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Supplements Kill

Cover image for Supplements Kill
March 13, 20255 min readAdam Schorr

Intro

Dietary supplements include vitamins, minerals, herbs, amino acids, and other substances people take to add nutrients to their diets and support their health. They are often beneficial—folic acid, for example, helps prevent birth defects—but they also carry real risks. An Ipsos survey shows 74% of Americans use them, with 83% trusting the industry [1], yet few recognize how dangerous they can be.

Supplements are not Harmless

Emily, 23 and otherwise healthy, took a popular 'all-natural' supplement and landed in acute liver failure, requiring a transplant [2]. Like most, she assumed it was harmless.

This 'harmless' reputation leads to massive underreporting of supplement-related harm: experts estimate that only about 2% of supplement related adverse events are ever reported [3]. The huge variety of supplements increases the chance of unreported dangerous side effects [4]. One estimate points to 23,005 emergency department visits each year, with 2,154 hospitalizations caused by supplement-related issues [5]; the true numbers are likely much larger due to underreporting.

This is because there is little regulation, and analyses call for 'stricter regulations' because many supplements have unproven benefits yet frequently cause liver injuries [6]. As Dr. JoAnn Manson puts it, "Only a tiny fraction of the dietary supplements on the market have been rigorously tested for efficacy or safety" [7].

This has led to the FDA receiving over 15,000 supplement-related reports, including 339 deaths and almost 4,000 hospitalizations between 2004 and 2013 [3]. Even 'mild' supplements can cause ER visits. Many young adults have experienced heart palpitations, chest pain, or heart attacks from 'weight-loss' and 'energy' products [5].

Logan Stiner, an 18-year-old wrestler, died from a lethal dose of pure caffeine powder sold as an "energy" supplement. His bloodstream had caffeine levels 23 times higher than a typical coffee drinker's [8]. OxyElite Pro caused liver failure in a 45-year-old and serious liver injuries in 56 others in 13 states, leading to one death and multiple transplants [9].

Supplements may seem "all-natural," but in some ways they cause more harm than potent medications. In 2014, herbal products caused 20% of U.S. drug-related liver injuries [10], and supplement-induced liver failure may be more likely to result in death or transplant than pharmaceuticals [2][10].

Mixing Mayhem

Mixing Mayhem Hero Image

While the risks of using these supplements alone are alarming, combining them with other drugs or supplements can amplify these dangers [11][12][13].

  • St. John's wort can speed up how the body processes certain drugs, making them less effective. It has caused acute rejection in heart transplant patients by lowering their anti-rejection meds [15][16]. It also makes birth control pills less effective and can dangerously raise serotonin levels if combined with antidepressants.
  • Ginkgo biloba can amplify the effect of the blood thinner warfarin, risking severe bleeding or stroke [17][18][19]. High-dose garlic, ginger, and other herbs can pose similar dangers [19].
  • Licorice root can cause electrolyte imbalances, and yohimbe can spike blood pressure if combined with stimulants or antidepressants.

Because most people don't think of supplements as 'drugs,' they often don't mention them to doctors or research potential interactions, with 7 in 10 surgery patients failing to disclose herbal remedies, risking harmful outcomes [14].

Labels Lie

When labels can't be trusted, even supplements that appear safe may be dangerous. Many products—especially for weight loss, muscle gain, or sexual enhancement—hide pharmaceutical compounds or harmful chemicals [3]. A study found 51% of dietary supplements have labels that don't match the actual contents [20].

  • Pai You Guo had banned sibutramine at twice the old prescription dose, causing heart palpitations and anxiety [21].
  • OxyElite Pro contained fluoxetine (Prozac) in at least one batch, risking severe mental and physical side effects for unsuspecting users [9].

These are just a few examples of the many supplements containing hidden compounds. This is why independent third-party testing (e.g. NSF, USP, and Informed Choice) with accessible Certificates of Analysis (CoAs) is essential.

Example CoA

CoA Example Image

Legal but Dangerous

Supplements that pose serious health risks are on the market, bearing the same disclaimer as safe supplements.

FDA Disclaimer Image
  • Bitter orange (Citrus aurantium) contains synephrine, a stimulant linked to heart attacks and strokes even in healthy people [23].
  • Yohimbe can spike blood pressure or lead to heart problems; kava can cause liver failure.
  • Other plants like chaparral, coltsfoot, comfrey, aconite, and pennyroyal oil have led to organ damage or death yet remain on the market [24].
  • Excess vitamins (e.g., vitamin A, B6) also harm the liver or nerves, with nearly 64,000 U.S. vitamin-overdose reports in 2016 [25][26].

