By comparison, the 2017–2018 National Health and Nutrition Examination Survey showed that 58% of adults 20 and older had used a dietary supplement in the past 30 days.

“I think people assume these things are safe,” said Dr. Dina Halegoua-De Marzio, a Jefferson Health hepatologist who treated Grafton. “The No. 1 reason we see people taking these are for good health or to supplement their health, and so I don’t think that they realize that there is a real risk here.”

Nutritional supplements are where a number of products that haven't actually met the bar to be a medicine go.

https://www.usada.org/dietary-supplements/medications-vs-supplements/

Given that they are both used for health purposes, it would be easy to assume that medications and supplements are regulated the same way and produced to the same standards, but unfortunately this is not the case. Unlike medications, supplements are regulated post-market, which means that no regulatory body evaluates the contents or safety of supplements before they are sold to consumers. Take a look below to learn more about the many differences between medications and supplements, and how those differences make supplement use risky for athletes.

MEDICATIONS

FDA Review

The U.S. Food and Drug Administration (FDA) maintains a comprehensive evaluation process for medications, assessing everything including the packaging, the design of clinical trials, and the manufacturing conditions.

Reliable Ingredient Labels

Medications must list every ingredient on the Drug Facts label, and these ingredients are confirmed through quality control analysis by the FDA.

Proven Safe Before Sale

To help protect consumers, medications are subject to strict premarket regulation, which means they go through a rigorous safety and efficacy evaluation process before reaching consumers.

SUPPLEMENTS

No FDA Review

Supplements don’t undergo any evaluation process or testing by the FDA before they are made available to consumers. In fact, most supplement companies are never inspected by the FDA to ensure manufacturing best practices.

Unreliable Ingredient Labels

Manufacturers may misidentify prohibited substances on Supplement Facts labels, or they may fail to list prohibited substances altogether.

Proven Unsafe Before Sale

Because they are regulated post-market, supplements are sold to consumers until it becomes evident that they are harmful following consumer adverse event reporting. Even then, supplements with illegal or dangerous ingredients may remain on shelves for years.