Walk through the supplement aisle of any pharmacy and you’ll find shelf after shelf of promises — stronger bones, sharper memory, less joint pain, better sleep. Americans spend roughly $60 billion a year on dietary supplements, and seniors are among the most enthusiastic buyers. But which of these products actually deliver, which are harmless but ineffective, and which could do real damage? The answers are more nuanced than the marketing suggests.
Older adults are often drawn to supplements because aging changes appetite, digestion, medication use, and nutrient absorption. But the general rule is simple: supplements work best when they fill a documented gap, and they are least useful when they are taken as a broad “insurance policy” by otherwise well-nourished people. Let’s take a closer look.
First, a ground rule that applies to everything in this article: dietary supplements are not FDA-approved drugs. The FDA treats them more like foods, meaning manufacturers don’t have to prove effectiveness before selling them. Quality control also varies widely — what’s on the label may not always match what’s in the bottle. As a result, the scientific evidence behind many supplements is limited or inconsistent. When shopping, look for products with a USP (United States Pharmacopeia) verified mark, which indicates independent testing for identity, purity, and potency.
The Genuinely Helpful Ones
Vitamin D and Calcium are probably the most well-supported supplements for older adults. Bone loss accelerates with age, and these two nutrients work as a team — calcium provides the raw material for bone, while vitamin D helps the body absorb it. The National Institute on Aging recommends 600 IU of vitamin D daily for adults aged 51–70, and 800 IU for those over 70. Most seniors don’t get enough from diet or sun exposure alone, making supplementation genuinely sensible for many people. This is especially true for prople with documented deficiency or osteoporosis risk. One important caveat: don’t go overboard. Too much vitamin D can cause calcium to build up in the blood, potentially harming the kidneys and blood vessels.
Vitamin B12 is another legitimate priority; Up to 15 percent of older adults may bedeficient.. Older adults are prone to B12 deficiency not because they eat less of it, but because the stomach produces less acid with age, and stomach acid is needed to release B12 from food. Those taking acid-blocking medications are at even higher risk. Deficiency can cause nerve damage and anemia. The good news is that the form of B12 in supplements is absorbed without needing stomach acid, making supplements effective where food sources may fall short.
Omega-3 fatty acids, found in fish oil, have earned a solid reputation for lowering triglycerides — a type of blood fat linked to heart disease. A large study of over 400,000 people found associations between fish oil use and improved cholesterol profiles. However, the picture is more complicated for other claimed benefits. Evidence for omega-3s preventing dementia is mixed, and some research suggests fish oil can actually raise LDL (“bad”) cholesterol in certain people, so monitoring is wise. For those who can’t eat fatty fish regularly, fish oil is a reasonable backup — just don’t expect miracles beyond the triglyceride benefit.
Melatonin has moderate scientific support for improving sleep, which is a chronic issue for many older adults. It’s particularly helpful for resetting disrupted sleep cycles. The key is using it at low doses — often 0.5 to 3 mg is sufficient, though most over-the-counter products contain far more. It’s generally well tolerated but should not replace evaluation of underlying sleep disorders.
Creatine and protein supplements may sound like something only gym rats need, but research increasingly supports their role in combating sarcopenia — the age-related loss of muscle mass that can lead to falls and loss of independence. A 2024 Stanford review found that creatine supplementation, combined with resistance training, can meaningfully preserve muscle in adults over 65. Branched-chain amino acids (BCAAs) can play a supporting role in certain situations, particularly when protein intake from food is inadequate. Vegans should pay particular attention to protein intake.
The Ambiguous Middle Ground
Glucosamine and chondroitin are among the most popular supplements for joint pain, and the scientific debate around them has been going on for decades. These are naturally occurring compounds in cartilage, and the theory is that supplementing them may slow joint deterioration in osteoarthritis. A 2024 systematic review of 146 studies found that over 90% of the studies reported positive outcomes — impressive on its face. But the landmark NIH-funded GAIT trial told a more sobering story: glucosamine and chondroitin, alone or together, were no more effective than a placebo for most people with knee osteoarthritis. The exception was a subgroup with moderate-to-severe pain, who did show moderate improvement. Safety is generally good, but those on blood thinners like warfarin should be careful, as glucosamine may affect clotting.
Turmeric and curcumin have generated enormous popular interest, and there’s at least a plausible scientific basis for the excitement. Curcumin, the active compound in turmeric, is a potent anti-inflammatory and antioxidant. Multiple clinical trials support some benefit for knee pain, and some research suggests potential benefits for cognitive health. However, curcumin is poorly absorbed on its own, which is why many products add black pepper (piperine) or use enhanced delivery formulations. The overall evidence, while promising, is still described as “mixed or low quality” by most reviewers. If you do try it, look for a formulation with enhanced bioavailability and give it at least 4–8 weeks and be aware that it may cause gastrointestinal symptoms.
