Introduction
For most of my medical career, I did what millions of Americans do every morning: I lined up my bottles and swallowed a handful of pills. Multivitamin. Vitamin D. Fish oil. CoQ10. A probiotic. Sometimes more, depending on what I'd read that month.
I told myself I was being proactive. Preventing deficiencies. Optimizing my health. The bottles promised "immune support" and "heart health" and "cellular energy." The research seemed to back it up. Everyone I knew was doing the same thing. I may have been a little overboard. OK, a lot overboard but for more than thirty five years this topic has been a passion for me. I read many news letters. I attended many conferences. Information overload. So, naturally i would accumulate all of the new products and consume them by the handful.
Looking back, I wasn't being proactive. I was responding to marketing that had convinced me that I needed chemical insurance against problems I didn't have.
At 75, I still take supplements. But I take fewer supplements, and each one deliberately targets a specific deficiency. And, I continue to learn and refine.
What has gradually changed my thinking was discovering the gap between how supplements are regulated and how drugs are regulated. That gap has created a $60 billion industry where most products have never been tested for safety or effectiveness, where contamination is common, and where the evidence supporting their use in healthy people is remarkably thin. There are SO many supplement manufacturers. I would go to the exhibit halls at the functional medicine meetings. I would talk with the principles of the companies. I learned which companies were going the extra mile to investigate their sources and confirm the purity. I am still biased about who I trust.
This isn't an anti-supplement position. I still believe most people supplements for specific reasons. But the supplement industry has built a business model on convincing healthy, well-nourished Americans that they're deficient in things they're not deficient in, and that taking more of something is always better than addressing the actual problem.
Here's what I learned from reading studies that weren't funded by supplement companies.
The Numbers That Made Me Question Everything
Three out of four Americans take dietary supplements. That's 75% of us, up from just over half the population a decade ago. We spent $54 billion on supplements in the United States last year. Globally, the market is approaching $400 billion.
This is no longer cutting-edge biohacker behavior, it is mainstream health culture.
The most common reason people give for taking supplements is disease prevention. We're trying to avoid cancer, heart disease, cognitive decline. We believe that vitamins and minerals provide a safety net against the chronic diseases that kill most of us eventually.
Here's what bothered me when I looked at the data: if supplements were actually preventing disease at the scale we believe they are, we should see a signal in the population. With 75% of adults taking them—many for years or decades—there should be a detectable difference in disease rates between supplement users and non-users in large population studies.
In 2021, researchers published a study in the journal JAMA looking at data from over 30,000 adults tracked for years. They wanted to see if supplement use was associated with lower mortality. After controlling for diet quality, exercise, smoking, and other health behaviors, they found no association. People taking supplements weren't living longer than people who weren't.
That's not one study. That's the pattern across multiple large trials in the past five years.
The COSMOS trial followed 21,442 adults for three years. Half took a daily multivitamin. Half took a placebo. The multivitamin group showed no reduction in cancer, no reduction in cardiovascular events, no reduction in death from any cause.
The VITAL trial was even larger: 25,871 participants followed for over five years. They tested vitamin D and omega-3 fatty acids. No reduction in cancer. No reduction in heart attacks or strokes. No reduction in mortality.
These weren't poorly designed studies. These were rigorous, randomized, controlled trials—the gold standard of medical evidence. And they showed that for healthy, reasonably well-nourished adults, supplementation doesn't prevent the diseases we're taking them to prevent.
The U.S. Preventive Services Task Force reviewed all the evidence in 2022 and concluded there is insufficient evidence to recommend multivitamins for disease prevention in healthy adults. They went further for beta-carotene and vitamin E: they recommend against taking them because of potential harm.
This shifted my thinking. I had spent years taking supplements based on the assumption that more vitamins equals better health. The large-scale evidence doesn't support that assumption. At all.
The Deficiency Versus Optimization Problem
There's a critical distinction the supplement industry doesn't want you to think about too carefully: the difference between correcting a deficiency and optimizing an already adequate system.
When you're genuinely deficient in a nutrient, supplementation works. Dramatically. Give vitamin C to someone with scurvy and they recover. Give iron to someone with iron-deficiency anemia and their energy returns. Give vitamin B12 to a vegan with low B12 and their neurological symptoms improve.
Deficiency diseases are real. Supplementation to correct deficiencies is evidence-based medicine.
But the majority of Americans aren't deficient in most vitamins. National nutrition surveys show that fewer than 20% of adults are deficient in the vitamins found in a typical multivitamin. For some nutrients like vitamin C, deficiency is virtually nonexistent—less than 2% of the population.
