The Future of Dietary Supplements Under Trump’s FDA
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Tickets at Exploratorium.edu slash After Dark. From KQED. From KQED in San Francisco, I'm Leslie McClurg. In today for Mina Kim, coming up on Forum, supplements have become a multi-billion dollar industry with little oversight, leading to health risks and concerns about their safety. And Robert F. Kennedy Jr. is calling for less regulation in the name of alternative health.

We talk about what actually works and what doesn't and what the future of supplements could look like under RFK's leadership. That's next after this news. Welcome to Forum. I'm Leslie McClurg. I'm in today for Mina Kim. And every morning this time of year, I pop a handful of vitamins. They're supposed to be good for my immune system. They're expensive. And I honestly don't have any idea if they actually work.

Apparently, I'm not alone, though. 75% of the country takes supplements, and the nation's likely top health official says he takes a fistful every morning. Robert F. Kennedy Jr. is a big fan of nutraceuticals, and he's really not so worried about the evidence.

So does that mean that a lot of snake oil is going to fly off store shelves? We're going to talk about which supplements are healthy and which ones could be dangerous. We are joined by Nicholas Florco. He's a staff writer at The Atlantic. Marilee Opetzo, she's a behavioral and learning scientist and a registered dietitian at Stanford's Prevention Research Center. And we're going to talk about what supplements are healthy and which ones could be dangerous.

and Dr. S. Bryn Austin, epidemiologist and professor of social and behavioral sciences at Harvard School of Health. Welcome to all of you. Marilee, let's just start with some basics. What exactly falls into the category of supplements?

A lot more than you think. Pretty much anything that's not a drug that comes in a pill. So vitamins, gummy vitamins, powders such as protein or creatine or green drinks, those are all kind of under the purview of supplements. It's pretty widespread.

I, like I mentioned there earlier, you know, because it's cold and flu season, I take a handful of vitamins every morning. And that's based because, you know, a good friend of mine who's at Health Net told me that they are supposed to work. So it's not really a solid medical source. How would you say most people determine whether or not they need or should take a supplement?

Yeah, some, a lot of people come to me because they have a symptom that they really want to try to address. A lot of people come and say they saw it on Instagram or exactly like you, a friend told them they take it and they feel amazing. So they should as well. And how are supplements regulated?

They are not regulated, actually. After an act passed, the Disha Act in 1994, there is no oversight committee on any of these supplements. So what we can do is come up with research after the fact, once it's been put on the shelf, and try to build a case to say that it's unsafe or that it should be removed from the shelves. But to get on the shelves, you actually don't have any oversight at all.

And why aren't they regulated like medications are?

That's a good question. I think that the why to that is basically it would be a really long time and a lot of research to do that. The rapid speed at which these things come out far exceeds the pace of what it takes for a FDA trial from idea to the

So basically not very feasible investment.

Nick, most of us know what the FDA is. I think fewer of us know exactly what the agency does. So can you just kind of talk about what the FDA does as an agency and what role they play in supplements? Yeah, absolutely. So

Basically, we think of the FDA, we think of them approving drugs that come on the market. As Merrilee said, drugs typically are reviewed for safety and efficacy before they hit the shelves. So drug makers are doing these big studies to figure out both the drug is safe and that it works. With dietary supplements, we have much less regulation from the FDA.

As Merrilee said, there's no pre-market review of these products. So dietary supplement companies aren't submitting these clinical trials that show their products work to regulators. Instead, the products go on the market and then the FDA has to figure out whether folks are playing by the rules. And there's sort of two major rules. I mean, the first is a product can't be actually dangerous. If it is dangerous, the FDA can pull it off the market if there's shows of harm. And then the second is really about the claims that these products make.

So dietary supplements can't say, for example, that they cure a specific condition. They can't say our vitamin cures cancer. They have to be a bit more vague. So they say things like it supports bone health or it supports the immune system. And when companies toe that line, that's when the FDA typically gets involved, sends them a warning and tries to take some action to protect customers. And if we go all the way back, remind us how the FDA start. How did this agency begin and why did it begin?

Well, it began to protect people from snake oil. I mean, it began to make sure that the products that we have on the market were safe and effective. So in a lot of ways, it is sort of there to prevent what we're talking about now, which is this influx of products coming on the market that we don't actually know if they work, if they're a waste of money, or if they could actually land you in the hospital.

And yet this agency that was started to do that to protect us from snake oil, RFK doesn't seem to be a huge fan. Back in October, he tweeted, quote, FDA's war on public health is about to end. This includes its aggressive suppression of psychedelics, peptides, stem cells, raw milk,

If you work for the FDA and are part of this corrupt system, I have two messages for you. Number one, preserve your records. Number two, pack your bags. Number three, don't be a drug addict.

