DEAR DR. ROACH: I see supplements advertised on television that are supposed to clear “brain fog” and do many other beneficial things. Are these any good, and can they actually do the things that they claim? If they are effective, why aren’t they sold at drugstores? If not, how is it that companies are allowed to make these false claims and advertise these supplements on television? — J.L.P.

ANSWER: I believe that there are over-the-counter supplements that are effective for treating some medical conditions, and there are a few instances in which there is strong evidence of benefit, such as a vitamin and mineral formula to slow progression of macular degeneration. Very often, there isn’t enough data to be sure a supplement is either effective or ineffective.

It is certainly true that supplement companies sometimes make claims that they cannot support. By law, supplement advertising can claim to support a body part or function (which is why you see claims like “supports heart health”), but these claims must be followed by: “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.”

Often, the advertising for a supplement is at odds with that statement, and there are many instances of supplement manufacturers having to pay fines or change their advertising. A supplement that is found to be unsafe can be removed from the market by the FDA. In addition, any substance can be toxic if taken at a high enough dose. Vitamin A supplements are a good example.

The U.S. FDA does not regulate supplements the way they do prescription drugs, and supplement manufacturers do not need to prove that their products are effective. Further, there is strong evidence that some supplements sold in the U.S. do not contain as much (or any!) of the supplement they claim to provide. I always recommend getting a supplement that is verified by a third party, such as the U.S. Pharmacopeia or the National Science Foundation, if possible.

There are very few supplements proven to prevent problems, so I generally recommend against supplements in people who are healthy and have no symptoms. This definitely includes vitamin supplements. Supplements may have benefit in relieving symptoms for some less-serious medical conditions, and physicians should be (or get) familiar with more common supplements, their potential benefits and their toxicities.

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DEAR DR. ROACH: I read your recent article on lichen planus. I have suffered with this for over two years. After doing a lot of research, I found that many people, like me, have diabetes. Nothing helped it, and the last treatment was too dangerous for me, although it did help me to lose 35 pounds and my sugar levels are now healthy. I understand that I can never get rid of lichen planus and that it’s just in remission now. — N.T.

ANSWER: Most studies show that people with diabetes are somewhat more likely to develop lichen planus (an itchy skin condition). About 1.5 percent of people with diabetes will develop lichen planus, compared to 0.75 percent of people without diabetes.

Unfortunately, I could not confirm that either weight loss or better diabetes control improves the symptoms of lichen planus. Sometimes lichen planus becomes inactive on its own. However, there are many good reasons to keep diabetes under control, and I am publishing your letter in the hope that it helps someone else.

Dr. Roach regrets that he is unable to answer individual questions, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.

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