I’m often asked my opinion about a diet or a disease is. Who cares what my or anyone else’s opinion is? All we should care about is what the science says. What does the best available balance of evidence published in the peer-reviewed medical literature have to say right now?
Welcome to the NutritionFacts Podcast – I’m your host Dr. Michael Greger.
Today, we examine the sketchy supplement industry. And by sketchy – I don’t mean artistic.
In our first story – we take a close look at the industry’s attempts to rebut an editorial in an alternative medicine journal.
An editorial was recently published decrying much of the multibillion dollar marketing of dietary supplements in North America as misleading, deceptive—even predatory. After examining hundreds of sales claims made when supplements are being marketed over the years, the author concluded: “Dishonesty or wild exaggerations are frequent occurrences in the marketing of supplements.”
My favorite quote was: “The marketers of supplements like to use scientific evidence the way a drunk uses a lamp-post: more for support than illumination.”
This is nothing new. Similar editorials have been published in the Journal of the AMA and the New England Journal of Medicine. What made this special was that it was, to their credit, published in the Journal of Alternative and Complementary Medicine. It’s like their own journal admitting it!
In response, the Head of Global Supplement Initiatives at Novus, which actually started out as the livestock feed additives division of Monsanto, before branching off into human feed additives—dietary supplements—starts his rebuttal with this counterpoint: “In his review entitled ‘’The Marketing of Dietary Supplements in North America: The Emperor is (Almost) Naked,’ [the author] may be mortified to know the emperor is still dancing in the street, dressed or not, to the tune of $68 billion. This figure is much higher and is a more relevant number than cited…indicating a very strong and respectable commerce.” That’s his first argument? That it’s highly lucrative?
He goes on to say that hey, they’re safer than some pharmaceutical drugs. But how much is that saying, given that prescription drugs kill an estimated 106,000 Americans every year? And that’s not errors; not abuse; not overdose. That’s just deaths from side effects, ADRs (adverse drug reactions), which would make doctors—me and my fellow colleagues—the fourth leading cause of death in the United States.
So, for the supplement industry to say, “Hey, at least we’re not the fourth leading cause of death,” isn’t saying much.
Next up – calcium supplements. Might they increase the risk of heart attacks? Here’s the story.
In 12 short years, government panels have gone from suggesting widespread calcium supplementation may be necessary to protect our bones to “Do Not Supplement”. What happened? It all started with a 2008 study in New Zealand. Short-term studies had shown that calcium supplementation may drop blood pressures by about a point. Though the effect appears to be transient, disappearing after a few months, it’s better than nothing. And excess calcium in the gut can cause fat malabsorption, by forming soap fat, reducing saturated fat absorption and increasing fecal saturated fat content. And, indeed, if you take a couple Tums along with your half bucket of KFC, up to twice as much fat would end up in your stool, and with less saturated fat absorbed in your system, your cholesterol might drop. So, the New Zealand researchers were expecting to lower heart attack rates by giving women calcium supplements. To their surprise, there appeared to be more heart attacks in the calcium supplement group.
Was this just a fluke? All eyes turned to the Women’s Health Initiative, the largest and longest randomized controlled trial of calcium supplementation. The name may sound familiar—that’s the study that uncovered how dangerous hormone replacement therapy was. Would it do the same for calcium supplements? The Women’s Health Initiative reported no adverse effects. However, the majority of participants were already taking calcium supplements before the study started; so, effectively the study was just comparing higher versus lower dose calcium supplementation, not calcium supplements vs. no calcium supplements. But what if you go back and just see what happened to the women who started out not taking supplements and then were randomized to the supplement group? Those who started calcium supplements suffered significantly more heart attacks or strokes. Thus, high dose or low dose, any calcium supplementation seems to increase cardiovascular disease risk.
Researchers went back, digging through other trial data for heart attack and stroke rates in women randomized to calcium supplements with or without vitamin D added, and confirmed the danger, and most of the population studies agreed—users of calcium supplements tended to have increased rates of heart disease, stroke, and death.
