During the COVID-19 pandemic, health misinformation has been soaring across the internet and social media platforms. Despite a lack of supplement regulation, vitamin and supplement use have seen a sudden 28% increase in the US and a 25% increase globally during COVID-19. Vitamin C supplements have gained particular attention because of studies finding it might reduce the severity of COVID-19 illness. Although the scientific community has mostly studied intravenous vitamin C, public support for this supplement has nonetheless increased.
Given the fast-paced change in knowledge surrounding COVID-19, and the volumes of misinformation, it is important to have adequate guidance from trusted leadership. The lack of supplement regulation by the Food and Drug Administration (FDA) currently does not position people to use supplements safely.
The widespread use of supplements
Vitamins and supplements are the most common forms of complementary medicine. Four out of 5 Americans take some sort of vitamins or supplements. The term “immune boosting” (used by many supplements) has received increased attention. Researchers conducted an online analysis of this term and found an uptick of its use (mostly for commercial interests) during the pandemic. Scientifically sound strategies were frequently paired with the misleading idea that people can actually boost their immune system.
Characteristics of supplement users and reasons for use
People use supplements for both protecting health and treating health problems. Almost 1 in 5 people with chronic conditions use supplements instead of their medications. Goldstein and colleagues have reported that 75% of veterans use vitamins or supplements, with 18% substituting for their medications. This is despite many of the veterans in the study being prescribed medications for serious medical conditions.
People commonly cite financial reasons for taking supplements. Uninsured people are less likely to see physicians and to disclose alternative medicine to providers, placing them at increased risk for adverse events. This is a problem if people are relying on unproven, potentially unsafe substances to treat their illness. Additionally, racial/ethnic minorities were less likely to tell their provider about their alternative medicine use. This pandemic has placed some people at higher risk of infection and complications.
Health care providers’ guidance on supplements
Patients should generally consult their health care providers about dietary supplements. Despite this recommendation, there is variety in how these conversations play out during clinic visits. One study found five topic areas discussed by a provider sample when counseling patients on supplements. Ranked from the most to least commonly included in discussions were:
- the reason for taking supplement
- how to take the supplement
- potential risks
- effectiveness
- cost or affordability
The study found that these conversations needed to occur more often to adequately engage more patients who took supplements.
Another study by the same research team found just 49% of people taking supplements disclosed their supplement use with a conventional healthcare provider. And those that did only disclosed about 34% of the supplements they took. A strong provider emphasis on the importance of asking about supplements, however, contributed to patient disclosure. Another study showed that providers have inadequate knowledge about the adverse effects of supplements. And most providers wanted more training.
The abundance of unproven and potentially dangerous COVID-19 supplements floating around the internet, like Vitamin C, colloidal silver and oleandrin, is concerning. Providers need to be informed about these supplements and willing to have discussions with patients to empower them to make safe decisions. With more than 15 million adults at risk for interactions between their medications and herbal supplements or high-dose vitamins, it is essential to provide the necessary training to providers to effectively guide patients.
Supplement “regulation”
The burden of determining supplement safety should not fall on the public. The Food and Drug Administration (FDA) is not allowed to review supplements before they are made available to consumers because of the Dietary Supplement Health and Education Act. This lack of proactive supplement regulation means the FDA can intervene only after the products are on the shelves. People usually think of supplements as safer than prescriptions, but their safety has not been tested or monitored by the FDA. In 2015, dietary supplements resulted in an estimated 23,000 emergency room visits. And recently, a study discovered five undisclosed and unapproved drugs in apparent brain-boosting supplements.
A call for better regulation
Increasing health literacy and access to insurance are certainly necessary to reduce the reliance on supplements. But it is also imperative to have effective leadership and guidance on the use of supplements, particularly in a pandemic. Specifically, the FDA should more tightly regulate supplements, in a similar manner to other products like medications and cosmetics. For years, people have called for the FDA to proactively regulate the supplement industry, which reached nearly $31 billion in revenue in 2018 in the United States.
With the risks posed by misinformation about supplements for COVID-19, the pandemic reminds us of the need to empower the FDA to uphold its mission of protecting the public health by ensuring safety in all consumer products.
Ashlyn Lipnicky