamins, take a photo of the label and Tweet it. Tag the manufacturer and store where you found it.
- Go post your photo on the manufacturer’s Facebook page asking why those toxic ingredients are there.
- Start a petition to get these ingredients out of our food supply.
- Write to the FDA asking that they follow the same cautions as Europe, such as their warning labels on foods containing artificial coloring.
- Research these ingredients at pubmed.com (the National Institute of Health) so you can answer anyone who comments (ignorantly) that these things must be safe if they’re in our food and not banned.
- Buy M&Ms in Europe
If we all kick up a bit of a ruckus, manufacturers will take these dangerous ingredients out.
Now that you’re aware of all these nasty ingredients in your supplements, go check your cupboard and let us know if you find anything scary!
Editors Note: This blog post was originally published in May 2014 and has been updated for accuracy. (December 2016)
Disclosure of Material Connection: I am the CIO of American College of Healthcare Sciences, the Institution that publishes this blog. However, all opinions are my own. This blog may contain affiliate links. I am disclosing this in accordance with the Federal Trade Commission’s 16 CFR, Part 255: “Guides Concerning the Use of Endorsements and Testimonials in Advertising.”
This article is for informational purposes only. It is not intended to treat, diagnose, cure, or prevent disease. This article has not been reviewed by the FDA. Always consult with your primary care physician or naturopathic doctor before making any significant changes to your health and wellness routine.
 U.S. Food and Drug Association. (2013, March). Overview of Food Ingredients, Additives, and Colors: Types of Food Ingredients. Retrieved from http://www.fda.gov/food/ingredientspackaginglabeling/foodadditivesingredients/ucm094211.htm#types
 Fulton, A. (2011). FDA probes link between food dyes, kids’ behavior. NPR. Retrieved from http://www.npr.org/2011/03/30/134962888/fda-probes-link-between-food-dyes-kids-behavior
 Official Journal of the European Union. (2008). Regulation (EC) No 1333/2008 of the European Parliament and of the Council of 16 December 2008 on food additives. Retrieved from http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2008:354:0016:0033:en:PDF
 U.S. Department of Agriculture and U.S. Department of Health and Human Services (2010). Dietary Guidelines for Americans. Retrieved from http://www.health.gov/dietaryguidelines/dga2010/dietaryguidelines2010.pdf
 Center for Disease Control and Prevention. (2010). Trans Fat. Retrieved from http://www.cdc.gov/nutrition/everyone/basics/fat/transfat.html
 MedlinePlus. (2014). Fish Oil. Retrieved from http://www.nlm.nih.gov/medlineplus/druginfo/natural/993.html
 American Heart Association. Getting Healthy (2014, May 14). Fish and Omega-3 Fatty Acid. [Web log post]. Retrieved from http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/HealthyDietGoals/Fish-and-Omega-3-Fatty-Acids_UCM_303248_Article.jsp
 Salzberg, S. (2013, July 23). Those fish oil supplements might cause cancer. Forbes.com Retrieved from http://www.forbes.com/sites/stevensalzberg/2013/07/23/those-fish-oil-supplements-might-cause-cancer/ Referencing http://jnci.oxfordjournals.org/content/early/2013/07/09/jnci.djt174.abstract
 Finney, M. (2010, March 2). Lawsuit over contamination in fish oil supplements. ABC7news.com Retrieved from http://abclocal.go.com/kgo/story?id=7306625
 Warner, J. (2011, December 7). Consumer reports: some popular fish oil supplements may contain PCBs. WebMd.com Retrieved from http://www.webmd.com/diet/news/20111206/some-fish-oil-supplements-fishy-on-quality
 Merliss, R.R. (1971, September 17). Talc-treated rice and Japanese stomach cancer. Science 173 (4002), 1141-1142. [DOI:10.1126/science.173.4002.1141] Retrieved from http://www.sciencemag.org/content/173/4002/1141.long and http://ajcn.nutrition.org/content/31/11/2017.full.pdf
 U.S. Food and Drug Administration. (2013, April 18). Select committee on GRAS Substances (SCOGS) Opinion: Magnesium silicate. Retrieved from http://www.fda.gov/Food/IngredientsPackagingLabeling/GRAS/SCOGS/ucm260465.htm
 Gil-Soon CHOI, et. al. (2014, March 7). Titanium dioxide exposure induces acute eosinophilic lung inflammation in rabbits. Industrial Health. Retrieved from https://www.jstage.jst.go.jp/article/indhealth/advpub/0/advpub_2013-0105/_article
 Chang X., Fu Y., Zhang Y., Tang M., & Wang B. (2014, January). Effects of Th1 and Th2 cells balance in pulmonary injury induced by nano titanium dioxide. Environ Toxicol Pharmacol. ;37(1):275-83. doi: 10.1016/j.etap.2013.12.001. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/24378593
 Makumire, S., Chakravadhanula, V.S., Kollisch, G., Redel, E., & Shonhai, A. (2014, May 16). Immunomodulatory activity of zinc peroxide (ZnO2) and titanium dioxide (TiO2) nanoparticles and their effects on DNA and protein integrity. Toxicol Lett 227(1):56-64. doi: 10.1016/j.toxlet.2014.02.027. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/24631018
 Suxin Gui, Xuezi Sang, Lei Zheng, et. al. (2013). Intragastric exposure to titanium dioxide nanoparticles induced nephrotoxicity in mice, assessed by physiological and gene expression modifications. Particle and Fibre Toxicology. 10:4 doi:10.1186/1743-8977-10-4. Retrieved from http://www.particleandfibretoxicology.com/content/10/1/4
 Nogueira, C.M., Mendes de Azevedo, W., Dagli, M.L.Z., et. a. (2012 September 14). Titanium dioxide induced inflammation in the small intestine. World J Gastroenterol. 18(34): 4729–4735. doi: 10.3748/wjg.v18.i34.4729. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3442211/