Show Notes

From multivitamins to protein powders, thousands of supplements crowd drugstore shelves offering over-the-counter answers to our nutritional needs. Yet with so many options out there, how do we know which ones to trust?

Joining us is US Pharmacopeia (USP), an organization focused on building trust in the supply of safe, trusted quality medicine. USP, is an independent, scientific nonprofit organization focused on building trust in the supply of safe medicines. Through rigorous science and the public quality standards they set, USP helps protect patient safety and improve the health of people around the world.

Episode Transcript

Lindsay Clarke:

Hi, everyone. I’m Lindsay Clarke, COO and senior vice president of Health Education at the Alliance. I’m excited to be here today to talk about dietary supplements. It’s hard not to notice the sheer volume of dietary supplements as we grocery shop, browse the shelves of our local pharmacy, or even scroll through our favorite social media apps. From multivitamins that claim to boost immunity to protein powders that promote muscle recovery, to our favorite multivitamins, thousands of supplements are out there offering over-the-counter answers to our nutritional needs. Yet, with so many pills, powders, oils, and chewables available, how do we know which ones to trust?

Well, one answer is the US Pharmacopeia or USP. USP is an independent, scientific, non-profit organization focused on building trust in the supply of safe, trusted quality medicines. Through rigorous science and the public quality standards that they set, USP helps protect patient safety and improve the health of people around the world. They’re also leaders in a campaign to promote transparency in the dietary supplement space.

Joining us today to discuss USP’s efforts and to break down what you should be looking for is Emily Britton, Senior Manager of Market Development, Dietary Supplement and Ingredient Verification programs. Emily has over seven years of experience in the dietary supplement and food testing industry. She has a PhD in medicinal biochemistry, and she’s a subject matter expert in dietary supplement quality. Emily, we’re so glad to have you on the show.

Emily Britton:

I am so happy to be here. I appreciate the opportunity.

Lindsay Clarke:

Absolutely. So let’s just start by setting the stage. Could you share what dietary supplements are and how they’re different from prescription and over-the-counter or OTC medications?

Emily Britton:

Sure. So while dietary supplements may look familiar to over-the-counter products and different medications because they come in the format of pills and capsules and tablets, they’re actually a subcategory of food. Dietary supplements are taken and intended to be taken by mouth. They are meant to help supplement your diet and fill in the gaps for things like vitamins, minerals, and also may contain botanicals with other sort of ingredients in there that are meant to elevate and support your health, not cure or treat disease.

Lindsay Clarke:

Emily, thank you so much for that explanation. I think it’s really interesting to hear you saying and explaining to folks that dietary supplements are actually food related as opposed to medicine related. I think that’s an important distinction. To that point, many people probably aren’t aware that dietary supplements don’t go through the same regulatory process or FDA review as prescription and OTC medications. So can you explain how they are regulated?

Emily Britton:

Yes, absolutely. I love this topic. So let’s first start with over-the-counter products and medications. These products are regulated by the FDA and they are actually researched, evaluated, and approved before they are available to patients or customers, whether that be through different retail outlets or via prescriptions provided by healthcare practitioners. These products, prescription medications and OTCs, are generally recognized as safe and effective when used for what they are intended for. They’ve been researched and proven to be that way, and that’s what actually differentiates them from dietary supplements.

Emily Britton:

One of the biggest misconceptions in the dietary supplement space is that dietary supplements are not regulated. And that is not true. They are regulated. It’s just more similar to the food industry than pharmaceuticals. The category of dietary supplements was actually created or officially defined in 1994 by the Dietary Supplement Health and Education Act. And that is where they were defined as products that are taken by mouth that are intended to supplement the diet, and they are not intended to treat or cure disease. So the way that works is that there is essentially rules that say that dietary supplements must contain ingredients that are classified as dietary ingredients. They’re generally recognized as safe or the ingredients have been demonstrated through safety evaluations that they will not cause any harm on average to most people when used as intended.

Emily Britton:

Now, these products are actually not approved before they become available for consumers to purchase online or in various stores. We call this a post-market regulation framework where these products are available, manufacturers and brands are expected to follow the rules and are expected to be compliant with FDA regulation’s Trust but Verify. So what happens is that if there is some sort of adverse event or consumer complaints, or potentially there’s some inappropriate branding and claims being made, the FDA can then take action. Once those products are available, they can respond and then take things off the market. So again, they are regulated, but instead of being approved, they are evaluated once they are out in the industry versus being approved and then made available to the consumers.

Lindsay Clarke:

That’s incredibly interesting, but that makes me wonder, does that mean that not all supplements are created equal?

Not all supplements are created equal.

