Imagine walking into Whole Foods and passing an aisle overflowing with vibrant bottles and wellness promises. You feel healthy enough, but you’re still drawn to apple cider vinegar gummies that claim to burn fat, bee pollen capsules promising an immunity boost and Ashwagandha pledging to clear brain fog. Without a second thought, you find yourself at the checkout, spending more than expected, buying supplements without truly understanding what you’re consuming.

Americans spend $30 billion a year on quick fixes to their health. The global dietary supplements market, according to Veri, is booming, projected to reach $200 billion by 2025. Stores and online markets have catalogs dedicated to health claimed vitamins, pills, and powders– yet none of these items are regulated, nor have plans to be.

While dietary supplements can be effective for addressing nutrient deficiencies or supporting poor diets, their role is often misunderstood. Common supplements like protein powder, calcium, vitamin D, and prenatals offer proven benefits. According to the NIH, they can help maintain strong bones, reduce birth defects, and improve heart health. Immunocompromised populations, pregnant women, and older adults are some of the essential consumers of supplements. Since supplements are conveniently packed into pills or gummies, they’re effortlessly integrated into daily routines with minimal time or preparation. Although supplements play a crucial role in helping people manage their health, they can not take the place of a nutritious diet– which is integral to a healthy eating routine.

Because supplements are sold over the counter and are readily accessible, consumers can choose and use them freely. While this accessibility allows people to support their health, it also introduces risks. Supplements can interact dangerously with medications or harm health if taken in incorrect dosages.

Health researchers from the University of Michigan, Ann Arbor, reviewed data from 2017 to 2021, covering 9,685 people, and found that nearly 4.7% of U.S. adults had used at least one potentially toxic supplement within the previous 30 days. In fact, nearly 15 million Americans take supplements that may be toxic to their liver. This may be due to the lack of regulation within the market, misinformation, and product labeling. The U.S. Drug Induced Liver Injury Network found that 51% of supplement products were mislabeled and failed to have chemical contents that match the label. With this in mind, we must question if some of the businesses within the supplement industry have their consumers’ best interests in mind.

As the name suggests, the Food and Drug Administration (FDA) regulates food products and drugs, but leaves the oversight of supplements largely to the discretion of the companies that produce them. The Dietary Supplement Health and Education Act (DSHEA) of 1994 amended the Federal Food, Drug, and Cosmetic Act (FD&C Act), defining the term “dietary supplement” and outlining the FDA’s role in regulation. Under this act, the FDA does not pre-approve dietary supplements for safety or effectiveness before they reach consumers. It is the responsibility of supplement manufacturers to ensure their products meet safety standards and comply with regulations. Labels must feature a “Supplement Facts” panel that details serving size, ingredient amounts, and a declaration that the product is a “dietary supplement” or similar description. Therefore, the FDA’s role only commences after a product enters the market. With periodic inspections, the FDA monitors adverse events reported by companies, healthcare professionals, and consumers. But, what happens when it’s too late?

Consider the case of a 40-year-old woman who, in pursuit of weight loss, began taking Hydroxycut—a popular over-the-counter supplement. Within weeks, she developed Acute Hepatitis, leading to jaundice and severe liver dysfunction. Despite hospitalization and intensive care, her condition deteriorated, culminating in liver failure that necessitated a transplant. This tragic outcome underscores the potential dangers of unregulated supplements, and highlights the critical need for stringent FDA oversight to prevent such life-threatening incidents.

Consumers are often misinformed about the science behind the supplements they use, which minimizes complaints and allows illegitimate companies to profit from misleading health claims. Many people blindly purchase new supplements in pursuit of optimal health, only to consume sugar-filled gummies that function more as snacks than medicine. Healthline mentions that gummy vitamins contain ingredients such as cornstarch, sugar alcohols, gelatin, and food coloring to give them an appealing taste and texture. These ingredients may do more harm than good as increased sugar consumption is linked to the development of metabolic diseases, like diabetes and obesity. Moreover, because of their addictive taste, gummy supplements are often over-consumed or taken at improper doses, which may contribute to the aforementioned health risks.

