Expat Life

The truth about dietary supplements: Do they sound too good to be true?

By Susan Burke March, MS, RDN, LDN, CDE

The Federal Trade Commission (FTC) has in the last decade filed more than 120 cases challenging health claims made for supplements, claims promising weight loss, cancer cure and reducing the risk for Alzheimer’s disease.

chl susan logo2When Dr. Oz promoted Green Coffee Bean Extract as a “miracle” weight loss supplement, the pills flew off the shelves. Then, after Oz was hauled before Congress to explain his claim, the manufacturer was fined $9 million for false advertising.

Close to a half-million people purchased Sensa powder, which when sprinkled on food, was touted as a “miracle” appetite suppressor, and the FTC made them return $26 million to consumers.

If weight loss were so easy, then surely more than 75% of Americans would not be overweight or obese. But that doesn’t stop people from buying these products. And when it comes to the dietary supplement industry, it’s “let the buyer beware”.


As reported in The Atlantic, unlike drugs, dietary supplements do not need approval for safety or effectiveness before they go to market. When safety issues arise, the FDA can investigate and take steps to resusan1move a product, but to ban a compound in a dietary supplement, it is required to undertake a series of lengthy scientific and legal actions. Under the Dietary Supplement Health and Education Act of 1994, manufacturers themselves are responsible for evaluating the safety of their products before marketing them, which is a little like having the fox guard the henhouse.

According to  Forbes.com, nutritional supplements is one of the fastest growing industries globally, producing about $32 billion in revenue in 2012, projected to double to over $60 billion in 2021. They report, “Ten years ago, it was just the muscle heads and the weekend warriors. Now, it’s the full spectrum with men and especially women.”

You might ask, what is a dietary supplement? According to the FDA, a dietary supplement is a product intended for ingestion that contains a “dietary ingredient” intended to add further nutritional value to the diet. A “dietary ingredient” may be one, or any combination, of the following substances:
• a vitamin
• a mineral
• an herb or other botanical
• an amino acid
• a product to increase total dietary intake
• a concentrate, metabolite, constituent, or extract


Recently, the Center for Science in the Public Interest reported thatsusan2 the New York State Attorney General commissioned an independent panel to test popular herbal supplements sold at major chain retailers GNC, Target, Walgreens, and Walmarts throughout the state. DNA testing found that only 21 percent of the herbal products tested contained DNA from the herb promised on the label.

That means that 79 percent either had no DNA from the advertised herb or had DNA evidence of material from filler plants, such as rice, beans or pine and, some cases, contaminants. They tested echinacea, ginseng, ginkgo biloba, St. John’s wort, and other popular store-brand supplements. None of Walmart’s Spring Valley line of Echinacea contained any DNA evidence of the herb. Instead, it contained powdered radish, houseplants and wheat — despite a claim on the label that the product was wheat- and gluten-free. This is very dangerous for people with celiac disease or who are gluten-sensitive, and must avoid all gluten and/or wheat. (Read my article about gluten here.)


My professional organization, the Academy of Nutrition and Dietetics says, “The best nutritional strategy for promoting optimal health and reducing the risk of chronic disease is to wisely choose a wide variety of foods. Additional nutrients from fortified foods and/or supplements can help some people meet their nutritional needs as specified by science-based nutrition standards.”

For example, vegans or people who eliminate all dairy foods from their diets often find it difficult to ingest adequate levels of nutrients such as calcium or vitamin D or B12, and supplements may be a logical alternative, especially if they lack exposure to good-quality sunlight.

Elderly people, even when healthy, often are unable to fully absorb vitamin B-12 from food, and supplements may be advised. People with certain food allergies, such as celiac disease, may need supplements due to gluten intolerance, which often leads to need for iron and calcium supplementation.


Herbs form the foundation of medical history. For thousands of years, people have identified and used medicines extracted from botanicals including basic aspirin, to penicillin, and morphine and more. Currently, about 76 percent of the world’s population have used or use some type of herbal supplement, most commonly echinacea, flaxseed, ginseng, ginkgo, saw palmetto, St John’s wort, black cohosh, evening primrose, milk thistle and garlic.