The supplement industry was not happy, accusing researchers of relying in part on self-reported data—like they just ask if people had a heart attack or not rather than verifying it. And indeed long-term calcium supplementation caused all sorts of gastrointestinal distress including twice the risk of being hospitalized with acute symptoms that may have been confused with a heart attack. But no, the increased risk was seen consistently across the trials whether the heart attacks were verified or not.
OK, but why do calcium supplements increase heart attack risk, but not calcium you get in your diet? Perhaps because when you take calcium pills, you get a spike of calcium in your bloodstream that you don’t get just eating calcium-rich foods. Within hours of taking supplemental calcium, the calcium levels in the blood shoot up and can stay up as long as eight hours. This evidently produces what’s called a hypercoagulable state, your blood clots more easily, which could increase the risk of clots in the heart or brain. And, indeed, higher calcium blood levels are tied to higher heart attack and stroke rates. So, the mechanism may be calcium supplements leading to unnaturally large, rapid, and sustained calcium levels in the blood, which can have a variety of potentially problematic effects.
Calcium supplements have been widely embraced on the grounds that they are a natural and, therefore, safe way of preventing osteoporotic fractures. But, it is now becoming clear that taking calcium in one or two daily doses is not natural, in that it does not reproduce the same metabolic effects as calcium in food, the way nature intended. And furthermore, the evidence is also becoming steadily stronger that calcium supplementation may not be safe. That’s why most organizations providing advice regarding bone health now recommend that individuals should obtain their calcium requirement from diet in preference to supplements.
Finally today – black raspberry supplements are put to the test.
The regulation of dietary supplements in the United States has been described as “Too Little, Too Late.” “Dietary supplements may be adulterated with dangerous compounds, be contaminated, fail to contain [what they say they contain],…contain unknown doses of the ingredients stated on the label, be sold at toxic dosages, or produce harmful effects” in other ways. This not only messes up any research done on them, but can put the general public “at risk.”
A third-party company that has tested thousands of supplements “identifies approximately 1 in 4 with a quality problem”—either not containing what they say, or contaminated in some way. One in four.
For example, I’ve done a few videos on the remarkable properties of black raspberries. Can’t always find them fresh or frozen; so, how about black raspberry supplements? You go to the store, or look online. How about this one? Fresh, raw, pure—that sounds good. Let’s look at the back. Says it just contains just seedless black raspberry powder and absolutely nothing else, exclamation point. It’s nice to see that there’s no fillers or artificial ingredients. So, you plunk down your $23.77.
But, it turns out you’ve been had. The first clue was that the picture on the front was actually blackberries photoshopped to look like black raspberries—they couldn’t even be bothered to put a real image on their fake supplement. The researchers’ second clue was that it sure didn’t look like pure black raspberry powder. And so, they put it to the test—and, indeed, there was no black raspberry at all. Instead of “absolutely nothing else,” they should have just stopped with this bottle contains “absolutely nothing.” Or, at least you hope it contains nothing; who knows what’s actually in those capsules?
They tested every black raspberry product they could find, and even ones with the right picture on the front and powder that actually looked real, yet more than a third appeared to have no black raspberry fruit at all. “At the moment, a consumer who assumes the US dietary supplement marketplace is free from risk [or even honest] is unfortunately naive.”
How widespread is this deception? Researchers used DNA fingerprinting techniques to test the authenticity of 44 herbal supplements from a dozen different companies. Less than half of the supplements were authentic—containing what they said they did. Most contained plants not listed on the label, substitutions with cheaper plants, contaminants, unlisted fillers—or, apparently, all filler.
And, this isn’t just fraud; some of this deception can really hurt people. For example, one St. John’s wort supplement had no St. John’s wort at all, but actually contained senna instead, which is an herbal laxative that can cause adverse effects—such as chronic diarrhea, liver damage, skin breakdown, and blistering.
Until dietary supplements in the U.S. “are better regulated and quality control standards…[are] defined and endorsed, the safer source [of phytonutrients] as a consumer is from [actual] food…”
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