Emily Britton:

Unfortunately, yes. Not all supplements are created equal. But there are many brands out there, big and small, that are champions of quality, that are following regulatory guidance, that are producing trusted quality products, that are reproducible consistent, and what’s in the bottle matches what’s on the label. So a consumer can look at it and be confident that what is there is what is there and nothing else. But fortunately, the FDA is involved. The FDA actually goes and inspects manufacturing facilities all over the world to make sure that they are following the processes that align with the standards that the United States has set for dietary supplements. So they’re working to protect consumer safety, but there are some other things that consumers need to be aware of as they are selecting dietary supplements for themselves and for their families. So I’m really excited to be here today to share some of the tools that we have that consumers can use to identify quality when they’re making decisions about their supplements.

Lindsay Clarke:

So Emily, that really tees up my next question, because earlier you said Trust but Verify, and here you are saying that the consumers have a role in this. So with all of these options, it’s hard to know which ones are safe and effective, and how do we know what to trust on the shelf? How can we ensure that the quality of the supplements that we’re choosing are good for us?

Emily Britton:

That is the challenge. I have worked in this industry for a little while. I’m also a consumer of dietary supplements, and when I go out shopping and I’m looking at all the different products that are available, it does feel overwhelming when there are so many different options, so many different types of products and formats. It’s hard to know which ones are quality. So I have a few tips for consumers when they’re making supplement decisions of how to identify quality products. One is, one of my favorites, to look for typos. If there are typos on the labels, if the resolution of the labels are a little bit off, if the formatting is suspicious, those can usually be indicators of products that may not be quality and maybe shouldn’t be in your shopping cart. Another way to select supplements that a consumer can trust is to look for national brands and brands that you recognize, that you see at various different retail outlets, because the retailers are also responsible for making sure that the products they make available are trusted quality for their customers. Just a few tips to look for.

Emily Britton:

But then, I would say the best tip for consumers when they’re purchasing supplements is to look for third-party certifications. So the USP Verified Dietary Supplement Program run here at USP. We are an independent organization, and we work with manufacturers to go in and evaluate their processes and their products to make sure that what’s on the label is what’s in the bottle, that they’re manufacturing products in a consistent way. And we have verified that. Because what brand is going to go out there and say, “Our products are good enough,” when they could say, “Our products are the best”? That’s how you sell products. But how can you trust marketing when ultimately companies want to sell products? Well, the way that brands can communicate trust is to rely on organizations like USP that can come in as a non-biased champion of quality, that can then provide this signal, the USP Verified Mark, that consumers can recognize and say, “I trust that organization because I know they did the work and they verified the quality, so I can feel confident in my decisions.”

Lindsay Clarke:

You mentioned, Emily, the USP Verified Mark, and just to note for listeners and viewers that there are more than 150 dietary supplement formulas that have earned that USP Verified Mark. Can you tell us what does this mark signify and why should consumers look for it?

…the USP Verified Mark means that USP has checked it, so you can trust it.

Emily Britton:

So the USP Verified Mark is a signal for quality, and that’s because we required these organizations and manufacturers to meet our very stringent requirements. So when that mark is present on a bottle, what that means is that USP went into their facilities and check to make sure that they follow all of FDA’s requirements and all of our requirements for how to make dietary supplements a way that can be trusted. That means we also reviewed all of their documentation, like their manufacturing records, essentially their recipes as to how they are making products, what ingredients that they’re using, to make sure that they are truly making sure that the ingredients that they’re using are authentic, and that the processes that they use result in a consistent product such that the product you take today is the same as it was a year ago and years into the future.

That means we also have tested their products. When I say tested, that can mean a lot of different things. So I’ve mentioned that USP Verified, that mark being on the bottle means that what’s on the label is what’s on the bottle. So that means you can trust that the vitamins, the minerals, maybe the herbal extracts that are present are actually there in the amounts that they claim. Because that’s one of the challenges in the industry. One of the concerns that even retailers have is whether or not the products that are there actually contain the things that they say they do, again, because they’re not approved before sale.

The other things that we also test for, which are also critically important, is contaminants. So we evaluate and test for heavy metals, bacterial contamination, and pesticides even in supplements that contain different botanical extracts to make sure that these products meet those requirements as well. Because it’s not just what’s in a product, it’s ensuring what is also not present. Especially today in times when consumer education is rising and transparency is becoming even more important, that’s what consumers are demanding. So the USP Verified Mark means that USP has checked it, so you can trust it.

Lindsay Clarke:

That’s really reassuring. Because as a consumer knowing that there’s something that I can look for, that says all of those things for me, and this information overload that we’re in, it’s really reassuring to know we can look for it. So why is USP taking the lead in helping to promote the transparency in this dietary supplement space?