That's a lot. I mean, I like sunshine. I think there's some that's good in this quote, but obviously some that's questionable in terms of the science behind some of these items. Bryn, what do you make of the overall take we've heard from RFK about supplements?

RFK is sending the wrong message. He talks about how he's using the products, but he's also really putting out a confused message about who runs the supplements industry. In that quote you just read from his post on X,

He said he wants to support all the products that can't be patented by pharma. But that's not the case. The supplements industry is a multibillion dollar industry. They most definitely have patented their products and they are profiting hand over fist. This is upwards of a 60 billion dollar industry per year just in the U.S. And this is really a global industry. So he's putting out

disinformation really about what this industry is doing. And that is frightening. That is frightening to those of us in public health to see a champion of pseudoscience may soon be running all of the health and human services in the U.S. Do you then disagree that, like he's saying, the FDA should have less authority over this industry? Would you like to see the FDA have more authority over the supplement industry?

As has been described, FDA's hands have already been

tide. Back in 1994, when the Deshaies Act was passed, it made it impossible for the FDA to require rigorous pre-screening of supplements before they go to market, not for safety and not for any of the claims that these companies are making. So they already have very little oversight. You put a champion of pseudoscience in charge of the agency, I shudder to think what's going to happen to the American marketplace in dietary supplements.

Nick, we just mentioned that tweet, or I read that tweet, which is, you know, fairly sensational, I would say. Did we get any concrete thoughts about what RFK Jr. is going to do during his recent Senate confirmation hearings in relationship to supplements? Unfortunately, we didn't. And I wish he would have clarified because it's quite interesting to hear him claiming aggressive suppression of these products.

just because they are so loosely regulated. Hardly anyone that I speak to is talking about how the FDA is being too hard on the supplement industry. And the other thing that I think is really fascinating coming out of these hearings was when you contrast RFK's view on supplements to his view on food.

In the food space, he keeps arguing that there isn't enough regulation of the things that are going into our food, our food additives. We need to step up FDA oversight. This is hurting children. It's hurting adults, all these things. But then you look at his views on supplements, and he's essentially saying we need less regulation when we already have such minimal regulation. It's kind of fascinating, and I'm

I'm really eager to see what he does here because no one that I've talked to has any good sense of exactly how you're going to loosen those regulations even more than they already are. Well, if he is confirmed as director of HHS, which it looks like he will be, does he have the power to carry out his agenda to do what he is vowing he will do?

So, I mean, he won't be the FDA commissioner who actually leads the day-to-day work of the FDA, but he will be the FDA commissioner's boss. So...

That's a lot of power there. And I think it kind of depends on what he decides to try to do. I mean, you could imagine a scenario where the HHS secretary tells the FDA commissioner, maybe let's focus our enforcement efforts on these other areas. Maybe we spend a little bit less time on dietary supplements. Maybe we cut the dietary supplement budget. Maybe folks get reassigned to other departments. Those sorts of things I feel like could happen. But I

Honestly, it'll be interesting to see if he does that because there is already such little enforcement going on. So cutting that further wouldn't make that big of a difference compared to where we are because we're almost there now. Bryn, RFK is an environmental lawyer. What are his medical credentials? About zero, I would say. He's got no medical training, no nursing training, no public health training, no scientific training. He's

unqualified to say the least for this position. This has been stated over and over and over, but we know that qualifications is not what's getting him nominated here. It's allegiance to the president.

This is what concerns us about somebody like that running the agency. But as Nick said, we don't know ultimately if he is appointed to the position. We don't know ultimately how he's going to spend his time. And that's something that we'll have to see how that plays out. But what I can tell you is that the supplements industry is absolutely gleeful over this. I mean, they're writing articles in their own publications about how excited they are for the idea of

the lifting of the paltry enforcement that's happening now. They're going to be pushing for trying to get supplements covered in SNAP and in medical reimbursements accounts, which right now is not legal. They're not able to do that because these are not evidence-based products. If they were to change that, that's really going to amp up the kind of predatory practices we see of these companies going for low-income communities.

We're talking about dietary supplements like those for weight loss, muscle building, boosting your immunity. We're going to get into all of the different products and what could happen under RFK's leadership. Stay with us after this break. We'll be right back. Hi, I'm Bianca Taylor. I'm the host of KQED's daily news podcast, The Latest.

