Many of us remember the days when taking vitamins was a dreaded chore. With the exception of those candy-like chewables named after a certain cartoon set in the Stone Age, most vitamins tasted bitter at best and felt something like swallowing rocks. And yet, Mom and Dad dutifully insisted that we choke down the yucky pills anyway, perhaps relying on that classic parental pitch: “But, they’re good for you!”
Indeed, we all need vitamins and minerals to help us survive and thrive. These micronutrients contribute to an impressive range of bodily processes ranging from building our bones and teeth, keeping our immune system strong, healing injuries, and converting the food we eat into energy. Most of us can get all the essential vitamins and minerals by eating a well-balanced diet that includes a variety of foods from the key food groups. But, at times, we might need to turn to dietary supplements for a bit of assistance.
Women of reproductive age or hoping to become pregnant, for example, may need to take folic acid to help prevent certain birth defects. People following a vegan diet often take a vitamin B12 supplement, since this nutrient is typically only available in animal products.
In addition to vitamin and mineral products intended to make up for gaps in nutrition, lots of folks use herbal and other dietary supplements with hopes of meeting goals like losing weight, improving sleep, boosting brain health, and increasing energy, despite their largely unproven claims and questionable safety.
While most supplements used to, literally, be hard to swallow due to their large size and unpleasant taste and texture, new formulations introduced in recent years have made taking them more tolerable.
“Many alternative forms of dietary supplements and vitamins, such as gummies or powders, are increasingly popular among adults, as well as for kids,” according to Shelby Yaceczko, MS, RDN-AP, advanced practice clinical dietitian at the UCLA Center for Human Nutrition in Los Angeles. “These often are more palatable as they generally are made with added sugars, sugar alcohols, or other sweeteners.”
Whether intended for nutritional purposes or lifestyle goals, the ease of use could make it tempting to take a “Why Not?” attitude about consuming such products, sometimes in larger quantities than recommended. As with conventional supplements, however, these new approaches present multiple potential risks ranging from mild to severe.
“The risks of adverse effects or interactions are somewhat similar [to medications], regardless of route of administration, if the ingredients are absorbed into the body,” notes Ilisa BG Bernstein, PharmD, JD, FAPhA, and senior vice president of Pharmacy Practice and government affairs at the American Pharmacists Association in Washington, DC.
Yaceczko points out that all vitamins and dietary supplements carry risks and side effects like those that can arise from the use of medications.
“Some supplements interact with prescription drugs, foods, or other dietary supplements, making them unsafe,” according to Bernstein. These interactions can make prescribed medications less effective. The herb, St. John’s Wort, for instance, can interfere with prescription medications or cause dangerous interactions. Likewise, taking vitamin E with the anticoagulant drug, Warfarin, may result in too much thinning of the blood, which increases the risk of stroke.
Unlike pharmaceutical drugs, dietary supplements and over-the-counter vitamins are regulated as food items by the United States Food and Drug Administration (FDA), so they don’t have to receive FDA approval or pass quality and safety tests like drugs would. This means it’s nearly impossible to know what you’re really taking, and you may be at risk of several issues when using these products.
The Ingredient List May Lie
When taking supplements, you might not get enough of the ingredient you’re going for – if any at all.
“In some cases, when herbal supplements have been tested, they have been found to contain very little or none of the ingredients listed on the product,” says Yaceczko.
A 2021 review revealed that 27% of commercial herbal products purchased in the US were impure, either containing substances not listed on the label or not containing the stated amounts of the herbal ingredients. For some supplements, the ingredients printed on the label were completely absent from the product and the labels included misleading claims regarding quality.
Plus, there’s a chance you’ll get a dose of other heavy metals or toxic substances that aren’t listed on the label. Nutritional powder supplements and herbal products “have been shown to contain heavy metals such as lead, arsenic, cadmium, and mercury, as well as bisphenol-A, pesticides, or other contaminants linked to cancer and other health conditions,” says Yaceczko.
Researchers have also detected ingredients not reported on the label of dietary supplements – including harmful substances like prescription drugs that can cause serious side effects. In a 2020 study that analyzed supplements marketed for “brain health” and “cognitive performance,” researchers observed that 83% contained compounds not listed on the label.
Vitamin Patches May Not Deliver the Goods
With the newer supplement forms, there are also problems related to how well the ingredients hold up and whether they can be fully absorbed by the body. While vitamin and dietary patches – which supposedly deliver these substances through the skin – are designed to replace oral supplements like vitamin D or vitamin B12, the “evidence for nutrient absorption through the skin barrier is very limited, and often many of the health-related claims are not backed by science,” notes Yaceczko.
Inone example, people who undergo gastric bypass surgery are advised to take oral vitamin supplements on a daily basis, and the use of multivitamin patches has been promoted for these individuals, even though no scientific evidence to support this suggestion exists. A study published in 2019 investigated the effects of multivitamin pills compared to patches in this patient group and found at least one nutritional deficiency – including lower levels of vitamins D, B1 and B12 – in 82% of those using vitamin patches compared to 41% in those using vitamins in pill form.
“Of note, patches are not considered dietary supplements under the law, and unless such a patch is permitted to be sold as a drug by the FDA, it may be illegally marketed,” Bernstein states.