Regulators can't ban a supplement until many injuries have already happened. Ephedra was used for weight loss in the 1990s, despite a long trail of heart attacks, strokes, seizures, and 155+ deaths—it wasn't removed from shelves until 2004 [27]. DMAA stayed on the market years after being connected to severe hypertension, bleeding in the brain, and sudden cardiac death, including at least six deaths in the U.S. military [22][28].

Supplement Safer

From the stories of individuals like Emily and Logan to the overwhelming statistics, it's clear that dietary supplements can pose major dangers. Due to industry lobbying, lack of funding, and cultural embedding, sufficient regulation is unlikely [1][29][30]. This is why there is "a critical need for reliable information" [31]. Here are a few steps to help you stay informed:

  1. Research Each Supplement Thoroughly
    Even if it's legal and sold widely, it can still be risky.
  2. Verify Third-Party Testing
    Look for trusted groups like NSF, USP, or Informed Choice, and ensure you have access to Certificates of Analysis (CoAs) as many supplements claim third-party testing without actually doing it.
  3. Watch for Interactions
    Interactions can be dangerous, so ensure your supplements do not dangerously interact with the other supplements and/or medications you're taking.
  4. Pay Close Attention to Your Body
    You're unique. Consider your preexisting conditions, metabolism, allergies, etc.

Supplement AI makes this process easier by identifying interactions, conducting rigorous research for you, and tailoring its recommendations to your needs—all while remaining free from industry bias.

Supplements kill, but by supplementing safely you can protect your health while reaping the benefits of dietary supplementation.