Powered by our award-winning newsroom, the latest keeps you in the know because it updates all day long. It's trusted local news in real time on your schedule. Look for the latest from KQED wherever you get your podcasts and stay connected to all things Bay Area in 20 minutes or less.

You're listening to Forum. I'm Leslie McClurg. I'm in today for Mina Kim, and we are talking about dietary supplements, everything that helps you lose weight or build muscle, or might not, depending on what we're talking about. We are joined by Nicholas Florco, staff writer at The Atlantic, Marilee Opetzo, registered dietitian at Stanford's Prevention Research Center, and Dr. S. Bryn Austin, epidemiologist and professor of social and behavioral sciences at Harvard School of Public Health,

We'd love to hear from you. Do you have any vitamin or supplement questions? Do you have questions about how to assess their quality? Email your comments, your questions to forum at kqed.org, or you can find us on X, Facebook, Instagram, or at KQED Forum. Or you can just give us a call right now at 866-733-6786. Again, that's 866-733-6786. Steve on Discord writes...

RFK Jr. is an odd duck. He's actually a strong advocate for whole food nutrition, for example, pushing for whole foods instead of ultra-processed food in school lunches. I find him and his policies and beliefs to cause me a bit of whiplash between strongly agreeing and strongly disagreeing, depending when he opens his mouth.

And Nicole on Discord writes, people who advocate for supplements say they are needed because we don't get enough nutrients from our food produced by the industrial food system. Curious to know if RFK Jr. would want more people to use supplements or to make food more nutritious in his Maha agenda. Nick, have we heard from RFK Jr. on that specifically? We have, in fact. I feel like the

Probably the most prominent message of Maha right now is about reforming our food system. There is this focus on whole foods, staying away from ultra-processed foods. It's really interesting, though, because like the first call-in said, you know,

This is just really at odds with his views on supplements. It's very interesting to see the two of them put next to each other. And then the other piece of this that is interesting is just the fact that RFK and Maha has talked a lot about transforming the food system, things like school lunches, SNAP. But in reality, even if RFK gets the job at the Department of Health and Human Services, he'll have no power to do those sorts of things. That's all within the purview of the Department of Agriculture, which, of course, he is not named to lead.

Just so folks know, SNAP stands for Supplemental Nutrition Assistance Program. It basically provides food benefits to low-income families, just so people can track that. Brynn, let's talk about some of these individual supplements. Which ones do you have the most concerns about? Which ones could be potentially dangerous? One of the areas that I specialize in is adolescent health, the health of young people. And we focus a lot on eating disorders prevention, promoting healthy body image.

These products, particularly targeting young people around weight loss, muscle building, detox, these are the ones we are most concerned about. We've seen again and again studies coming out about how these products are laced with dangerous ingredients. We've found illegal steroids, pharmaceutical drugs, excessive stimulants, heavy metals. There have even been found

experimental drugs not approved for human use showing up in some of these products. Now, go to the social media platforms. They are littered with influencers who are pushing these products specifically to young people. But they can be really downright dangerous. They don't work. They're not medically recommended. They can cause strokes, heartburn.

heart attack, liver injury. They're actually products that are marketed as if they're healthy and effective actually can cause liver failure or kidney failure. This concerns us, of course, when they're sold to kids. So it's the weight loss, the muscle building, detox are some of the worst offenders. Also know that the kind that are marketed for sexual function, those are also some of the worst offenders. I would say to any listeners, stay away from these products.

Is there any particular ingredients that you want to call out as particularly dangerous or just those general buckets?

Well, there's lots of dangerous ingredients. What they don't do, often they don't do like they should, is disclose what's in the products in enough detail. So repeatedly, they've been found that it may say one thing on the label, but it's actually something else that's quite different in the product. But what they usually do claim as common is to say they have green tea or green tea extract. Don't be fooled by that.

Green tea, it sounds healthy. It's, you know, many of us drink green tea. That's fine. But the form it comes in and these supplements as an extract, that is actually a liver toxin. They don't tell you what the full 10 syllable chemical name is for what that is, but that is a liver toxin. But it gives this gloss of the health halo is what these kinds of products are hiding under. But don't be fooled by that marketing language.

You've also highlighted nutraceuticals. This is a subtype of a dietary supplement. What are those and what should we know about them?

I would say all of these different kinds of terms I would categorize under pseudoscience there. It used to be back, go back a century or two, they were called elixirs and potions. That's the same as what we have now, the kind of snake oil we have now, but they put these scientific sounding names on them. But again, don't be fooled by that. These products have not been rigorously tested and they have not had to provide any evidence that they work.

for what they claim. And that's because of the very lax regulation. Tamara asks, is there a scientific consensus on the benefits of magnesium? I started taking it to help with my sleep, which is just one of its supposed benefits. I would love to know if those claims are backed by any kind of evidence. And also, how do I determine which form of magnesium is best for me? Marilee?

