Vitamins and Supplements

Will insurance pay?

As a general rule, health insurance does not cover over-the-counter supplements. However, prescription supplements may be covered.

Your doctor may have to explain why you need them and what specific medical condition they're for.

• Some vitamins are considered necessary after gastric bypass and similar surgeries.

♦ Most insurance companies cover most or all of the cost of prescription prenatal vitamins. Your insurer will usually have a preferred generic vitamin that can cut your costs a lot.

♦ Thanks to the Affordable Care Act, most plans have to cover a few supplements at no cost to you, as long as your doctor writes a prescription. These include folic acid for women who could become pregnant, and fluoride supplements for young children.

If your insurance doesn't cover your supplements, keep in mind that some may be tax deductible as a medical expense. Again, they have to be a necessary part of your doctor's treatment plan, not just everyday vitamins. Ask your tax preparer or check IRS Publication 502.

From IRS Publication 502:

You can't include in medical expenses the cost of nutritional supplements, vitamins, herbal supplements, "natural medicines," etc. unless they are recommended by a medical practitioner as treatment for a specific medical condition diagnosed by a physician.

Otherwise, these items are taken to maintain your ordinary good health, and aren't for medical care.

The same rule applies to HSAs and FSAs. Supplements generally only qualify if your doctor recommends them to treat a specific medical condition.

Supplement use in the United States

Americans have been taking multivitamin and mineral (MVM) supplements since the early 1940s. They're still popular. By some estimates, more than one-third of Americans take them.

MVMs make up almost one-sixth of all dietary supplement purchases and 40% of all vitamin and mineral supplement sales.

There's no standard or official definition of an MVM, such as which nutrients it has to contain or at what levels. So the term can cover products that are very different from each other, and there are many kinds on the market.

♦ The U.S. supplement market was worth $55.7 billion at the end of 2023.

Vitamin sales have been growing the fastest. Vitamin C and D sales spiked during the pandemic.

♦ Growth is also being fueled by an aging population and more interest in fitness and well-being.

With so many supplements out there, and so many claims about their health benefits, it can be very hard to decide whether a supplement is useful or safe.

About dietary supplements

Dietary supplements were defined in a 1994 law called the Dietary Supplement Health and Education Act (DSHEA). Under DSHEA, a dietary supplement is a product that:

• Is meant to supplement the diet

• Contains one or more dietary ingredients (including vitamins, minerals, herbs or other botanicals, amino acids and certain other substances) or their parts

• Is meant to be taken by mouth, as a tablet, capsule, powder, softgel, gelcap or liquid

• Is labeled as a dietary supplement

♦ Herbal supplements are one type of dietary supplement. An herb is a plant or plant part (such as leaves, flowers or seeds) used for its flavor, scent or possible health benefits. "Botanical" is often used to mean the same thing.

An herbal supplement may contain a single herb or a mix of herbs. The law requires that all the herbs be listed on the label.

♦ Research has shown that some supplements do help.

Scientists have found that folic acid (a vitamin) prevents certain birth defects.

Other research has come up empty. For example, several major studies of the herbal supplement echinacea found no evidence that it helps with the common cold.

Reliable sources of information

It's important to find reliable information on dietary supplements so you can judge the claims made about them.

To get reliable information on a particular supplement:

• Ask your health care providers. Even if they don't know about a specific supplement, they can look up the latest medical guidance on its uses and risks. A laptop is as common as a stethoscope these days.

When you ask, see how fast your doctor turns to the internet. Peek over their shoulder and see where they go for information. You may be surprised. Most likely you can go there too.

• Check the NIH Office of Dietary Supplements (ods.od.nih.gov). It has free fact sheets on nearly every vitamin, mineral and herb. MedlinePlus (medlineplus.gov) is another good one.

• Look for scientific research on the supplement. Seek out federally funded studies or reports from reputable universities and medical research groups.

