Supplementation Safety
January 1999

Occupying a middle ground between food and medicine, supplements have been eagerly adopted by millions of Americans for a host of reasons. In general, supplements are freely available without prescription, yet the ease with which they can be obtained carries a price: use them knowledgeably and with caution or be prepared to bear the consequences.

Mounting evidence suggests that benefits far outweigh negatives in the area of dietary supplementation. While annualized incident reporting shows a modest number of negative reactions to supplementation, it must be remembered that with the exception of daily vitamins, supplement use is still fairly limited in the U.S. Yet, the media, medical organizations, public interest groups and others regularly raise safety concerns relating to dietary supplements.

For perspective, consider the following: According to Drug Topics, in the reporting period ending September 30, 1998, U.S. domestic sales of dietary supplements amounted to more than $3 billion. While this figure may sound substantial, the Statistical Abstract of the United States reports that U.S. shipments of food and kindred products for 1997 amount to over $470 billion. Further, according to Drug Topics, prescription drug sales for 1998 amounted to $102 billion, while over-the-counter drug sales for the same period amounted to $23.5 billion.

One does not think of peanut butter as a killer, yet allergic reactions to peanuts, which can cause severe respiratory problems and even death, are fairly common. Milk is a staple of the American diet. Yet undiagnosed lactose intolerance is another common cause of illness. On such evidence should we limit public access to peanuts and milk?

The same might be asked of over-the-counter and prescription medicines. Unsupervised children are regularly poisoned by Tylenol and aspirin despite the best efforts of manufacturers to limit children's access to such common drugs. In April of 1998, the Journal of the American Medical Association reported that properly prescribed pharmaceutical drugs killed over 106,000 hospital patients in the preceding year due to toxic reactions.

Other injuries are caused by medical administration errors and out-of-hospital, prescription-drug-related incidents. The fall 1998 edition of Natural Health reports that adverse events from prescribed drugs sent over 1 million people to the hospital in the previous year.

Yet these statistics, which on their face appear to be a devastating indictment of the medicinal use of drugs, must also be placed in perspective: About 2.3 million Americans die every year, many of them as the result of chronic illness or severe trauma. To suggest that advanced medical care and hospital facilities that save millions of lives be called into question on the basis of limited mortality statistics flies in the face of logic. Suicide alone caused by misuse of prescriptive or over-the-counter drugs killed upwards of 2800 Americans in 1995. On balance, drugs heal and cure far more than cause toxic reactions and death. Along similar lines, food can cause illness and even death if at-risk individuals eat without caution and proper knowledge.

But what of dietary supplements? By comparison, incidents resulting in death are extraordinarily small: Only about 50 deaths from all causes attributable to dietary supplements have been reported over the last decade!

Thus, for every one person who dies from a dietary supplement toxicity, thousands die from prescription drugs. Why such a dramatic difference? Many dietary supplements have a history that is literally "as old as the hills." They are derived from natural substances that have been used and evaluated for centuries. Also, supplements tend to be less concentrated and less dangerous than "invented" substances.

Again, some perspective is in order. Hundreds of deaths occur annually from eating soft cheese alone. Long term health is compromised as well by certain foods. For example, high levels of saturated fat are associated with heart disease, vascular disease, cancer, obesity, and other illnesses.

Even though dietary supplements are generally quite safe, consumers occasionally report adverse events associated with their use. It is important to be aware of potential problems and how to avoid them.

There are two general categories of concern regarding the safety of dietary supplements: toxicity (the possible negative effects inherent in a supplement) and contamination (impurities introduced during production). Either can result in an adverse event. To read more about these subjects, click on a section title to the right or use the Next Page buttons for continuous reading.