The supplement industry has convinced us that "optimal" is somewhere above "adequate." They've created a moving target where normal lab values aren't good enough. You need to be at the top of the reference range. You need supraphysiologic levels.
This is where the science gets murky. Most vitamins and minerals don't have linear dose-response curves where more is always better. They have U-shaped curves. Too little is bad. Too much is also bad. There's a sweet spot in the middle.
Take vitamin D. The Endocrine Society released updated guidelines in 2024 recommending against routine vitamin D testing and supplementation for healthy adults under 75. Why? Because decades of research have failed to show that raising vitamin D levels above 20 nanograms per milliliter provides additional benefit for bone health, cardiovascular health, or mortality.
The Regulation Gap Nobody Talks About
Here's something I didn't learn in medical school because it wasn't relevant to how I practiced medicine: dietary supplements are not regulated like drugs. Not even close.
When a pharmaceutical company wants to sell a new medication, they need to prove two things to the FDA before a single pill reaches the market: the drug is safe and the drug works. This requires years of testing, multiple phases of clinical trials, and hundreds of millions of dollars.
Supplements require none of that.
In 1994, Congress passed the Dietary Supplement Health and Education Act, or DSHEA. This law classified supplements as a special category of food, not drugs. The practical effect: manufacturers can bring a supplement to market without proving it's safe or effective. They just have to notify the FDA that they're selling it.
The FDA can only act after a product is already on the market and causing harm. They have to prove it's dangerous. The burden is reversed.
This isn't a small regulatory difference. It's the reason there are now somewhere between 80,000 and 100,000 different dietary supplement products available in the United States, up from about 4,000 when DSHEA passed in 1994. The market exploded because the barrier to entry dropped to almost nothing.
Now I’m not saying that all this would be fixed if the FDA was involved. I talk in different articles about the many shortcomings and mistakes of the FDA. But in the current state of things a supplement company can manufacture a product in a facility with minimal quality control, make broad health claims, and sell it to millions of people without ever running a single human trial.
And that’s why you have a market flooded with products of wildly variable quality, many of which don't contain what the label says they contain, and some of which contain things that aren't listed on the label at all.
The Quality Crisis You Probably Don't Know About
In 2023, researchers published a study in JAMA analyzing 25 different melatonin gummy products. They tested the actual melatonin content against what the label claimed.
88% of the products were inaccurately labeled. Not by a small margin. Some contained as little as 74% of the claimed dose. Others contained 347% of the claimed dose. Five of the products contained CBD—which wasn't listed on the label at all.
This wasn't a study of sketchy products from unknown manufacturers. These were popular brands you'd find at Target or CVS.
The FDA maintains something called the Tainted Products Database. It's a list of supplements that have been found to contain undeclared pharmaceutical ingredients. As of the most recent count, there are over 1,000 products on this list.
The most commonly contaminated categories: sexual enhancement supplements, weight loss supplements, and bodybuilding supplements. Nearly half of sexual enhancement supplements tested contain sildenafil—the active ingredient in Viagra—or similar drugs. Weight loss supplements frequently contain sibutramine, a drug withdrawn from the market in 2010 because it increases the risk of heart attack and stroke.
These aren't trivial issues. People take these supplements thinking they're natural and safe. They're unknowingly taking pharmaceutical drugs at unknown doses without medical supervision.
Heavy metal contamination is another problem that gets less attention than it deserves. Consumer Reports tested 23 protein powder products in 2025 and found that 70% exceeded California's Proposition 65 threshold for lead. Plant-based protein powders averaged nine times more lead than dairy-based powders.
Lead doesn't have a safe level. Any exposure, particularly chronic low-level exposure from daily protein shakes, adds to your total body burden. This is especially concerning for younger people who are consuming these products regularly.
The mislabeling and contamination problems persist because enforcement is minimal. A 2023 analysis found that 29% of products that received FDA warning letters for safety violations were still available for sale years later. More than half still contained the prohibited ingredients the FDA had warned about.
I always assumed the industry had more oversight than it does. I knew to seek out quality products and those are more expensive. I’ve never been inclined to shop for those products at the large chain sellers. But, I wasn’t the average citizen buying something they saw on TV.I did assume that all of those sold would be safe and accurately labeled. That assumption was wrong.
When Supplements Actually Make Sense
To be clear, I'm not arguing that no one should ever take supplements. I'm arguing that supplementation should be targeted at documented needs, not universally diagnosed across the entire population.
There are situations where the evidence for supplementation is strong.
Pregnancy and folic acid. Women who may become pregnant need 400 to 800 micrograms of folic acid daily to prevent neural tube defects in developing fetuses. This is one of the clearest public health successes in supplementation. Neural tube defects dropped by more than 35% after folic acid fortification of grain products began in the United States.