Saw palmetto is widely used by older men for symptoms of benign prostatic hyperplasia (BPH) — the enlarged prostate that causes frequent urination. A 2024 updated Cochrane review found some evidence of limited benefit for urinary symptoms for some men, though the results are inconsistent and most mainstream urology guidelines do not formally recommend it. It’s generally well tolerated. Men using it should still get their prostate checked regularly and not assume saw palmetto rules out other conditions.
Magnesium has had a social media moment, with enthusiastic claims about better sleep, improved mood, and reduced muscle cramps. The actual science is more cautious — there’s limited evidence for magnesium supplements providing any of these benefits in people who aren’t already deficient. That said, deficiency is relatively common in older adults, and correction of a true deficiency can absolutely help. A blood test can tell you if you actually need it.
Multivitamins present a genuine paradox. They’re the most commonly taken supplement category, often recommended by physicians as a nutritional safety net. And for seniors with reduced appetite or limited dietary variety, that logic holds. But large, well-designed studies have found limited evidence that multivitamins improve longevity or prevent major diseases in otherwise healthy older adults. A newer 2024 analysis from the COSMOS trial suggests some modest benefit for cognitive function. Senior-specific multivitamins are preferred — they typically contain more vitamin D and B12 and less or no iron, which reflects the actual needs of older adults.
The Ones That Raise Red Flags
Iron supplements deserve special caution in older men and post-menopausal women. Unless there’s a documented deficiency confirmed by blood testing, taking iron supplements can be harmful. In men, iron overload is a genuine risk, and about twice as many men carry the gene for hereditary hemochromatosis (a condition where the body absorbs too much iron) as carry the gene for iron deficiency. Excess iron has been linked to liver damage and may raise cancer risk. Senior-specific multivitamins wisely contain little or no iron for exactly this reason.
High-dose Vitamin A is another potential problem. The liver’s ability to clear vitamin A decreases with age, and older adults absorb more of it. Doses above recommended daily values can accumulate to toxic levels, potentially harming the liver. This is specifically the retinol form of vitamin A. Beta-carotene from plant sources is much safer. Check your multivitamin label carefully.
High dose Vitamin B6 can cause nerve damage, balance problems, and sensory neuropathy when taken over long periods but is safe at recommended levels.
Many supplements claim to improve memory or prevent dementia. Unfortunately, the evidence is generally weak. Fish oil, ginkgo biloba, and other popular products have not demonstrated clear benefits for preventing cognitive decline in controlled studies. Some research suggests that long-term supplementation with B vitamins might slow certain aspects of cognitive decline in specific populations, but results remain inconsistent.
St. John’s Wort is widely used for mild depression, but it comes with a serious warning: it interacts with a long list of medications, including antidepressants, blood thinners, heart medications, and antiretroviral drugs. For seniors managing multiple conditions with multiple prescriptions, this herb is particularly risky. Ginkgo biloba carries similar drug interaction concerns, especially around bleeding risk when combined with blood thinners or aspirin.
High-dose antioxidants — vitamins A, C, and E taken in large amounts — have largely failed to deliver on their promise of preventing heart disease and cancer. The US Preventive Services Task Force does not recommend these for prevention. In some cases, large antioxidant supplements may actually interfere with the body’s natural disease-fighting mechanisms.
The Bottom Line
Given the mixed evidence, a sensible approach to supplements includes several principles:
- Food first. A balanced diet usually provides most necessary nutrients.
- Test before supplementing. Blood tests can identify deficiencies such as B12 or Vitamin D.
- Avoid megadoses. Excessive intake of vitamins can cause toxicity.
- Check medication interactions. Many supplements interact with common drugs, including blood thinners.
- Treat supplements like medications. They should have a clear purpose and measurable benefit.
Supplements that address documented deficiencies or fill genuine dietary gaps — vitamin D, B12, calcium, omega-3s — offer the best evidence for benefit in seniors. Joint supplements like glucosamine and turmeric may help some people, though the evidence is mixed enough that a try-and-see approach (with a 2–3 month window to assess benefit) is reasonable. And several common supplements, particularly iron in unsupervised use, high-dose vitamin A, and certain herbals in combination with medications, carry risks that are easy to overlook because they’re sold without a prescription.
I always advised my patients to bring all their supplement bottles to at least one visit each year and to bring any medicines prescribed by specialists. Physicians can spot dangerous overlaps, flag interactions with your prescriptions, and tell you if what you’re taking makes sense for you. Many seniors never hear a list of side effects for supplements the way they do for prescription drugs — and they often assume that means there aren’t any. That assumption, unfortunately, can be costly.
Illustration generated by author using ChatGPT.
Sources
National Institute on Aging. Dietary Supplements for Older Adults.
