The experience of buying supplements in a health food store can be daunting. Multiple companies sell similar or identical vitamins, herbs and other supplements, and choosing one can seem like a Herculean task if you don’t come armed with some specific information.
When I prescribe or recommend supplements, I give patients very detailed information on exactly what to buy, often including a few specific brand names that provide the quality and dose I recommend but are more flexible in price.
Labeling requirements for companies that make vitamins, herbs and supplements are regulated by the U.S. government, in the form of the Dietary Supplements and Health Education Act of 1994, and overseen by the Food and Drug Administration.
Companies are not allowed to make explicit claims about how the contents in the bottle may play a role in preventing or treating a medical condition. They can, however, put information on a bottle about the function of a product in the body (e.g., “helps maintain healthy intestinal flora”) or how it may affect the structure of the body (“assists in lubricating joints”). These are called “structure/function claims.” The FDA is responsible for stepping in and enforcing the rules if a company strays from the requirements.
Despite these rules, what is advertised on the front of the label may not necessarily be the whole truth for what is truly in the bottle.
I was reminded of this the other day when looking at a calcium supplement bottle brought in by a patient. The front of the label advertised this as a calcium/magnesium supplement; the Supplement Facts label on the back told a different story. Included in the product were turmeric, ginger, horsetail, spirulina and willow bark.
While these unexpected additions may be fine for some people, they could potentially increase the possibility of bleeding risk in other patients on certain medications. Of note, there was no warning on the bottle for consumers about potential herb/drug/supplement interaction risks.