Yeah, well, the magnesium literature is vast. It kind of depends if you're deficient in the first place. So I like to tell people if they're going to be taking a supplement,

They should have some biomarker or some measure that they believe that they can measure to show change because we're really bad at causal inference. So if someone thinks that they're deficient in magnesium, do you have a reason to believe that you are in the first place? And did you get a recommendation from a doctor as opposed to like, wow, I have trouble sleeping. Maybe I'll take this thing.

There is a lot, because it's an essential mineral, more research around magnesium than some of these other nutraceutical things that are out there. And magnesium is used in a non-bioavailable form to actually improve GI motility. That's the magnesium that you don't absorb. And then there's a magnesium that you do absorb that would be used in the body.

I think that there's some literature that's a little thin, in my opinion, yet to believe that it's going to help for sleep. I'm not quite sure that we have a forum that...

crosses the blood brain barrier and that we even know that if it did. But yeah, magnesium as an essential mineral has more research around it, mostly in the deficiency literature. So if somebody is deficient and then they replace it, then they see benefits. Not meaning if you are not deficient and take more of it, then you're going to get more benefits.

Let's go to the phones. Edward in Oakland, you're on the air. Yeah, I'm a retired physician. And back in the day when I was practicing, I noticed that a lot of my patients who were taking a supplement that contained glucosamine were developing blood pressure problems, cardiac arrhythmia problems. And so I started to research this and found out that

in fact, glucosamine could have these side effects. And so I said, well, why are they allowing this to happen? And so I looked into the Snake Oil Act. And basically what I found was the Snake Oil Act was propagated by Orrin Hatch, the senator from Utah. And what I then found out, of course, was that all of these companies that were making

supplements were based in Utah. And it was like a pork barrel legislation almost. And Hatch pushed this through. And the justification for it

was that these items are foods. They're not drugs. And one of your commenters did make note of that, that there are certain restrictions in terms of saying, oh, it can't cure a particular disease, but it can support arthritis health or immune health. And it's all a matter of following the money.

So the Snake Oil Act from 1994 did a great disservice to the public, but at the same time made a lot of people in Utah very rich. Brent, do you want to add anything there?

It's absolutely right. I named the snake oil act for Dachet. I might use that from now on because that's absolutely what it is. And an orange hatch is credited, although in infamy, I would say, for pushing that through. And that's what tied the hands of the FDA so that the FDA couldn't require rigorous prescreening for safety before these products go to market. And what that

What that law has done is it basically has turned Americans, including our kids, into the lab rats for this industry. Because it's not until after the FDA discovers that one of these products is having really dangerous effects on consumers that the FDA then can step in, just like the caller described.

Nick, what do you foresee? We've talked a lot about RFK Jr. and him being on tap for HHS. But what about who's on tap to lead the FDA and what direction do you think he will take on supplements?

Yeah, absolutely. So President Trump's nominee for the FDA is a man named Martin Macari. He's a surgeon over at Johns Hopkins University. And it's interesting, I haven't seen him say much about supplements directly. He's largely aligned with RFK in this sense of

questioning current medicine and approaches towards medicine. So, you know, he's written a book about like all the different blind spots that he sees among his colleagues in how we treat people. And I would say generally you could put him in this space of enthusiasts around sort of like functional medicine, for example. So,

I don't want to say one way or the other whether he is pro or anti-supplements because I haven't seen him say that, but I would say generally that approach, those functional medicine type approaches, are folks who are a little bit more open to the idea of supplements. And I'll

I'll say, too, the one thing here that I think is really important just to point out is, you know, the tragedy of an act like DeShea is that it has ceased the research that we would want to see around these products. I think, you know, there's a lot of concern about dietary supplements, but there's

The problem is we don't get the research to actually test whether they work. There's a chance that some of these products actually could deliver good for people, but we need the studies to actually do that. And when you have a law that allows you to put products on the market without doing those studies, there's no incentive to then do those studies.

So I think that's really the piece of this that worries me the most is we have all of this excitement around supplements happening right now, but no one's talking about, hey, why don't we put a lot more money into testing these products? Because maybe there is some benefit for some of them, but we need to actually figure that out with good science.

On that note, Marilee, would you say there is a bucket that is helpful? I mean, some of us do have vitamin and mineral deficiencies, and those supplements really are necessary medically. So how would you frame what's good for us and how do folks ensure that they are following that track?

