Gunter's Guide to Supplements
You Deserve Informed Consent
In this subsection of The Vajenda, you’ll find a table of contents (this post) and posts about vitamins, minerals, probiotics, vaginal products, and a whole host of special mixes, as well as background information about legislation or lack thereof (in the United States anyway). And, of course, plenty of information about risks. If the supplement industry isn’t going to provide you with informed consent, then I’m stepping up!
Most of the supplements you’ll read about here are understudied; for some, the data amounts to little more than a hypothesis. Sometimes people think, well, I want to be cutting edge, so I’m okay trying something new, but it’s important not to confuse a novel hypothesis for cutting-edge. Cutting-edge therapy is my 20-year-old son having open heart surgery where a valve was replaced without needing a blood transfusion and being able to walk a mile just two weeks later. The surgery, multiple post-operative protocols, and even the choice of valves weren’t just an idea his surgeon dreamed up; his cutting-edge therapy was the tip of a massive research iceberg that started with many intriguing hypotheses.
Medicine is littered with incredible harm from so-called disruptive or novel medications and interventions that were never evaluated appropriately. The Rely tampon is a classic example (unstudied super absorbent material led to toxic shock syndrome and some deaths), there is the medication thalidomide (unstudied in pregnancy, which led to miscarriages and severe birth deformities), and the Dalkon shield (inadequately studied IUD, which led to severe infections and some deaths), and many more. It’s important not to confuse “cutting edge” with inadequately studied products quickly foisted on people courtesy of unfettered capitalism. And it’s equally as important to note how many of these unstudied/inadequately studied products and medications were meant for women.
With supplements, it’s hard to know the dangers because there is so little research, so in many cases, the waters are essentially uncharted. In addition, supplements are a supplement adulteration, often with pharmaceuticals or even completely novel drugs, is a real concern. There is also microbial contamination, and many supplements don’t contain the amount of active ingredient that the label claims. For example, in a study published in JAMA (2024), researchers looked at the accuracy of labeling for products containing galantamine, a medication used to treat dementia (primarily Alzheimer's disease), but it has some off-label indications as well. Galantamine offered a unique opportunity to compare the accuracy of labeling for a prescription product versus a supplement, as galantamine is available as both a prescription (regulated) and as a supplement (unregulated). With the regulated prescription (generics were chosen), galantamine in the pills was between 97.5% and 104.2% of the amount indicated on the label, which is not an uncommon margin of error, and there was no bacterial contamination. However, with the unregulated, over-the-counter supplement version, the amount of galantamine ranged from less than 2% to as much as 110% percent of what was printed on the label, and only one product contained what is claimed with the same margin of error as the prescription products. In addition, three or 30% of the supplements were contaminated with genes for the enterotoxin produced by Bacillus cereus sensu stricto, which is a cause of food poisoning.
What about third-party validation? While it may help, especially when it comes to identifying contaminants or adulteration, it may not guarantee the product contains the amount of product that it claims. You can read more about that in this post on prenatal vitamins.
We also don’t know how supplements might negatively affect the body or interact with other medications. For example, turmeric/curcumin interferes with iron metabolism and can cause iron deficiency. How many other supplements negatively affect a different bodily function?
Trying a supplement that isn’t recommended in any guideline is not wrong. It’s your body and your choice. What is wrong is for a medical provider, coach, or person with a supplement store to misrepresent supplements as being “science-backed,” “doctor-approved,” or “expert-recommended” when quality studies supporting effectiveness and safety are lacking. And it’s wrong not to inform you of the risks. You can make an informed choice only when you are given accurate information.
With that preamble, here is Gunter’s Guide to Supplements and Such. As I write about more products, I’ll add them to the Table of Contents below with a hyperlink. If you have specific products you’d like me to write about, leave the request in the comments! And as always, the information here is not individual medical advice.
Gunter’s Guide to Supplements and Such
The Basics
***START HERE*** -> What is a supplement anyway? This post breaks down the basics of the different types of products. Really, read this first because there are some cases where supplements are indicated, and the language can be confusing (which the industry counts on)
The Death-Strewn Backstory of Big Supplement, how we got here (in the United States)
My Open-Minded Approach to Alternative Medicine. Really!
Homeopathic remedies, do you know what they are? Many people do not. Read this post before taking any.
Supplement companies often use podcasts to gain influence. An important read about advertising and using trusted podcasters to whitewash supplements.
The Money
The Money in Menopause Supplements. I created my own supplement to show how much someone can make selling supplements and how easy it is.
Avenir Nutrition, a company that makes a useless product that glorifies binge drinking, is making millions in sales. Read about their cash claims here. It seems that cultivating a large, engaged following on social media can be wildly profitable.
Adulteration and Contamination
Lead poisoning in Ayurvedic Medicine. It’s a huge issue.
Mislabeling and dangerous ingredients in sports enhancers. One product even contained a compound that has NEVER BEEN TESTED IN HUMANS (yes, I am shouting).
Products
Hair Growth
Nutrafol, read my in-depth review here
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Hangovers/Alcohol/Liver
The Liver Shield, a supplement that claims to support the liver and help you recover from drinking.
Z-Biotics. A product that claims it can prevent hangovers.
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Magnesium
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Menopause
Dr. Kellyann & ME Peri plus Menopause, promoted by Drew Barrymore
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Menstrual-Related Concerns
Castor Oil Packs for Menstrual Pain
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Probiotics
Can probiotics prevent osteoporosis?
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Pregnancy
Mislabeling of prenatal vitamins. This is one of the most pressing reasons we need legislation because prenatal vitamins are among the few medically recommended supplements.
Folic acid: Why you need a prenatal vitamin with folic acid and not “natural” folate or methylfolate. Most designer prenatal vitamins do not have folic acid!
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Vaginal Products
Vaginal boric acid, this is one of those products that is taken advantage of as it does have a legitimate use for two conditions. However, it is inappropriately promoted to balance the vaginal pH, which it cannot do.
References
Tucker J, Fischer T, Upjohn L, Mazzera D, Kumar M. Unapproved Pharmaceutical Ingredients Included in Dietary Supplements Associated With US Food and Drug Administration Warnings. JAMA Netw Open. 2018;1(6):e183337. doi:10.1001/jamanetworkopen.2018.3337
Ghabril, M, Ma J, Patidar K, et. al. Eight‐Fold Increase in Dietary Supplement–Related Liver Failure Leading to Transplant Waitlisting Over the Last Quarter Century in the United States. Liver Transplantation 28(2):p 169-179, February 2022. | DOI: 10.1002/lt.26246
Cohen PA, Jacobs B, Van Hoorde K, Vanhee C. Accuracy of Labeling of Galantamine Generic Drugs and Dietary Supplements. JAMA. 2024;331(11):974–976. doi:10.1001/jama.2024.0328
Dear Doctor Gunther, thank you for all your work regarding supplements and their possible problems. Could you tell us which, if any, supplements that you do recommend? Not by brand (unless you are fine with letting us know your preferred and trusted brands) but by type of supplement. Thank you. Judith
Thank you for all that you continue to do. This takes so much work, and I appreciate how thoughtful and thorough you are, constantly educating us about what is what. THANK YOU.