Powders and Gummy Vitamins Make It Easy to Overdo It
On the other hand, you may get too much of the ingredients you want and others that you don’t want. As reported in March 2021, a personal trainer in Australia died after he miscalculated the amount of caffeine powder he put in his smoothie and consumed the equivalent of roughly 200 cups of coffee. In two earlier instances in the U.S., young men died after consuming caffeine powder. Although these may be rare cases, they highlight another risky aspect of the newer supplement forms – it’s easy to take too much.
Vitamins, minerals, and other nutritional products can be harmful when taken in excess, which may be more likely to happen with the newer types of supplements.
“These formulations can be dangerous, as a larger amount can be ingested at one time or they can be more attractive to children in the gummy form,” explains G. Sam Wang, MD, pediatric emergency medicine specialist and toxicologist at Children’s Hospital Colorado and associate professor of pediatrics at University of Colorado Anschutz Medical Campus in Aurora.
These products are more attractive to children because they are branded with popular cartoon characters and sometimes marketed with the claim that they are “fun to eat.” Since kids could easily mistake the gummy supplements for gummy candy, they may be tempted to gobble up far more than the recommended amount.
Even if a parent is tightly monitoring their child’s consumption of gummy or other chewable vitamins, there’s still a risk of overdoing the dosage since it varies widely between brands. A 2019 study found that one brand of vitamin B6 for kids contained one thousand percent more of the vitamin than other brands, for instance. Adding to the confusion, different brands recommend different amounts of gummies per dose – ranging from four to 15 across certain brands of omega-3 gummies for kids.
“Most of the time the adverse effects are mild, such as stomach upset or allergic type reactions, but when large quantities are taken over a long period of time, some vitamins and minerals can cause damage to your liver, nervous system, and other body systems,” said Wang.
Reports of liver injuries in particular are increasing as the multibillion-dollar supplement industry continues to grow. Wang adds that iron is one of the most concerning supplements in terms of possible poisoning. In young children, iron overdose is reportedly common and represents a top cause of poisoning deaths, typically after accidental ingestion.
New Gummy Vitamin Formulations Can Be Iffy
“There are stability concerns about gummy forms, meaning the gummies can lose potency over time,” says Yaceczko. Certain vitamins, such as vitamin C, can break down if exposed to air, moisture, heat, or light – even during the manufacturing process, before they ever reach the shelves. To ensure that the product contains the dosage of the vitamin listed on the label, manufacturers may add excessive amounts during production. Once it reaches the consumer’s mouth, the supplement could contain more or less than stated, but it’s impossible to know by that point without having it tested in a lab at the same moment of consumption.
Gummies are also typically made with sugar and citric acid, which can lead to dental cavities and the erosion of tooth enamel, along with unhealthy levels of sugar intake. Just a few servings of some gummy vitamins could place you or your child at the daily limit of sugar recommended by the American Heart Association. If the product contains sugar substitutes instead, then the risk of stomach issues goes up.
Proceed With Caution
To stay on the safe side with supplements, heed the following advice from the experts.
Keep it kid-proof
Due to the chance that children may get curious and take supplements that could cause severe side effects or worse, Wang cautions.
“Similar to medications, keep supplements out of the reach of children, preferably in a child-resistant package,” he said.
Avoid the temptation to give them an unproven supplement just because it’s trendy. The use of melatonin supplements for kids in gummy, chewable, and liquid forms is becoming more common although little is known about its long-term effects. As a result, melatonin poisoning is affecting children more frequently, with 46,300 cases in those age 5 and under reported in 2021. The Centers for Disease Control and Prevention reported that nearly 5,000 children have suffered serious outcomes from melatonin supplements in the past decade, with two deaths occurring in children under the age of 2 years.
Get what you need from your diet
Keep in mind that it’s ideal – and usually possible – to get all the nutrients we need through foods and beverages. This goes for kids, too.
“The American Academy of Pediatrics states that healthy children with a well-balanced diet do not need vitamin supplementation,” with the exception of vitamin D for breastfed infants and other children who are not likely to consume enough of the nutrient from their diet.
To learn about which foods and drinks offer various vitamins and minerals, check out the fact sheets provided by the National Institutes of Health Office of Dietary Supplements.
Check with the pros
“It is important for patients to talk to their doctor or pharmacist before taking any dietary supplement, regardless of the type of formulation, to ensure that it is appropriate for their condition and does not adversely interact with their medicines, foods, or other dietary supplements they are taking,” Bernstein recommends.
For times when supplements may be necessary, healthcare providers may be able to suggest reputable brands to patients.
“There are various organizations, such as the Clean Label Project, which focuses on consumer product quality and safety, that can help guide consumers on product selection,” Bernstein notes, and some companies voluntarily go through third-party testing to help assure consumers that the product contains the ingredients listed on the label.
The US Anti-Doping Agency, for example, which sets rules about supplements banned for use by US Olympic athletes, suggests that athletes use products certified by NSF International if they choose to use allowed substances, despite the known risks associated with these products.
Health Claims Are A Red Flag
Study the product label and make sure to follow the recommended dosage and take as directed.
“A supplement cannot claim to treat or cure disease and they must bear appropriate ingredient and nutrition labeling,” says Yaceczko. “There is very little clinical evidence to prove the health claims associated with many dietary supplement products.”
That is especially true of those promoting rapid weight loss or a quick fix for health issues. Claims like these should be a red flag to consumers that the brand can’t be trusted.
“All in all, over-the-counter vitamins and dietary supplements can be used to supplement the diet, but should not be used in place of food or to treat a disease state,” Yaceczko advises.