Yeah, it's a good question. I hate to say that everyone's a snowflake, but really everyone is. Like, you see all these lists of side effects on the drug commercials, right? And everyone's like, oh, wow, I don't want to take a drug because listen to all those side effects. But what everyone's been saying is the reason why they have that list of side effects is because it's been tested. Right.

And any of these supplements, if they had a commercial and they were actually backed by decades of research, they would have a list of side effects too. If they actually work and do something in your body, you can bet that it'll probably do other things in your body that the supplement company is not telling you because they haven't actually identified it in a rigorous way or had any incentive to do so.

And for the supplements that do quote unquote work, yeah, I really like to address deficiencies in people if they have a deficiency.

I think a food first approach is great, but I think for some of them, you know, it's really hard to get there, especially as we get older, you know, it gets harder to eat that much or chewing is hard. So I think that there are places where supplements can help augment an already food first diet approach. So I'd be hesitant to list out the supplements that I think are beneficial, but

but versus not beneficial. But I definitely tend to err towards things that are naturally present in food that people might not be getting enough of or have some medical reason why they might not be absorbing this. Just real quickly, you mentioned there that it sounds like you would prefer food first. Just talk about that a little bit instead of finding your supplements. Well, it is interesting because when you say food first,

Everyone's like, well, that must mean whole foods. It's funny because if you have a bowl of cereal, it's pretty much like you're having a multivitamin. So a lot of foods are fortified just with that clarification. But if you just have a

I like to say whole foods, plant-first diet, you get a lot of the basic nutrition that you need. You get a lot of fiber from whole foods. So if you grind up greens into a powder, for example, and dehydrate it, you probably heat kill any nutrients in there. And you're not even sure that you're getting the original food matrix that all of these nutrients were part of. But if you eat

kale instead of powdering your drink with it. You get a lot of things from that kale, which is the food first, as opposed to a powdered version of it. You get actual fiber, you're chewing it. You have some of the phytochemicals in it, which are plant chemicals that are good for your body and in a dose that they can absorb. So there's other things that you get from eating the actual food.

Barbara writes, supplements are here to stay. A danger lies in the assumption that supplements and herbs are natural and therefore safe. One example is Herba Ephedra or Mu Wong. For many years, Mu Wong was touted as a way to lose weight and get a good workout. It was not until unregulated use started causing heart attacks that attention was given to safety. While I believe people should be proactive about health care, I think it must be acknowledged that marketing these supplements and herbs needs oversight.

Lauren writes, I have worked in the supplement industry for close to 20 years and know that all of the companies we carry have biochemists on their staff that test the herbs, aminos, vitamins, and minerals to ensure they are the actual supplement. Many people want to take something more natural than a prescription or over-the-counter drug that causes a variety of side effects. Herbs have been used for centuries as medicine. Our Western way of pharmaceuticals is not the only one. Thoughts there, Bryn?

Sure. I mean, you're making a good point that people are looking for alternatives for a few different reasons. One of them is if they're not satisfied with what pharmaceuticals are available to them or the medical treatment they're getting. Another reason people are looking for alternatives is when they're shut out of the medical system. That's where they don't have insurance. They don't have adequate insurance. They don't have access.

or they're mistreated when they go to the medical system. We did a study recently where we compared across states that expanded Medicaid so that has made access to health care more accessible or they did not expand it. What we found is that people living in states where Medicaid was not expanded, so people had less access to the health care system, were more likely to use supplements. And

And that really speaks to this point that people need alternatives. There's some criticism of pharmaceuticals, criticism of the health care system, and certainly criticism of access to care. This is all being leveraged by the supplements industry to sell their snake oil to these folks. So that's where I come down here. People need alternatives at times, but this isn't the type of product that's going to get them there.

Nick, we're about to go to a break, but what are you going to be looking for in these next few weeks, months, given the fact that RFK is likely to be confirmed?

Well, I'm really just going to be looking at the FDA's enforcement actions. You know, they post all these warning letters that they send to companies on their website. I'm going to be very curious to see if the ones targeting dietary supplements go away. And with that, I'm going to be looking at online marketplaces and seeing sort of how the supplement industry is adapting, if they feel emboldened to be making claims that they maybe wouldn't have otherwise have made.

And I think, too, you know, the reason why I'm so interested in these issues is not just with, of course, it impacts public health, and that's really important. But also, I think one of the tragedies of the law here is just the fact that, you know, there is, you can't tell which companies are safe and which aren't. And we really, without that oversight, it's really difficult just to tell who's a good actor and who isn't. Thank you, Nick. We'll be right back after this break to continue talking about supplements. Stay with us.