Emily Britton:

Well, USP has been a champion of transparency and quality since the start. If I take it back a few hundred years, USP was formed in 1820 by 11 physicians that came together because they were concerned about the quality of medicines that were available to their patients, and they wanted to be part of the solution. And a fun fact there is that these medicines that the physicians were concerned about back then are actually what we know today as dietary supplements, because back then physicians and patients were often relying on different natural extracts and products to support their health. I studied botanical medicine as a graduate student, and so I love being part of USP today knowing that botanicals were part of USP’s origin story.

Emily Britton:

But anyway, going back to quality and transparency, USP cares about consumer and patient safety, and we look at the industry and try to find ways to solve these challenges, not just for consumers and everybody else, but us as well because we also are consumers or patients in this network. USP realized that there was this gap where, in the supplement space, it was hard to determine what products someone should purchase, because even back in 2002, there were plenty of products on the market. So USP identified this challenge and launched the Dietary Supplement Verification Program in 2002. As I’ve alluded to, we require these manufacturers to let us in to evaluate all of it. We require them to pull back the curtain and reveal everything. And USP looks in every nook and cranny to make sure that all of these manufacturers are following regulations.

Emily Britton:

So ultimately, transparency isn’t optional; it’s required. It’s required if they want to earn that USP Verified Mark on their product. We have a lot of scientific experts here at USP, and we know a lot about dietary supplements. Not everybody wants to go that in depth with manufacturing processes and regulations and analytical methods. And ultimately, that is information overload. The average consumer probably doesn’t know how to evaluate all of this information to make decisions, and ultimately it’s not available to them. So what we do is we translate all of that complex scientific information into the USP Verified Mark, so consumers don’t have to bear the burden of learning all of this so they can make informed decisions. We provide that USP Verified Mark as a tool for them so they can quickly recognize quality.

Lindsay Clarke:

I love that, because you’re right, there’s so much information, and knowing that someone else is doing it for me in a reliable, trustworthy way is so important.

Emily Britton:

Agreed.

Lindsay Clarke:

If people have additional questions, where can they go to get more information?

Emily Britton:

I have various resources that I’m happy to share.

Lindsay Clarke:

Great.

Over 75% of Americans use dietary supplements daily, and less than half of them talk to their healthcare practitioners about it.

Emily Britton:

But first and foremost, I’ve talked a lot about USP as a resource, but I want to first mention that anybody who’s taking supplements should first talk to their healthcare practitioner about their individual circumstances and health goals. Over 75% of Americans use dietary supplements daily, and less than half of them talk to their healthcare practitioners about it. Ultimately, sharing this information with them helps them take better care. They’re able to maybe provide guidance as to what sort of supplements may be beneficial, maybe which ones to avoid based on any sort of potential medication interactions. So I encourage anybody who’s taking supplements to not be shy, because most people take them. Please share that information and share your questions and your goals for your health with your healthcare providers so they can be empowered to help you the best that they can.

On the flip side of that, I also encourage healthcare practitioners to proactively ask their patients about their supplement usage and do so in an inviting way so that they feel inspired to share. Because I think there is a bit of a stigma sometimes sharing the different supplements that you may or may not be using, or maybe a lack of awareness of the fact that they could potentially interact with medications. So that’s my number one advice: open communication between your healthcare practitioners and patients.

But if I take it back to USP for a moment, we do have a website, quality-supplements.org, that has educational information about how to choose quality supplements, what the USP Verified Mark represents. We also include a product finder where people can go on there and select different brands, they can select different product types and see what all USP verified products are available. And we also link out to different places where these products can be purchased, whether that’s on a brand’s website or through various e-commerce platforms. We try to make it as easy as possible, and we update that product finder routinely. We actually have a button on that website that switches it over to a healthcare practitioner view so they can view information relevant to their conversations with their patients. So we aim to provide this website as a tool for both communities.

I also want to mention that there are other organizations that provide educational resources. For example, the National Institutes of Health Office of Dietary Supplements publishes fact sheets about different types of dietary supplements. The National Center for Complementary and Integrative Health, that’s an organization or a division that really invests in research around botanical ingredients and herbal medicines, they publish different fact sheets about herbs and botanicals, and how they’re used in dietary supplements, and potential cautions related to different medication interactions, or gaps in information that are also very important when someone’s considering using dietary supplements.