Celebrity influence has also amplified the allure of supplements, turning them into status symbols. Brands like Kourtney Kardashian Barker’s ‘Lemme,’ markets to young women with promises of boosted focus, regulated blood sugar, and more, leveraging aesthetics and celebrity status over scientific backing. They entice their customers through their vegan, non-GMO products and not to mention, aesthetically pleasing bottles. Lemme Purr (a vaginal probiotic from Barker’s brand) has been under investigation due to their false health claims. More specifically, Dr. Melanie Bone – an OBGYN and member of Daye’s medical board, a gynecological health research and development company – previously stated that since vaginas are self-cleaning, products that play on false insecurities about women’s health should be treated with caution. Active ingredients such as pineapple extract reduce the credibility of the brand and its purpose. This trend is part of a larger industry pattern where companies capitalize on trust in public figures, while avoiding stringent scrutiny. Similar marketing tactics can be seen with other wellness influencers who promote unverified benefits, underscoring the need for better oversight.

Herbalife is another well-known example of how misleading marketing can raise questions about transparency in the supplement industry. The company, which markets nutritional products like protein shakes and vitamins, agreed to a $200 million settlement with the Federal Trade Commission (FTC) in 2016 over accusations that it misled consumers about earning potential through its multi-level marketing model. Although not officially labeled as a pyramid scheme, Herbalife was compelled to restructure its practices and improve its income disclosures to distributors. Moreover, the safety of some Herbalife products has been scrutinized, with reports linking them to potential liver damage and other health issues. While Herbalife maintains that its products are backed by research, critics note that these studies often involve company-sponsored investigations, which may not be fully impartial. The brand’s history undermines the broader issue of how supplement companies use aggressive and sometimes deceptive marketing to attract consumers, raising questions about regulatory supervision and consumer protection.

The FDA must strengthen pre-market regulations and enforce clearer safety standards for supplements. However, consumers also play a role. By seeking advice from healthcare professionals before starting new supplements and scrutinizing claims — no matter how appealing the packaging or who endorses it — we can collectively reduce health risks. Look for third-party certifications, like USP or NSF, to ensure quality, and avoid supplements with vague ingredient lists or exaggerated claims. Focus on a balanced diet as the primary source of nutrients, using supplements only to fill gaps. Research ingredients through credible sources like the NIH, monitor for side effects, and report adverse reactions to the FDA’s MedWatch program. Stay informed about FDA warnings and recalls, and prioritize education to make informed decisions that will prevent falling for trends or misleading marketing. Enhanced consumer awareness and education, paired with robust regulation, are crucial to safeguarding health in an industry that often prioritizes profit over transparency.

It’s hard to think of an ailment for which there isn’t a supplement that promises relief — and Australia’s fastest growing chronic condition is no exception.

With one person estimated to develop diabetes every five minutes, it’s no surprise there are a host of vitamins, minerals and herbs that claim to improve metabolism and lower blood sugar levels.

Earlier this week, the ABC revealed diabetes experts were being used to falsely promote dietary supplements and peddle harmful health advice in deepfake online scams.

It’s prompted concerns people may forgo diabetes medicines in favour of over-the-counter and often unproven vitamins and minerals.

So what’s the evidence for supplements when it comes to type 2 diabetes, and could there be any harms?

Remind me, how does diabetes work?

Diabetes is a chronic health condition in which a person has too much glucose in their blood. Glucose is the body’s primary source of energy and it comes from the food you eat.

“Your body uses a hormone called insulin to help move glucose from the bloodstream into your cells for energy or for storage,” said Melinda Coughlan, a nutrition scientist at Monash University.

“In diabetes, this system doesn’t work properly, leading to high blood sugar levels, and this can cause serious health problems over time.”

Unlike type 1 diabetes, an autoimmune disease in which the body’s insulin-producing cells have been destroyed by the body’s immune system, type 2 diabetes occurs when the body becomes resistant to and gradually loses the ability to produce insulin.

“This type is more common and often linked to lifestyle factors like obesity, inactivity and poor diet,” Professor Coughlan said.

How is diabetes normally treated?

People with type 1 diabetes rely on taking insulin everyday — through injections or delivery devices such as insulin pumps — to ensure they stay within their target glucose range.

Those with type 2 diabetes, on the other hand, can often manage the condition, at least initially, with healthy eating and regular physical activity.