You're listening to Forum. I'm Leslie McClure again today for Meena Kim, and we're talking about dietary supplements, whether they work, whether they don't, and what's on tap under the new administration. We're joined by Nicholas Florco. He's a staff writer at The Atlantic. Marilee Opetzo, behavioral and learning scientist and registered dietitian at Stanford's Prevention Research Center. And Dr. Esperin Austin, epidemiologist and professor of social and behavioral sciences at Harvard School of Public Health.

Nick, I just want to give you a chance. Was there anything you wanted to continue in your thought before we cut you off before the break?

No worries at all. I mean, I guess what I was getting at is reacting to the last caller who had talked about being in the industry and seeing folks in the industry that really do care. And I think that's really the difficult part here is that because there's no oversight really from the FDA, it's really hard to differentiate between the companies that legitimately are trying to create products to help folks and companies

are trying to advance science in some way, and those who just want to try to sell something to make a quick buck. It's really hard for the average consumer to tell the difference. And it's often even hard for us experts to tell the difference unless you actually, you know, get under the hood and do some chemistry experiments and figure out what's in these supplements. I mean, it's, it's really difficult to actually know who is who is a good actor and who isn't.

Skid on Discord writes, I would be curious to have your guest comment on homeopathic drugs being regulated by the FDA versus dietary supplements, which ostensibly make similar claims about being regulated under the Dietary Supplement Health and Education Act. How do the regulative bodies compare? Bryn, do you know that? Oh, gosh, I think I have to punt that one over to Nick. Homeopathic medications.

Yeah, I mean, homeopathic medications are really interesting. And sometimes there's just really tragic results. I mean, one of the cases that really stands out to me is there was these homeopathic teething tablets that were harming and at times killing children who are going through teething. You know, the FDA, again, has a very, very loose regulation on homeopathic products. And

You know, there's often there's just this concern that like the products won't work, that somebody will go into the store, they have a cold and they buy a homeopathic product and don't realize it and they don't get any relief. But there's also these situations where there are products that are actually dangerous and cause lasting harm, like these teething tablets, for example. Let's go back to the phones. Peggy in Montara, you're on the air.

Thank you. I subscribe online to a website, consumerlabs.com, and they do extensive research on supplements, pages and pages on each supplement, like 30 pages. They list all the benefits. They list all the side effects. Then they take...

the individual supplements and they test them for heavy metals. Do they actually have what they say they do? And then they rate them from not approved to approved to, and then they compare cost. And my doctors haven't had any problems with the supplements that I've chosen from that. It's a wonderful resource and I hope your listeners can get benefit from it. Thank you.

Marilee, would you agree with that caller? Yeah, I love Consumer Lab. I think it's a good topic to bring up. I am a member of that because I support their services. It's a third-party verification service. So they'll go in and take select brands of supplements and they test just like US Pharmacopoeia does this as well and NSF International. They go in to see, now they don't test for effectiveness, right?

But they do test to see identity. Does the supplement contain all the ingredients indicated on the label? Potency, the potency of the product, which is indicated on the label, is accurately represented. So meaning like it's saying this is going to be this amount of this drug or this supplement, and is it correct? Correct.

purity, which is like, does it have heavy metals in it or other contaminants that they test for? And then bioavailability. So it's like, is it going to actually get absorbed into your body? Now, I don't use consumer labs for their sum up of the research or their takeaway on it. They do do a great job of co,

a lot of the research on each supplement, but I don't use them to tell me whether or not this supplement is effective. But I do love the site for what it does to make sure if you've already bought in and this is what you are going to do and this is what you're going to take,

The consumers should definitely find a third party tested supplement. So at least if this thing, whether or not it works or not, has been tested to have what it says it has on the label, doesn't have contaminants and will get absorbed into your body. Again, I want to emphasize that it doesn't mean that it's been tested for all the risk profiles or effectiveness. Let's stay with the phones. Dave in Mountain View, you're on the air.

Morning. I get my information a lot of times off the web between, say, like Google Scholar. You can find tons of, you know, the latest research and the oldest research. And would you believe on YouTube there's a bunch of PhDs that publish all sorts of good information all the time and have different perspectives and talk about the same things? And it's all very educational.