Because of herbal’s medicinal effect, it’s important to not take them haphazardly, but to work with an expert and understand any potential interactions with medications and other herbal supplements. Click here for more information about herbals.


The  FDA says, “Some products encourage consumers to self-treat for a serious disease without benefit of a medical diagnosis or treatment. Products sold as dietary supplements that bear a claim to treat, mitigate, or cure a disease are drugs and are subject to regulation as such.”

The potential for negative interactions between medications and dietary supplements is well known, but typically you’ll not find that information on the label. For example, the herb St. John’s Wort is often taken for depression and anxiety, but negatively interacts with Xanax (a common medication for anxiety), contraceptive drugs, and Warfarin (Coumadin).

Utilize a drug interaction checker to learn more about the medications and supplements you are taking. If you find interactions, review them with your primary care physician. Be very careful about supplements if you’re scheduled for surgery since some herbal supplements can increase bleeding or cause high blood pressure.

Supplementing a single nutrient or substance, such as vitamin E or B vitamins, is not advised unless your physician says you have a deficiency. More is not better, especially when it comes to vitamins and minerals, because some nutrients taken in excess can cause an imbalance in others. Even a water-soluble vitamin like vitamin C, when taken in excess, can cause stomach problems, including chronic diarrhea. Too much selenium can lead to hair loss, gastrointestinal upset, fatigue, and even nerve damage.

On the other hand, you might just be producing expensive urine? Excessive amounts of water-soluble vitamins, like vitamins C and B, are not used by the body and are flushed down the commode.

Although the American Medical Association recommends a multivitamin, other health experts say they’re not essential. But, taking a multi means you’ll consume at least the minimum daily requirement of essential vitamins and minerals without taking in too much of any single one.


And as we age, we metabolize medications differently, and that goes for herbal supplements too. MayoClinic.org recommends you take your herbs with a grain of salt:
• Follow instructions. Don’t exceed recommended dosages or take the herb for longer than recommended.
• Keep track of what you take. Take only one supplement at a time to determine if it’s effective. Make a note of what you take, and how much for how long, and how it affects you.
• Herbal products from some European countries are highly regulated and standardized. But toxic ingredients and prescription drugs have been found in supplements manufactured elsewhere, particularly China, India and Mexico.
Check alerts and advisories. The FDA maintains lists of supplements that are under regulatory review or that have been reported to cause adverse effects.


The best dietary supplement comes in cute little colorful packages called fruits and vegetables. Only 25% of Americans eat the minimum amount of fresh fruits and vegetables recommended by the USDA daily (5-9 servings, combined). In my next column, I’ll talk about the best places to invest your calories.


Even well-known brands have been found to not contain the active ingredients as advertised, and worse, can contain ingredients that can be hazardous to your health. Two third-party independent testing agencies, USP and NSF assure that products bearing their seal contain the ingredients that are listed on the label (and nothing more).



Susan Burke March

Susan Burke March

Susan Burke March, a Cuenca expat, is a Registered and Licensed Dietitian, a Certified Diabetes Educator who specializes in smart solutions for weight loss and diabetes-related weight management. She is... Read More

  • Steve

    Eat lots of meat and you’ll get all the best nutrients and vitamins known to man. No need for supplements.

  • Kenneth A. Merena Ph.D.

    What!? Does this mean that all the cures, potions, elixirs, compounds and incantations that I was offered in Vilcabamba to cure my various ailments won’t work? Even if I wear my tin foil hat? What about that water fast that promised to cure cancer? Is that out too? What about the “black salve” with the same promises?

    What’s a man to do? I was sure these quacks… er, folks, would be able to help me. What if I speak cool things, like “Namaste” when I am taking them? Will that help? What about crystals and laser lights? Are you telling me that there are really no magic potions? Sheesh!

    Okay, then how am I going to protect myself from the chemtrails?

    Kenneth A. Merena Ph.D.