Emily Britton:

I would also like to mention one more thing, taking it back to our healthcare practitioner community. USP has actually published a resource guide about dietary supplement quality for pharmacists, provides a variety of different educational information about supplements and also resources that pharmacists and others can share with their patients about supplements, just to ensure that the flow of information is connected and that pharmacists have the tools that they need in case someone comes up to their counter and says, “What do you think about this gummy? What do you think about this capsule?”

Lindsay Clarke:

That’s a great point because folks are often turning to the pharmacists for questions. To have this as a resource for the pharmacists to turn to and the healthcare professionals to facilitate that conversation is amazing. I just want to underscore, don’t forget, when you are listing that in the many forms that we fill out at our healthcare professional’s office, don’t forget to list the supplements. I think to your point, there is a stigma sometimes, but I also think we just forget. So thank you for that reminder. It’s really important that we’re having those conversations.

Emily Britton:

Yeah. I also want to mention too that we at USP are a resource as well. We have an email, [email protected]. If you are a consumer, you’re taking supplements and you have questions, you can email that address, and me or some of my colleagues will respond and help provide guidance or direct you to other sources of information that can bring value.

One last thing that we offer, we have patient-facing brochures that inform about the USP verified program and what the mark represents, and we make those for healthcare practitioners. So if anyone out there is listening that’s interested in maybe providing these educational tools to their patients, they can email us, and we can send them brochures to have available in their office settings or wherever they may be and wherever they go to do patient education, and they can hand those out. I would say we usually send out batches of those monthly. So I hope that everyone who’s listening reaches out. We’re happy to share. That’s what we’re here for.

Lindsay Clarke:

Well, there’s a lot to learn, but I think through all of those resources, all of the questions can get answered. So thank you.

Emily Britton:

Of course.

Lindsay Clarke:

Emily, now we turn to our final questions, which we like to ask all of our guests. First is, when you were a kid, what did you imagine that growing older would be like?

Emily Britton:

That’s such a fun thing to reflect on. I think I always viewed growing older as a set of steps or milestones to work towards and then accomplish, like turning 16 and getting your driver’s license, or turning 18, graduating high school. And then being someone who was in college for a very long time. Looking forward to getting my bachelor’s degree, and then eventually my PhD, and then getting a job. I feel like it’s always been this chasing of the next thing.

Emily Britton:

I’ve also reflected on this and remembered that I don’t think I had very healthy, active adult role models in my life growing up. I feel like the adults in my life often went to work, went to the doctor, came home, and didn’t do much else than that. So it’s interesting being where I am now, where I am in my career and my age, and thinking about how the world is so much different than I realized. You can be active. You can have fun and do things other than work, but then there’s also all of these other tools like dietary supplements that exist to help support your health so that you don’t just get into this routine of not having fun and maybe not being as active as you once were, and eventually having to deal with health challenges.

You can take health into your own hands, and you can be your own advocate so that you continue to be able to do activities and have fun and explore and live life to the fullest. I know that’s my goal. Maybe not because I observed it when I was younger, but because I want something different for myself.

Lindsay Clarke:

Yeah. Well, it’s clear from your answer and your bio that you’re very goal-oriented, and it’s really interesting. I do remember having those milestones that you sort of felt like you would get to, and then what, right? And then you set the new one. I love that. Now that you have a different view of it, what do you enjoy most about growing older?

Emily Britton:

I recently had a milestone birthday. Since this birthday, I now have to select a different age bracket when I fill out surveys.

Lindsay Clarke:

Isn’t that fun?

Emily Britton:

I’m like, “Oh, so this is what growing old is? Filling out surveys and selecting a different bracket.” But reflecting on that, I’ve realized that what I’m enjoying most about growing old is the level of confidence that just grows inside of you as you accumulate experiences and experience the world. It may also be in part due to a lack of care about what other people think. You know?

Emily Britton:

So I’m finding that I’m really enjoying the confidence that I have in myself, in my goals. I didn’t necessarily do it on purpose, but I found that I’ve been mentoring. I’ve been mentoring different women who are also in the scientific field and interested in supplements, and I think it’s a result of this confidence that I’ve been developing. And then I thought, “Wow, there’s people out here who were coming to me because I have the knowledge.” So it’s really special to be in a place where I’ve realized that I’m now doing the things that people have done for me when I was advancing in my career. So it’s a very heartwarming thing to realize, and I look forward to continuing that on as I grow older and learn more and more.

Lindsay Clarke:

I love that we asked that of all of our guests, and one of the common threads is that growing wisdom and confidence. I’m glad that you are using it to help and advance others. But thank you, Emily, for being here, for joining us for This is Growing Old. For those out there who are listening or watching, please be sure to visit usp.org to learn more about their incredible work. To hear more episodes like this, please visit us at agingresearch.org, and we’ll see you and hear you next time.