Supplements: the real toxicity
RFK Jr says he wants data.
From 1995 through 2020, supplement-related liver failure requiring U.S. patients to be waitlisted for transplants increased eightfold, according to a 2022 study in the journal Liver Transplantation. In addition, a 2017 review in the journal Hepatology found that 20% of liver toxicity cases nationwide are tied to herbal and dietary supplements.
Drug-induced liver injury is a real thing. And it’s not reserved for chemicals requiring a script.
Yet in our world of binaries, we’ve created a division between pharmaceuticals and supplements—a political division dating back to the Dietary Supplement Health and Education Act of 1994.
To be clear, the division previously existed. The legislation, written by two senators that personally benefitted from the growing supplements lobby, essentially gave a free pass to an industry now valued at $192 billion. After that time, supplements became an increasingly popular monetization vehicle for fitness and wellness influencers, as well as right-wing pundits like Alex Jones. More and more people realized the cash grab available to them, which has dramatically mainstreamed a wide range of chemicals.
Of course, supplements have medical use. Doctors prescribe them. Some are well-studied. The number one supplier is Costco, which makes common supplements cheaply available. If you happen to not be deficient in the vitamin or mineral you’re taking, you’ll likely urinate it out. Waste of money, though not necessarily dangerous.
Until it is. As NBC News reports, liver toxicity from supplements is rare. But with more people ingesting them, more side effects are being recorded.
What is known is why cases are on the rise: More Americans are taking supplements. As many as 3 in 4 adults 18 and older take them, according to a 2024 survey by the Council for Responsible Nutrition, a trade group representing the dietary supplement and functional food industry. Almost 4 in 5 users said they prefer supplements to prescription or over-the-counter medications.
This is the result of marketing, not science. Supplements manufacturers are legally allowed to describe a relationship between a nutrient and reduced risk of a disease, with some conditions:
Must require FDA review and authorization before use
Must be supported by significant scientific agreement or an authoritative statement from a recognized scientific body
Must use FDA-approved language verbatim
May not state that the supplement “prevents,” “treats,” or “cures” diseases
The last bullet is reserved for clinical drug claims. Broadly, here are the supplements guardrails.
Wellness influencers have continually exploited loopholes in the regulations—or played loose with evidence and language. Since they need to upsell their premium versions of what people can otherwise purchase at Costco, wild health claims, often paired with claims of “purity,” become essential.
For example, chiropractor Will Cole sells a lot of branded supplements. One is huacapurana, an Amazonian tree anecdotally used to treat a range of health issues, including Lyme disease, fever, and colitis. No clinical trials have been published in peer-reviewed medical literature about its effect on humans. There’s at least one animal study—a precursor to clinical evidence, not a replacement for it.
Instead of directly making a medical claim, here’s how Cole positions his $57.60 dropper bottle:
Huacapurana is an extract made from the bark of Campsiandra angustifolia, a tree native to Peru and Northern Brazil, and used traditionally by native South American peoples to reduce inflammation and support gut and overall health*.
Huacapurana may help to maintain and support the health of red and white blood cells for healthy immune system function*. It may also help to support gut health*.
Here’s where the asterisk leads:
*Benefits assume daily use and are evidence-based estimates rooted in clinical science at the ingredient level. Individual results may vary.
That’s quite a mouthful of a disclaimer. I’m not sure how it holds up, as “evidence-based” is doing a lot of heavy lifting considering the animal trial was not on “immune system function” and treating colitis is not the same thing as supporting “gut health.”
Likewise, the idea that a supplement “supports” health is common in wellness doublespeak. It’s not healing you, it’s merely holding you up so you don’t fall down!
I’ve been playing this supplements game for years. You can read a much deeper dive into CBD here or watch my response to AG1’s marketing team sending me an email about their health claims:
You would hope that reports of increased liver toxicity would result in greater scrutiny of an industry that’s long gotten a free pass from presenting clinical evidence. Then you remember who’s in charge of America’s health regulatory bodies.
Here’s what RFK Jr posted in October:
If you believe a few months in office broadened his perspective, think again. While most news today is about Kennedy telling wellness hack Gary Brecka that he’s planning on banning federal scientists from publishing in journals like NEJM and the Lancet, this moment is also worth considering.
We’re going to end the war at FDA against alternative medicine: the war on stem cells, the war on chelating drugs, the war on peptides, the war on vitamins… FDA has a job: just do the science on these kind of issues and then tell the public what they’ve learned from the science.
As usual with Kennedy, it’s unclear what wars he’s referring to, or who’s fighting them:
Opposition to stem cell therapy has largely come from Republicans appeasing Christian nationalists and anti-abortion activists
Chelating drugs play an essential role in detoxification; they are not, as Kennedy suggests here, a “biohack”
There are currently over 60 peptide drugs approved for clinical use, with over 400 currently in clinical development
Vitamins are practically unregulated and can be easily and cheaply purchased (if you’re not buying an influencer’s branded version, that is)
Kennedy’s wars seem to be of his own making. He certainly has no interest in “just doing the science.” If he did, he’d look into the increasing (actual) toxicity due to the barely regulated supplements market he thinks is being “suppressed.”
Then again, MAHA has never actually been about health.
