Supplements for salvation: trends, illusions and dangers

They promise relief from ‘physical fatigue’, ‘mental fatigue’, ‘stress’, a ‘bad mood’, ‘indigestion’, ‘insomnia’, ‘bad cholesterol’ and the ‘effects of ageing’. But they can also give you something you’ve never had, or no longer have, or will never have without taking them: an “energy boost”, a “jolt”, “digestive harmony”, “a sense of well-being”, “a good mood”, “the colour of life”, the ability to “unleash the light within you”. Dietary supplements do not cure diseases, do not tackle ailments, do not combat illness, but they do ensure that they stay away from you. They come in coated tablets, chewable tablets, effervescent tablets, sublingual tablets, or as powders, in water-soluble sachets, orally-soluble sachets, in jars, but also in single-dose vials, as drops, syrups, oral sprays, gels and plasters. “In every respect, they take the form of medicines. But they are not medicines,” Professor Paolo Magni, coordinator of the course in Nutraceuticals, Dietary Supplements and Health at the University of Milan, explains to "Il Foglio". “They are not required to guarantee quality, efficacy or safety. They do not undergo clinical trials, nor do they pass the checks carried out by the medicines regulatory agency.” They are vitamins, minerals, probiotics, prebiotics, plant extracts, fatty acids and proteins. Backed by aggressive advertising, they have taken over the pharmacies. Doctors now prescribe them liberally too, even though they do not need to be prescribed. They embody the contemporary myth of health. Consequently, they measure it in terms of performance. In particular, they care deeply about yours. They guarantee that they will protect it, safeguard it, strengthen it and enhance it. They will make you feel this way or that way. They will make you do this or that. They bend over backwards to meet the needs of the elderly, pregnant women, women going through the menopause, and men over fifty. They cost far more than a generic medicine. No one, however, shies away from them. More than eight out of ten Italians used them in 2025. And almost all of them believe they have improved their well-being. Not based on clinical analysis, but on how they feel.

The place where they sell the most – 61 per cent – is the chemist’s. Next comes online sales, currently at 33 per cent. At the chemist’s I go to in Rome, the chemists are reluctant to talk: ‘Make an appointment with the owner,’ they reply when asked which supplements sell the most. There’s no doubt whatsoever that they sell well. The figures show that, until less than fifteen years ago, 125 million packs were sold annually in Italy. In 2025, 325 million were sold. Turnover has risen from 1.8 billion euros to over 5 billion euros. A boom. In pharmacies, shelves upon shelves of supplements are positioned right at the entrance. You come face to face with them as soon as you step over the threshold. Looking at them closely, you’ll notice that quite a few promise to reduce physical and psychological fatigue. From this, one might deduce that Italians must be feeling a bit low. Otherwise, why such a wide range on offer? Among the most popular types of supplements, in fact, those for the immune system and physical energy take top spot, followed by supplements for more specific needs such as bone health, diet support, beauty and gut health. However, a significant share of the market is dedicated to psychological wellbeing: supplements to aid sleep, combat stress, improve mood and boost concentration. When it comes to the range on offer, you’re spoilt for choice.

As it is not a medicine, a food supplement does not have to undergo the same checks as a medicine in order to be placed on the market. That is to say, a trial period that can last up to ten years, verification of compliance with the requirements of the Italian Medicines Agency, negotiation of price and reimbursement, and finally its arrival on pharmacy shelves. No, a supplement enters the market sixty days after a certified company has notified the Ministry of Health. If the authorities raise no objections, the product goes on sale, backed by its advertising and the promise of salvation inherent in every advertisement. This does not mean, however, that there is no need for subsequent intervention at times. For example, when it was discovered – as happened at the end of April – that two zinc supplements contained excessively high levels of lead, and the Ministry was forced to withdraw them from the market. The main psychological reassurance offered by supplements is the fact that they are natural compounds. ‘Natural’ has now become synonymous with ‘healthy’ and ‘good’ in our way of thinking. Yet a lethal poison such as strychnine, or a powerful opiate such as morphine, is also natural. Nature has become the great contemporary superstition. To the extent that, simply because a product has a natural origin, it cannot, by definition, be harmful.

The same goes for dietary supplements. “At worst, it won’t do me any harm,” says a lady in the queue at the chemist’s, holding a box of multivitamins. But is that really the case? Not quite, Professor Silvio Garattini, an internationally renowned pharmacologist, would tell her if, like Marshall McLuhan in Woody Allen’s “Annie Hall”, he were to suddenly materialise in front of us whilst we’re queuing at the till. Speaking to Il Foglio, Garattini explains that “in reality, we know nothing about dietary supplements: neither their benefits nor their contraindications”. This is because, in most cases, neither has been studied. The main problem with supplements, according to Garattini, lies in the mixture of substances that make up each supplement. “If I have an iron deficiency, it’s good to take iron. But why do supplements, alongside iron, give me, for example, vitamin C – which I’m not deficient in – or vitamin B12, which I have no need for?” According to Garattini, the lack of specific studies on supplements not only prevents us from establishing their positive or negative effects, but also overlooks an essential element. “What is the interaction between the various substances present in the supplement?” And, an even more delicate question: “What happens when the substances in a supplement I’m taking for reason X interact with the active ingredient in a medicine I’m taking for a completely different reason?” The truth is that we don’t know. At least, not for many substances. And for this reason, according to Garattini, we should be very cautious. “Meanwhile, advertising relentlessly hammers home the idea that they’re good for you, that there are no side effects, and that taking them is like drinking a glass of water.”

