As a dermatologist who’s written extensively on beauty supplements, I’m sometimes asked to speak with reporters and podcasters. One conversation stands out in my mind.
I was speaking with a popular beauty podcaster and reviewing the multiple potential risks of supplements when she stopped me.
Host: “Wait, did you just say that beauty supplements can cause birth defects?”
Me: “Yes. In fact, several popular beauty supplements have been linked to birth defects.”
Host: “I had no idea. I get sent lots of samples of beauty supplements, and I don't think I've ever been told that beauty supplements may be linked to birth defects. I’m really shocked, especially considering I just had a baby.”
I wasn’t surprised to hear this. In speaking to multiple patients, I’ve found that the risk of birth defects from supplements just isn’t common knowledge.
As a physician, and as a consumer, it’s frustrating and alarming. The bottom line is that when it comes to supplements, it’s really up to the general public to educate themselves-- because the industry isn’t required to do so.
What are some ingredients in beauty supplements that have been linked to birth defects?
Saw palmetto, sometimes found in hair loss supplements due to its anti-hormone effects, may cause genital abnormalities in a male fetus
High doses of vitamin A, sometimes found in acne supplements, may cause serious head and neck malformations in a fetus
Melatonin has not been studied in children long-term, but in animal studies the long-term use of melatonin has resulted in profound effects on the reproductive organs
Zinc has not been studied, but in one study, elevated levels of zinc in the umbilical cord blood were associated with problematic neurobehavioral development in newborns
Aren't “beauty supplements” supposed to be different from medical supplements?
Aren't they supposed to be "all-natural" and free from the side effects of prescription medications?
I want you to picture yourself walking into your local Target. You head down the skincare aisle, and you’re presented with row after row of products.
As you find yourself drawn to the beauty masks, you notice that there are entire shelves of beauty supplements, many with eye-catching logos and bold colors. They seem so enticing and fun.
“What could be the harm? I mean, they’re right there, in the skincare aisle. It’s not like they’re in the “medical” supplement aisle. And there’s nothing on the bottle that talks about side effects.”
Here's the thing, though. Beauty supplements, in some cases, can have serious side effects hidden behind the alluring promises.
Why would a supplement that has been linked to birth defects not require at least a pregnancy warning label?
Why do supplements with saw palmetto not warn about the risk of birth defects?
Let’s start with one popular hair loss supplement. This supplement, called Nutrafol for Women, contains an ingredient called saw palmetto.
Despite this known risk, you won’t find pregnancy warning labels on the bottles of supplements that contain saw palmetto.
Why don’t supplements that have been linked to birth defects warn about this risk on the label?
Basically….because they’re not required to. These manufacturers are entirely within their legal obligation. The FDA doesn't require any pregnancy warning labels on supplements.
Why not? Basically, this is a function of the way supplement laws in the United States are set up. Many consumers have no idea that supplements are minimally regulated in the United States.
Yes, there are certain packaging and labeling laws. However:
No supplement requires FDA approval.
Any manufacturer can bring a supplement to market without seeking FDA approval.
While manufacturers are expected to adhere to good manufacturing practices, there’s no required inspection.
Supplements are not required to disclose the risk of birth defects, even when known.
Supplements are not required to disclose other risks, such as interference with lab tests, even when known.
That is why it is truly buyer beware.
Although Accutane requires strict procedures for patients due to the risk of birth defects, high-dose vitamin A supplements that may cause the same risk of birth defects do not require any special labeling or procedures
There are many teenagers and young adults who have had to go on Accutane for the treatment of their acne. (Accutane is the brand name for a powerful prescription acne medication called isotretinoin. Many consumers know this medication by its brand name Accutane.)
If you talk to these patients, they’ll tell you exactly what a complex process it can be to start treatment with Accutane. Going on Accutane requires pregnancy tests every month. It requires two forms of birth control. Even the pills themselves have a no-pregnancy symbol on the pill.
How were patients with severe acne treated in the days before Accutane? They were treated with vitamin A. In fact, vitamin A in high doses can have similar anti-acne effects as Accutane.
Despite this fact, when we did a research study looking at warning labels for online vitamin A supplements, we found that nearly none of them disclosed the risk of birth defects. There were a few that mentioned consulting with your physician before using this product, but none came out and cautioned against pregnancy while taking these potentially dangerous supplements.
This is a real concern, because some of these supplements are easily available through just a simple click on Amazon.
What is the connection between retinoids, retinol, and Vitamin A?
I was speaking to one of my teenage patients. We were prescribing Retin-A cream, a topical acne medication. Retin-A is the brand name for a medication called tretinoin, in a category of medications called retinoids. My teenage patient knew about the fact that topical retinoids should not be used during pregnancy, because of the risk to a fetus.
However, most patients don’t realize that retinoids and retinol are forms of vitamin A. They don’t make that connection between a prescription retinoid that is dangerous to a fetus and that vitamin A supplement that you can buy in your drugstore that may also be dangerous to a fetus.
There are also beauty supplement ingredients, such as melatonin and zinc, where the risks to the fetus are not known
The New York Times recently published an article where they were talking about how many parents don’t realize the potential risks of melatonin.
Melatonin is a supplement often advertised to help with sleep issues. I was speaking to one of my friends, and she said that her son was taking melatonin to help him sleep.
She was really surprised when I told her that animal studies have shown that melatonin has profound harmful effects on reproductive organs.
If melatonin can harm the reproductive organs of animals, what does it do to children?
We don’t know, because we don’t have human research studies.
Why would melatonin affect the reproductive organs in animals?
It’s probably because melatonin is a hormone. Although it’s marketed simply as a sleep aid, in actuality melatonin is a hormone in the human body that controls circadian rhythms.
What are the risks of giving hormones to a child over the long term?
Any time you are giving a hormone to a child, you have to stop and ask yourself if there might be potential for long-term harm.
In the New York Times article, none of the experts were concerned about the short-term use of melatonin.
It has certainly been very helpful in specific situations.
However, should you be taking melatonin every single day for months on end?
Should teenagers be taking this supplement for months on end?
We simply don’t have enough research at this time to know what the long-term use of melatonin would do to children or teenagers (or adults), but the animal research is concerning enough that it should be studied further.
Zinc is another ingredient where we don’t know the potential effects in pregnant women. Zinc, in high doses, has been used in acne supplements. However, in one study, elevated levels of zinc in the umbilical cord blood were associated with problematic neurobehavioral development in neonates.
The bottom line: if you’re considering a beauty supplement and you might get pregnant, you need to discuss this with your physician.
We know that certain supplements, such as hair loss supplements that contain saw palmetto and acne supplements that contain high doses of vitamin A, pose known and definite risks to a fetus.
With other beauty supplement ingredients, we don’t have enough research to know whether or not risk might occur.
And with the current labeling laws in the United States, supplements do not require any type of pregnancy warning label, even if they have a known risk of birth defects.
Given these facts, it is definitely buyer beware when it comes to beauty supplements. Always consult with your physician before starting a beauty supplement, especially if there’s a chance you may become pregnant.