  • belladonna

    I enjoy your column, even though much of this is not new information. I wonder if you might have some suggestions for people of retirement age who live alone? When you don’t have others to cook for, you can fall into bad habits, such as eating what’s convenient or eating too much because often, recipes are for more than one serving. I take supplements because I know that I often do not eat ‘healthy meals’.

  • Mary Kay Brautigan

    What about Q-10?

  • Susan Burke March

    Hi Belladonna, that’s a great comment, and very relevant to my column today. There are some good of tips that are offered in this article, http://www.med.nyu.edu/content?ChunkIID=47259 and my best advice is to break your meals out into small, mini-meals. It’s not necessary to have three squares daily – in fact, as we age, we need fewer calories, but that doesn’t mean we need less nutrition. Boost your nutrition by eating yogurt with nuts, dried fruits, seeds (sunflower/pumpkin) – you can make a couple of servings of oatmeal on Monday, and then enjoy it also on Tuesday so you don’t have to cook again, just re-heat. Take recipes that you enjoy and double or triple, and then save in portions that are right for you and freeze-reheat at your convenience. I like this website for some really practical strategies for eating and staying healthy. http://www.nlm.nih.gov/medlineplus/nutritionforseniors.html

    Feel free to email me directly at SusanTheDietitian@gmail.com for more information.

  • The last people/agency I would ever rely on is the FDA! If you mean by primary care physician, an M.D., I’ve had a few of them tell me about the ridiculously little training they received in med school concerning vitamins & nutrition. Numerous studies, some as early as the 1930s, show that the soils in the U.S. & elsewhere are so lacking nutrients as to render food of low quality, even if it’s actually organic. We rely on our naturopath’s review of bloodwork to know what supplements to take. My husband is a very picky eater, so for him, supplementation is a must, & if he goes without taking them, there’s a huge decline in him! We happen to live near Vilcabamba, but I can assure everyone that we’re not all carrying crystals & uttering incantations here.

  • Susan Burke March

    Hi Mary Kay: Here’s a good article from WebMD about CoQ10. “Although CoQ10 plays a key role in the body, most healthy people have enough CoQ10 naturally. There is some evidence that adding more — in the form of CoQ10 supplements — may be beneficial. Increasing age and some medical conditions are associated with dropping levels of CoQ10. But in these cases, it’s uncertain that adding CoQ10 will have an effect.” You can read more here: http://www.webmd.com/vitamins-and-supplements/lifestyle-guide-11/supplement-guide-coenzymeq10-coq10

  • Susan Burke March

    Some excellent points, Judy…I’m with you about geography – I never discriminate against people for where they live – hey, I used to live in Flagler Beach, FL, and…well, I better not go there! The point of my article is not that all people should not use supplements – it’s that for many people, they take supplements without understanding the (potentially) potent side effects, and I also want to provide the late-breaking info about the shady supplements that fraudulently carry labels describing non-existing ingredients and worse, supplements that while labeled “gluten-free”, contain wheat. And I provided some valuable links to agencies where readers can check food/drug/supplement interactions as well as see if the supplements they are taking carry the seal that assures quality.

    And I also think that working with a credentialed, educated health provider (as you and your husband are) who’s trained in biochemistry is necessary when taking supplements. Supplements are definitely indicated for some people who are deficient. Addressing the poor quality of American soil, I found a good article in Scientific American that says, “What can be done? The key to healthier produce is healthier soil. Alternating fields between growing seasons to give land time to restore would be one important step. Also, foregoing pesticides and fertilizers in favor of organic growing methods is good for the soil, the produce and its consumers. Those who want to get the most nutritious fruits and vegetables should buy regularly from local organic farmers. UT’s Davis warns that just because fruits and vegetables aren’t as healthy as they used to be doesn’t mean we should avoid them. “Vegetables are extraordinarily rich in nutrients and beneficial phytochemicals,” he reported. “They are still there, and vegetables and fruits are our best sources for these.”” I’ve pasted the link here, and thank you for reading and writing in! http://www.scientificamerican.com/article/soil-depletion-and-nutrition-loss/

