ACSH has published several articles criticizing the misuse of supplements and the industry itself. In an April article, Katie Suleta highlighted three key myths that marketers exploit to drive sales and create a false sense of need for supplementation:
- Appeal to Nature Fallacy: The assumption that something is good simply because it is "natural." Marketers use "nature" in branding to imply benefits.
- "More is Better": The belief that consuming more of a “beneficial” substance always leads to greater results.
- Action Bias: The idea that taking action, such as using supplements, is better than doing nothing, even if it is unnecessary.
These myths not only deceive consumers but contribute to a growing supplement market.
Market Growth and Influencer Impact
A recent report projects the vitamin and mineral supplements market will reach $58.8 billion at year's end and $99.7 billion by 2034, driven by online sales.
Factors fueling this growth include an increasing interest in “preventative” healthcare, a growing preference for natural and organic products, and products offering “immunity boosts.”
Social media and celebrity endorsements are common strategies driving sales. Many influencers—and even healthcare professionals—maintain financial ties with supplement companies, frequently encouraging their followers to purchase products based on questionable claims.
Troubling Trends in Influencer Marketing
Celebrity promotion of products is not new. An article published in the Public Health Journal analyzed 165 radio advertisements for supplements in Spain. It examined the type of endorser (experts, celebrities, or anonymous spokespeople), health claims (disease treatment or risk reduction), and product composition.
As a result:
- 47.3% of ads featured anonymous spokespeople, followed by experts (27%).
- Functional claims were the most common, whereas disease claims frequently appeared in ads featuring doctors.
- 77.7% did not mention the composition of the supplements.
The analysis identified unethical practices, such as the use of “fake doctors,” exploiting journalists’ and experts’ credibility in making misleading comparisons between supplements and medications. Fear-based messaging was another common tactic to manipulate consumers.
While acknowledging the limits in generalizing their findings, they warned that similar practices might occur elsewhere.
The Social Media Megaphone
I would argue that social media amplifies these marketing strategies.
In 2023, The Washington Post revealed that the food industry paid dozens of dietitians, many of whom are also influencers, to post promotional videos on Instagram and TikTok. These videos encouraged the consumption of diet sodas, sugar, and supplements and defended aspartame after its classification by the IARC as possibly carcinogenic (Group 2B).
Following the WHO’s concerns about aspartame, the hashtag #SafetyofAspartame spread across social media. For example, dietitian Steph Grasso, who has 2.2 million TikTok followers, described the WHO’s warnings as “sensationalism” based on “low-quality science”— a view I share. Many dietitians echoed similar sentiments but often failed to disclose that American Beverage, an industry lobby, sponsored their posts.
An investigation revealed that American Beverage paid 10 dietitians, a physician, and a fitness influencer to downplay the WHO’s claims, with 35 posts from 12 professionals identified as part of this campaign. Among 68 dietitians with 10,000+ followers on TikTok or Instagram, about half promoted products like sweets, ultra-processed foods, and unsubstantiated supplements to a combined audience exceeding 11 million people.
While some posts disclosed paid partnerships, only 11 of 35 videos explicitly mentioned links to American Beverage. Other promoted supplements included collagen (for skin and joints), detox teas, and mitochondrial health capsules — products lacking scientific consensus on their benefits. For instance, nutritionist Cinthia Scott (300,000+ Instagram followers) recommended omega-3 supplements for children over six months in a paid post for Carlson Labs.
This strategy leverages health experts’ credibility to target Gen Z consumers and millennial parents reliant on social media for health advice. American Beverage spokesperson William Dermody defended the practice, stating that these nutritionists are trusted experts who provide informed opinions and maintain transparency regarding compensation.
The growing reliance on influencers is reflected in marketing trends. A survey conducted by CreatorIQ and SAPIO found that organizations spend an average of $360,800 annually on influencer marketing. Companies report that influencer-generated content offers a higher return on investment (ROI) than traditional advertising, allocating 57% of their marketing budgets to creator marketing. While Instagram remains the top platform for ROI, its importance has declined as TikTok gains significance.
