Science Friday - How Shoddy Science Is Driving A Supplement Boom

Episode Date: September 9, 2025

Dietary supplements are big business, with one recent estimate showing the industry is worth almost $64 billion in the United States alone. Take a casual scroll through your social media and you’ll find influencers hawking all kinds of supplements. But how effective are they? How are they regulated? And why are these “natural” remedies so appealing to millions of Americans? To size up the science and culture of supplements, Host Flora Lichtman talks with supplement researcher Pieter Cohen, and Colleen Derkatch, author of Why Wellness Sells: Natural Health in a Pharmaceutical Culture. Guests: Dr. Pieter Cohen is an Associate Professor of Medicine at Harvard Medical School and an internist at the Cambridge Health Alliance where he leads the Supplement Research Program. Dr. Colleen Derkatch is the author of Why Wellness Sells: Natural Health in a Pharmaceutical Culture and professor of rhetoric at Toronto Metropolitan University.Transcripts for each episode are available within 1-3 days at sciencefriday.com. Subscribe to this podcast. Plus, to stay updated on all things science, sign up for Science Friday's newsletters.

Hi, this is Flora Lickman and you're listening to Science Friday. Today in the show, a remedy that's not a medicine, a treatment that's not regulated like one. Supplements. People really believe that they are basically farm to capsule, that these are plants that are grown and somehow they kind of magic their way into capsule form. Dietary supplements are big business. One recent estimate shows the industry is worth almost $64 billion. just in the United States. And in fact, chances are you take a dietary supplement.

Most Americans do. It's hard to escape the claims about some new vitamin or mineral that will give you more energy or make you stronger or make your brain work better. If you need caffeine to function, take vitamin B12. If you carry too much in your midsection, take Aschwaganda. Here are some of my favorite weight loss supplements. Number one is black seed oil.

So I recently started taking this supplement that has been a game changer from my PCOS. I'm talking about CO-10. But how effective are supplements? How safe are they? How are they regulated? And why are these remedies so appealing to us? Here to help us size up the science and culture of supplements are Dr. Peter Cohen, head of the supplement research program, an associate professor of medicine at Harvard Medical School and an internist at the Cambridge Health Alliance based in Somerville, Massachusetts. And Dr. Colleen Dirk, author of Why Wellness Cells Natural Health in a Pharmaceutical Culture. She's also a professor of rhetoric at Toronto Metropolitan University based in Ontario, Canada. Okay, welcome to you both to Science Friday. Thanks for having us. Yes, hi. Thanks. Let's start with some definitions. Peter, what makes something a dietary supplement versus a medication?

It's a great question. A dietary supplement doesn't really mean anything. It's just a legal term that was in. invented over 25 years ago by Congress. And it's part of the law to combine many different types of ingredients together into this category of dietary supplements. So they can include vitamins, minerals, amino acids, protein powders, botanical, porcine thyroid extracts, live microorganisms like bacteria and fungus. So it's a real mixed bag. a big bucket, I'm hearing. Very big. Yeah. Colleen, what about our perception? I mean, how does our perception of what a supplement is match with this bucket? It's about as varied as the bucket itself, I would say. Yeah. Yeah, people think of supplements as all kinds of things. They think of them as

fundamentally distinct from pharmaceuticals. And that's one of the reasons why they're so powerful. people really believe that they are basically farm to capsule, that these are plants that are grown in very kind of bucolic fields with little downhome families farming. And somehow they kind of magic their way into capsule form. And the similarities to pharmaceuticals become kind of a lot murkier, right? They are pills and bottles. They are synthesized in labs. Like there's a lot of correspondence between the two things. They are. products that people take to affect a change in the body. And for a lot of people, that's really appealing because they may be concerned about what's going into pharmaceuticals. They may be concerned

about the pharmaceutical industry. They may be feeling like, you know, doctors don't really care about their health or don't get to root causes. And so, so supplements are able to kind of behave like both things at the same time. And I think that that's really powerful. People do find that quite appealing. How does supplement culture intertwine with kind of maha culture and this move towards you being in charge of your own health? I mean, from where I sit, it's not surprising to me. So if you look at the history of wellness culture, it has always had a really strong libertarian streak to it. And I think we're kind of seeing some of that come to fruition right now. When people use supplements, they frequently serve primarily as symbols of other things. And I think that