  • Matthew

    The original gerontological and longevity studies were initiated by the government of Ecuador with support and co-sponsorship of Harvard University. The first investigative site interestingly enough was San Pedro de la Bendita, just a few kilometers up the road from Catamayo. The second was Vilcabamba. [which since, has ironically garnered all the kudos and laurels. So much for marketing…..] Those studies, when reviewed in tandem with research by Henri Coanda, Patrick and Crystal Gael Flanagan [look up – colloidal water research], verify that a simple diet derived from an ecologically un-compromised growing source, with simple herbal supplements combined with a regular daily intake of large quantities of colloidal water, was responsible, in the main, for the extraordinary longevity of the inhabitants of these sites. Having spoken with some of the most senior of residents in both pueblos, I can tell you, that when I say, ‘…most simple of diets, I mean, the most simple of diets…’ These folks ate mostly macrobiotically because that was, frankly, what was available at the time, ie, seasonally, where they lived. Food stuffs were predominantly home grown and home prepared, that’s to say ORGANIC, {this was prior to the advent of petrol-chemicals derivatives in all forms of cultivation}.

    All myths aside, these men and women worked very hard physically, walked a lot [!], and had a relatively stress free existence; that is, when it rained regularly. No glamor, no new age P.R., very few [if any at all] modern pharmaceuticals [they didn’t have the money and where they lived, they weren’t available]. Think early American pioneers, plus two generations… now you have the picture. As a personal anecdote, one of my friends here in Catamayo, remembers conversations with his grand dad (passed on at age 96?), who woke up at 5:30 a.m., six days a week to work a field one and a half hours walk away!!! Then, after working as many hours as possible prior to the onset of dusk, walked back home again! Try that some time folks! I mean just the walking part…. What did this guy eat? Mostly, the same thing day in and day out, varied by his crops, the local fruit in season and whatever he and his wife could afford to buy in the local market as variety. [No running to the doctor every time you had a cramp!]

    Now, overlay that scenario on the contemporary pandemic obesity in the U.S.of A (second most grossly obese nation on the planet – not to mention the 300,000 in hospital deaths annually [by the AMA’s own admission] by the administration of contra-indicated pharmaceuticals), and you see the real difference in distance between where the U.S., was and where it is today. Even pictures of servicemen in the Vietnam war show a predominately lean profile. What has happened…? There’s the real story….?

  • Josie

    Yes I agree somewhat that many pills don’t work but from my personal experience, I do find that some naturalpathic/Wholistic remedies and herbs do work.

  • Great article! I sold packaging and processing equipment to supplement manufacturers for about 20 years and almost all of it is “snake oil” . I don’t take supplements.

  • kit

    unfortunately, the New York State Study you site was biased with the sole purpose of discrediting supplements. It was based on methods that are not used to assess anything. remember that the death rate from supplements is miniscule whereas over one hundred thousand americans die annually from taking pharmaceuticals as prescribed.

    coq10 is critical if anyone takes a statin since it interferes with coq10 and is one of the reasons for the massive rise in congestive heart failure. unfortunately our food has perhaps 25% of the nutrition it had 100 years ago due to monoculture and poor agricultural practices.

    high doses of vitamins are sometimes warranted……certainly more advisable to take under the care of a knowledgeable practitioner.

    good resources to learn more include drmercola.com and naturalnews.com . relying on synthetic pharmaceuticals which the body cannot recognized versus herbs and methods which have been used for thousands of years is questionable at best and is partially responsible for the massive amount of chronic disease in the US and soon around the world.

    there is a massive effort by the pharmaceutical companies and their minions to discredit natural medicine so they can increase their profits. Incidentally, supplements ARE monitored thru the FDA and the 1994 law. One does need to research the sources of each product however there are many many good brands out there.

  • LadyMoon

    Since I know I don’t eat ‘properly’, I’d like to take a multi-vitamin as insurance. Does anyone know something I might find in Cuenca that is ‘good’?

