Key takeaways:
Consumers in the U.S. regularly use supplements to help improve and maintain their health. From dietary supplementation to disease prevention, their use is widespread.
Many patients don’t disclose supplement use to their healthcare team, so it’s important to find ways to open lines of communication.
When speaking with patients about supplements, key topics to cover include drug interactions, risks, and product quality. Pharmacists are also an invaluable resource when discussing the safe use of supplements.
You’ve likely received questions from patients about dietary and herbal supplements. It’s a hot topic in the wellness space, and supplement use is common across all age groups. Research suggests use increases with age.
While there is a role for supplements in certain situations, safety counseling is important. There is often a misconception that supplements are inherently safe because they’re available over the counter (OTC). And that can make patients feel like they don’t need to discuss their use of supplements.
Here, we’ll discuss supplement safety in the U.S. and how physicians and other healthcare professionals can counsel patients regarding safe use.
Supplement use in the U.S
Supplement use in the U.S. is very common. One study showed about 85% of adults ages 50 and older regularly use dietary supplements. Another found that almost 60% of U.S. adults over age 20 take supplements.
Multivitamins are among the most common supplements taken in the U.S. Other popular supplements include:
Vitamin D
Omega-3 fatty acids
Calcium
Vitamin C
Vitamin B12
According to a study that analyzed data over several years from the National Health and Nutrition Examination Survey (NHANES), consumers typically use supplements for a variety of reasons including:
Improving and maintaining health
Supporting bone health
Supplementing diet
Improving energy
Preventing disease
However, patients often don’t readily report supplement use to their healthcare team. The most commonly reported reasons for nondisclosure include:
The prescriber didn’t inquire about supplement use.
Patients believe the prescriber isn’t knowledgeable about supplements.
Patients are fearful that their prescriber may disapprove of supplement use.
Patients believe that it isn’t necessary to provide information about supplements.
Having a discussion with patients about supplements is essential to get a complete and accurate medication history. It’s also a good way to help patients avoid harm, as many dietary and herbal supplements can cause side effects or interactions. Often patients aren’t aware of these risks.
What are some safety risks associated with supplement use?
Helping patients understand safety risks is a critical step in preventing adverse events. Many supplements are promoted online without much discussion about safety and risks. Here are some talking points that can be helpful when counseling your patients on supplement safety.
Supplements don’t go through the FDA’s drug approval process
In 1994, the Dietary Supplement Health and Education Act (DSHEA) placed dietary supplements in a separate category from drugs. Because they’re not categorized as drugs, supplements are not subject to the same FDA regulations as conventional medications. Supplements can be marketed without prior clinical trial evidence to show efficacy, safety, or quality of the products.
The FDA does regulate certain aspects of supplements though. The FDA’s Current Good Manufacturing Practices (CGMPs) for dietary supplements require products to be properly labeled, free of impurities, and manufactured according to specified standards. The FDA typically steps in once products are on the market and they identify a safety concern or the supplement company reports one. For example, the FDA has issued warnings on several sexual enhancement and weight loss supplements because they can contain hidden ingredients, such as sildenafil or sibutramine.
Healthcare professionals and patients can report supplement concerns to the FDA’s Safety Reporting Portal. These include adverse effects and product quality issues.
Supplements can interact with medications
Before patients start any supplements, it’s important to screen for drug interactions with their prescription and OTC medications. Pharmacokinetic interactions are most common: Many supplements have the same mechanism of absorption, distribution, metabolism, or excretion (ADME) as a co-administered drug.
Outcomes to consider include:
Interference with medication efficacy: Cytochrome P450 3A4 (CYP3A4) inducers, like St. John’s wort, can result in drug-herb interactions with cyclosporine, warfarin, oral contraceptives, and others.
Increased risk of serotonin syndrome: Some supplements have serotonergic agents, such as curcurmin, nutmeg, and St. John’s wort, which can be dangerous when combined with SSRIs.
Increased bleeding risk: Patients on anticoagulation should avoid supplements containing gingko biloba, turmeric, and fenugreek, among others.
It might feel impossible to remember all the possibilities. But the key is finding out which supplements your patients are taking. You can use other resources to help check for interactions (more on this below).
Supplements can cause toxicity
Many patients don’t realize that taking too much of certain dietary supplements can cause toxicity. And the reality is that your patient may be taking a dietary supplement that you didn't prescribe, so it’s helpful to proactively address supplement toxicity. They may not even think to mention that they’re taking a supplement because they simply don’t realize the potential for harm, like hypervitaminosis. For example, it may be helpful to contrast water-soluble and fat-soluble vitamins, which build up more easily and are slower to clear.
Patient education: Parents often worry that their child isn’t getting enough vitamins. But many don’t realize the risk of overdose. This patient resource overviews overdose warning signs and safety precautions for common vitamins and minerals.
