It can be intimidating and confusing when someone is ill to decide what they should buy when they go to the pharmacy, supermarket, gas station, or health food store. If they have a cold, should they pick up elderberry, guaifenesin, or Oscillococcinum? They might not feel they are sick enough to visit the doctor, but they also don't know what product will actually alleviate their sniffles.
As a pharmacist, I have found that many people do not realize the significant difference between supplements and drugs in the United States. They are often sold side by side at Walmart or CVS, but the two groups have undergone different amounts of testing and are not under the same amount of regulation. Thanks to the Dietary Supplement Health and Education Act of 1994 (DSHEA), supplements do not require any kind of approval from the FDA before they are sold to the consumer. While drugs have to undergo stringent testing showing that they are safe and effective, supplements do not.
Usually, you can tell these products apart by looking at the labels. Drugs will list the amount of the ingredients under a section that says "Drug Facts," while supplements will have a section that says "Supplement Facts" instead. Also, supplements are required to have a warning that says, "This statement has not been evaluated by the Food and Drug Administration." While drugs will make specific claims like "alleviates fever," "improves symptoms of allergies," or "for migraine headaches," supplements cannot make these claims. So they make broad statements like "improves heart health" or "boosts cognitive performance."
Another downside of the lack of regulation of the supplement industry is that sometimes they don't even contain the promised ingredient. A Google search for "supplements with no active ingredient" will give you a number of hits. Since supplements are not regulated, sometimes manufacturers will just sell you a capsule filled with something like rice flour instead of St. John's Wort or Echinacea.
Finally, in my opinion, supplements themselves can be subdivided into categories based on possible usefulness.
Vitamins and minerals are likely the most useful and trustworthy. We know that quite a few people are deficient in Vitamin D. We had evidence that people fared worse if they had Zinc deficiencies and were diagnosed with COVID.
Herbals, are on shaky middle ground that may be useful, but have a lot of conflicting evidence. This includes all the plant-based capsules you find in pharmacies and supermarkets: garlic, kava, elderberry, and black cohosh to name a few. Their benefit is often extremely exaggerated. Unlike drugs, even if these herbs are beneficial, there is no agreed upon dosage or frequency for their use.
The third, and least useful, group of supplements are the homeopathic products. I have yet to meet a healthcare professional that recommends these. I may create another post just to discuss the idea of homeopathy. Simply put, homeopathy relies on unproven concepts that run contrary to everything we know about medicine today. It claims that products become more potent as a product is diluted, and that water has a memory of the things that have been dissolved in it. I would personally avoid anything that had the word "homeopathic" anywhere on the bottle or box.
When in doubt, stick with things that have "Drug facts," follow the instructions, and ask the pharmacist if you have questions.
Dr Pasteur, PharmD