    • Why don’t you eat properly? LOL! It’s so easy to do in Cuenca. Do you mean you don’t eat enough fruits and veggies? Regarding the multi, I spoke with a pharmacist at Fybeca and she said that all supplements in EC sold in pharmacies are regulated and inspected for purity and are certified to contain what’s on the label, unlike the supplements in the USA…so I’d speak with a pharmacist and get a recommended multivitamin with at least 100% of the RDA for essential nutrients. If you don’t want to take a supplement, some breakfast cereals are enriched with essential vitamins and minerals, such as Total cereal…but I’m not sure if it’s sold in EC?

      • LadyMoon

        I just do not LIKE fruit! Try to eat it twice a week but almost never do that. I don’t eat enough (quantity) of food…I think. Good news about the supplements in Cuenca! Thank you! (I think Total IS here…will check that too)

      • Delores

        As to all supplements in Ec. sold in pharmacies being “regulated and inspected for purity and certified to contain what’s on the label,” the children’s vit. C and zinc showed aspartame as one ingredient. There must have been other complaints besides mine and the next month and ever since the only ingredients shown are “vit. C and zinc”! We know tablets must have more than that just to hold them together! They are usually listed as “other ingredients.” But no longer on that product found in local pharmacies.
        When I had the pharmacy manager call the manufacturer to inquire as to the vit. B1 source of the children’s mult. vitamin (I do not use mononitrate), the company refused to disclose this, telling him only how important B vitamins are!
        In requiring full disclosure the US is not perfect but the CDC does pretty closely control vitamin ingredients disclosure in my experience.

  • Ramona

    “The elderly” and B12 from which source?
    As “the elderly” we found through blood testing (the Journal of Urology says urine testing for this is more accurate, but is often unavailable) we were not absorbing B12 in any one of several forms due to lack of the stomach’s intrinsic factor. We switched to injectable every two weeks which has given normal readings now for a couple of years.
    Yes, Steve, we alternate the best meat, fish, and chicken available here; however, those in advanced age, and even many younger folks, do not well digest and utilize the nutrients in foods for a number of reasons. Eating the best fresh, whole foods is very important but not the whole picture!

    • StillWatching

      Beautiful, Ramona, science, not quackery guided you. I applaud you but be careful if you go to Vilca’ as they have vigilantes looking for you there.

  • David Cooper

    another excellent article, Susan!! I love your articles, keep up the good work!!

  • The NY State attorney general’s action against manufacturers of discredited supplements stands and if you have references that say differently, please share. http://www.ag.ny.gov/press-release/ag-schneiderman-issues-cease-and-desist-letters-13-makers-devil%E2%80%99s-claw-supplements

    You’re missing the point of my article, especially by citing Joseph Mercola as a “good resource”…his website promotes “cures” and conspiracy theories, he’s against vaccinations that save lives, and has been discredited by regulatory agencies for making false claims about the products he sells. All pharmaceuticals are not “synthetic” and I’ve written previously about the value of traditional medicines as helpful for some conditions, but not for all. “Natural News” is more of the same. A place to find conspiracy theories, and “natural cures” for whatever ails you. My point of the article is to be sure you’re not self-treating a symptom with a supplement that may not be reliable, and I provide references to help you locate supplements that are reliable.

  • You might try roasting your fruit…it’s just such a different flavor. Pineapple, apples, pears…sturdy fruit, chunked up…roasted in the oven with maybe a sprinkle of balsamic vinegar…caramelizes the flavors and yum yum!

    • LadyMoon

      OH! Great reminder…I don’t do well with anything raw…thinking of a curried fruit recipe I love. Thanks!

  • StillWatching

    Susan beat me to it. If you can cite a REPUTABLE source refuting the NY State study, I’ll eat my tin foil hat.

    Let me break this to you gently; Mercola is a quack that is worse than any pharmaceutical company when it comes to hawking his own worthless products, and Natural news is a repository of pure garbage that is as bad as Mercola. I suppose you read Infowars as well. All conspiracy kooks have subscriptions.

    Perhaps you can tell us what you take to protect yourself from chemtrails.