that's what's really important is that the actual intervention that people buy and, you know, swallow with water represents so much more than just what's in the capsule or the pill. And people are seeking to return to a state of kind of purity. And whether that's purity from, you know, chemicals that they think are in their body or chemicals from pharmaceuticals or even if they just want to do something for themselves to make them feel better, to make them feel like they're taking care of themselves, to make them feel like they're good people. And a lot of that connects back to decades now of public health messaging in both the U.S. and in Canada where I live, that we are each of us responsible for our own health. We each need to take steps to support and enhance our

health, and supplements really tap into that. Peter, how are dietary supplements regulated? So here in the States, the concept is that all those ingredients we were talking about are presumed to be safe to consume and can be sold directly to consumers. The FDA is just in the position, who technically oversees supplements, the FDA is in the position of just keeping an eye out and in case there is something that they detect, that there's danger coming from the supplements, they can take steps, small baby steps actually, to try to remove those products from the marketplace. So it's very much reliant on the industry to self-police and ensure that their own products are safe. I mean, presumed safe sounds unnerving to me personally.

Well, the concept came around because of the FDA's efforts back in the 1970s and 1980s to try to more tightly regulate vitamins and minerals. And the FDA made some moves to try to make it such that certain high doses of vitamins, like let's say a dose of 10 or 20 times what was necessary in a day. If that was going to be marketed, that should go through a more stringent regulatory review. the FDA. And it was in a backlash against that move by the FDA that led to the current laws that really tell the FDA, you know, hands off here, we can sell what we want to and consumers can purchase what they want to. We asked our listeners to weigh in on this topic and we got many,

many calls. People had a lot of thoughts and feelings about this, which I'm sure will not surprise you to because you work in this field. Let's go to Maggie in Montana. I wanted to tell you that I was a truck guard for a little more than seven years, and I was shopping one day. I had some vitamins on sale, so I picked them up, and it turned out that they really made a difference in my performance, my ability to stay with the job and have physical energy, and that was COQ10 with the unusual item in there, and want to make sure that I'm not ill-advising my friends. COQ10 or CO-Q-10, I've heard it called. Peter, what do we know about this supplement? Well, like many supplements, there's a very important role for this in modern medicine. In this case, it's a very important enzyme that's at the cornerstone of how we generate energy in the body and the mitochondria.

And some people, it's rare, but have genetic disorders that don't make enough co-enzyme Q10. And in those situations, it's a cornerstone of treatment. Now, it doesn't always work, but it's certainly what should be tried first. It's that sort of utility that then leads to interest in using it in other situations. And for one, it's been studied extensively for people who have muscle aches after taking common cholesterol medications, statins. And in that case, it's found. not to be particularly effective. And I'm not aware of other strong evidence to suggest that healthy people who don't have these rare genetic disorders would have great benefit from co-enzyme Q10. But that doesn't stop the supplement industry from being able to promote it for a variety of a variety of reasons. You know, I want to dig in a little bit on this because, you know, Peter, you said you don't know of sort of a lot of good evidence to back up the idea that it will help healthy people. And that

seems common for a lot of supplements. Is that because we haven't done enough research into supplements? Or is it because scientists have done research into supplements and actually it just doesn't support being helpful? It's a combination of both. In some areas, there's extensive research. So a good example of that is a multivitamin. So we have a very important. So we have a combination of very well-conducted large randomized controlled trials showing that multivitamins really don't help much unless people have vitamin deficiencies or need them. Do not help much. Right. But they also don't hurt. So they're not going to be causing cancer or increasing risk

of heart disease. They're pretty neutral. Now, with a majority of other supplements, they haven't been studied in large trials. And there's no incentive. to at this point because when the industry can market products directly to consumers, which as I mentioned, I'm a fan of having access, that means that the manufacturers don't have incentive to do the large studies to sort out what works and what doesn't work, particularly because the manufacturers can also advertise their products with all sorts of claims, such that it will help with everything from brain health to the immune system to giving you more energy without having to prove that in human clinical trials.

And they're also limited to the types of claims they can make, so they can make structure claims. They can make claims about supporting health without making disease claims, and I think that's a really important distinction, because then you can kind of say anything. What I found is that people just translate them in their own minds. And so they'll see, like, support sleep on a bottle of melatonin, and they'll translate that to treats insomnia. Don't go away because after the break, we're talking megadosing. At higher dosages, you're pretty much with all the vitamins and minerals eventually going to run into trouble. Ceplepod Week is swimming along.