• Don't depend on websites pushing the latest, greatest weight-loss supplement.

• Look for a quality seal like USP Verified or NSF. These mean an independent lab checked that what's on the label is actually in the bottle. They don't mean the supplement works, but at least you know what you're getting.

Safety considerations

If you're thinking about taking a supplement, or already take one, here are some things to keep in mind.

• Tell all your health care providers about any supplement you take or plan to take. Work with your doctor to make sure your care is safe and coordinated.

♦ It's especially important to talk to your health care providers if you:

• Take any medications, prescription or over-the-counter. Some supplements interact with medications.

The herbal supplement St. John's wort interacts with many medications and can make them less effective. That includes birth control pills, some blood thinners, certain antidepressants, and some HIV and transplant drugs.

• Are thinking about replacing your regular medication with one or more supplements.

• Expect to have surgery. Some supplements can increase the risk of bleeding or affect how you respond to anesthesia.

• Are pregnant, nursing, trying to get pregnant, or thinking about giving a child a supplement. Most supplements have not been tested in pregnant women, nursing mothers or children.

• Have any medical conditions. Some supplements can harm you if you have certain health problems.

For example, people with hemochromatosis, an inherited disease where too much iron builds up in the body, can raise their iron levels even more by taking supplements with iron. That increases their risk of complications like liver disease.

• Ginkgo biloba is a popular herbal supplement promoted for memory, dementia, anxiety and more. Big studies haven't found that it prevents dementia or memory loss.

Many seniors take it anyway. Many also take blood thinners or anti-inflammatory drugs for arthritis or pain. Taken together, ginkgo can raise the risk of bleeding.

• If you take a supplement, follow the label instructions. Most importantly, talk to your health care provider if you have any questions, especially about the best dose for you and any possible interactions with your medications.

If you have any side effects that worry you, stop taking the supplement and contact your health care provider.

♦ Keep in mind that even though many supplements (and some prescription drugs) come from natural sources, "natural" does not always mean "safe." For example, the herbs comfrey and kava can seriously damage the liver. And a label that says "standardized" (or "verified" or "certified") doesn't necessarily guarantee quality or consistency.

• Be aware that an herbal supplement may contain dozens of compounds, and not all of them may be known. Researchers are studying many of these products to figure out which ingredients are active and what they do in the body.

• What's on the label may not be what's in the bottle. Tests of supplements sometimes find differences between the label and what's actually inside. For example:

– An herbal supplement may not contain the right plant species.

– The amounts of ingredients may be lower or higher than the label says. That means you may be taking less or more than you think.

– The supplement may be contaminated with other herbs, pesticides or metals, or even spiked with unlisted, illegal ingredients like prescription drugs.

Regulation of dietary supplements

The federal government regulates dietary supplements through the FDA. But the rules aren't the same as for prescription or over-the-counter drugs. The manufacturers are responsible for making sure their products are safe and their labels are truthful and not misleading.

♦ Supplement makers are not held to the same strict standards as drug makers. They don't have to prove their products are safe or that they work before selling them.

♦ Supplement makers can claim their product affects how the body works, like "supports immune health" or "promotes healthy joints," without proving it. But when they do, they have to add this disclaimer:

This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.

What they can't do is claim it treats or prevents a disease. That would make it a drug, and drugs need FDA approval.

♦ Supplement makers must follow Good Manufacturing Practices (GMP) to ensure consistency and quality, and the FDA tries to keep an eye on them. But when a supplement is made in another country, the FDA has very limited resources to check. The agency is already stretched thin monitoring overseas drug factories, so overseas supplement makers aren't a top priority.

♦ It's not just a problem overseas. The FDA regularly finds supplements sold in the U.S. that are secretly spiked with prescription drugs. The worst offenders are products sold for weight loss, sexual enhancement and bodybuilding. If a supplement promises dramatic results, be suspicious.

Source: NIH, FDA,DNA