National Institute on Aging. Vitamins and Minerals for Older Adults.
Linus Pauling Institute, Oregon State University. Older Adults — Micronutrient Information Center.
National Center for Health Research. Glucosamine Supplements: Do They Work and Are They Safe?
BodySpec. Supplements for Joint Health: 2025 Evidence-Based Guide.
Cleveland Clinic. Dietary Supplements Compound Health Issues for Older Adults.
FDA. Mixing Medications and Dietary Supplements Can Endanger Your Health.
NIH Office of Dietary Supplements. Iron — Health Professional Fact Sheet.
Foods (MDPI). Food Supplements and Their Use in Elderly Subjects — Challenges and Risks. 2024.
Memorial Healthcare System. Herbal Supplements and Prescription Drugs: Know the Risks. 2024.
WebMD. Saw Palmetto: Overview, Uses, Side Effects, Precautions.
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Medical Disclaimer
The information provided in this article is intended for general educational and informational purposes only and does not constitute medical advice. It should not be used as a substitute for professional medical advice, diagnosis, or treatment.
Always seek the guidance of a qualified healthcare provider with any questions you may have regarding a medical condition or treatment. Never disregard professional medical advice or delay seeking it because of something you have read here.
If you are experiencing a medical emergency, call 911 or your local emergency number immediately.
The author of this article is a licensed physician, but the views expressed here are solely those of the author and do not represent the official position of any hospital, health system, or medical organization with which the author may be affiliated.
Understanding Vitamins, Supplements, Herbal Preparations, Patent Medicines, and Homeopathic Medications
By John Turley
On October 4, 2024
In Commentary, Medicine
What you should know.
The cost of prescription medications is almost constantly in the news. It has even become a topic of debate in the current presidential elections. Americans spend over $500 billion annually on prescription medications. This includes drugs covered by insurance, and out of pocket costs and specialty drugs for chronic conditions.
But this is not the only expense Americans have for drug related health care items. Almost $90 billion a year is spent on nonprescription preparations.
The shelves of pharmacies, health food stores and convenience stores are lined with a vast array of vitamins, supplements, patent medicines, herbal preparations, and homeopathic medications. They are also available from hundreds of online sources, both reputable and of questionable origin.
Many people turn to these products in the hope of improving their health, boosting their immune systems, or addressing specific ailments. However, the development, testing, approval processes, and regulation of these products can be confusing, even for the most educated consumer. We will delve into each of these classes of health products, exploring how they are developed, tested, and regulated, and highlighting some potential drawbacks of which you should be aware.
Vitamins and Dietary Supplements
Development and Testing
Vitamins and dietary supplements include a broad range of products such as vitamins, minerals, amino acids, and other nutritional components. These products are typically developed through a combination of scientific research and commercial interest. Manufacturers may isolate nutrients from food sources or create them synthetically. Testing often involves ensuring that the products contain the stated ingredients in the correct amounts. However, unlike pharmaceuticals, these products are not usually subject to rigorous clinical trials to prove efficacy and safety before they are marketed.
Approval Process
In the United States, vitamins and dietary supplements are regulated by the Food and Drug Administration (FDA) under the Dietary Supplement Health and Education Act (DSHEA) of 1994. Under DSHEA, manufacturers are responsible for ensuring the safety and labeling of their products before they reach the market. However, the FDA does not approve dietary supplements before they are sold. Instead, the FDA can take action against any supplement that is found to be unsafe once it is on the market.
Drawbacks
One of the primary drawbacks of dietary supplements is the lack of pre-market approval, which means that the burden of proving safety is often on the consumer or the FDA post-market. This can lead to situations where unsafe or ineffective products remain on the market until sufficient adverse events are reported. Additionally, the quality of supplements can vary widely between manufacturers, and contamination with other substances is a known risk. Although, given the competitive nature of these products and the number of distributors, questionable products are usually forced out of the market early.
Herbal Preparations
Development and Testing
Herbal preparations include products made from plants or plant parts, used for their supposed medicinal or therapeutic properties. The development of these products is often rooted in traditional medicine practices, although modern herbal preparations may undergo some degree of scientific research. Testing for herbal preparations can vary widely; some are backed by clinical studies, while others rely on anecdotal evidence or traditional use.
Approval Process
The FDA considers herbal supplements as foods, not medicines. So, they are not subject to the same testing, manufacturing, and labeling standards and regulations as medicines.
This means they do not require pre-market approval by the FDA. However, in other parts of the world, such as Europe, herbal products may undergo more rigorous testing and regulation. All herbal products that display an intended use must be accompanied by a box warning stating: “These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnosis, treat, cure or prevent any disease.”
