Resource Roundup on Dietary Supplements
The conversations around dietary supplements can be confusing. Which ones are safe? Which ones are effective? Any to avoid? Here are some resources you may find useful.
The Dietary Supplement Market is Big Business
Who is taking supplements? A LOT of people in the US and beyond. A Research and Market Report last year shared that:
The global market for Dietary Supplements is estimated at USD 155.2 billion in 2022; it is projected to grow at a CAGR of 7.3% to reach USD 220.8 billion by 2027.
The challenge? Even though the total industry profits for companies selling these products are in the 155+ billion USD range, government-funded dietary supplement research is estimated to reach only $282 million USD this year. In other words, only 0.18% of the total profit amount in this sector is being dedicated to government research on often understudied ingredients that people take for unproven claims and which could even be potentially hazardous to some.
What About the Research?
Funding for the scientific investigation of these ingredients is incredibly limited, and this has stymied research that would benefit the public good.
In the United States, research on dietary supplement ingredients is primarily funded through the National Center for Complementary and Integrative Health (NCCIH), with support from the Office of Dietary Supplements (ODS). NCCIH was originally established as the Office of Alternative Medicine in 1992, and the name changed to NCCIH in 1999. The entire budget appropriated by Congress for NCCIH was $159.3 million USD in 2022, and this must be used to support their full mission—including research on a variety of alternative therapies such as yoga, acupuncture, natural products, and more. The ODS, on the other hand, was established in 1994 at the time the Dietary Supplement Health and Education Act was signed into law. I’ll cover more on the legislation behind DSHEA in a future post.
Who is Using Supplements?
A 2022 Council for Responsible Nutrition (CRN) report revealed that an astonishing 75% of Americans use dietary supplements, with the majority of these being regular users. I’m one of those ~248 million Americans who take supplements every day, but I have the unique advantage of having studied botanical ingredients for more than 20 years! Two examples of well-studied and safe supplements that I take include in my routine are turmeric with black pepper for my osteoarthritis and psyllium husks for gut health. See these older posts for more info on these particular supplements:
What about everyone else? Where can they find resources on this? This is a tough one to answer, but there are some useful resources available.
Key Resources for Information of Supplement Ingredients
Here are some trusted sources of information that you can turn to when investigating certain supplement ingredients
NCCIH Herbs at a Glance
This resource is offered by the National Institute of Health, National Center for Complementary and Integrative Health (NCCIH). Herbs at a Glance currently provides information on more than 50 botanical ingredients commonly found in dietary supplements. The informational sheets are free and available on their website or phone app. They are written with the consumer in mind and are meant to be a resource for the public and healthcare professionals.
Operation Supplement Safety (OPSS)
The OPSS is a resource developed by the US Department of Defense for the military community, leaders, healthcare providers, and civilians. It includes lists of dangerous ingredients, and I’ve found it to be exceptionally useful as a source of public-friendly information on supplements used for weight loss and athletic performance. In addition to lists of ingredients to avoid, they also offer a “supplement scorecard” tool as a screen for safety. This resource is free and open to the public.
American Botanical Council’s Herbalgram
Herbalgram is a subscription-based platform that offers regular research summaries and reports of the latest news from the dietary supplement industry as well as on popular ingredients and use trends. Individual memberships start at $50 per year in the US, $70 international. There are many resources offered of interest to physicians such as The ABC Clinical Guide to Herbs. Members can also access the resource Herbal Medicine: Expanded Commission E Monographs to learn more about specific ingredients.
Center of Excellence for Natural Product-Drug Interaction Research (NaPDI)
The NaPDI is an NCCIH-funded collaborative research initiative with the dual goals of developing and applying approaches in the scientific evaluation of herbs for their potential interactions with pharmaceutical drugs. My research group participates in this initiative and has contributed key data on cinnamon in herb-drug interactions. While this resource is still under development, it will be a useful tool for informing medical care professionals in the future. This resource is free and includes data summaries geared toward a scientific audience.
The Takeaway
The number of ingredients and options of offerings in the dietary supplement industry can feel overwhelming. We clearly need Congress to mandate more research funding dedicated to the scientific investigation of the safety and efficacy of these ingredients. Alternatively, Congress could levy a tax on the industry to better support basic research (even 0.5% of profits would go a long way in building up the science in this field so we can better inform consumers). In the meantime, take a look at the resources I’ve provided above, and as always, keep reading my newsletter as I’ll continue to bring the latest in this field to you with my posts.
Yours in health, Dr. Quave
Cassandra L. Quave, Ph.D. is a scientist, author, speaker, podcast host, wife, mother, explorer, and professor at Emory University School of Medicine. She teaches college courses and leads a group of research scientists studying medicinal plants to find new life-saving drugs from nature. She hosts the Foodie Pharmacology podcast and writes the Nature’s Pharmacy newsletter to share the science behind natural medicines. To support her effort, consider a paid or founding subscription, with founding members receiving an autographed 1st edition hardcover copy of her book, The Plant Hunter.
There is also the question of say, a supplement based on food fragments (curcumin and piperine) which is then passed off as turmeric. The supplement is likely to have negative (secondary) effects due to the extracts used rather than the whole foods from which they came.
The anti-inflammatory action is not only due to the extracted component as what remains of the turmeric root powder and the black pepper fruits provide synergistic and even protective activity such as antioxidant and adaptogenic qualities. Ingesting too much of the whole foods is practically impossible and highly unlikely.
Interesting too that a whole food turmeric product I brought onto the market (Karuah Activated Turmeric™) and which includes seriously nutrition Indigenous Australian wild foods in freeze-dried form, addresses metaflammation, not just pain in joints. All my customers once took the chemical supplements but tell me that my formulation is far superior to their previous choices.
My simple 4-product range is based on the scientific research into the phytonutrients in wild foods and the fact that these foods supported the World's longest living culture in near ideal health. Traditional 'bush medicines' typically treated basic illnesses such as burns, headaches, cuts, wounds, irritations and gut ailments. Multiple studies on the paleoethnopathology of traditional, pre-agricultural cultures in Australia, Africa and the Americas reports "extremely rare" incidences of ischaemic heart disease, mental diseases, Metabolic Syndrome conditions and gout. This supports a significant protective role from their respective wild foods.
Another interesting area of supplement misuse is that of adding mineral calcium to synthetic vitamin D concoctions. The whole area of calcium being essential for healthy teeth and bones is a classic mis-direction by the dairy industry. Calcium is actually less essential than magnesium, vitamin K2, phosphate and the energy molecule ATP. Too much calcium has the negative effect of increasing magnesium excretion and reducing its absorption resulting in most of us in the developed world consuming 20 times more calcium than we do magnesium.
The net result is that cramped muscles, low energy (chronic fatigue), susceptibility to a host of mental and immune dysfunctions, osteoarthritis, gout, stones in different organs and ducts, various cancers and more, all have calcium calculi (granules) as the initial trigger to the condition.
Fortunately, a whole food nutrient booster exists that addresses these conditions too and again, has 65,000 years of use in Australia and less but still long histories of use in Asia, the sub-continent and the Americas.
I spend a small fortune on supplements, and as you know, the good ones are costly. I'd like to narrow my list down but don't know which ones I would give up.