We've got an awesome article about an octopus garden. Think underwater nursery with a bunch of octo moms and octo babies. And if you're looking for a hands-on family activity, dive into our hide-like-a-cephalopod activity, perfect for young scientists from pre-K to early elementary. Explore it all at ScienceFriday.com. I want to bring in another listener who has his own experience with this subject. He wrote the nutrition curriculum at Yale Medical School. This is DeVary Boyd. I am a physician. oncologist, I would avoid the use of very high dose supplements. One classic one is B12,

and people are completely unaware of this, including physicians, that B12 has been linked at higher doses to a higher risk of lung cancers. And why would that be? It activates cell growth, cell replication, and as a result, you end up raising the risk of diseases like lung cancer. and it's very easy to give it because you think it's great for fatigue or other reasons. Those are not appropriate approaches to using B12 in very high doses. I would love to hear what you all think of this. I mean, I've had many doctors offering me a B12 shot. Right.

Well, I think this is a great example of how vitamins and minerals are active in the human body. and a small amount, which might be helpful, could lead to some benefit if someone's deficient in the vitamin or the mineral, but at higher dosages, you're pretty much with all the vitamins and minerals eventually going to run into trouble. And that's a problem with how these products are marketed. Because they're presumed safe, basically by Congress, defining them as safe, it gives the impression to consumers that, you know, if a little bit of a vitamin's good, then a lot must be better. And that, unfortunately, is inaccurate. I mean, but many of the supplements you see that are not multivitamins, but just, you know, one compound, one mineral will say this gives you, you know, 453 percent of your daily value. How do I interpret that number? Is that real and is it a good thing? Right. So I think that that gets to another issue that we haven't talked about yet, which is manufacturing problems and manufacturing control, quality control in the supplement industry. This is a very serious problem. And in fact, I really wouldn't trust most of that information that I see on the label. We did a study of melatonon gummies to see how did the actual quantity of melatonin in the gummies compare to the labeled amount of melatonin. And

And what we found was really surprising. I was expecting to find variability, and I thought some manufacturers might have not included enough melatonin. But in fact, it was the opposite, really. We found that there was much more melatonin in most of the gummies than expected or listed on the label. And sometimes two or three times more. So this is the situation where consumers really can't get a straight story about what's in the supplement just by reading the labels, and that has to do with very profound problems in manufacturing a supplement. Have you found ingredients that don't even belong there? Yes. So we've done many studies looking deeply at what's actually in the pills. And in the melatonin study we did, we found CBD. And CBD would not be sold as a dietary

supplement. So that's an example of finding other things. But we've also found in many other studies that we have in the supplements supply in the United States, chemicals and pharmaceutical drugs that might be approved or not even approved in other countries are appearing in the United States in dietary supplements. We've talked about the shortfalls of supplements and some of the risks, is there promise in the supplement world to actually develop new effective treatments? Well, I think that the problem is, unfortunately, the situation is designed such that since you can go and start selling products without having done the research, it doesn't encourage innovation. So that's going to be a challenge for in the future is can we create a situation where consumers have

access to supplements, which I believe is important, but the same time we incentivize good science and research to find out which ones can benefit human health. Yeah, I agree. And I think for me, a lot of it comes to legislation. You know, we can't be sure about what is in supplements because supplement manufacturers are not required to investigate that. Years ago in Canada, our CBC, the national broadcaster did a very hilarious and notorious investigation where they got approval to sell a homeopathic sleep aid from Health Canada by literally pouring tap water into a bottle, photocopying a couple of pages of a homeopathy textbook and creating a marketing campaign. And they got a natural health product number to sell that product legally in Canada as a sleep

paid for children. And to me, that shows that the biggest hole, I think, is that legislation isn't requiring manufacturers to guarantee the safety and efficacy of their products. And consumers don't know that because they go to their local pharmacy, which they trust, and they see these bottles on the shelf next to products like Tylenol, Cold and Flu and other products that are tested for safety. and so people believe that the bottles contain what they say they contain and will do what they say they do, but we know that's not true. Thank you both for this conversation. Thank you. Thanks for having us.

Dr. Peter Cohen, head of the supplement research program, associate professor of medicine at Harvard Medical School and internist at the Cambridge Health Alliance based in Somerville, Massachusetts, and Dr. Colleen Durkatch, author of Why Wellness Cells Natural Health in a Pharmaceutical Culture, and Professor of Rhetoric at Toronto, Metropolitan University. Thanks for listening. Don't forget to rate and review us wherever you listen. It really does help us get the word out and get the show in front of new listeners. Today's episode was produced by Shoshana Bucksbound. I'm Flora Lichtman. Thanks for listening.