Vitamin B12 for specific populations. Vegans need B12 supplementation because the vitamin is only found in animal products. Older adults often develop reduced stomach acid production, which impairs B12 absorption. People taking metformin for diabetes or proton pump inhibitors for reflux also commonly develop B12 deficiency. Testing confirms the deficiency, supplementation corrects it.
Iron for documented anemia. About 10% of non-pregnant women and up to 25% of pregnant women develop iron deficiency. If you have low ferritin levels and low hemoglobin, iron supplementation is appropriate. But iron supplementation without testing can cause problems—excess iron accumulates and may increase cardiovascular risk.
Vitamin D for certain groups. Despite my earlier comments about vitamin D, there are populations where supplementation makes sense. Adults over 75, pregnant women, and children between ages 1 and 18 all benefit from vitamin D supplementation according to current evidence. The key is targeting supplementation to groups with demonstrated benefit and checking a Vitamin D blood level.
Zinc lozenges for colds. This one surprised me. Zinc lozenges started within 24 hours of cold symptoms can reduce the duration of illness by about a third. The evidence is reasonably strong. The mechanism makes sense—zinc interferes with viral replication in the nasal passages. But this is acute treatment, not daily supplementation.
Probiotics for specific uses. Certain probiotic strains reduce the risk of antibiotic-associated diarrhea and may help with irritable bowel syndrome. The evidence is strain-specific. Lactobacillus rhamnosus GG works for antibiotic-associated diarrhea. Other strains don't. You can't just grab any probiotic and expect the same effect.
Notice the pattern: these are targeted interventions for specific populations or specific situations. They're not blanket recommendations for everyone to take everything.
The supplement industry makes money by convincing healthy people they're not healthy enough because they lack supplementation. They've medicalized normal aging and normal variation in energy levels and normal ups and downs. They've created a culture where we reach for a bottle instead of addressing sleep, stress, diet quality, or exercise habits.
The Economic Incentives That Shape What You're Told
There's a reason you hear more about supplements than about foundational health behaviors. The economics of the supplement industry create powerful incentives to promote products over practices.
A bottle of multivitamins costs maybe two dollars to manufacture and sells for twenty dollars or more. The profit margins are substantial. Compare that to telling someone to eat more vegetables, get eight hours of sleep, and take a 30-minute walk daily. There's no profit in that advice.
The research incentives are equally skewed. Natural compounds can't be patented. If a supplement company funds a study showing that a particular herb or vitamin prevents disease, any other company can immediately start selling the same product. There's no exclusivity period to recoup the research investment.
This is why the National Institutes of Health has spent only $2.4 billion on vitamin and mineral research since 1999, while pharmaceutical research funded by NIH contributed to 210 patented drugs worth over $100 billion between 2010 and 2016. The patent system creates financial incentives for pharmaceutical research that don't exist for supplements.
The result: most supplement research is either industry-funded (which introduces obvious bias) or consists of small mechanistic studies that show a compound does something interesting in cells or animals but never get tested properly in humans.
Only about 26% of supplement companies fund their own clinical studies. The rest rely on mechanistic plausibility, testimonials, and aggressive marketing.
I spent roughly $75 or more per month on supplements for years. That's $600 to $900 annually on products that, for the most part, weren't providing any measurable benefit. Multiply that across tens of millions of Americans and you understand why the industry defends the current regulatory system so vigorously.
Senator Orrin Hatch, who championed DSHEA in 1994, represented Utah—home to a $7 billion supplement industry. Multiple former Hatch staffers became supplement industry lobbyists. When Senator John McCain proposed stricter supplement regulation in 2010, the industry mobilized opposition and the legislation failed.
As I’ve said before, I am not trying to be conspiratorial, I'm simply describing incentive structures. The system is designed to favor product proliferation and permissive regulation. It's working exactly as designed.
What I'm Taking Now (And Why)
After going through all of this research, here's what's left in my supplement cabinet:
Vitamin B12, 1000 micrograms daily. I'm 75. My intrinsic factor production has declined. I had my B12 level checked and it was ____ per milliliter—technically normal but on the lower end. I supplemented for six months and retested: 580 pg/mL. I continue taking it because the evidence for B12 supplementation in older adults is solid, the cost is minimal, and there's essentially no downside.
Magnesium glycinate, 200 milligrams before bed. This one is more subjective. I notice better sleep quality when I take it. Magnesium deficiency is relatively common—some nutrition surveys suggest 45% of Americans don't get adequate dietary magnesium. I haven't had my red blood cell magnesium tested (which is more accurate than serum levels), but given the high prevalence of insufficiency and the low risk, I'm comfortable with this one.