Nick, what would you say of finding your information on the web? I mean, the caller's right. There is good information on the web. There's just a problem where not everyone is literate enough in the scientific literature to know what is reputable or what isn't. I mean, and that's why we have regulations. That's why we have the FDA so that

Everyone who is curious about a supplement doesn't have to then dig into hundreds of pages of academic studies on Google Scholar or trust that the person they're watching on YouTube doesn't have some sort of hidden financial interest in one of these companies and they actually know what they're talking about.

I think it's right. You can, you know, you can do your own research and be safe, but that's not a substitute for actually having a regulatory system that protects everyone, not just those who know how to read this literature.

Kyler writes, I've mostly ignored supplements, but I recently started taking turmeric because I heard a couple of studies that found some correlation, not necessary causation. Don't really feel any different. Part of taking turmeric is maybe more for my mental health for me. Shows that I'm doing something kind for my body and showing myself I care about myself. I'm pretty sure this common food is not going to harm me. But does your guest have any views on powdered turmeric encased in capsules? It's definitely all the rage. What do you think, Marilee?

It looks like Bryn also has some thoughts. Yeah, I am aware that it is all the rage, but I also would say that it's not always like free of contaminants. And there has been some reports of turmeric supplements causing liver toxicity. So I kind of bring the caller back to making sure that there's a third party verification at the very least.

If you're signed up for this, for giving yourself a feeling of taking care of your health, I love that. I just want to make sure that you get at least a non-contaminated sample that's been tested by a third party. So there have been reports of bad effects from turmeric supplements, from my awareness. Brynn, do you want to add anything?

Just in general, the problem with trying to find it online around the pseudoscience is put out there. The point was made earlier that the incentives are not to have rigorous research done because products can go to market before they're tested. Merrilees emphasized that.

We don't have any evidence on most of these products that they actually work. We just finished another study where we looked at 72 randomized control trials. So trials designed to evaluate the effect of dietary supplements on weight loss. So we know that that's a big part of the market is the ones sold with claims to lead to weight loss.

Well, what we looked for is who paid for those studies. Nearly 90% of these studies in the last five years were actually paid for by companies that sell supplements, either their parent company subsidiary or they do themselves. So that makes it really hard for the consumer to be able to parse through that and figure out where is this more like a conflicted pseudoscience trying to get me to buy something.

Talk about your study on the role of TikTok as well. I thought that was kind of fascinating and on point. Certainly, yeah. Our group does a lot of research and research around supplements. And one of the studies we recently finished and published was looking at the most popular videos on TikTok. This was led by my colleague, Amanda Rafoul, looking at the most popular videos of

hashtag diet pills, hashtag detox, hashtag pre-workout, which is often what the muscle building supplements are sold under. And then the team evaluated, well, do they have any evidence for the claims they're making? And virtually none of them provided any evidence to support any of the claims around weight loss or muscle building or so-called detox. And they also did not reveal where the funding came from. We know influencers will get paid

by companies to promote their products and none of them, nearly none of them had gave any information along those lines. What's most worrisome is that if these are videos on TikTok, these are being marketed directly to children, to children and young people. And that's what concerns us the most. Consumer labs might be a great resource, but what 12-year-olds going there before they evaluate a product? And yet these kinds of dangerous products are sold to kids

all over the country, except New York State. New York State, I'm going to share with the readers, New York State last year made it illegal to sell the weight loss and muscle building supplements directly to children. That includes online and in stores if they're younger than 18 years old. And it's just a common sense protection that we could have in place right here in California and all across the country just to protect kids from all of this deception around supplements.

Kathleen asks, is the USP, that's the United States Pharmacopoeia, logo on supplements reliable? I've heard that the USP logo means that what the marker says is in the supplement is actually true in the kind and quantity stated. Also heard that USP is a voluntary thing that makes makers submit their products too. How reliable is this stamp, Marilee?

Yeah, so I think USP, which is US Pharmacopoeia, the colors, right? The NSF, National Sanitation Foundation, and, you know, or a third party site like Consumer Lab, they actually do have testing of that bottle, that batch, that supplement to say that it does have what it says it has in it.

that the ingredients on the label are accurately represented, that they don't have contaminants, and that it's bioavailable. So I would trust the USP symbol. Now, again, I just want to emphasize that doesn't mean that the structure function claims or the claims that the supplement makes is going to be true. And it doesn't mean that they've tested for side effects. All it's saying is that at least when you buy this bottle and it says USP, that little symbol on it, you know you're getting what's in the bottle.

And you know it's bioavailable. We are not telling you that this is necessarily going to do what you think it's going to do or that it's free from, you know, it's been tested for all of these various side effects and risk profiles. You're listening to Forum. I'm Leslie McClurg in today for Mina Kim, and we are talking about the world of supplements. Let's go to another caller, Eric, in San Francisco. You're on the air.