“Diet is really crucial because what you eat directly impacts your blood sugar levels but also your insulin sensitivity,” Professor Coughlan said.

“You want to limit refined carbohydrates — sugars and high glycaemic index foods like white bread, pastries and sugary drinks — and you want to opt for complex carbohydrates, such as wholegrains, legumes and non-starchy vegetables.”

Exercise is also important because it helps increase your “glucose disposal rate”, Professor Coughlan said, so your body uses glucose effectively rather than storing it as fat, which can further drive insulin resistance.

However, many people with type 2 diabetes eventually require medicine as their body’s ability to produce insulin further deteriorates.

Metformin, a drug which improves insulin sensitivity, is the most common first-line treatment, but there are several classes of diabetes drugs available, endocrinologist and diabetes researcher Jonathan Shaw said.

“The reason we use metformin and a range of other drugs is that they have been studied very carefully,” Professor Shaw, who is also deputy director of the Baker Heart and Diabetes Institute, said.

“We have established, typically in multiple clinical trials … that they actually lower blood glucose, and that they’re safe.”

What’s the evidence for supplements?

A number of studies have investigated the potential benefits of dietary supplements for the prevention and treatment of type 2 diabetes, but the overall quality and amount of information we have on them is “limited”, Professor Shaw said.

“Generally, the evidence around these supplements is much weaker than what exists for drugs,” he said.

Some studies suggest chromium (a mineral), berberine (derived from plants) and cinnamon might help with blood sugar control, while alpha-lipoic acid (or ALA, an antioxidant) might reduce pain associated with diabetes-induced nerve pain.

There is also some research to suggest magnesium may improve insulin sensitivity and blood sugar control, while evidence for vitamin D is less convincing — and similarly weak for herbal supplements including bitter melon and ginseng.

According to the US National Institutes of Health, there is “weak evidence of a possible benefit” for a few dietary supplements, but for most, there isn’t evidence to support a beneficial effect for diabetes.

“There is no doubt that there is some evidence — for at least some supplements — that they may be helpful,” Professor Shaw said.

“But the amount of information, the size of the trials, and the quality of the trials is often far inferior to what we have for drugs.

He added that the limited evidence available for supplements was almost entirely restricted to their effects on blood glucose levels — and not the complications of diabetes such as kidney disease, eye disease, foot problems, heart attacks and strokes.

“In the end, the main thing we’re trying to do is prevent people from having things that make them unwell, put them in hospital or even kill them,” Professor Shaw said.

“For most of the prescribed drugs we use, we have clear evidence on whether or not they have benefits on those outcomes … and we just don’t have any of that kind of information for supplements.”

Are supplements regulated?

In Australia, most supplements fall into the category of low-risk complementary medicines, which means the Therapeutic Goods Administration only regulates them for safety and quality — not for whether they actually do what they claim to.

Prescription medicines, meanwhile, undergo rigorous assessment for safety, quality and efficacy, Professor Shaw said.

Large clinical trials of prescription medicines allow researchers to understand possible side effects, and determine which people should not be prescribed certain treatments.

“Drugs can only be licensed if they have been extensively studied, whereas supplements … there isn’t a large body of evidence that is developed to understand their strengths and weaknesses,” he said.

Are supplements likely to do any harm?

If you’re considering taking a supplement for diabetes prevention or management, it’s important to speak with a GP or health professional first.

That’s because supplements — even those made of natural ingredients — can sometimes cause side effects or interact with other medications, Professor Coughlan said.

“They could, for example, intensify the effect of your diabetes medication, causing low blood sugar or hypoglycemia, which can be dangerous,” she said.

When considering potential harms, Professor Shaw added that “harm to your back pocket” was also something to consider.

For people with type 2 diabetes, he said the risk of serious harm from supplements was likely to be “pretty small” in the short-term, but he stressed that people with type 1 diabetes should never take supplements in the place of insulin.

“People with type 1 diabetes get into a lot of trouble very quickly without insulin,” he said.

“In type 2 diabetes, if you go off your medication and go onto something that isn’t working well, it’s not good for you in the long term. If you’ve got type 1 diabetes, going off insulin can be fatal.”