References

  1. Nine in ten dietary or nutritional supplement users agree that dietary supplements are essential to maintaining their health | Ipsos. (2023, October 13). https://www.ipsos.com/en-us/nine-ten-dietary-or-nutritional-supplement-users-agree-dietary-supplements-are-essential
  2. Castro • •, B. (2019, December 31). Doctors Believe Health Supplement Led to 23-Year-Old's Acute Liver Failure. NBC 5 Dallas-Fort Worth. https://www.nbcdfw.com/news/health/doctors-believe-health-supplement-led-to-23-year-olds-acute-liver-failure/2284635
  3. Richardson, E., Akkas, F., & Cadwallader, A. B. (2022). What Should Dietary Supplement Oversight Look Like in the US? AMA Journal of Ethics, 24(5), 402–409. https://doi.org/10.1001/amajethics.2022.402
  4. Dwyer, J., Coates, P., & Smith, M. (2018). Dietary Supplements: regulatory challenges and research resources. Nutrients, 10(1), 41. https://doi.org/10.3390/nu10010041
  5. Geller, A. I., Shehab, N., Weidle, N. J., Lovegrove, M. C., Wolpert, B. J., Timbo, B. B., Mozersky, R. P., & Budnitz, D. S. (2015). Emergency department visits for adverse events related to dietary supplements. New England Journal of Medicine, 373(16), 1531–1540. https://doi.org/10.1056/nejmsa1504267
  6. García-Cortés, M., Robles-Díaz, M., Ortega-Alonso, A., Medina-Caliz, I., & Andrade, R. (2016). Hepatotoxicity by Dietary Supplements: A Tabular listing and Clinical characteristics. International Journal of Molecular Sciences, 17(4), 537. https://doi.org/10.3390/ijms17040537
  7. Nutritional supplements and vitamins are more popular than ever. Do they work? (2025, January 5). NBC News. https://www.nbcnews.com/health/health-news/do-nutritional-supplements-really-work-regulation-rcna186045
  8. Court: Amazon not liable in teen's powdered caffeine death. https://spectrumnews1.com/ap-online/2020/10/01/court-amazon-not-liable-in-teens-powdered-caffeine-death
  9. Public Notification: Oxy ELITE Pro Super Thermogenic contains hidden drug ingredient. FDA. https://www.fda.gov/drugs/medication-health-fraud/public-notification-oxy-elite-pro-super-thermogenic-contains-hidden-drug-ingredient
  10. Liver injury caused by herbals, dietary supplements rises in study population. ScienceDaily. https://www.sciencedaily.com/releases/2014/09/140904084608.htm
  11. Ronis, M. J., Pedersen, K. B., & Watt, J. (2017). Adverse effects of nutraceuticals and dietary supplements. The Annual Review of Pharmacology and Toxicology, 58(1), 583–601. https://doi.org/10.1146/annurev-pharmtox-010617-052844
  12. Levy, I., Attias, S., Ben‑Arye, E., Goldstein, L., & Schiff, E. (2016). Adverse events associated with interactions with dietary and herbal supplements among inpatients. British Journal of Clinical Pharmacology, 83(4), 836–845. https://doi.org/10.1111/bcp.13158
  13. Gardiner, P., Filippelli, A. C., Sadikova, E., White, L. F., & Jack, B. W. (2015). Medication and Dietary Supplement Interactions among a Low-Income, Hospitalized Patient Population Who Take Cardiac Medications. Evidence-based Complementary and Alternative Medicine, 2015, 1–8. https://doi.org/10.1155/2015/429826
  14. R. Davis, 'Patients Fail to Fess Up on Herbal Remedies,' USA Today, 29 May 2000.
  15. Ruschitzka, F., Meier, P. J., Turina, M., Lüscher, T. F., & Noll, G. (2000). Acute heart transplant rejection due to St. John's wort. Lancet, 355(9203), 548–549. https://doi.org/10.1016/S0140-6736(99)05467-7
  16. St. John's wort Information | Mount Sinai—New York. https://www.mountsinai.org/health-library/herb/st-johns-wort
  17. Warfarin: eat, drink and be wary. Medsafe. https://www.medsafe.govt.nz/profs/PUArticles/December2022/Warfarin-eat-drink-and-be-wary.html
  18. Tan, C. S. S., & Lee, S. W. H. (2020). Warfarin and food, herbal or dietary supplement interactions: A systematic review. British Journal of Clinical Pharmacology, 87(2), 352–374. https://doi.org/10.1111/bcp.14404
  19. Moeinipour, A., Abbassi Teshnizi, M., Manafi, B., Yavari, H., Moeinipour, Y., & Hoseinikhah, H. (2017). Possible interaction of warfarin with peppermint herbal tea: A case report. Reviews in Clinical Medicine. https://rcm.mums.ac.ir/article_7899.html
  20. Navarro, V., Avula, B., Khan, I., Verma, M., Seeff, L., Serrano, J., Stolz, A., Fontana, R., & Ahmad, J. (2019). The Contents of Herbal and Dietary Supplements Implicated in Liver Injury in the United States Are Frequently Mislabeled. Hepatology Communications, 3(6), 792–794. https://doi.org/10.1002/hep4.1346
  21. Cohen, P. A., Benner, C., & McCormick, D. (2012). Use of a pharmaceutically adulterated dietary supplement, Pai You Guo, among Brazilian-born women in the United States. Journal of General Internal Medicine, 27(1), 51–56. https://doi.org/10.1007/s11606-011-1828-0
  22. Army News Service. (2013, April 19). Soldier deaths spur campaign against supplements. Army University Press. https://www.armyupress.army.mil/Journals/NCO-Journal/Archives/2013/April/Supplements/
  23. Bitter Orange: Usefulness and Safety. NCCIH. https://www.nccih.nih.gov/health/bitter-orange
  24. Tanne J. H. (2004). US consumer group names "dirty dozen" dietary supplements. BMJ, 328(7446), 975. https://doi.org/10.1136/bmj.328.7446.975-c
  25. Hypervitaminosis. (2024). In Wikipedia. https://en.wikipedia.org/wiki/Hypervitaminosis
  26. Gummin, D. D., Mowry, J. B., Spyker, D. A., Brooks, D. E., Fraser, M. O., & Banner, W. (2017). 2016 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 34th Annual Report. Clinical Toxicology, 55(10), 1072–1254. https://doi.org/10.1080/15563650.2017.1388087
  27. Agency finalizes ban on ephedra – Deseret News. https://www.deseret.com/2004/2/7/19810978/agency-finalizes-ban-on-ephedra
  28. Lieberman, H. R., Austin, K. G., & Farina, E. K. (2018). Surveillance of the armed forces as a sentinel system for detecting adverse effects of dietary supplements. Public Health Nutrition, 21(5), 882–887. https://pmc.ncbi.nlm.nih.gov/articles/PMC5848759/
  29. Binns, C. W., Lee, M. K., & Lee, A. H. (2018). Problems and Prospects: Public Health Regulation of Dietary Supplements. Annual Review of Public Health, 39, 403–420. https://doi.org/10.1146/annurev-publhealth-040617-013638
  30. Brown, E. (2019, June 21). How the Dietary Supplement Industry Keeps Regulation at bay. OpenSecrets News. https://www.opensecrets.org/news/2019/06/dietary-supplements-industry-keeps-regulation/
  31. Djaoudene, O., Romano, A., Bradai, Y. D., Zebiri, F., Ouchene, A., Yousfi, Y., Amrane-Abider, M., Sahraoui-Remini, Y., & Madani, K. (2023). A Global Overview of Dietary Supplements: Regulation, Market Trends, Usage during the COVID-19 Pandemic, and Health Effects. Nutrients, 15(15), 3320. https://doi.org/10.3390/nu15153320
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