Are vitamins a scam?

A Vox reader asks: How do I know which vitamins and supplements are right/safe for me?

I feel inundated by the vitamin craze these days. When I’m scrolling Reddit, I frequently see promotions for the Hims brand that sells pills for erectile dysfunction and hair loss; I guess the algorithm has figured out I’m middle-aged. I hear ads for supplements on my NBA podcasts all the time. (To be honest, I try to skip ahead.)

The vitamin business is booming: As my former colleague Katlin Tiffany wrote in 2019, vitamins have become cool and trendy over the past decade. You see lifestyle influencers, like Gwyneth Paltrow’s company Goop, selling vitamin packs these days along with the rest of their inventory. Our new health secretary, Robert F. Kennedy Jr., is a big fan of vitamins and supplements. Supplements have invaded our grocery stores, our social media feeds, and even our podcast routines.  

By one estimate, some 70 percent of Americans take a dietary supplement. So yours is a natural question. Everybody seems to be taking either vitamins, like vitamin B capsules, or supplements that combine a few different vitamins or minerals. They must be getting something out of it, right? Shouldn’t I take something?

Well, it’s a little more complicated than that.

There are two distinct parts to your question: Which vitamins are right for me — and which ones are safe? Let’s break them down — starting with the most important thing that you should know.

Are vitamins and supplements well regulated?

No!

Please understand this: Vitamins and supplements are not subject to the same rigorous safety and effectiveness tests that prescription or over-the-counter drugs are before they are approved by the Food and Drug Administration. The FDA must approve a medication before its maker is ever allowed to market it. No such rule exists for supplements. A vitamin manufacturer can put their product on store shelves without any review at all. Even if they are using an entirely novel ingredient, the only requirement is that they notify the federal government.

That’s why, as a 2016 Vox investigation found, there are many reports of vitamins and supplements containing ingredients that could be worrisome or downright dangerous. It is only after the fact, if adverse effects are reported to the authorities, that the FDA can step in and take a closer look at one of these products.

Beyond that, vitamin makers are ostensibly barred from making false or misleading claims. But that’s another fuzzy area. You might notice that if you look closely at a box, there’s an asterisk next to all of the exciting health benefits. That asterisk will often inform you that these amazing claims have not actually been reviewed by the FDA. It may be no surprise then that in a systemic review for the US Preventive Services Task Force, researchers from Kaiser Permanente found negligible health benefits. 

With all that in mind, it’s wise to be cautious.

How can I figure out what vitamins or supplements might be good for me?

Even though many vitamins are not evaluated before they reach the market, and they may not be able to convincingly substantiate their health claims, there may still be some supplements that are useful to you. The best first step would be to talk with your doctor and get their input. 

Your health provider might even endorse certain supplements. My primary care doctor said he was happy to have me take fiber supplements (as I occasionally do). Fiber is a superfood that helps our bodies in so many ways, but most Americans don’t eat enough fiber in their diet (guilty). Our pediatrician has advised our kids and us to take a little vitamin D in the winter because we live in Cleveland, Ohio, and see very little sunlight during the season.

The point is, supplements can have a place in your health and wellness regimen — in consultation with a medical professional (which, to be clear, I am not) and based on your own personal circumstances and characteristics (and no two people are precisely the same). Instead, think of them as true supplements. Maybe a little extra fiber to keep you regular or a little folic acid during pregnancy, as is often recommended. Maybe a little extra vitamin B if you have an iron deficiency. There are no ironclad rules or silver bullets here.

How can I know if my supplements are safe?

There are vitamins that can help — but it’s also hard to know which products you can trust, given the lax regulations. How can you know? 

In preparing to answer your question, I revisited this guide from my friend and former Vox writer Julia Belluz on how to think about supplements if you are serious about trying them out. She has a few handy tips for thinking about a vitamin or supplement you might want to try. Like: Look for third-party certification seals on the label, which indicate the product has undergone an independent review of safety and efficacy; USP and NSF are popular ones. And do your research, like checking the USADA’s website for any products that have been red-flagged by health officials already.

But this one stuck out to me the most: Avoid weight loss, muscle-building, and sexual enhancement supplements. For one, according to Belluz’s reporting, they are the most likely to be unsafe because they frequently contain powerful but undisclosed pharmaceutical agents that can lead to bad health reactions. This can be hard to predict because it depends on our unique biology, which is why it’s so important to consult with a health professional.

These vitamins and supplements are not miracle drugs that will make you strong or let you lose weight or increase your sexual performance. They may also pose unique risks: One study published last year by researchers from the University of Michigan linked some of the commonly used ingredients in US-sold supplements to liver damage. 

In terms of maintaining your overall health, the old-fashioned guidance about trying to eat well and exercise remains supreme. Vitamins also can’t replace the actual pharmacological drugs — such as the new semaglutide class of weight loss medications or Viagra for sexual performance — that have been tested and reviewed by the FDA and proven to be effective. 

Anybody who says take one unregulated pill and you’ll be a new person is probably pulling one over on you.

But please, don’t take my word alone nor the word of any ads you see on social media or astounding claims you read on their packaging. Talk to your doctor. That’s where all of us should start.

This story was originally published in The Highlight, Vox’s member-exclusive magazine. To get early access to member-exclusive stories every month, join the Vox Membership program today.