Supplements on social media
With the rise of TikTok, researchers have explored how supplements are portrayed on the platform. A recent study published in Eating Behaviors analyzed TikTok videos about diet products, focusing on supplements for weight loss, muscle gain, and detoxification, “detoxes.”
The study analyzed the top 100 TikTok videos using the three most-viewed hashtags as of June 2021:
- #dietpills: related to weight loss supplements (9.3 million views)
- #preworkout: for muscle gain supplements (2.1 billion views)
- #detox: focused on cleansing and detox supplements (3.4 billion views)
Most videos featured a spokesperson, with males predominantly appearing in #preworkout and females in #dietpills and #detox.
Key findings:
- 6.4% of spokespeople cited professional qualifications, and 4.3% disclosed sponsorships.
- Personal testimonials were prominent in 67% #preworkout and 75% #detox videos.
- 97% of videos lacked scientific evidence.
- 56.4% of #dietpills videos warned against diet pills while promoting healthier alternatives like diet and exercise.
- 70.9% of #preworkout videos emphasized general health, muscle gains, and social status, with a mostly positive or neutral tone.
The authors note that their research identified a lack of transparency regarding industry sponsorships and misleading claims about unregulated supplements.
Supplements: risks without clear benefits
While I do not advocate for the abolition of supplements, they can be beneficial in specific situations; it is crucial to recognize the risks of excessive use. Consuming nutrients beyond what is necessary for health—typically achievable through a balanced diet—offers no additional benefits and may pose significant risks.
A meta-analysis published in Arq Gastroenterol analyzed 189 studies, documenting 428 cases of liver injury linked to dietary supplements, medicinal herbs, and steroids. The products most frequently associated with liver damage include supplements designed for weight loss, enhanced performance, or a combination of various ingredients (primarily herbs and micronutrients).
The increase in reported cases over the past two decades likely reflects both the growing use of these products and improved monitoring by healthcare professionals. An earlier study in Hepatology found that supplement-induced liver injury cases related to supplements and herbs in the US grew from 7% to 20% between 2004 and 2013.
A related article in JAMA Network Open examined the hepatotoxicity of six botanicals commonly found in herbal supplements. Among nearly 10,000 adults surveyed, 4.7% reported using at least one supplement linked to liver injury.
The most common botanicals consumed were:
- Turmeric: 236 participants (26.8%) used for joint health or arthritis
- Green tea: 92 participants (27.2%) used for energy
- Garcinia cambogia: 20 participants (70%) used for weight loss
Adverse events from these supplements led to around 23,000 annual emergency room visits and 2,154 hospital admissions estimated in 2014. Liver injury from supplements now accounts for over 20% of all liver injury cases reported to the Drug-Induced Liver Injury Network, which tracks severe injuries from various substances.
While studies cannot definitively establish causal links—adverse effects occur in less than 1% of exposed individuals—the seriousness of liver damage cannot be overstated. Such injuries often require significant lifestyle changes for treatment, and in many cases, liver transplantation becomes the only long-term solution.
Equally concerning is that most users consume these products without clinical recommendations, often relying on the promised benefits. Today, approximately 80,000 such products are on the market, raising concerns about their safety and labeling.
In the US, manufacturers are solely responsible for ensuring supplements' safety, labeling, and efficacy; the FDA only intervenes when health risks emerge. In contrast, Brazil’s “FDA,” ANVISA, is more proactive in evaluating products before they reach consumers.
While severe liver diseases remain rare and no direct causal link has been established between supplements and liver damage, the rising incidence of such cases over time underscores the need for stronger regulations.
When viewed through a risk-benefit lens, the imbalance is clear. On one hand, there are unsubstantiated promises of drug-like effects without adverse outcomes. On the other, there is a real—though small—risk of severe liver damage, which in extreme cases may require a transplant or even lead to death.