Would you treat them as medicines? “No, because they aren’t medicines. Technically, they’re nutrients. But I eat pasta, vegetables, legumes and fruit. These are things I don’t find in a chemist’s, but I do find them in the supermarket.” Don’t you think supplements should be sold in chemist’s? “These days, chemist’s sell everything. But a chemist’s should be an educational place. A place that educates people about health. Instead, it has become the equivalent of a bazaar.” But then why are doctors the first to recommend supplements? “Because they don’t receive independent information either. In other countries, such as France, there are scientific journals that provide non-advertising information on these products. Doctors are more aware. In Italy, however, in the absence of any information other than that provided by advertising and manufacturers, doctors prescribe them. Often, too, to give their patients the impression that they’re doing something, that they’re not just sitting idly by.”

At this point, I decide to try a personal experiment. ‘I take a supplement too,’ I explain to Professor Garattini. ‘It was prescribed by my cardiologist for high cholesterol, and I have what’s described as a “significant” family history.’ In other words: my father died of a heart attack, my grandfather had a stroke – it’s as if I’ve got one foot in the grave, as the doctor implied. I pick up the box of my supplement and read out the ingredients one by one to Professor Garattini. Fermented red rice. “This actually does lower cholesterol.” Policosanols. “I don’t understand what they’re for.” Coenzyme Q10. “Ditto.” Trigonella foenum-graecum. “But what’s the point of that?”

I’ll ask the cardiologist at my next appointment. “What do I need?” In the meantime, it’s a fact that 40 per cent of those who take supplements were recommended them by a doctor. The rest receive advice at the chemist’s. Or they find out for themselves. There are also supplement influencers on social media. People who explain which supplements are essential for daily intake, which are useful and which are useless, which are fundamental, and which to take when you’re exercising, or when it’s hot, in the morning or in the evening. “Health is not a gift from the state, but a personal achievement,” Germano Scarpa, president of Integratori & Salute – a national association representing Italian supplement companies that generate around 80–90 per cent of the sector’s turnover – tells Il Foglio. A pharmacist, Scarpa entered the world of supplements forty years ago. “Back when it was still largely uncharted territory.” Over the years, he has witnessed the sector’s explosive growth. “Especially since Covid,” he says, “staying healthy has become a widely shared priority.” According to Scarpa, this has happened because there has been a radical shift in the mindset of Italians: the concept of ‘wellbeing’ has taken root in the consciousness of a great many people. It is they who are putting themselves first. Without the need for doctors, institutions or third-party authorities. “I believe that many people, including some in the scientific community, still hold an outdated view of the role of supplements. Supplements are not intended to fill a deficiency, but to support and optimise the physiological functions that the body already performs, such as metabolism.” But why is there a need to boost metabolism if it’s already working? “It helps keep it active. Ultimately, this is what we need to understand about supplements: they do not cure diseases, but they help maintain health.” To clarify the concept further, Scarpa gives a concrete example: “If we all took Omega-3 regularly, the European healthcare system would save 20 billion euros every year on the treatment of cardiovascular diseases.” But Professor Garattini, for example, argues that in reality we do not know enough about either the benefits or the adverse effects. “In fact, we now have a vast body of scientific literature on vitamins, minerals and plant extracts that provides solid evidence of their efficacy and physiological benefits.” But do these studies also document the interaction between the various components of the supplement and the active ingredients in medicines? “Yes, they do.” Could you please provide me with them? We are not aware of them. “Of course, I’ll send them to you.”

President Scarpa has provided "Il Foglio" with studies on the properties of red rice in the treatment of cholesterol. Not those concerning the interaction between supplements and medicines. He writes: “Interaction is a known but not very frequent occurrence.” However, Professor Carla Ghelardini, a lecturer in pharmacology at the University of Florence, does not downplay the issue at all. She has studied some of these interactions and gives an example: “St John’s wort is a natural substance taken to improve mood. Among other things, however, St John’s wort also increases metabolism. So if I take it, for example, alongside the contraceptive pill, it has been shown to reduce the pill’s effectiveness, because the liver metabolises the contraceptive more quickly as well.” This is just one of the examples that can be given. It goes to show that it would certainly be beneficial to know what the effects of these interactions are – to avoid unwanted side effects.

In any case, the fact that there are issues requiring monitoring in the supplements market is confirmed by the fact that even the Under-Secretary of State for Health, Marcello Gemmato, has decided to set up a national technical working group. He told Il Foglio that “the sector’s growth calls for more specific governance”. This is the reason why he decided to set up the working group. “During the initial meetings, priority areas for action were identified, with particular attention paid to the efficacy and safety of products, the provision of accurate information to consumers, and the appropriate use of food supplements.” We shall see what results they produce. In the meantime, Italy will continue to be the European country where dietary supplements are sold most widely and most successfully. A nation of poets, artists and heroes. And, now, also consumers of dietary supplements.