Part of the reason the general public may view supplements as benign is that they’re often marketed as “natural.” This is often the case with supplements containing botanical compounds, which also have potential for toxicity.
How to counsel patients on supplement safety
Counseling patients on supplement safety can feel daunting at first, especially if you don’t feel confident in your supplement and/or pharmacological knowledge. One survey study found that about 43% of physicians have average baseline knowledge about supplements. This likely reflects the lack of standardized educational curriculum on supplements in the U.S.
Another potential barrier to effective counseling is time. In any clinical setting, multiple competing priorities and time constraints can prevent effective conversations. This can make it hard to assess the use of dietary supplements and counsel patients appropriately. But, this conversation is critical to improving medication use and avoiding drug-related problems.
Here are a few tips to get you started.
Assess your patient’s supplement use
Patients may not readily give information on supplement use to their healthcare team. Getting a complete and accurate medication history includes reconciling both prescription and non-prescription products. So this might fit into your practice during medication reconciliation with a patient. You or another member of the staff can ask about the use of supplements during the medication history by asking open-ended questions. One question you can ask is "What prescription, OTC medicines, vitamins, herbs, or supplements do you take currently?"
Fear of judgment can keep patients from sharing supplement use, so consider these tips to keep the lines of communication open:
First express that their safety and well-being is your goal.
Keep an open mind.
Refrain from using language that could be perceived as shaming.
For patients that report using supplements, it’s important to ask about how they take it and why. Finding out the reasons why a patient uses a certain supplement may create opportunities to discuss health concerns that could be better managed with more evidence-based therapies, if applicable.
Use your pharmacist
Pharmacists are an important resource for supplement safety. As medication experts, they are uniquely qualified and equipped to counsel patients and prescribers about supplement use.
Having open lines of communication with your local pharmacists can benefit you and your patients. When in doubt, don’t be afraid to discuss supplement safety and potential interactions with them. Plus, in a community pharmacy setting, pharmacists have multiple opportunities to consult with patients about supplement use, and they can relay any concerns back to you as the patient’s clinician.
Stay informed
It can feel overwhelming to try to keep up with everything. Here are a few resources that can help save you time and streamline your search:
Supplement safety alerts through the FDA’s Health Fraud Product Database
Free educational resources from the American Medical Association and the FDA
Online databases for interactions and quality data such as Prescribers’ Digital Reference, Allied and Complementary Medicine Database, or Natural Medicines
Discuss supplement facts and safety
It’s helpful to educate patients on the risks, as mentioned above. Many consumers are unaware of the lack of regulation and testing, so it’s a good place to start. Caution them on dubious marketing claims; for example, “natural” doesn’t always mean “safe.” It’s also important to point out the very real risk of medication interactions.
Scientific evidence, specifically randomized-controlled trial data, on many supplements is limited. So, patients should be educated about the uncertainty of these products’ safety and efficacy. These discussions should be documented in the patient’s medical record or where appropriate. Also remember to encourage them to consult with you before starting any supplements.
Of course, supplement use may be clinically indicated in certain situations, such as for a known nutritional deficiency. It may be reasonable to recommend the use of a particular supplement if there is evidence for its quality, safety, and efficacy. Vitamin use in this case may also qualify as an eligible medical expense for HSA/FSA purposes, helping your patients save money. When additional guidance is needed, prescribers can consult with pharmacists for supplement recommendations.
Good to know: Encourage patients to read the Supplement Facts panel before purchasing a supplement. This lists all the ingredients contained in the product.
Make sure your patients use high quality supplements
Certain independent organizations offer quality testing for dietary and herbal supplements, including:
US Pharmacopeia (USP Verified)
Manufacturers can voluntarily submit for their products to be evaluated by these organizations for quality, accurate labeling, good manufacturing practices, and the absence of harmful contaminants. Supplement products that have been found to meet these standards have a seal of approval displayed on the labeling. While this seal can instill some confidence regarding supplement safety, it does not guarantee the product’s efficacy.
Patient education: Whether you’re recommending a supplement to a patient or they’re already taking one, consider sharing these tips for choosing safe OTC supplements.
The bottom line
Dietary and herbal supplements are widely used in the U.S. and across the world — despite their possible harmful effects and limited evidence of efficacy. It’s important to ask patients regularly about their supplement use and counsel them on the risk-benefit ratio. As medication experts, pharmacists are a uniquely qualified resource for patients and prescribers alike.
Why trust our experts?
References
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Maldonado-Puebla, R. A., et al. (2025). The effects of St. John’s wort and its interactions with SSRIs. European Psychiatry.
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U.S. Food and Drug Administration. (n.d.). Safety reporting portal.
U.S. Food and Drug Administration. (2022). Dietary supplements: What physicians should know.
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U.S. Food and Drug Administration. (2026). Health fraud product database.
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