Dietary supplements: Safer than food - much safer than drugs
May 1999

Dietary supplements enjoy a stellar safety record. They stand head-and-shoulders above the other three categories of consumables as distinguished by U.S. law: food, over-the-counter drugs, and prescription drugs.

Food consumption is quite safe in the United States. Some dry foods like spices are about as safe as dietary supplements. Yet other foods, particularly perishables, cause thousands of deaths every year from food poisoning. More die from allergic reactions. Over-the-counter drugs, still generally safe, also cause thousands of deaths every year.

At the opposite end of the safety spectrum, prescription drugs are the most dangerous. While they are vitally important, they kill more than 100,000 people every year. In contrast, an average of only about 2 people die every year from consumption of a dietary supplement.

Given their relatively benign effect, why are there so many stories in the news about the dangers of dietary supplements? The FDA and other organizations interested in expanding government regulation regularly issue alarming reports of harm caused by dietary supplements. Well-intended as they may be, these stories frequently turn out to be misleading. Yet vindication of the implicated products is often sorely missing.

For example, media reports that received national attention claimed that a California teenager died from taking ma huang, or ephedra. The coroner's report, however, later revealed that there was no trace of this dietary supplement in her blood at the time of her death. It turned out that she died from a congenital heart defect.

If a proportionate amount of press coverage were given to actual harm caused by prescription drugs, newspapers would be chock full of tragedies resulting from drug side effects, errors in administration, and experimental use. We have a real opportunity to save lives by exercising greater caution in the use of prescription drugs. In contrast, dietary supplements have low toxicity and their rate of contamination is a non-problem.

Some have suggested that dietary supplements, sometimes called "nutraceuticals", be government-regulated at a level that lies between food and drugs: more restrictive than foods but less restrictive than drugs. This is illogical. As noted, dietary supplements are much safer than food. If regulation is needed to protect consumers from unsafe substances, then supplements should be less government-regulated than food, not more so.

Legislation was passed in 1994 (the Dietary Supplement Health and Education Act or DSHEA) to ensure that regulations remain as lenient for dietary supplements as for food. It is imperative that this standard be upheld. If anything, it should be relaxed. (DSHEA defined the term dietary supplement to include a vitamin, mineral, herb or other botanical, amino acid -- or a concentrate, metabolite, constituent, extract or combination of any of these ingredients intended to supplement the diet, other than tobacco.)

Should producers of dietary supplements regulate themselves to ensure their products are safe? Of course they should - and they do. It is in their best interest to maintain a reputation for delivering safe products. The consequences of marketing an unsafe product are extremely dire and likely to ruin a multi-million dollar investment overnight.

Is there any safety issue with which consumers of dietary supplements should be concerned? Yes, any substance can be toxic when taken in excess -- even natural products and herbal remedies. Therefore it is important to know what the appropriate dosage level is for a given supplement and to observe it.

Furthermore, individual responses to supplements vary just as they do with drugs and should be adjusted accordingly. Like drugs, some supplements provoke allergies, have exaggerated effects when taken simultaneously with other substances, or are contraindicated for certain conditions such as pregnancy. Certain supplements can cause undesirable side effects. All these factors should be considered before taking a supplement.

Because incidents of contamination are extremely rare, the safety of any particular brand of dietary supplement is of negligible concern. However to ensure we maintain safety - and promote quality - it always helps to buy from a reputable manufacturer. This doesn't necessarily mean a large manufacturer since quality, and lack thereof, comes in all sizes. But it does mean seeking those companies that demonstrate a commitment to high levels of quality.

Safety of any consumable product should never be ignored. Yet consumers can take comfort in knowing that dietary supplements, when taken as recommended, are exceptionally safe.

For more information about safety, check out our safety issues page.