Drawbacks
The primary concerns with herbal preparations are the variability in potency and the potential for contamination or adulteration with other substances. Additionally, the lack of standardization in the preparation of herbal products can lead to inconsistent effects. Herbal supplements, unlike medicines, do not need to be standardized to make sure of batch-to-batch consistency. Some herbs can also interact with prescription medications, leading to adverse effects.
Homeopathic Medications
Development and Testing
Homeopathic medications are based on the principle of “like cures like,” where substances that cause symptoms in a healthy person are believed to cure similar symptoms in a sick person when taken in highly diluted forms. The development of homeopathic remedies typically involves diluting a substance repeatedly until little to no trace of the original substance remains.
While counterintuitive, homeopaths believe that a homeopathic medicine is more powerful the more times the active ingredients have been diluted. A 6X potency indicates that the drug has been diluted at a ratio of 1 to 10 for a total of six times. A C potency means the dilution ratio is 1 to 100. The higher the numeral, the lower the concentration of active ingredients in the medicine.
Testing in homeopathy is controversial, as traditional scientific methods, such as randomized controlled trials, often find no evidence that homeopathic remedies are more effective than a placebo. Some supporters claim that homeopathic remedies are developed for a specific patient making general testing irrelevant.
Approval Process
In the U.S., homeopathic medications are subject to regulation by the FDA under a different framework compared to dietary supplements. Historically, these products were allowed to be sold without pre-market approval as long as they were prepared according to the guidelines of the Homeopathic Pharmacopeia of the United States (HPUS) and the FDA’s Good Manufacturing Practices. All products are required to be clearly marked as “homeopathic”. In recent years, the FDA has increased scrutiny of homeopathic products, particularly those marketed for serious conditions, or containing potentially harmful ingredients, as well as those for eye conditions, and all homeopathic injectables.
Drawbacks
The major drawback of homeopathic medications is the lack of scientific evidence supporting their efficacy. Most scientific reviews and clinical trials have found that homeopathic remedies do not perform better than placebos. Moreover, because homeopathic products are so highly diluted, they are generally considered safe, but they may delay patients from seeking effective medical treatments for serious conditions.
Patent Medicines
History and Evolution
Patent medicines have a colorful history. They began in the 19th century and were popular into the early 20th century before evolving into the over-the-counter industry that we now know. This class includes many modern over the counter medications produced by reputable drugs companies and also medications of dubious quality and effectiveness produced in garages and basements.
In the late 19th and early 20th centuries, medicine wagons and medicine shows became popular vehicles for the promotion and sale of patent medicines. These traveling shows often combined entertainment with health claims, featuring acts such as music, magic tricks, and even wild west performances. At the center of the spectacle, a charismatic “doctor” or salesman would tout the benefits of their patent medicine—a proprietary formula claimed to cure a wide range of ailments.
Patent medicines of this era were largely unregulated, and their ingredients were often a secret. Some contained alcohol, opium, or other stimulants, which provided temporary relief or a placebo effect. Because there were few laws governing their production and sale, these concoctions could be marketed without scientific proof of their efficacy or safety.
Medicine shows traveled to rural and urban areas alike, attracting customers who had little access to conventional medicine, particularly those in remote regions. Unfortunately, these products were often ineffective or even dangerous. The rise of the Pure Food and Drug Act of 1906, which required the labeling of ingredients and restricted misleading claims, signaled the decline of these shows and the broader patent medicine industry.
A few of the original patent medicines stayed on the market until the late 20th century. The most famous of these was Carter’s Little Liver Pills which was touted for curing headaches, constipation, dyspepsia and biliousness. Lydia Pinkham’s Vegetable Compound which was sold for “female complaints “, is still on the market though it has been significantly reformulated. A number of medications on the market now could be considered as the descendants of early patent medicines, perhaps the best known of these is Geritol
Approval Process
Modern patent medicines fall into the category of over the counter (OTC) drugs. Preparation of these medicines must either follow a monograph established by the FDA (essentially a recipe book) or undergo New Drug Application (NDA) process. All patent medicines must comply with strict labeling standards and include accurate ingredient lists, dosage instructions, and warnings. Any health claims must be supported by scientific evidence.
Drawbacks
There are several drawbacks to over the counter (patent) medications. There’s a significant risk that people may intentionally take more than the recommended doses. This is particularly dangerous with some medications such as Tylenol which can lead to liver damage. People may use medications for a longer than the recommended period. They may also be used in an attempt to treat conditions for which they are not intended. They may mask symptoms of a more serious condition leading to a delay in seeking appropriate medical care.
Conclusion
Vitamins, supplements, herbal preparations, patent medicines and homeopathic medications each occupy a unique space in the health and wellness industry. While they offer consumers more choices in managing their health, the differences in how these products are developed, tested, and regulated are significant. As a consumer, it’s essential to be informed about these differences to make safe and effective choices.
I’d like to thank my friend Steve Kaplan, a Registered Pharmacist, who is also my coauthor for this post.