Creatine monohydrate, 5 grams daily. Creatine is one of the most studied supplements in existence with consistent evidence for maintaining muscle mass and strength in older adults. A 2023 meta-analysis found that creatine supplementation combined with resistance training improved muscle mass and functional capacity in adults over 65. I'm training for my 90s. This is a tool that helps me maintain the muscle mass I need for independence.
I tend to have at least one and usually more protein smoothies per day. To a whey protein powder I add the creatine powder. I usually also add spirulina and chlorella powders.I do take a fish oil supplement and I like Krill oil in particular.
Coenzyme Q 10 has been a staple of mine for years.
I often have several others and those change over time as I have and lose enthusiasm for them.
The shift wasn't about becoming anti-supplement. It was about applying the same standard of evidence to supplements that I'd apply to any medical intervention: is there a documented problem, and does this intervention address that problem better than alternatives? What’s the downside over the expense.
How to Navigate the Supplement Landscape
If you're going to take supplements, here's the practical framework I use now.
Start with testing, not assumptions. You can't correct a deficiency you haven't documented. A comprehensive metabolic panel plus vitamin D, B12, and ferritin covers most of the common deficiencies. There are now several labs that have extensive panels with more than 100 biomarkers and the cost is relatively cheap ($200-500) and that cost is dramatically lower than if your doctor ordered them.
Look for third-party certification. USP (United States Pharmacopeia), NSF International, and ConsumerLab.com all test supplements for quality. USP has verified about 1,000 supplement products. NSF has certified several hundred more. ConsumerLab tests products independently and publishes the results (subscription required).
Only about 12% of supplements carry third-party certification. This immediately narrows the field. If a company won't submit to independent testing, ask yourself why.
Understand risk stratification by category. Not all supplements carry the same contamination risk. Basic vitamins and minerals from major brands (Nature Made, Kirkland, NOW Foods) have relatively low rates of quality issues when third-party tested. Herbal products and specialty supplements have moderate risk—ConsumerLab finds that more than 25% fail quality testing. Bodybuilding supplements, weight loss products, and sexual enhancement supplements are highest risk. The FDA's Tainted Products Database is 97% these three categories.
I avoid the high-risk categories entirely. The contamination risk isn't worth it. That’s why I tend to stick with companies I trust.
Be skeptical of disease claims. If a supplement bottle says it "treats," "cures," or "prevents" a specific disease, that's an illegal claim under FDA regulations. The company is either ignorant of the rules or deliberately violating them. Neither scenario suggests a trustworthy manufacturer.
Legal structure-function claims are vague: "supports immune health," "promotes cardiovascular function," "maintains healthy joints." These phrases are carefully written to imply benefit without making testable claims. Treat them as marketing, not evidence.
Calculate the actual cost. Supplements marketed for longevity or optimization tend to be expensive. A quality NAD+ precursor runs $80 to $120 per month. Specialized mitochondrial blends can exceed $150 monthly. Before committing to ongoing supplementation, calculate the annual cost and ask whether that money might be better spent on other health investments: a gym membership, higher-quality food, a continuous glucose monitor to understand your metabolic responses, or saving for future healthcare needs.
Question the premise. The single most important thing I learned from this research: the default should be why should you supplement unless there's a specific reason to supplement. This is the opposite of how supplement marketing works, which assumes everyone needs everything and the only question is which brand to buy.
Before you supplement, ask yourself “how clean is my diet?” Your body evolved to extract nutrients from food. Whole foods contain thousands of compounds we don't fully understand that work together in ways isolated supplements don't replicate. A 2025 study found that people who got their vitamins from food had lower mortality than people who got the same vitamins from supplements, even after controlling for overall diet quality.
The explanation isn't clear yet, but it suggests that the form matters. Nutrients in food come packaged with cofactors, fiber, phytonutrients, and other bioactive compounds that supplements lack.
The Bottom Line
There are legitimate uses for specific supplements in specific populations. Folic acid for women who may become pregnant. B12 for vegans and older adults. Iron for documented anemia. Vitamin D for elderly adults, pregnant women, and children. These are targeted interventions with supporting evidence.
But the baseline should be skepticism, not assumption. Test before you supplement. Choose third-party certified products. Avoid high-risk categories. Question whether you're addressing a real deficiency or responding to marketing.
At 75, I continue to supplement more than I would advise for most of my patients. I admit that I am my own guinea pig. I’m always looking for products that produce a noticeable change in the way I feel.
The industry wants you to believe that more is better, that optimization requires supplementation, that normal aging needs pharmaceutical intervention. The evidence doesn't support these claims. For most of us, what we need is better sleep, regular movement, stress management, and real food. Not more bottles.