To myself, turmeric was a trigger of sorts. It seemed to wrap the snake oil conversation around Ayurvedic and Eastern medicine. While there may not be scientific proof that turmeric, for example, is an anti-inflammatory, there are two billion people in the world who use it.

And it falls right into your food first comment in that when you go to an Indian restaurant, there's food, there's turmeric in the food. Your thoughts? Brynn? I think the challenge with supplements is it is not like eating a meal. And also the idea of the ultra-processed, many of the supplements out on the market actually are ultra-processed.

And we don't know often what's in the bottle. Now, eating a healthful diet, wonderful, all for that. Traditional diets, wonderful. But once you get the commercial interests involved in this with very little regulation, that's where we're running into trouble. Marilee, I want to talk about the framework that you've developed to vet supplements. Walk us through how a consumer should decide whether or not they need a supplement and then how to go about finding it.

Yeah. Okay. I don't, again, when I say vet, I kind of mean like, this isn't to say that this is definitely going to be something you should take, but I always walk people through this. First, why do you think you need this in the first place? Do you have a symptom that you're feeling is not being heard? Do you have a friend who told you an ad that made you curious? Did a dietician tell you this?

And then why this supplement? Do you have an influencer that, you know, listed all of these claims and claims to have read the research? Did you read the original research? Did you work with a professional who is literate in the scientific literature to tell you, you know, what are, what is the evidence that might help support this supplement for you? So,

I think that first has to be a big why. Why are you doing it? Why the supplement? Do you have any good evidence and belief in solid background that this should be something that you should even take in the first place? So I kind of try to stop people there. The next part is what are the risks?

Let's pretend the supplement does have an effect and maybe no scientist is up on it yet. And this happens to be this magic thing, but we don't have any research behind it yet. And you've decided you're taking it. Has anyone looked at it? If it does have an effect, let's pretend it might be doing other things in your body that have not been tested. So just be aware of the risk profile when you go into this. What is the benefit you think you're going to get? And what is the potential risks that haven't been identified yet?

And then if you've gotten through those two steps and you're like, nope, I want to take this, how will you know it's working? Are you going to take a photo of something? Do you have a biomarker or an objective test of what you expect and hope to change to show up? It's not always a blood test, right? Like your calcium in your blood is not a marker of how much calcium is in your bones. So you can't use that to tell if this supplement is working.

So we're really bad at causal inference. So can you find something objective that you can use to show you once you've gotten this far that you will see the change that you're hoping for? And then finally, if you've made it through all of these checkpoints, which brand to get? And that's where I'm saying get a third party verification at the very minimal. A USP, NSF certified, something on Consumer Labs certified.

Because there is no incentive, as both Nick and Bryn have pointed out, there's no incentive for the company to go and show you all of this, you know, background information to show you that it's safe, that it's free from contaminants, that they don't have any other ingredients in there. There's little to no incentive. And that doesn't mean that these companies are all nefarious, but it is expensive to do that.

So, there's not a lot of incentive because there's no requirement. So, just doing a diligent background check on why, why do you think you need it? What's the evidence behind it? What's the possible risks? How will you know it's working? And then make sure you get third-party verification. And I would also highly, highly suggest you work with a trained professional, a registered dietitian, or a PhD in nutritional science.

or a clinician that is trained in nutritional science would be where I would start. Marilee, we're bumping up against the end of the hour, but I want to give people tangible advice. What do you want people to leave this conversation knowing?

I think everyone's made some good points about the cause-pre-pause. Just because it's natural doesn't mean it's necessarily good in that form. And yeah, I think just proceed with caution when you have these promises of something that's so easy. Just take a pill. What's the harm? I think that there's a lot of harm that we don't think about. And that's what I hope the conversation today has been.

Need a winner. Brandon, our final 30 seconds. Any thoughts from you? Cause for pause might work for adults, but we got to do more to protect children. This is complicated. The federal government's going in the other direction. States can step up like New York did. Let's put common sense protections in for children and don't sell weight loss and muscle building supplements to kids.

That's it. Thank you so much for joining us. That was Nick Florco, staff writer for The Atlantic, Marilee Opetzo, behavioral and learning scientist at Stanford, and Dr. S. Brin, Austin epidemiologist and professor of social and behavioral sciences at Harvard. Thank you to all of our listeners. Have a wonderful weekend.

Funds for the production of Forum are provided by the John S. and James L. Knight Foundation, the Generosity Foundation, and the Corporation for Public Broadcasting.